Download - Influenza Surveillance in Washington Anthony A Tellez-Marfin Washington State Department of Health
Influenza Surveillance
in Washington
Anthony A Tellez-MarfinWashington State Department of Health
Making Sausage
How does tradition disease surveillance work in most states?
Traditional Disease Surveillance
Health Eventsof Interest
HCFs HCPs LabsReporters
Traditional Disease Surveillance
Health Eventsof Interest
HCFs HCPs LabsReporters
Traditional Disease Surveillance
Health Eventsof Interest
HCFs HCPs LabsReporters
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Traditional Disease Surveillance
Health Eventsof Interest
HCFs HCPs LabsReporters
County
Traditional Disease Surveillance
Health Eventsof Interest
HCFs HCPs LabsReporters
County
Traditional Disease Surveillance
Health Eventsof Interest
HCFs HCPs LabsReporters
County
Traditional Disease Surveillance
PHIMS
Why Isn’t Influenza Notifiable?
• Significant PH problem
• Leading cause of mortality
• Transmission interruption possible
• Preventable (vaccine)
• Lots of cases ….every year
• Traditional surveillance for flu resource-demanding for yield
• Annual reports (hospitalization & death certificate data) to
evaluate vaccine delivery & identify at-risk groups
• Never been need for real-time surveillance
Goals of Influenza Surveillance Changing
• Start & stop of annual epidemic
• Cost, morbidity, & mortality of influenza
• Measure vaccine / vaccine delivery effectiveness &
make corrections
• Evaluate public health outreach to high-risk groups
• Monitor emergence of anti-viral resistance
• Emergence of significant viral mutations
• Anticipate impact on healthcare & HCFs
• Bed availability
• Ventilator availability
• Anti-viral availability
How Much Data Do We Really Need for Flu Surveillance?
• For annual epidemic influenza, not so much data needed
to answer these new, pressing questions
• Minimize reported data for each case
• Basic demographics
• Age
• Gender
• County of residence
• Date of illness onset or sample collection
• Lab result
New / Enhanced Influenza Surveillance(Post-Pandemic)
7 new surveillance systems (largely automated)
• Sentinel lab network (typing, resistance)
• Mandatory influenza death reporting
• Pneumonia & influenza mortality eDR (in 2010-11,
6 counties; in 2011-12, all counties)
• Statewide sentinel ER ILI surveillance
• ELR: Messaging individual records (PHRED)
• ELR: Web-based aggregate data entry (PHRAID)
• Limited flu hosp surveillance using HIE (Spokane)
PHRED & PHRAID
• Use ELR for surveillance
• Developed during 2009 flu pandemic
• PHRED: Centralized reporting from labs to DOH
with distribution to local health jurisdictions
• PHRAID: Centralized reporting aggregate data from
labs to DOH (influenza A, influenza B, RSV)
• Next step? More complete lab data to populate web-
based notifiable condition reporting system (PHIMS)
• Changes in WA administrative code to improve
content of lab-submitted reports
LABSWA DOH PHRED
Flu Lab Results
WA DOHCDES
Weekly surveillance report
LABSWA DOH PHRAID
Aggregate Flu Lab Results
WA DOHCDES
PHRED-to-PHIMS
• Under development
• Use content of the PHRED data message to pre-
populate PHIMS case report
• Distribute pre-populated PHIMS records to local
health jurisdictions
• LHJs to handle as per available resources
• Entry into PHIMS or identification as a case does
not mean mandatory investigation
LABSWA DOH PHRED
Flu Lab Results
WA DOHPHIMS
Lab datapre-populatesPHIMS record
PHRED-to-P
HIMS
Next Step: Health Information Exchange
• Move data from EHR → “cloud” (“hub”)
• Data messaging (HL7)
• Inland Northwest Health Services
• 21 hospitals in 14 WA & ID counties
• Inpatient, emergency department, & lab data since
• Massive amounts of data transmitted every 20 minutes
(“sipping from a fire hose”)
• UW staff package data; DOH staff link data for use
• 2010, greater data utilization
• Start with influenza
LABS HIE Data Hub
HCV Lab Results
WA DOHPHRED
WA DOHPHIMS
Lab datapre-populatesPHIMS record
HIE Use in 2010-2011*
• Within 2-3 days of occurrence:
• Identified first lab-confirmed flu cases in E Washington
• Cluster primarily comprised of unvaccinated Latinos
from an agricultural community
• Identified that more than 70% women presenting for
delivery in December 2010 not vaccinated against
influenza
• Information distributed to local public health and healthcare
providers
* Kathy Lofy, Natasha Close, Tracy Sandifer, & Marisa D’Angeli
Summary
• 2010-2011: Flu surveillance emphasized centralized
ELR system with local distribution of results
• Model emerged in Spring 2009 Influenza Pandemic
• Applicable to other high volume diseases where
traditional surveillance is too resource-intense (e,g.,
Campylobacter, RSV, pneumococcus, hepatitis C)
• Next step, more integration of HIE data to identify
potential points for intervention in real-time
Thank you!!