Transcript INFLUENZA (AND OTHER RESPIRATORY VIRUS) SURVEILLANCE IN WISCONSIN Thomas Haupt M.S. Wisconsin Influenza Surveillance Coordinator.

INFLUENZA (AND OTHER RESPIRATORY VIRUS)
SURVEILLANCE IN WISCONSIN
Thomas Haupt M.S.
Wisconsin Influenza Surveillance Coordinator
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Greetings and Thank You From Wisconsin!
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WISCONSIN THE “BADGER” STATE
Average high temperature (July) 82 degrees
Population approximately 5.6 million
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WISCONSIN THE “SWINE-FLU” STATE
>6,000 Confirmed and Probable Cases
Population approximately 5.6 million
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Surveillance Methods
Current and Future
Current
• Virologic (Lab)
• Rapid Test Site (RTS)
• ILINET (Influenza-like illness)
Future
• Enhanced ED monitoring
• Hospitalizations
• Enhance Antiviral Resistance Monitoring
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PANDEMIC INFLUENZA VIROLOGIC SURVEILLANCE
IN PERSPECTIVE
Confirmed
Cases
% cases
WORLDWIDE
94,500
100%
UNITED STATES
37,250
39%
6,300
7%
WISCONSIN
(worldwide)
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4 Labs Certified to do Pandemic Influenza Confirmation
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Week Ending April 25th
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MAY 2
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JUNE 6
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Week Ending May 2nd
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Week Ending May 9th
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Week Ending May 23rd
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Week Ending June 6th
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Week Ending June 13th
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WISCONSIN PANDEMIC INFLUENZA LAB SURVEILLANCE
Tested
Confirmed
% Positive
3500
60%
3000
50%
2500
2000
30%
1500
% Positive
# Tests
40%
20%
1000
10%
500
0
0%
2-May
9-May 16-May 23-May 30-May 6-Jun
13-Jun 20-Jun 27-Jun
4-Jul
week ending
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3Ja
10 n
-J
a
17 n
-J
a
24 n
-J
a
31 n
-J
an
7Fe
14 b
-F
e
21 b
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e
28 b
-F
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7M
14 a r
-M
21 ar
-M
28 ar
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a
4- r
Ap
11 r
-A
18 pr
-A
25 pr
-A
p
2- r
M
a
9- y
M
16 a y
-M
23 ay
-M
30 ay
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ay
6Ju
13 n
-J
u
20 n
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un
# Tests
Tested
5000
50%
4500
45%
4000
40%
3500
35%
3000
30%
2500
25%
2000
20%
1500
15%
1000
10%
500
5%
0
0%
% Positive
WISCONSIN SEASONAL and PANDEMIC INFLUENZA
LAB SURVEILLANCE
% Positive
week ending
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Virologic Surveillance
• Need to determine a median between testing
everyone and those needed to be tested
– Severely ill
– High risk patients, and
– Residents of LTC, Corrections and other
Institutions
• Need a more streamline, accurate (yet
simple) method of reporting data i.e..
“Electronic lab reporting”
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Rapid Test Site (RTS) Surveillance
• Done for several years very informally
• 2008-09 CSTE Grant to Enhance
Influenza Surveillance
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Geographic Distribution of Laboratory
Surveillance Contributors
Bayfield
Douglas
Ashland
Iron
Washburn
Vilas
Sawyer
Burnett
Price
Forest Florence
Oneida
Polk
Barron
Rusk
Marinette
Lincoln
Taylor
St. Croix
Dunn
Langlade
Chippewa
Pierce
Menominee
Marathon
Clark
Green Bay
Shawano
Eau Claire
Pepin
Buffalo
Oconto
Wood
Door
Waupaca
Portage
Kewaunee
Outagamie
Trempealeau
Jackson
Brown
Juneau
Monroe
Adams Waushara
LaCrosse
Manitowoc
Winnebago
Calumet
Marquette
Fond du Lac
Rapid Test Site
Vernon
Sheboygan
Green Lake
Sauk
Columbia
Dodge
Richland
Ozaukee
Washington
Crawford
Virology Laboratory
Milwaukee
Dane
Grant
Jefferson
Iowa
LaFayette
Green
Rock
Waukesha Milwaukee
Walworth
Racine
Kenosha
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Ja
10 n
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4Ap
11 r
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pr
3-
#Tests
Flu Tests
% Flu +
2500
2000
1500
20%
1000
500
0
% Positive
Wisconsin
RSV Tests
% RSV +
40%
30%
10%
0%
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Percent Positive Lab Tests
Culture
PCR
Rapid
50%
% Positive
40%
30%
20%
10%
0%
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43
46
49
52
3
6
9
12
15
week
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Rapid Test Site (RTS) Surveillance
•
•
•
•
•
Advantages
Many more sites (Data)
Consistent with both PCR and Culture
Can be easily broken down by regions of
the state
Disadvantage
Use early and late in season (Low PVP)
Use during Pandemic Influenza
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ILINet – WI Outpatient ILI
surveillance
• Wisconsin had 66 Sentinel Clinicians, 50 of
which were regular reporters
– 30 of which do year-round surveillance
• Data analyzed by Public health Region and
statewide
– Baseline and threshold levels of ILI
• “Traditional” state
– Limited electronic ILI, more syndromic
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ILINet – WI Outpatient ILI surveillance
network, through Jun 27
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ILINet – WI Outpatient ILI surveillance
network, through Jun 27
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ILINet – WI Outpatient ILI
surveillance network
• Continue to recruit/maintain clinicians
• Gear toward more electronic ILI reporting
– Hospital ED surveillance
– Validate criteria for surveillance
• Chief Complaint/ discharge diagnosis etc
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Future Surveillance
• Enhance and develop “severity” surveillance
– Hospitalizations from flu
– ED data
– Deaths
• Antiviral Resistance
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Hospitalizations and ED Data
• Intra –state pilot program to identify
admissions due to ILI and ED visits due to
ILI on a daily/weekly basis
– By age group (0-4,5-24,25-49,50-64, >64)
– Web based reporting system (WI-Trac)
– early results varied
• 10 minutes to 1 hour of ICP time
• ability of hospitals to do it also varied
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Wisconsin Health Information
Exchange (WHIE) Network
Currently in Milwaukee County only
• 16 hospitals
Plan to expand to larger hospitals, hospital
corporations this fall
Uses chief complaint “Fever” or “Flu”
Daily, weekly monthly
Hospital Death reporting being considered
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Weekly ED visits with chief complaint of “fever” or “flu” at 11
Milwaukee area hospitals, by age-group, Jan 2008 – Jul 4, 2009
Wisconsin Health Information Exchange (WHIE) data
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Wisconsin Health Information
Exchange (WHIE) Network
Use in local areas is better than ILINet
Use in statewide or regional areas is being
reviewed
Data needs to be validated for use in ILINet
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Wisconsin Health Information
Exchange (WHIE) Network
Chief Complaint Categories
Fever
Flu
Respiratory
Asthma
Sepsis
Diarrhea
Rash
Other
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Antiviral Resistance
• Wisconsin State Lab currently tests for
seasonal influenza resistance to
adamantanes and neuraminidase inhibitors
• Beginning July 2009 will test Pandemic
H1N1 for resistance to adamantanes and
neuraminidase inhibitors using CDC
methodology
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What we don’t do
• Statewide school absenteeism
– Some local surveillance that varies greatly
• Large Business absenteeism
• Long term care (Except for clusters)
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“Other” Respiratory Viruses
Surveillance
•
•
•
•
•
•
•
Statewide and Regionally
RSV (Rapid tests)
Statewide
Parainfluenza (1-4)
Adenovirus
Rhinovirus
Human metapneumovirus
Coronavirus (OC-43 and others)
Enterovirusus
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VIRUS CULTURE
Based on 206 tests
Virus
Virus
%
Positive
Total % Positive
16.0%
Influenza (Tot.)
Influenza A
Influenza B
9.7%
1.5%
8.2%
0%
hMPV
RAPID TESTS
#
Tests
SELECT PCR TESTS
% Positive
Virus
Influenza A & B
Influenza (Tot)
957
Positive/
total
number
44/206
13.6%
Influenza A
3.6%
# A/H1
8
Influenza B
9.9%
# A/H3
0
Influenza Unk.*
0.1%
# B
RSV
1.9%
RSV
Adenovirus
1.0%
Adenovirus
Parainfluenza
3.4%
Rhinovirus
0.0%
Enterovirus
0.0%
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207
9.2%
RSV
55
0.0%
Adenovirus
1/38
Parainfluenza
6/76
Rhinovirus
3/38
Enterovirus
0/38
*Influenza unknown (Unk) are positive influenza
test results that cannot be distinguished between
Type A and B
6/122
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Again…
Thank you for invitation and hospitality !!
Questions and comments … Please
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