HAPPY MOTHER S DAY. May 10, (see below)

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1 May, HAPPY MOTHER S DAY (see below) Wisconsin: Influenza activity in Wisconsin has declined to low levels. The prevalence of influenza-like illness [fever of of or higher and either cough or sore throat] in Wisconsin's primary care patients is estimated to be.6%. 9.8% of last week's primary care patients had all-cause respiratory infections. The prevalence of acute diarrheal illness (ADI) in Wisconsin's primary care patients is.% Primary Care Snapshot: The most common identified cause of Acute Respiratory Infection (ARI) in Wisconsin surveillance clinics is Rhinovirus. Over the past weeks the typical ARI case presenting for primary care has been.6 years old and 6% of patients have been female. 6% of patients identified a sick contact - days before illness onset and typically presented to the clinic. days after illness onset. % of illnesses are characterized as mild, with 7% having moderate symptoms and 8% having severe symptoms. Typical symptoms include: nasal congestion - 8% cough - 76% nasal discharge - 68% sore throat - 6% headache - % fever - 6% CLINICAL NOTES: Prophylaxis There has been good match between the current influenza vaccine and circulating strains - It is reasonable to stop immunizing with influenza vaccine at this time Diagnosis - influenza infections are at low levels at this time - PPV of rapid antigen tests at this time is moderate - NPV of rapid antigen tests at this time is high Treatment Antivirals need to be started with 8 hours of symptom onset to be effective against influenza Antivirals started after 8 hours may be effective for hospitalized patients with confirmed influenza Resistance Patterns - 6 of,67 isolates (.5%) of 9 A(HN) was resistant to oseltamivir - all tested recent influenza A(H) and B isolates have been sensitive to oseltamivir and zanamivir - high levels of adamantine resistance exist in influenza A isolates from around the world Other - Rhinovirus, Human Metapneumovirus, and RSV are also co-circulating in Wisconsin. - Rubella: The number of confirmed cases of rubella remains at one. A number of rash/fever illnesses have been reported but further investigation and laboratory testing has ruled out rubella or measles in all cases reported. Pertussis: The Pertussis Update from the Wisconsin Division of Public Health, dated May,, is attached.

2 The pertussis outbreak across Wisconsin continues. Labs performing PCR reported that.% of the, specimens tested were positive for B. pertussis. Current - Bordetella pertussis/parapertussis activity can be viewed at: Across the U.S.: (5.%) respiratory specimens during week 7 (April -8, ) were positive for influenza. For the - influenza season to date: -88.6% of subtyped isolates have been type A 7.6% of all sub-typed A viruses have been 9 HN 7.% of A viruses have been HN -.% of isolates have been type B -6.9% of deaths during week 7 (April -8, ) were due to pneumonia or influenza [below the seasonally-adjusted epidemic threshold of 7.6%] - pediatric deaths have been reported this season Global News [from the WHO]: The Indonesian Ministry of Health has notified WHO of a new case of human infection with avian influenza A(H5N) virus. The case is a year-old male who developed fever on 7 April and was hospitalized on April but he died on 7 April. Epidemiological investigation is ongoing. Preliminary findings indicate that the case s parents are quail egg vendors. Avian Influenza (H5N): Since the beginning of, there have been 5 laboratory-confirmed cases and 6 deaths due to Avian influenza (A-H5N) from Bangladesh, Cambodia, China, Egypt, Indonesia, and Viet Nam. Since, there have been 6 laboratory-confirmed cases of influenza (A-H5N). There have been 56 associated deaths (case fatality rate= 59.%). Other Observations: May th Phenology: Today s photoperiod is hours and minutes. Daylength is increasing by minutes and 6 seconds each day. Mother s Day : Celebrations of mothers and motherhood occur throughout the world; many of these can be traced back to ancient festivals. The United States celebrates Mother's Day on the second Sunday in May. Julia Ward Howe (the prominent American abolitionist, social activist, poet, and author of "The Battle Hymn of the Republic) first issued her Mother's Day Proclamation in 87 as a call for women to join in support of disarmament. In the 88s and 89s there were several further attempts to establish an American Mother's Day, but these did not succeed. The current holiday was created in 98 by Anna Jarvis in Grafton, West Virginia, as a day to honor one's mother. It turns out that her mother, Ann Jarvis, had founded Mothers' Day Work Clubs in five cities to improve sanitary and health conditions. The Mothers' Day Work Clubs also treated wounds, fed, and clothed both Union and Confederate soldiers with neutrality. Jarvis wanted to accomplish her mother's dream of making a celebration for all mothers, although the idea did not take off until she enlisted the services of wealthy Philadelphia merchant John Wanamaker. She kept promoting the holiday until President Woodrow Wilson made it an official national holiday in 9. The holiday eventually became so highly commercialized that many, including its founder, Anna Jarvis eventually ended up opposing the holiday she had helped to create That said, forgive my use of a commercially produced video, but this one is nice: Thanks to all the Moms out there.

3 Great Lake Photo Contest Winners: and speaking of one mom out there my wife, Jo, runs the annual photo contest at the Wisconsin Department of Natural Resource s - Office of the Great Lakes and has compiled the following video of the winners for. Enjoy the beauty of Wisconsin's precious resources: Jonathan L. Temte, MD/PhD Advisory Committee on Immunization Practices Professor Department of Family Medicine University of Wisconsin School of Medicine and Public Health Delaplaine Court Madison, Wisconsin 575 Telephone: Fax: Jon.Temte@fammed.wisc.edu

4 DIVISION OF PUBLIC HEALTH WEST WILSON STREET P O BOX 659 Scott K. Walker MADISON WI Governor State of Wisconsin Dennis G. Smith FAX: Secretary TTY: Department of Health Services dhs.wisconsin.gov Pertussis Report, Wisconsin March, Pertussis activity remains at increased levels in several areas of Wisconsin. Using the information local health departments have entered into the Wisconsin Electronic Disease Surveillance System (WEDSS), this report summarizes the pertussis investigations reported in and, highlighting those that occurred most recently (between // and /9/). Note: A pertussis investigation was defined as a WEDSS report of pertussis with a positive PCR or culture result for Bordetella pertussis or a Resolution Status of confirmed or probable. Recent Pertussis Activity As of //, 6 pertussis investigations with cough onset between // and /9/ have been reported among Wisconsin residents to the Wisconsin Division of Public Health (DPH). Of the 5 Wisconsin counties that reported investigations with onset between // and /9/, Outagamie (n=), Waukesha (n=6), Winnebago (n=5), Dane (n=), Milwaukee (n=6), Walworth (n=), and Eau Claire (n=) Counties reported the highest numbers of investigations. The incidence of pertussis investigations was highest in Forest, Outagamie, Bayfield, Wood, Jackson, Walworth, and Calumet Counties. See Figure. Age groups most commonly affected between // and /9/ did not vary significantly by Wisconsin region. In the Northern, Northeastern, Southeastern, and Western regions, approximately 7-75% of all investigations were among school-aged children. In the Southern region, 6% of investigations were among school-aged children. In the Southern and Western regions, children aged <5 years accounted for % of all investigations. See Figure. One death was reported in an infant aged < month at cough onset. Pertussis in As of //,, pertussis investigations with cough onset in have been reported among Wisconsin residents; the annual incidence was.6 investigations per, persons.,78 (98%) of the investigations in have been completed and (%) remain ongoing. See Figure. Among complete investigations, 5% (n=77) met the surveillance definition of confirmed, % (n=6) met the definition of probable, and 5% (n=5) met the definition of suspect pertussis. This is the highest annual number of confirmed and probable investigations reported since the large pertussis outbreak in. See Figure. 6 of 7 (89%) Wisconsin counties reported at least one pertussis investigation in. The number and incidence of completed investigations meeting the definition of confirmed or probable pertussis, by county, is shown in Table. Age at cough onset ranged from < week to 86 years (median =.8 years). The incidence was highest among children aged < year and children aged - years. See Figure 5. Non-Hispanic American Indian/Alaskan Natives had the highest incidence of any racial/ethnic group (. per,), followed by non-hispanic whites (8.9), Hispanic whites (7.), non- Hispanic Asians (.), and non-hispanic blacks (7.). Approximately % of all investigations did not have a race or ethnicity specified. Wisconsin.gov

5 Hospitalization was reported for.6% (n=6) of complete investigations. 7% (n=7) of all reported hospitalizations were among infants aged <6 months. No deaths were reported in. Among complete investigations in children aged 8 years with confirmed or probable pertussis, 7% were up to date for age for pertussis immunizations, % were underimmunized, and % were too young for immunization. 5% of month-olds, 5% of yearolds, and 8% of year-olds had received zero doses of pertussis-containing vaccine. Parent refusal was the most common reason for not being up to date with immunizations. See Figure 6. Note: Up to date for age was defined as having received the number of doses recommended according to the Advisory Committee on Immunization Practices (ACIP) schedule. Individuals aged years or older at cough onset were considered under-immunized if they had not received Tdap. As of //, infants aged < year at cough onset met the surveillance definition of confirmed (n=6, 7%) or probable (n=77; 6%) pertussis. 6% (n=79) were aged <6 months at cough onset and 8% (n=5) were aged < months at cough onset. Among those aged < months at cough onset, 7% (n=) were hospitalized for a median of 6 days (range: to days). Reminders DPH guidelines for the investigation, testing, treatment and control of pertussis can be found here: Only symptomatic persons suspected of having pertussis should be tested for B. pertussis. To confirm a diagnosis of pertussis, test with both PCR and culture whenever possible. If only one test can be conducted, test with PCR. The most up to date recommendations from the ACIP on and Tdap vaccination can be found here: Contact your regional immunization representative listed below if you have any questions or comments about pertussis or this report. DPH Regional Immunization Representatives Region Immunization Representative Contact Information Southeastern Cathy Edwards () 7-995; Cathy.Edwards@wi.gov Jacqueline Sills Ware () 7-876; Jacqueline.SillsWare@wi.gov Northeastern Susan Nelson (9) 8-5; SusanL.Nelson@wi.gov Northern Jane Dunbar (75) 65-79; Jane.Dunbar@wi.gov Western Jim Zanto (75) 86-99; James.Zanto@wi.gov Southern Wilmot Valhmu (68) 66-8; Wilmot.Valhmu@wi.gov Parapertussis As of //, 5 lab-confirmed reports of Bordetella parapertussis infection have been reported to DPH since //. of 7 (7%) Wisconsin counties have reported parapertussis infection among their residents. Laboratories have been asked to report all positive B. parapertussis results to DPH via the local health department or electronically to DPH. The parapertussis case report form has been added to WEDSS to aid in the follow up of all reported incidents of parapertussis. Please contact DPH or consult the DPH pertussis website if you have any questions about how to manage and follow up incidents of parapertussis. Page of 6

6 Figure : Recent pertussis activity: Number and incidence of pertussis investigations with cough onset between // and /9/, by Wisconsin county (N=6) 8 5 Counties are shaded according to the incidence of pertussis and labeled with the number of pertussis investigations reported Investigations per, observed person-days < > Figure : Recent pertussis activity: Number of pertussis investigations reported by age group and Wisconsin region, with cough onset between // and /9/ (N=6) to 5 to 9 to Northeastern Northern Southeastern Southern Western Page of 6

7 Figure : Number of pertussis investigations reported by week of cough onset and status of the investigation, Wisconsin, //-/9/ (N=,5) Investigation Complete (n=787) Investigation Ongoing (n=58) Jan Feb Mar Apr May Jun Jul Aug Cough Onset Week Sep Oct Nov Dec Jan Feb Figure : Number of completed pertussis investigations that met the surveillance definition of confirmed or probable pertussis, by month of cough onset, Wisconsin, // through /9/,, 8 6 Jan- Apr- Jul- Oct- Jan-5 Apr-5 Jul-5 Oct-5 Jan-6 Apr-6 Jul-6 Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Onset Month-Year Oct-8 Jan-9 Apr-9 Jul-9 Oct-9 Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Page of 6

8 Table : Number and incidence of completed pertussis investigations that met the surveillance definition of confirmed or probable pertussis, by county of residence, Wisconsin, and Year * ** County Number Incidence Number Incidence Adams Ashland Barron Bayfield..6 Brown Buffalo.. Burnett.. Calumet Chippewa Clark Columbia Crawford.. Dane Dodge Door.. Douglas.5. Dunn.56. Eau Claire. 5. Florence.6. Fond du Lac Forest Grant Green Green Lake.. Iowa Iron.. Jackson Jefferson Juneau 5.. Kenosha Kewaunee.86. La Crosse Lafayette.. Langlade Lincoln.. Manitowoc Marathon Year * ** County Number Incidence Number Incidence Marinette Marquette 6.9. Menominee 7.6. Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin. 8.8 Pierce.. Polk.6. Portage Price.. Racine Richland.. Rock Rusk Saint Croix.9. Sauk Sawyer.8. Shawano Sheboygan 5.. Taylor Trempealeau.88. Vernon.. Vilas Walworth Washburn.57. Washington Waukesha Waupaca 7.6. Waushara 8.6. Winnebago Wood * incidence per, persons ** incidence per,, calculated using observed person-days (//-/9/) Source: AVR/WEDSS Page 5 of 6

9 Figure 5: Number and incidence of pertussis investigations, by age group, Wisconsin, (N=,) 5. Incidence < to 5 to 9 to 5 to 9 to 5 to 6 >=65 Age Group Figure 6: Number of doses of pertussis-containing vaccine received by individuals aged -8 years with completed investigations meeting the definition of confirmed or probable pertussis, by age at cough onset, Wisconsin, (N=9) Tdap Investigations per, persons Unknown Tdap <m m m m m 5m 6-8m 9-m y y y y 5y 6y 7y 8y 9y Age y y y y y 5y 6y 7y 8y Page 6 of 6