1 influenza (and other respiratory virus) surveillance in wisconsin thomas haupt m.s. wisconsin...

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

Greetings and Thank You From Wisconsin!

Population approximately 5.6 millionAverage high temperature (July) 82 degreesWISCONSIN THE BADGER STATE

Population approximately 5.6 million>6,000 Confirmed and Probable CasesWISCONSIN THE SWINE-FLU STATE

Surveillance MethodsCurrent and Future CurrentVirologic (Lab)Rapid Test Site (RTS)ILINET (Influenza-like illness)

FutureEnhanced ED monitoringHospitalizationsEnhance Antiviral Resistance Monitoring

PANDEMIC INFLUENZA VIROLOGIC SURVEILLANCE IN PERSPECTIVE Confirmed % cases Cases (worldwide)

WORLDWIDE 94,500 100%

UNITED STATES 37,250 39%

WISCONSIN 6,300 7%

4 Labs Certified to do Pandemic Influenza Confirmation

Week Ending April 25th"

Week Ending May 2nd

Week Ending May 9th

Week Ending May 16th

Week Ending May 23rd

Week Ending May 30th

Week Ending June 6th

Week Ending June 13th

Week Ending June 20th

WISCONSIN PANDEMIC INFLUENZA LAB SURVEILLANCE

WISCONSIN SEASONAL and PANDEMIC INFLUENZA LAB SURVEILLANCE

Virologic SurveillanceNeed 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 InstitutionsNeed a more streamline, accurate (yet simple) method of reporting data i.e.. Electronic lab reporting

Rapid Test Site (RTS) SurveillanceDone for several years very informally2008-09 CSTE Grant to Enhance Influenza Surveillance

Geographic Distribution of Laboratory Surveillance ContributorsRapid Test SiteGreen BayMilwaukee

Rapid Test Site (RTS) Surveillance AdvantagesMany more sites (Data)Consistent with both PCR and CultureCan be easily broken down by regions of the state DisadvantageUse early and late in season (Low PVP)Use during Pandemic Influenza

ILINet WI Outpatient ILI surveillanceWisconsin had 66 Sentinel Clinicians, 50 of which were regular reporters 30 of which do year-round surveillanceData analyzed by Public health Region and statewide Baseline and threshold levels of ILI Traditional state Limited electronic ILI, more syndromic

ILINet WI Outpatient ILI surveillance network, through Jun 27

ILINet WI Outpatient ILI surveillance network, through Jun 27

ILINet WI Outpatient ILI surveillance networkContinue to recruit/maintain cliniciansGear toward more electronic ILI reporting Hospital ED surveillance Validate criteria for surveillanceChief Complaint/ discharge diagnosis etc

Future SurveillanceEnhance and develop severity surveillance Hospitalizations from flu ED data Deaths

Antiviral Resistance

Hospitalizations and ED DataIntra 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

Wisconsin Health Information Exchange (WHIE) NetworkCurrently 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

Weekly ED visits with chief complaint of fever or flu at 11 Milwaukee area hospitals, by age-group, Jan 2008 Jul 4, 2009Wisconsin Health Information Exchange (WHIE) data

Wisconsin Health Information Exchange (WHIE) NetworkUse 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

Wisconsin Health Information Exchange (WHIE) NetworkChief Complaint Categories

Fever Flu Respiratory Asthma Sepsis DiarrheaRash Other

Antiviral ResistanceWisconsin 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

What we dont doStatewide school absenteeism Some local surveillance that varies greatly

Large Business absenteeism

Long term care (Except for clusters)

Other Respiratory Viruses SurveillanceStatewide and RegionallyRSV (Rapid tests)StatewideParainfluenza (1-4)AdenovirusRhinovirusHuman metapneumovirusCoronavirus (OC-43 and others)Enterovirusus

VIRUS CULTUREBased on 206 testsRAPID TESTSSELECT PCR TESTSVirus% PositiveVirus#Tests % PositiveVirusPositive/total numberTotal % Positive 16.0%Influenza A & B44/206Influenza (Tot.) Influenza A Influenza B hMPV 9.7%1.5%8.2%0%Influenza (Tot) 95713.6% Influenza A 3.6% # A/H18 Influenza B 9.9% # A/H30 Influenza Unk.*0.1% # B34RSV1.9%RSV2079.2%RSV6/122Adenovirus1.0%Adenovirus550.0%Adenovirus1/38Parainfluenza 3.4%Parainfluenza6/76Rhinovirus0.0%*Influenza unknown (Unk) are positive influenza test results that cannot be distinguished between Type A and BRhinovirus3/38Enterovirus 0.0%Enterovirus0/38

AgainThank you for invitation and hospitality !!

Questions and comments Please