Objectives of Influenza Surveillance Influenza Activity in Indiana 2014-2015 Reema Patel, MPH Respiratory Epidemiologist Epidemiology Resource Center Indiana State Department of Health Monitor influenza-like illness (ILI) activity levels in the state Rapidly detect novel influenza events Describe the seasonal occurrence of influenza in the state Determine the types of circulating influenza viruses and noninfluenza respiratory viruses Inform healthcare professionals and public health partners with weekly influenza surveillance data Support influenza vaccination with real-world influenza surveillance data Respond to community or institutional ILI outbreaks Weekly Influenza Reports Syndromic Surveillance Published every Friday for the previous MMWR Week Published through MMWR Weeks 40 20 Provide a general understanding of the burden of influenza-like illness to our partners in the state Local health departments Hospital administrators Health professionals Indiana residents NEW! Additions during the 2014-2015 season Graph of influenza-associated deaths by MMWR week Graphs of district-level ILI activity by MMWR week ~118 hospitals Emergency Department chief complaint data Respiratory Syndrome Alerts Pneumonia Cough Difficulty Breathing or Shortness of Breath Sore Throat Influenza-like Illness Subsyndrome Influenza Fever and Cough and/or Sore Throat) 1
Number of Weeks 4/2/2015 Syndromic Surveillance Syndromic Surveillance 14 12 10 8 6 4 2 0 Influenza-like Illness Geographic Spread in Indiana During the 2014-2015 Influenza Season* Geographic Spread Indicator No Activity Sporadic Local Regional Widespread *Data are preliminary. Influenza Season is currently ongoing Sentinel Surveillance Sentinel Surveillance Fever (> 100 F, 37.8 C) and cough and/or sore throat (without a known cause other than influenza) Weekly reporting by outpatient clinics in Indiana Recruiting additional sentinel sites for the 2015-2016 influenza season program ISDH provides influenza rapid test kits to sentinel sites ISDH offers influenza specimen supplies and testing to sentinel sites ILI data from sentinel sites is important for both the state and CDC s surveillance programs! 2
Sentinel Surveillance Sentinel Surveillance Influenza-like Illness Activity Level Indicator In Indiana During the 2014-2015 Influenza Season Minimal Low Moderate High 16% 12% 0% 72% *Data are preliminary. Influenza Season is currently ongoing Reportable Condition: Influenza-Associated Deaths Influenza-Associated Deaths All physicians, laboratories and hospitals are to report influenza-associated deaths to local health department within 72 hours of knowledge of death. An influenza-associated death is a human death in which an influenza diagnosis has been detected by: Commercial rapid antigen testing Viral culture Direct Florescent Antibody (DFA) Indirect Florescent Antibody (IFA) Enzyme immunoassay RT-PCR Immunohistochemistry (IHC) A report is not necessary if the deceased has a diagnosis of influenza by clinical presentation without detection by the tests above listed. This may change in the revised version of the Communicable Disease Reporting Rule 3
Influenza-Associated Deaths Influenza-Associated Deaths Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct 2009-2010- 2011-2012- 2013-2000- 2001-2002- 2003-2004- 2005-2006- 2007-2008- May May May May May May May May May May May May May May Age Group 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 0-4 3 0 0 1 3 0 1 1 1 1 1 0 1 0 Complications Acute Respiratory Distress Syndrome Pneumonia 5-18 0 0 1 1 1 1 1 1 0 3 1 0 4 0 19-24 0 0 0 0 0 0 0 1 0 1 0 0 0 0 25-49 2 0 1 1 1 1 1 4 1 5 5 0 6 19 50-64 0 0 1 8 2 2 0 8 1 1 13 0 11 27 Risk due to underlying medical conditions COPD Cardiac Disease Renal Disease Immunosuppressive conditions or treatments 65+ 4 18 6 80 47 22 2 58 3 7 5 3 51 24 Total 9 18 9 91 54 26 5 73 6 18 25 3 73 70 2014-2015 Seasonal Influenza Vaccine 2014-2015 Seasonal Influenza Vaccine Effectiveness 2014-2015 Trivalent Vaccine an A/California/7/2009 (H1N1)pdm09-like virus an A/Texas/50/2012 (H3N2)-like virus a B/Massachusetts/2/2012-like (B/Yamagata lineage) virus 2014-2015 Quadrivalent Vaccine All of the trivalent viruses, plus B/Brisbane/60/2008-like (B/Victoria lineage) virus CDC published interim influenza vaccine effectiveness (VE) estimates January 2015 23% overall VE estimate February 2015 19% overall VE estimate 18% VE estimate against influenza A H3N2 viruses 45% VE estimate against influenza B viruses Final VE estimates will be published by CDC at the end of the season 4
2014-2015 Seasonal Circulating Influenza Viruses Implications of this Season s Flu Vaccine A/California/7/2009 (H1N1)pdm09 A/Texas/50/2012 (H3N2) B/Massachusetts/2/2012 (B/Yamagata lineage) B/Brisbane/60/2008 (B/Victoria lineage) A/Switzerland/9715293/2013 NOT included in the 2014-2015 Northern Hemisphere vaccine First detected in U.S. in March 2014 (AFTER vaccine recommendations and production) Still need to emphasize influenza vaccination Protects against influenza A H3N2 and H1N1pdm09 viruses Protects against influenza B viruses Influenza season may range from October through May Recommend the use of antiviral medications For chemoprophylaxis and treatment As soon as possible, but optimal within 48 hours of symptom onset Helps shorten duration of fever and illness Helps reduce the risk of complications from influenza, including death and duration of hospitalization stay 2015-2016 Seasonal Influenza Vaccine 2014-2015 Seasonal Circulating Influenza Viruses Northern Hemisphere Vaccine Recommendations World Health Organization (WHO) U.S. Food and Drug Administration 2015-2016 Trivalent Influenza Vaccine A/California/7/2009 (H1N1)pdm09-like virus A/Switzerland/9715293/2013 (H3N2)-like virus B/Phuket/3073/2013-like (B/Yamagata lineage) virus 2015-2016 Quadrivalent Influenza Vaccine All of the Trivalent viruses, plus B/Brisbane/60/2008-like (B/Victoria lineage) virus *Source: http://www.cdc.gov/flu/weekly/ 5
2014-2015 Seasonal Circulating Influenza Viruses Infection Prevention in Healthcare Settings 97% Percent of positive specimens by type, Week 52 3% Influenza A Influenza B *Source: http://www.cdc.gov/flu/weekly/ Percent of positive specimens by type, Week 11 75% 25% Influenza A Influenza B Starts with influenza vaccination for staff and patients! Good respiratory hygiene and cough etiquette Signage and education for patients and visitors to minimize exposure and transmission Adherence to standard and droplet precautions Train and educate healthcare personnel Monitor influenza activity use local and state resources! Consider antiviral chemoprophylaxis and treatment when necessary Infection Prevention in Healthcare Settings Infection Prevention in Healthcare Settings Overall, 72% of healthcare personnel reported having had an influenza vaccination during the 2012-2013 influenza season 92.3% coverage among physicians; 84.8% coverage among nurses 83.1% coverage in hospital-based healthcare personnel (highest) 58.9% coverage in healthcare personnel in long-term care facilities (lowest) *Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6238a2.htm?s_cid=mm6238a2_w Vanhems P, Voirin N, Roche S, et al. Risk of Influenza-Like Illness in an Acute Health Care Setting During Community Influenza Epidemics in 2004-2005, 2005-2006, and 2006-2007: A Prospective Study. Arch Intern Med. 2011;171(2):151-157. 6
Infection Prevention in Healthcare Settings Influenza-Associated Parotitis -Blumenfled HL, Kilbourne ED, Louria DB, Rogers DE. Studies on influenza in the pandemic of 1957 1958. I. An epidemiologic, clinical and serologic investigation of an intrahospital epidemic, with a note on vaccination efficacy. J Clin Invest 1959;38:199-212. -Bridges CB, Kuehnert MJ, Hall CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis 2003; 37: 1094 101. Parotitis, inflammation of the parotid gland, is a rare complication of influenza Parotitis is more commonly associated with mumps infection Starting December 2014, several cases of influenzaassociated parotitis were reported to ISDH Indiana was the first to notify CDC Currently assisting CDC on a multistate investigation Describe the occurrence of influenza-associated parotitis Identify the risk factors for developing influenza-associated parotitis 2014-2015 Influenza Season at a Glance Resources >100 reported influenza-associated deaths among all ages 1 pediatric death reported in the state Circulating H3N2 viruses mismatched to the H3N2 vaccine virus Several Indiana hospitals reported visitor restrictions Multiple influenza-like illness outbreaks among long-term care facilities Investigation of influenza-associated parotitis cases No reported statewide or national antiviral shortages; sporadic shortages may have been specific to pharmacy or facility locations ISDH Weekly Flu Report http://www.in.gov/isdh/22104.htm CDC Weekly Flu Report http://www.cdc.gov/flu/weekly/ Prevention Strategies for Seasonal Influenza in Healthcare Settings http://www.cdc.gov/flu/professionals/infectioncontrol/ Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities http://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm Influenza Vaccination Information for Health Care Workers http://www.cdc.gov/flu/healthcareworkers.htm 7
Questions? Contact Information R E E M A PAT E L, M P H R E S P I R AT O R Y E P I D E M I O LO G I S T E P I D E M I O LO G Y R E S O U R C E C E N T E R I N D I A N A S TAT E D E PA R T M E N T O F H E A LT H R E PAT E L @ I S D H. I N. G O V ( 3 17 ) 23 4-2 8 0 9 8