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

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  • 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


    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



  • 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