2015 Kick the Flu Summit Review of Influenza Activity in San Diego County 2014-2015 Season Jeffrey Johnson, MPH Senior Epidemiologist Epidemiology & Immunization Services Branch Public Health Services 9/18/2015
Headlines from last influenza season.
Headlines from last influenza season.
Rates of Estimated Vaccine Effectiveness by Season 80 70 60 50 40 30 52 37 56 60 47 49 51 Last Season 20 19 10 0 Influenza Season Source: Centers for Disease Control and Prevention
Influenza Surveillance World U.S. California San Diego County
Purpose Top 5 Reasons Influenza Surveillance Matters 1. To measure population impact 2. To identify novel influenza strains 3. To assess match of circulating strains to vaccine 4. To identify outbreaks and severe illness trends 5. To provide surveillance data to stakeholders
INFLUENZA SURVEILLANCE ACTIVITIES San Diego County Case Reporting and Data Collection Data Analysis Sentinel Sites Syndromic Surveillance Media Requests Laboratory Testing Outbreak Detection Preparing Reports
LAST FLU SEASON (2014/2015) 7,395 TOTAL REPORTED INFLUENZA Total Reported CASES influenza cases 154 ICU CASES 97 DEATHS 78 CONFIRMED OUTBREAKS
INFLUENZA TYPE, 2014/2015 Flu Type Flu Sub-type/Strain Count Percentage Influenza A 4,830 Flu A Influenza A (H3) Seasonal 1,217 81.9% Influenza A (H1N1)pdm09 9 Influenza B 1,122 Flu B Influenza B/Yamagata Influenza B/Victoria 68 49 16.7% Flu A/B Influenza A/B 100 1.4% N = 7,395
Influenza Detections by Type and Week, 2014-2015 Number of cases 1200 N = 7,395 1000 800 600 400 200 0 27 29 31 33 35 37 39 41 43 45 47 49 51 53 2 4 6 8 10 12 14 16 18 20 22 24 26 Week Influenza A Influenza A(H1N1)pdm09 Influenza A(H3) Influenza B Influenza B/Victoria Influenza B/Yamagata
INFLUENZA SEASONS Cumulative # Influenza Reports 8000 7000 6000 5000 4000 3000 2000 1000 Cumulative Influenza Case Reports by Week & Season 2014-15 N=7,395 2009-10 N=6,692 2012-13 N=5,438 0 27 29 31 33 35 37 39 41 43 45 47 49 51 53 2 4 6 8 10 12 14 16 18 20 22 24 26 week # 2014-15 2013-14 2012-13 2011-12 2010-11 2009-10 2008-09 2007-08 2006-07 2005-06 2004-05 2003-04
INFLUENZA ACTIVITY HEAT MAP Week 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ICU Cases Deaths Outbreaks Calls Specimens ED % ILI 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 3 2 3 9 17 21 13 18 14 11 5 9 1 2 3 2 0 2 1 3 2 2 3 8 3 1 4 3 6 3 3 10 5 12 15 16 16 43 82 125 198 296 631 946 707 856 820 643 352 275 129 153 142 80 60 34 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 7 14 8 16 5 7 7 2 5 0 0 1 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 2 0 2 6 22 20 15 27 16 15 6 8 2 1 0 3 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 2 0 7 9 40 41 31 37 30 22 16 4 3 2 3 3 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 5 6 12 30 27 76 152 65 77 53 41 26 26 27 11 16 11 8 6 2 3 2 2 3 3 3 2 2 2 4 3 4 2 4 2 1 2 3 3 4 3 6 7 6 8 11 8 6 6 4 5 5 5 5 3 4 3 2 AUG SEP OCT NOV DEC JAN FEB MAR APR 2014 2015
INFLUENZA CASES BY REGION 2014/2015 REGION East Central N. Central N. Coastal N. Inland South # of CASES 1067 880 1004 720 1031 667 RATE Per 100,000 224.2 179.9 161.9 136.7 174.0 136.1
INFLUENZA BY GENDER, 2014/2015 Female Male 3,650 Cases 3,164 Cases 53.4% 46.1% Note: 531 cases (7%) were missing gender information
INFLUENZA CASES BY AGE 2014/2015 200 Frequency of Cases by Age N = 7,395 150 100 50 0 0 24 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 100 102 104
Influenza Cases by Age Group, 2014/2015 Number and Age Specific Incident Rate 2400 Count Rate per 100K 2,000.0 1,800.0 1900 1,600.0 1314.6 1,400.0 Count 1400 900 400 460.5 396.8 382.3 1,200.0 1,000.0 800.0 600.0 400.0 Rate per 100K 70.7 150.4 123.2 200.0-100 0.0
INFLUENZA DEATHS BY SEASON 100 80 60 4 40 20 0 1 22 5 14 4 9 51 6 2 7 8 17 2 11 61 42 28 97 Seasonal / Un-typed Pandemic H1N1
INFLUENZA DEATHS, 2014/2015 N = 97 Female 57.0% Male 43.1% 100% Had underlying health conditions 22% Were residents of a long term care facility with a reported flu outbreak 10 8 6 4 2 0 Frequency by Age Range 51-104 years 51 55 59 63 67 71 75 79 83 87 91 95 99 103
Influenza Case Severity Rates, 2014/2015 By Age Group 12.0 10.0 10.4 8.0 Rate 6.0 4.0 2.0 0.0 1.5 0.7 0.4 0.6 2.1 0.3 4.8 3.0 4.3 Flu Severity (ICU) Rate per 100K Case Fatality Rate
Influenza Outbreaks N=78 Frequency by Week Outbreak Was Reported 16 14 12 10 8 6 4 78 Flu outbreaks All outbreaks lab confirmed 1,050 total cases Avg. of 13 cases per outbreak 22 deaths among residents of outbreak locations (e.g. LTCF) 2 0 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Week
CASE EXAMPLE: FLU OUTBREAK Outbreak A 44 cases Call from LTCF Public Health Response Initiate use of anti-virals Hosp Death #1 77% of staff vaccinated 67% of residents vaccinated Last day of new onset of ILI Monitoring for additional cases Outbreak closed Residents & staff ill Multiple hospitalizations for flu Hosp Death #2
OUTBREAK DETECTION Expanded Approaches Individually Reported & Registered Cases Matching by Disease & Address D O B Potential Outbreak Detected Public Health Investigation Initiated
SURVEILLANCE REPORTS Influenza Watch report posted and emailed weekly Regular alerts and updates through CAHAN Information used in HHSA reports and press releases
ELECTRONIC DEATH REGISTRATION DETECTION Death occurs Physicians diagnose and staff initiates electronic record Electronic registration process at County Cause of death detector Influenza Deaths matched to communicable disease registry! Detection
Flu Forecast?
** CURRENT UPDATE ** Reported Influenza Cases Since July 1, 2015 48 TOTAL REPORTED INFLUENZA CASES Flu A 65% 0 ICU CASES 0 DEATHS Count 15 10 5 0 Flu B 35% 27 28 29 30 31 32 33 34 35 36 Week
REPORTING FLU CASES Please report positive influenza results to public health Lab results and demographics Fax to 858-715-6458 Please report influenza deaths Please report influenza ICU cases Please report influenza outbreaks Questions about reporting? Call 619-692-8499
THANK YOU For More Information epi.hhsa@sdcounty.ca.gov 619-692-8499
CASE EXAMPLE: FLU OUTBREAK Outbreak A 44 cases