2018-2019 flu surveillance updates & reminders...2018-2019 flu surveillance updates &...

Texas Department of State Health Services

2018-2019 Flu Surveillance Updates &

Reminders

Hailey Rucas, MPH

August 1, 2018

Texas Department of State

Health Services

DSHS-Austin Influenza Surveillance Team

• State Influenza Surveillance Coordinator: Hailey Rucas, 512-776-6358, [email protected]

• ILINet Coordinator: Robert “Bob” Russin, 512-776-6242, [email protected]

• Invasive/Respiratory Team Lead: Johnathan Ledbetter, 512-776-6223, [email protected]

mailto:[email protected]




Human Infections with Avian or Swine

Influenza

1: Epidemiological curve of avian influenza A(H5N1) cases in humans by week of onset,

2003-2017

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Numtl.r of Conflrm•d Human H5N1 CHH by month or onHt as or 2017-0t•ZS

a traatll � Laoi;(2) � tAyamnar(l ) � Ni11tt1a(1)

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Human Infections with Avian Influenza A (H5N1) • Since 2003, 860 laboratory confirmed cases and 454 deaths

have been reported from 16 countries*

• No cases reported to the WHO in 2018

* As of May 28, 2018 from WHO

Health and Human Services

Texas Department of State Health S•rvices

Figure 1: Epidemiological curve of avian influenza A(H7N9) cases in humans by week of onset, 2013-2018.

60

50

40

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30

20

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� Casas � 01 .. 111

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08 18 28 38 48 06 16 26 36 46 03 13 23 33 43 01 11 21 31 41 51 09 19 29 39 49

2013 2014 2015 2016 2017 2018

Human Infections with Avian Influenza A (H7N9) • Since 2013, 1567 laboratory confirmed cases including at

least 615 deaths have been reported to the World Health Organization (WHO)

* As of May 28, 2018 from WHO

Variant Flu Infections in the U.S. for the 2017-18 Season

• 1 case in Colorado • Case tested positive for H1N2v

• 2 cases in Iowa • One tested positive for H1N1v • The other tested positive for H3N2v

• 1 case in Indiana • Case tested positive for H3N2v

• All 4 cases reported exposure to swine prior to onset

• No human-to-human transmission reported for all 4 cases


Weekly State Influenza Surveillance Report

2· Number and Percentage of Tests (Antigen, Culture, PCR) Positive for Influenza by Type, Subtype, and Lineage Reported by Texas Public Health Laboratories, 2017-2018 Season

160 ~

.. .E 100 G> 2 !: II> 80 -1 0 Q. II> -II> G> 60 -1 --0 .. G>

s::J. 40 E :, z

0 1 2 3 4 5 6 7 8

October November December January February

2017

MMWR reporting week

c:::::::!Other" ~ Flu B (Vidoria) - F1u B (Yamagata) - Flu B (lineage not determined) c:::::::::JFlu A (not subtyped) - FluA(H3N2) c::::::::::>FluA(H1N1 ) - Percent ftu positive

March

2018

April May

90.00%

80.00%

70.00% :S C CD ::, r;:

60.00% .E .. .E

50.00% ~ ; vi 0

40.00% c.. Ill ... Ill

30.00% .! -0

20.00% CD Cl l!! C CD

10.00% ~ CD a.

0.00%

Removal of Percent Positive Line, Public Health Labs (Figure 2)

Health and Human Services

Texas De artment of State

Texas Surveillance Component

Percentage of specimens positive for influenza by bile health laboretones

Number of regions reporting increased flu/ILi activity Number of regions reporting decreased flullLI activity Number of variant/novel influenza infections Number of ILi/infiuenza outbreaks Number of pediatric influenza deaths

Change from Prttvious Week

Not detenrnned duri the summer

Not determined dun the summer

.&0.04%

No change

No change No cases reported

• 1 No new cases

~ ed

Current Week

NIA

0.34%

0.00%

1 3 0 0

0

10liu dlsi:,layed have been uPdallNI since last week's~ r-1 w1ll1 a:iy ,_ r-15 r~

Texas Surveillance Component

Statewide influenza act1vrty level reported to CDC ra hie s read of influenza

Statewide IUNet Activity Indicator assigned by CDC 1ntens of influenza-like illness

Percentage of specimens positive for influenza by hos ital laboratories Percentage of Visits due to ILi (ILINet) Number of regions reporting increased flu/ILi activity Number of regions reporbng decreased flu/lll activity Number of vananl/novel influenza infections Number of ILl/influenz.a outbreaks Number of pediatric influenza deaths

Change from Previous Week

Not determined duri the summer

Not determined dun the summer

.&.0.04%

A.0.42% • 1

No change No cases reported

• 1 No new cases

re ed iOilla dSl)layecl have been Ul)Olted since last -i('s ill J81)0(t w1ln llflY new J9l)(WtS ,~

Previous Week t

NIA

0.30%

000%

Current Week

NIA

0.34%

2.21% 1 3 0 0

0

0

2

4 4 4 4

5

Previous Week'

NIA

0.30%

1.79% 2 3 0 1

0

1

2 4 4 4 4

5

Removal of Percent Positive, Public Health Labs on Summary Table (Table 1)

Current Table:

Future Table:


Surveillance Activities

TdE H~~ervices Health an

Department of State Texas . Health Services

Pneumonia and Influenza Mortality from the National Center for Health Statistics Mortality Surveillance System

Data through the week ending June 23, 2018, as of July 12, 2018

12

l01S 201, ,.,. ,015 2017 201t 4 .._ __________________________ _

•o 50 10 20 JO •o 50 10 20 JO 40 50 10 20 30 40 50 10 20 JO •o 50 10 20

MMWRWeek

Pneumonia and Influenza (P&I) Death Data

• Used to identify: • Additional influenza-associated pediatric

death cases

• Possibly use SAS code from CDC to produce new graph (as shown below)


Right Size Surveillance Project

• Third season: 2018-19 season

• Reporting period: Sept. 30, 2018-Aug. 31, 2019

• Number of participants: 5 LHDs

• Two objectives: 1. Situational awareness for influenza

• Reporting ILI to ILINet • Collect and submit up to 10 specimens from

patients who present with medically-attended influenza-like illness (MA-ILI)

2. Novel influenza detection • Submit up to 10 pre-screened influenza

positive specimens to a public health laboratory for seasonal and novel influenza testing


Right Size Surveillance Project

≠ Right Size Goals


DSHS Laboratory Reminder

• Specimen labeling • Specimens must be labeled with at least two

patient specific identifiers • Primary identifier- patient’s name (first and

last) • Secondary identifier should be one of the

following: • Date of birth • Medical record number • Social security number • Medicaid number or • CDC number

• Both identifiers must appear on the primary specimen container AND the associated submission form


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DSHS Laboratory Updates

• Testing • No changes in regards to influenza testing

• Remel viral transport media (VTM) is still being sent out instead of DSHS prepared media • Remel VTM should be stored according to

the manufacturer’s instructions

• Laboratory Specimen Form • G-2V form • Will not be updated until

Fall 2019


LRN Laboratory Updates

• No updates


CDC Laboratory Updates

• Testing

• Antigenic characterization is being phased out

• Transition to genetic testing


2018-19 Flu Surveillance Reminders

• Check expiration dates on viral transport media

• Send specimens year round

• Obtain copies of HD G-2V

• Report any influenza-associated pediatric deaths and ILI/flu-associated outbreaks


Priority Specimens

• Specimens of interest: • Extremely severe or unusual presentation • Not responding to AV treatment • Person that received an influenza vaccine

at least 2 weeks prior to illness onset • History of animal contact (avian/swine) • History of international travel

• Other priority specimens: • Early and late season specimens • Outbreaks • Pediatric deaths • Unsubtypeables


Surveillance: Pre-season Activities

• Recruiting reporters and specimen submitters • Recruitment usually occurs

between July-Sept

• Ordering VTM and other supplies

• Receiving VTM and other supplies

• Updating influenza surveillance data collection forms or electronic surveys

• Surveillance • Official Influenza Season

• September 30, 2018- May 18, 2019

Timeline for Ordering Supplies

August 2018 Sun Mon Tue Wed Thu Fri Sat

1 2 3 4

5 6 7 8 9 10 11

12 13 14† 15 16 17‡ 18

19 20 21 22 21 24 25

26 27 28 29 30 31

†Suggested deadline for LHD and provider orders to RHDs ‡Deadline for Regional HDs to send orders to DSHS Austin

Timeline for Shipping Supplies

September 2018 Sun Mon Tue Wed Thu Fri Sat

1

2 3 4* 5 6 7 8

9 10* 11 12 13 14 15

16 17 18 19 20 21 22

23 24** 25 26 27 28 29

30

*Shipping day **Backup shipping day


Other Updates: ILINet

• Current no. of participating providers: 144

• 123 providers reported to the ILINet

• 21 providers are being reviewed for lack of participation

• State ILINet Coordinator conducted ILINet recruitment trips to HSR 11 in June 2018

• Recruited 3 additional providers


Other Updates:Vaccines

• Recommended viruses for 2018-19 Northern Hemisphere Influenza Vaccine

• Trivalent vaccine

• an A/Michigan/45/2015 (H1N1)pdm09-like virus;

• an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus; and

• a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)

• Quadrivalent vaccine

• Three viruses listed above

• a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage)

Texas Department of State

Health Services

Other Updates:Vaccines

• Recommendations: • Everyone 6 months and older is

recommended for annual flu vaccination with rare exception

• “Nasal spray” flu vaccine was recommended for the 2018-19 flu season by the Advisory Committee on Immunization Practices (ACIP) • https://www.cdc.gov/mmwr/volumes/6

7/wr/mm6722a5.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a5.htm


Other Updates: DSHS Flu Surveillance Handbook

• Goal: Update by end of September

• Changes posted to DSHS IDCU website

• Anticipated changes to include: • Minor information changes

• Updating links within the handbook


Flu Report Website

• Current web address: • https://www.dshs.texas.gov/IDCU/disease/influenz

a/surveillance/2017---2018-Texas-Influenza-Surveillance-Activity-Report.xls

• Updated web address for 2018-19 season:

• http://www.dshs.texas.gov/idcu/disease/influenza/s urveillance/2019/

• Sign-up to get the Weekly State

http://www.dshs.texas.gov/idcu/disease/influenza/s

https://www.dshs.texas.gov/IDCU/disease/influenz


Other Updates:Texas Syndromic Surveillance (TxS2)- Current Status

• May 2017 – ESSENCE installation complete

• Recruiting, registering, and onboarding hospitals across the state – 94 facilities in production, 96 in testing

• Distributing ESSENCE user credentials to DSHS staff, LHD staff, and hospital staff – over 350 ESSENCE users

• Developing standard queries

• June 2018 – First Train-the-Trainer session

• July 2018 – Tarrant County on boarded

Other Updates: Texas Syndromic Surveillance (TxS2)- Future Activities

• Fall 2018 – Onboard Houston Health Department

• December 2018 – Decommission former TALHO system

• Consider potential data streams • Poison control calls • Over-the-counter medication • School absenteeism • 911 and Nurse hotline calls • Zoonotic disease • Death records

• Continued training

• Development of Use Cases

• Continued recruitment

• Development of success stories with partners


Future Efforts

• Improve Texas ILI data that is reported into ILINet

• Recruit more hospital/clinical laboratories for NREVSS

• Improve influenza-associated pediatric mortality reporting

• Determine if and how to incorporate ILI data from TxS2 into the weekly state influenza surveillance report

• Improve specimen submission numbers to public health laboratories

2018-2019 flu surveillance updates & reminders...2018-2019 flu surveillance updates &...

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