February 9, 2017 Influenza is Active

Transcription

1 February 9, 2017 Influenza is Active Wisconsin: Wisconsin is experiencing an uptick influenza activity, with 85% of recent detections being influenza A; 97% of A viruses are H3N2. There have been 587 influenza-related hospitalizations since September 1, 2016, with 70 admitted to ICU and 9 requiring mechanical ventilation. This compares to 131 hospitalizations last year at this time, and 3,596 for the season. 66% of hospitalizations have been in individuals age 65 and older. Influenza A[H3N2] is less kind to elders; across the US one out of every 1,064 people age 65 has been hospitalized with laboratory-confirmed influenza (so far). The estimated prevalence of influenza-like illness [fever of 100 o F or higher with either cough or sore throat] in Wisconsin's primary care patients is at 3.8% and is increasing. 11.1% 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 at 1.7% Primary Care Snapshot: The most commonly identified viral causes of Acute Respiratory infections (ARI) in Wisconsin are Coronavirus, RSV and Influenza A. Over the past 4 weeks the typical ARI case presenting for primary care has been 35.0 years old and 69% of patients have been female. 59% of patients identified a sick contact 1-to-3 days before illness onset and typically present to the clinic 4.1 days after illness onset. 24% of illnesses are characterized as mild, with 65% having moderate symptoms and 9% having severe symptoms. The typical symptoms reported include: cough - 84% nasal congestion - 70% nasal discharge - 62% sore throat - 61% fever - 53% headache - 51% malaise - 49% myalgia - 35% CLINICAL NOTES: Prophylaxis there is a good match between this year s vaccine and circulating viruses - Influenza vaccine is recommended universally everyone over the age of 6 months, including pregnant women - Pneumococcal vaccine PPSV23 is indicated for smokers, people with asthma and other chronic lung conditions as well as a number of other chronic conditions - ACIP routinely recommends PCV13 for individuals 65 years and older PPSV23 should be given 12 months after PCV13

2 Diagnosis Performance of Rapid Influenza Diagnostic Tests (RIDTs) depends on age and time from symptom onset Higher sensitivities are attained at younger ages and within the first 3 days of symptoms Clinical judgment is essential in diagnosis - influenza infections are at moderate levels at this time - PPV of rapid antigen tests at this time is high - NPV of rapid antigen tests at this time is moderately high Treatment: Oseltamivir is now available as a generic Antivirals need to be started with 48 hours of symptom onset to be effective against influenza Antivirals started after 48 hours may be effective for hospitalized patients with confirmed influenza Resistance Patterns: influenza A[H3N2], 75 influenza A[H1N1] and 147 influenza B viruses have been tested no viruses (0.0%) were resistant to oseltamivir, zanamivir or peramivir - high levels of adamantane antiviral resistance exist in influenza A isolates from around the world Adamantanes include amantadine and rimantadine; there are ineffective for influenza B Other - Coronaviruses are the predominant respiratory viruses in Wisconsin - RSV is near peak - Rhinovirus/enteroviruses, human metapneumovirus, parainfluenza and adenovirus are cocirculating at lower levels Across the U.S.: influenza is increasing 4,786 (18.0%) respiratory specimens during week 4 (January 22-28) were positive for influenza. For the season to date (last week): -87.4% (88.3%) of subtyped isolates have been type A 97.4% (98.2%) of A viruses have been H3N2 1.6% (1.8%) of all sub-typed A viruses have been 2009 H1N % (11.7%) of isolates have been type B 50.3% (63.5%) of B viruses have been of the Yamagata lineage 49.7% (36.5%) of B viruses have of the Victoria lineage -7.4% of deaths during week 1 (January 1-7) were due to pneumonia or influenza [above the seasonally-adjusted epidemic threshold of 7.3%] -Seven additional pediatric deaths were reported last week. 15 pediatric deaths have been reported this season. Six deaths were associated with influenza A[H3]; five deaths were associated with influenza A viruses for which no subtyping was performed; three deaths were associated with influenza B; and one death was associated with an influenza virus for which the type was not determined.

3 Global News [from the WHO/CDC]: Zika: 4,973 cases have been reported in the U.S. with 1,394 cases in pregnant women. Wisconsin has had 48 cases so far all associated with travel. See: for up-to-date information. Other Observations: February 9 th Phenology: Today s photoperiod is 10 hours and 18 minutes, and daylength is increasing by 2 minute and 37 seconds per day. Goodbye to a Chicago Grandad: On 2/06/2017, Chicago's Shedd Aquarium announced the passing of Granddad the lungfish, one of its most iconic and beloved family members for more than 80 years. Bison return to Canada s Banff National Park for first time in more than century: Never Again: A little over 3 years ago, in December 2013, Ebola Virus Disease (EVD) reemerged in one of the poorest areas in the world. It made its way into concentrated, urban slums, thus setting off the worst EBV outbreak in history. The final toll: 28,652 total cases and 11,235 deaths. We now have a highly effective vaccine. This is what biomedical science, committed researchers and volunteers can do. Volunteers also did many other things Katie Meyler was one of them. Katie Meyler an American who had moved to Liberia years earlier started her own school that provides free education, meals and health care for girls in kindergarten through sixth grade. When the Ebola outbreak hit Liberia two years ago, Katie turned her school into an emergency response headquarters (see: Never Again - Katie Meyler Thank You, Thank You my Lord Men in moon suits shovel corpses like their rubble Bodies piled high in the back of pick ups Crowds across the street keep their distance The sounds of mourning screams are constant People lie like dogs on the street Their cries for help go unanswered

4 The world s afraid to come too close In my rubber boots on bended knee The stench of death was mixed with feces His soft baby checks were against the dirt and dust There was no ma for his hand to cup Alone In a bath of his own blood His big brown eyes looked at the world with love I asked him name He could barely speak Softly he tells me I m Charlie He reached for my arm But I back up as much as I wanted to hold him this is an enemy that preys on love If only my songs Could hold his face Encircle him in a warm embrace The soft notes down his back they d trace Thank you, thank you my Lord Death tolls rising like the tide Tension is more tangible than touch Bodies are being buried in mass graves While experts sip coffees and lattes Have cocktail parties and all day debates On the best strategizes and philosophies That determine the fate of these communities That they have never even frickin been to? So I beg you now please help! Boots on the ground is what we need We are out of water and PPE s No bleach, no beds, and no IV s Wages for employees?? Hospitals transmitting more disease A country that lacks complete capacity And there was Esther Hairnet on her head In a woman s oversized flower dress All the people around her sang With arms stretched to the sky in praise

5 They were thanking God for their lives. This was a survivor s party Except there was nothing about Esther that was happy She survived Ebola, but when she woke up from a coma She learned that her entire family didn t. She was about to be released Except there was nobody there to get her In a country without adoption and with no foster care system Where will she go? And the world leaves her in the hands of the Liberian Government that is vividly broken as you freak out about an outbreak in America that will never freakin happen For God sake get a grip Sarah was stronger than any human being I ve known I gave her two teddy bears and a telephone We stood outside the Ebola treatment unit I looked into her eyes I told her she was going to be okay. I lied. She walked down that dark hall And she never came back out Are you sure? She seemed so strong? Sometimes they just drop dead I couldn t get the words out I just looked at her mother My lips quivered I dropped my head and sobbed She got the message And collapsed She flung her arms in the air and shook no place to say her last goodbyes no I love you baby, no tears to wipe no hand to hold throughout the night Sarah s life is gone. The world doesn t stop, the debates go on, the blame goes on, the fight for attention the corruption. This circus goes on. Sarah s life is gone. Gone, gone. We let this go on. And now her precious life has slipped gone. I m not okay and no one gets it

6 No one These images won t go away They stain my mind and keep me awake I think about the little girl just dead on a bench or Sarah s mothers face I sometimes weep thinking about what an inhumane, lonely death small Charlie had It s sad and dark but then I think about all of the survivors Like Esther. All she has lost but she has life I have life. And you have life. And we must use it to the max. This will never be okay until we make sure it never happens again. Jonathan L. Temte, MD/PhD Chair, Wisconsin Council on Immunization Practices Professor, Department of Family Medicine and Community Health University of Wisconsin School of Medicine and Public Health 1100 Delaplaine Court Madison, Wisconsin Telephone: Fax: Jon.Temte@fammed.wisc.edu