1 Februrary 2018 Groundhog Day (2/2/2018) Influenza Alert

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1 1 Februrary 2018 Groundhog Day (2/2/2018) Influenza Alert Wisconsin: Wisconsin influenza activity is widespread and is at peak level. Influenza A has been the dominant strain so far in Wisconsin, comprising 95% of all tested viruses; A[H3N2] has been identified in 85% of A detections and A[H1N1] has been identified in 15%. As of January 20, 2017, there had been 3,196 influenza-related hospitalizations since September 1, 2017; 67% of hospitalizations have been in individuals aged 65 years. There have been 396 admissions to ICUs, 59% were aged 65 years; and there have been 109 cases requiring mechanical ventilation, 56% aged 65 years. Whereas this level is well above last year at this time, it is below the 3,437 hospitalizations reported at this time in The prevalence of influenza-like illness [fever of 100 o F or higher and either cough or sore throat] in Wisconsin's primary care patients is at 4.3% and is near peak level. 12.0% 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 cause of Acute Respiratory infections (ARI) in Wisconsin is Influenza A. Over the past 4 weeks the typical ARI case presenting for primary care has been 36.8 years old and 61% of patients have been female. 60% 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. 32% of illnesses are characterized as mild, with 60% having moderate symptoms and 6% having severe symptoms. Typical Symptoms Percent Viruses in Circulation Percent fever 63 Influenza A 39 cough 85 Influenza B 0 sore throat 60 Coronavirus 16 nasal congestion 64 RSV 3 nasal discharge 59 Parainfluenza 10 headache 52 hmpv 3 malaise 57 Rhino/Enterovirus 26 myalgia 51 Adenovirus 3 Bocavirus 0

2 Symptoms in Patients with PCR-Confirmed Percent Influenza fever 82 cough 92 sore throat 60 nasal congestion 63 nasal discharge 69 headache 55 malaise 62 myalgia 50 CLINICAL NOTES: Prophylaxis - Influenza vaccine is recommended universally keep vaccinating everyone over the age of 6 months, including pregnant women - there is a good match of vaccine to the currently circulating viruses, but the current vaccine had low overall efficacy during the 2017 Australian influenza outbreak - 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 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 high 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 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

3 Resistance Patterns: influenza A[H3N2], 181 influenza A[H1N1] and 229 influenza B viruses have been tested since 10/01/17. - two influenza A[H1N1] viruses (1.1%) were resistant to oseltamivir and peramivir - all influenza A[H3N2] and influenza B viruses have been sensitive to oseltamivir, zanamivir and peramivir - high levels of adamantane antiviral resistance exist in influenza A isolates from around the world Adamantanes include amantadine and rimantadine; they are ineffective for influenza B Other - Coronaviruses, human metapneumovirus and rhinoviruses are co-circulating in Wisconsin. - RSV activity is increasing Across the U.S.: 13,421 (26.7%) respiratory specimens during week 3 (January 14-20) were positive for influenza. For the season to date (last week): -82.1% (78.5%) of subtyped isolates have been type A 90.9% (86.4%) of A viruses have been H3N2 9.1% (13.6%) of all sub-typed A viruses have been 2009 H1N % (21.5%) of isolates have been type B 90.5% (94.1%) were of the Yamagata lineage (Yamagata lineage is not included in this year s trivalent vaccines, such as high-dose IIV) 9.5% (5.9%) were of the Victoria lineage -9.1% of deaths during week 1 (December 31 January 6, 2018) were due to pneumonia or influenza [at the seasonally-adjusted epidemic threshold of 7.2%] -37 pediatric deaths due to influenza have been reported this season: 5 deaths were due to A[H3N12], 10 deaths were due to A[H1N1], 12 deaths were due to an A virus for which no subtyping was performed, and 10 deaths were due to influenza B. This compares to 56 pediatric deaths at this time during the 2014/2015 influenza outbreak. Global News [from the WHO/CDC]: Zika: 5,646 cases have been reported in the U.S. with 2,395cases in pregnant women. Wisconsin has had 4 cases in 2017 all associated with travel. See: for up-to-date information. Other Observations: February 1 st Phenology: Today photoperiod is 9 hours, 57 minutes and 28 seconds, and daylength is increasing by 2 minutes and 23 seconds per day.

4 Of groundhogs and sunlight: Although Punxsutawney Phil may be the most famous groundhog (Marmota monax), other prognosticators include West Virginia's French Creek Freddie, Georgia's General Beauregard Lee, Ohio's Buckeye Chuck, North Carolina's Sir Walter Wally, Louisiana's Cajun Groundhog, Alabama's Smith Lake Jake, New York's Staten Island Chuck, and Wisconsin s own Jimmy the groundhog. Jimmy s accuracy is reported to be about 80%. Tomorrow s forecast sunny: six more weeks of winter. Groundhog Day's origins lie in an ancient European celebration of Candlemas, which is a point midway between the winter solstice and the spring equinox the exact midpoint of astronomical winter. How glorious these sunbeams are! They seem to call Earth to the Heavens The last words of Alexander von Humboldt ( ). Humboldt was a German naturalist and explorer, considered to be one of the most influential scientists of the 19 th century. More Light The last words of German poet, novelist, playwright, and scientist, Johann Wolfgang von Goethe ( ). Goethe was a friend and mentor to Alexander von Humboldt. The Groundhog Richard Eberhart ( ) In June, amid the golden fields, I saw a groundhog lying dead. Dead lay he; my senses shook, And mind outshot our naked frailty. There lowly in the vigorous summer His form began its senseless change, And made my senses waver dim Seeing nature ferocious in him. Inspecting close his maggots might And seething cauldron of his being, Half with loathing, half with a strange love, I poked him with an angry stick. The fever arose, became a flame And Vigour circumscribed the skies, Immense energy in the sun, And through my frame a sunless trembling. My stick had done nor good nor harm. Then stood I silent in the day Watching the object, as before; And kept my reverence for knowledge Trying for control, to be still, To quell the passion of the blood; Until I had bent down on my knees Praying for joy in the sight of decay. And so I left; and I returned In Autumn strict of eye, to see

5 The sap gone out of the groundhog, But the bony sodden hulk remained. But the year had lost its meaning, And in intellectual chains I lost both love and loathing, Mured up in the wall of wisdom. Another summer took the fields again Massive and burning, full of life, But when I chanced upon the spot There was only a little hair left, And bones bleaching in the sunlight Beautiful as architecture; I watched them like a geometer, And cut a walking stick from a birch. It has been three years, now. There is no sign of the groundhog. I stood there in the whirling summer, My hand capped a withered heart, And thought of China and of Greece, Of Alexander in his tent; Of Montaigne in his tower, Of Saint Theresa in her wild lament. [note: Richard Eberhart was one of the most prominent American poets of the twentieth century, and a winner of the Pulitzer Prize. He was described as a modern stylist with romantic sensibilities. Sometimes labeled a nature poet, he often writes about death, most notably in his famous poem "The Groundhog," but his themes also include a preoccupation with such things as the tension between childhood and adulthood, innocence and experience.] 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 Please do not print this unless necessary.