RSV Surveillance in the U.S. Susan I. Gerber, MD Respiratory Virus Program Division of Viral Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Jan. 30, 2013 San Jose, Costa Rica
RSV Surveillance Updates The National Respiratory and Enteric Virus Surveillance System (NREVSS) Seasonality in the U.S. Recent morbidity data
RSV Seasonality: NREVSS NREVSS (National Respiratory and Enteric Virus Surveillance System) Tracks laboratory detections of RSV and other respiratory and enteric viruses Passive and voluntary surveillance system Indicator of seasonality in the U.S.
NREVSS Overview Viruses include: Influenza Respiratory Syncytial Virus (RSV) Human Parainfluenza (HPIV) Viruses 1-4 Respiratory & Enteric Adenovirus Rotavirus Human Metapneumovirus* Enterovirus* Rhinovirus* * added in 2007
NREVSS Overview Data sources Over 500 state and local public health laboratories, commercial labs, and hospitals/universities Weekly reporting of number of tests and number of positives Test types Antigen detection Virus isolation PCR
Participating Labs Uniform web-based reporting structure Comprehensive and representative reporting ~75 labs report directly to CDC Data sharing agreement (2006-2009) with SDI, Inc.* added 200-600 additional labs In Sept 2010, 3 Year contract awarded to SDI, Inc. from competitive bid *Surveillance Data, Inc. (SDI), recently acquired by IMS Health.
Map of Participating NREVSS Labs http://www.cdc.gov/surveillance/nrevsslabs/map.html
NREVSS Overview Improving data management and accessibility Participating laboratories and health departments may export their historical data Recent upgrades to the system to add flexibility in generating tables and graphs for participating labs and health departments Assessing other sources of data to supplement NREVSS
NREVSS Webpages Improving public accessibility Information available to public health partners at websites: http://www.cdc.gov/surveillance/nrevss/ http://www.cdc.gov/flu/weekly/fluactivitysurv.htm
Current NREVSS Website http://www.cdc.gov/surveillance/nrevss/
Current NREVSS website
National Trends
Regional Trends
RSV Detections in Florida
NREVSS: Inclusion Criteria Reported RSV Ag testing results 30 weeks during the NREVSS season Averaged 10 tests per week during the NREVSS season Example: For July 2011-June 2012, 522 labs reporting, 174 (33.3%) labs in 42 states reported 270,441 tests of which 41,299 (15.3%) were positive
Onset NREVSS: Onset and Offset 2 consecutive weeks when the weekly mean of the percentages of specimens testing positive for RSV Ag in all reporting labs in the area is 10% Offset Last 2 consecutive weeks when the mean percent positive drops below 10% Duration Onset week, the weeks between onset and offset, and offset week Peak Week when the mean percentage of positive RSV Ag tests is the highest
RSV Season Onset and Offset Range and Median: NREVSS, July 2007-June 2011
The Pediatric Infectious Disease Journal: Vol. 31, Number 1, January 2012
RSV-associated Hospitalizations: Children <5y, 1997-2006 Hospital discharge data Acute and lower respiratory tract illnesses RSV-coded illnesses Used NVSN (New Vaccine Surveillance Network) estimates for % bronchiolitis and pneumonia likely to be RSV Severe RSV-coded hospitalizations Stockman etal. Ped Infect Dis J 2012;31: 5-9
RSV-associated Hospitalizations:Children < 5y, 1997-2006- Results An estimated 172,000 hospitalizations (132,000 RSV-coded plus 40,000 bronchiolitis and pneumonia hospitalizations not coded as RSV) caused by RSV in children <5y each year during this study period Hospitalization rate highest among infants <3mo (48.9 per 1000) Most children hospitalized with RSV do not have an underlying health condition that would place them at high risk for severe disease Stockman etal. Ped Infect Dis J 2012;31: 5-9
RSV-associated Hospitalizations: Children < 5y, 1997-2006 - Results Younger infants more likely to have an underlying condition and more severe disease Stockman etal. Ped Infect Dis J 2012;31: 5-9
Clinical Infectious Diseases 2012;54(10):1427-36
Hospitalizations Associated with Influenza and RSV in the U.S., 1993-2008 Healthcare Cost and Utilization Project (HCUP) data 13 states with weekly records Estimates of contribution of influenza and RSV to hospitalizations for respiratory and circulatory disease by using modeling and weekly surveillance data as covariates 5 age groups: <1y 1-4y 5-49y 50-64y 65y Zhou etal. Clin Infect Dis 2012;54(10):1427-36
Hospitalizations Associated with Influenza and RSV in the U.S., 1993-2008- Results Rates of RSV-associated hospitalizations were highest among infants and young children followed by the elderly <1y: (2350/100,000; 95% CI, 2220-2520) 1-4y: (178/100,000; 95% CI, 155-230) 65y: (86.1/100,000; 95% CI, 37-326) Zhou etal. Clin Infect Dis 2012;54(10):1427-36
Widmer etal. J Infect Dis 2012;206:56-62
Hospitalization Rates in Older Adults 3 seasons in Davidson County, TN 50y adults admitted to 1 of 4 hospitals with acute respiratory illness (2006-2009) PCR detection of RSV, HMPV, and influenza virus Widmer etal. J Infect Dis 2012;206:56-62
Hospitalization Rates in Older Adults: Results Over 3 years, RSV and HMPV accounted for 6.1% and 4.5% of hospitalizations for acute respiratory illness during the winter viral respiratory season, respectively. Influenza was detected in 6.5%. Widmer etal. J Infect Dis 2012;206:56-62
Pediatric Mortality Estimates Estimated <500 deaths per year Most of these deaths occur among children with underlying cardiac and/or lung disease