Transcript Texas Influenza Surveillance Lesley Bullion Influenza Surveillance Coordinator Infectious Disease Control Unit Flu Surveillance Basics Flu is not a notifiable condition* Participation in surveillance is voluntary “Official”

Texas Influenza
Surveillance
Lesley Bullion
Influenza Surveillance Coordinator
Infectious Disease Control Unit
Flu Surveillance Basics
Flu is not a notifiable condition*
Participation in surveillance is voluntary
“Official” flu season is approximately
October to May (MMWR week 40 to
MMWR week 20)
Texas Flu Surveillance
U.S. Outpatient Influenza-Like Illness
Surveillance Network (ILINet)
Influenza-like illness (ILI) data
Culture Surveillance ‘Network’
Specimens from clinics, hospitals, public health labs, health
departments
Limited specimens from some ILINet providers
Research and Hospital Laboratories
Flu test results from NREVSS, WHO, TCH, S&W,
USAFSAM
Regional Flu Surveillance Coordinator Reports
ILI, school closures, institutional outbreaks, laboratory
results, rapid flu test results, pediatric flu deaths
U.S. Outpatient
Influenza-Like Illness
Surveillance Network
(ILINet)
ILINet Basics
Voluntary nationwide network of healthcare providers
sponsored by the Centers for Disease Control and
Prevention (CDC)
Recruited by each state health department
Weekly reports of influenza-like illness (fever ≥100°F
AND cough and/or sore throat in the absence of a known
cause other than influenza)
Some Texas providers also submit specimens to DSHS
ILINet Reporting Forms
ILINet Data
U.S. Outpatient Influenza-Like Illness Surveillance Network
(ILINet), Texas Participants (N=143), 2008-09
HSR
1
2/3
Total
9
27
4/5N
8
6/5S
36
7
9
8
11
9/10
18
11
25
Grand Total
143
As of 7/13/09
Culture Surveillance
Culture Surveillance Sites,
1998-1999
2008-09 Influenza Surveillance Specimens
Submitted to DSHS Austin Lab (N=1,419*)
HSR
1
Total
40
2/3
642
4/5N
120
6/5S
48
7
246
8
106
9/10
11
Grand Total
44
173
1419
*through April 15,
2009
Additional Laboratory Data
Weekly Reports by Individual Labs
Texas Children’s Hospital: +cultures
Scott & White Hospital Laboratory: +tests
(culture, PCR, antigen) by patient county
USAFSAM: +cultures/PCR by base
LRN laboratories: +PCR
NREVSS Laboratory Data
NREVSS Flu Reporters in 2008-09 season:
Arlington Memorial Hospital
Children’s Hospital of Austin
Children’s Medical Center of Dallas
Cook Children’s Medical Center
Covenant Medical Center
Driscoll Children’s Hospital
Hunt Memorial Hospital District
Medical Center of Plano
Medical City Dallas Hospital
Methodist Children's Hospital
Methodist Hospital
Mother Frances Hospital
Santa Rosa Health Care
Scott & White Memorial Hospital
South Texas Regional Medical Center
Tarrant County Public Health
Texas Children’s Hospital
Texas Department of State Health Services
Tomball Regional Hospital
University Hospital/South Texas Medical Center
University of Texas Medical Branch – Children’s Hospital
University Medical Center
Regional Flu Reports
Flu Activity Levels
No Activity:
– Low clinical activity and no lab confirmation
Sporadic:
– ILI activity not increased
– Isolated lab confirmed cases OR an institutional outbreak in a single institution
Local:
– Increase in ILI plus recent lab confirmation in ONE region of the state
OR
– Recent lab confirmation AND two or more ILI or lab confirmed outbreaks in ONE
region
Regional:
– Increased ILI OR institutional outbreaks in ≥2 but less than half of the regions
– AND recent lab confirmation in affected regions
Widespread:
– Increased ILI OR institutional outbreaks in at least half of the regions
– AND recent lab confirmed influenza in affected regions
Texas Weekly
Flu Report
Flu activity level
Regional reports
Lab data
Outbreaks
SPSN ILI data
Link to national report
Texas Weekly Flu Report
How does Texas
surveillance contribute to
national surveillance?
National Flu Surveillance
Centers for Disease Control (CDC)
components of influenza surveillance in
the U.S.
– Viral Laboratory Surveillance
– Outpatient Illness Data
– Mortality Surveillance
– Hospitalization Surveillance
– State and Territorial Epidemiologists Reports
2008–2009
Influenza Season
in Texas
(through April 15, 2009)
U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet),
Data From Texas Participants, 2008-09
50000
8%
45000
7%
40000
25000
4%
20000
3%
15000
2%
10000
1%
5000
October
November
December
January
ILI
%ILI
March
April
200915
200914
200913
200912
200911
200910
200909
200908
200907
200906
February
MMWR Week
Patients
200905
200904
200903
200902
200901
200853
200852
200851
200850
200849
200848
200847
200846
200845
200844
200843
200842
0%
200841
0
Percentage of Visits For ILI
5%
30000
200840
Number of Patient Visits
6%
35000
Texas Flu Summary, 2008–09
First isolate of the season (DSHS Lab)
– Flu A/unable to subtype!
Specimen collected October 15, 2008
Bell County
Swine influenza A (H1N1)
– Flu B
Specimen collected October 21, 2008
B/Malaysia/2506/2004-like (Victoria lineage)
Webb County
Predominant type/subtype: A (H1N1)
Percentage of Specimens Positive for Influenza and
Types/Subtypes of Influenza Isolated at DSHS Austin Lab, 2008-09
160
100%
80%
Number of Flu Isolates
120
70%
100
60%
80
50%
40%
60
30%
40
20%
20
10%
0
0%
40 41 42 43 44 45 46 47 48 49 50 51 52 53
October
November
December
1
2
3
4
5
January
6
7
8
9
February
2008
2009
MMWR Week
A/H1
A/H3
A/Unable to subtype
B
%FLUPOS
10 11 12 13 14 15
March
April
Percentage of Specimens Positive for Flu
90%
140
Texas Flu Summary, 2008-09
Early appearance of influenza B and A (H1N1)
– Influenza A (H3N2) absent until week 52
Seasonal peak: early February
– 221 specimens collected, 147 (67%) positive for flu
during week 5 (week ending February 7, 2009)
– ILINet peak: 7.06% in week 6
– NREVSS-Texas peak: 28.1% in week 5
– “Widespread” designation for 7 weeks
Late, small flu B wave (week 8)
Mild compared to 2007-08
Influenza Types and Subtypes Identified in Positive Specimens,
DSHS Austin Laboratory, 2008-2009 Season
Virus
Total
A H1
468
A H3
37
Unable to subtype
B/Florida/04/2006-like
B/Malaysia/2506/2004-like
1
15
248
Influenza B
7
Grand Total
776
2008-09 Flu Season in Texas
(through April 15, 2009)
100%
12%
Widespread flu activity
reported to CDC
%Flu Pos, DSHS Austin
%Flu Pos, NREVSS
80%
10%
%ILI, ILINet
70%
8%
60%
6%
50%
40%
4%
30%
20%
2%
10%
0%
0%
40 41 42 43 44 45 46 47 48 49 50 51 52 53
October
November
December
1
2
3
January
2008
4
5
6
7
8
February
2009
MMWR Week
9
10 11 12 13 14 15
March
April
Percentage of Visits Due to ILI
Percentage of Specimens Positive for Influenza
90%
Influenza-Associated Pediatric
Mortality
Reportable beginning in 2007 in Texas
Laboratory-confirmed influenza death in a
person under 18 years of age
11 deaths (through week 15)
–
–
–
–
–
Age range: 7 months to 17 years
4 Flu A, 7 Flu B
Known MRSA or MSSA co-infection: 2/11 (18%)
Significant underlying medical condition: 8/11 (73%)
Not vaccinated for flu: 4/6 (67%)
Review of 2008–09 Vaccine
Components (Northern Hemisphere)
All 3 were new components!
– A/Brisbane/59/2007-like (H1N1)
– A/Brisbane/10/2007-like (H3N2)
– B/Florida/4/2006-like (B/Yamagata lineage)
Antigenic Characterization Testing
Performed on limited Texas isolates at
CDC laboratory
20 A/H1 (seasonal) isolates: 100% match
to vaccine strain
8 A/H3 isolates: 100% match
23 influenza B isolates:
– 30% match to vaccine strain (Yamagata
lineage)
– 70% Victoria lineage
Antiviral Resistance Testing
Performed on limited Texas isolates at CDC
laboratory
1 swine influenza A/H1 tested (October 2008)
– Sensitive to oseltamivir, zanamivir, adamantanes
22 seasonal influenza A/H1’s tested
– 100% resistant to oseltamivir (sensitive to zanamivir
and adamantanes)
7 influenza A/H3’s tested
– 100% resistant to adamantanes (sensitive to
oseltamivir and zanamivir)
22 influenza B’s tested
– 100% sensitive to oseltamivir and zanamivir
2009-10 Vaccine Composition
(Northern Hemisphere)
Only the B strain will be changed:
– A/Brisbane/59/2007-like (H1N1)
– A/Brisbane/10/2007-like (H3N2)
– B/Brisbane/60/2008-like (B/Victoria lineage)
Texas Flu Surveillance
2009-2010 Season
Continue funding all packaging, shipping, and
testing related to flu surveillance; however,
testing may be limited – how?
Increase ILINet participants & culture
surveillance sites in selected areas
PCR to continue at LRNs
VTM ordering process? Limits?
To sign up for automatic notification of new flu
reports:
http://www.dshs.state.tx.us/idcu/disease/
influenza/surveillance/2009/