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September 24, 2015Vickie Horan, SD Department of Health
Influenza Surveillance [email protected]
605-773-3737
1
Human Influenza: What is it?What is influenza ?• Contagious respiratory illness caused by influenza viruses that
infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death.
Signs and symptoms of influenza:• Fever* or feeling feverish/chills.• Cough.• Sore throat.• Runny or stuffy nose.• Muscle or body aches.• Headaches.• Fatigue.• Some (especially children) have vomiting and diarrhea.
2
Influenza: How bad is it?
Uncomplicated influenza: • Abrupt onset after an incubation of 1-2 days.• Duration of symptoms: typically 3 days, but may last 4-
8 days.
Pneumonia complications of influenza:• Primary influenza viral pneumonia:
– Risk factors: pregnancy, cardiovascular disease, young adult.– Relentless progression from classic 3-day influenza.
• Secondary bacterial pneumonia: – Risk factors: age >65 years, pulmonary disease.– Bacteriology: Pneumococcus, Staphylococcus, Haemophilus.
3
Influenza and pneumonia deaths, South Dakota 2002-2013 (J09-J18)
239223
180
242
173189 186
135
166178
188 186
0
50
100
150
200
250
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Calendar year4
Human Influenza A virus subtypes circulating 1918 to present
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
H3N2
H1N1(s)H1N1(
09)
H2N2
H1N1(A0)
H5N1
H7N9
• Antigenic Drift: minor changes occurring frequently.• Antigenic Shift: radical changes occurring at unpredictable intervals.
1957
19181968
1977
2009
5
Mandell, Douglas and Bennett. 2015. Principles and practice of infectious diseases 8th ed. P. 2004.
Other Influenza Viruses of Public Health Concern
• Human Influenza B virus:
– B strains drift but do not shift
– Victoria and Yamagata lineages currently circulating
• Swine influenza virus:
– A(H3N2) variant (Brookings County, SD 2008).
– A(H1N1) variant (Iowa Case Hospitalized in SF, SD, 2015)
• Avian influenza viruses:
– A(H5N1) emerged in Hong Kong in 1997, ongoing
– A(H7N9) emerged in China in 2013, ongoing
6
SD Influenza Surveillance: When? Where? What?
• Influenza surveillance conducted year round
• Enhanced surveillance October – May
– ILI Net
– Weekly aggregate Influenza Rapid Antigen reporting
– Laboratory confirmed influenza (PCR, culture, DFA)
– All Influenza-associated deaths
– All Influenza-associated hospitalizations
– School Illness Absentee Reporting
– Outbreak reporting (schools, day-care, long term
care facilities).
7
Confirmed, Hospitalizations & Deaths 2004-2015
8
Season Dominate virus Deaths Hospitalizations
Confirmed
cases
(Culture,PCR,
DFA) Peak week
2004-2005 A(H3N2) 42 Not reportable 684
February 3rd
week
2005-2006 A(H3N2) 11 Not reportable 636 March 2nd
week
2006-2007 A(H1N1) 6 132 400
February 3rd
week
2007-2008 A(H3N2) 22 361 684
February 4th
week
2008-2009 A(H1N1) 4 134 525 March 1st
week
2009-2010
A(H1N1)
pandemic 24 431 2,303
October 2nd
week
2010-2011 A(H3N2) 20 290 860
February 3rd
week
2011-2012 A(H3N2) 17 164 505 March 3rd
week
2012-2013 A(H3N2) 38 365 993
January 2nd
week
2013-2014
A(H1N1) 14 239 659 January 1st
week
2014-2015 A(H3N2) 63 793 1,703
January 1st
week
Influenza: ILI, confirmed cases, hospitalizations, school absenteeism and %+ rapid tests,
South Dakota 2014-2015
9
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
22%
24%
26%
28%
30%
32%
34%
0
20
40
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80
100
120
140
160
180
200
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apid
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% o
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chool ill
ness a
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# o
f cases
Influenza A Untyped
Influenza AH1
Influenza AH3
Influenza B
% RA Positive
% School illnessabsenteeism
Influenza cases, hospitalizations, and deaths by age group, South Dakota 2014-2015
584
509
55244
108
3
315
80
2
317
28242
68
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Confirmed cases Hospitalizations Deaths
0-4 years
5-18 years
19-49 years
50-64 years
>64 years
10
1702 793 63
Confirmed influenza cases, South Dakota 6 seasons 2009-2015
0102030405060708090
100110120130140150160170180190
40 42 44 46 48 50 52 1 3 5 7 9 11 13 15 17 19
Co
nfi
rme
d c
ase
s
MMWR weeks (First week October 2014 to second week May 2015)
2009-2010
2010-2011
2011-2012
2012-2013
2013-2014
2014-2015
11
Antivirals
• There are 3 Antiviral medications approved for prevention and treatment of Influenza A & B in the United States (dosing is based on age, underlying health conditions, and weight of patient):– Oseltamivir (Tamiflu): Used for treatment any age or
chemoprophylaxis >3 months.– Zanamivir (Relenza): Used for treatment >7 years or
chemoprophylaxis > 5 years. – Peramivir (Rapivab): Approved for use in U.S. Dec
2014 IV med used for treatment >18 years…not recommended for chemoprophylaxis.
12
Why use Antiviralshttp://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
• Early treatment can shorten duration of symptoms and may reduce complications of influenza.
• Early treatment of hospitalized patients can reduce death
• Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset.
• Influenza hospitalized patients antiviral treatment is warranted even if hospitalized after 48 hours of illness onset.
• Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza.
13
State Influenza vaccination percent coverage for 2014–2015 season (NIS and BRFSS estimates)
30
35
40
45
50
55
60
Sou
th D
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Rh
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Ham
psh
ire
Haw
aii
Min
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irgi
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Ark
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Texa
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Mex
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Mai
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Was
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Mis
sou
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Okl
aho
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Ten
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Yo
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Kan
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Mic
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14
South Dakota rates and rank among states by age group, (NIS/BRFSS influenza vaccination), 2014-2015
59.6%
74.3%
64.4% 63.2%59.5% 58.1%
52.3% 53.8%
59.6%56.5%
74.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
≥6 m 6m-4 yr 6m-17yr
5-12 yr 13-17 yr 18+ yr 18-49 yr 18-64 yr HR 18-64 yr
50-64 yr 65+ yr
1st13th 12th 22nd 3rd1st1st 1st 2nd
2nd 3rd
What can we expect this upcoming influenza season?
16
Global Influenza Surveillance and Response System (GISRS)
as of 17 Sep 2015
17
Current influenza in Southern hemisphere (as of 7Sep15)
• South Africa: peak 27 June, influenza activity decreased, with influenza type B predominating in recent weeks.
• South America temperate zone: peak 22 Aug, ILI and SARI activity remained low and continued to decrease in general.
• Australia: peak 30 Aug, influenza activity increasing with predominantly B virus followed by A(H3N2) detections.
18www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en/
Best Prevention?
1. Get Vaccinated 2. All persons aged 6 months and
older should be vaccinated annually, with rare exception
3. When to Vaccinate?
19
Influenza peaks, South Dakota, 1999-2015Flu Season: peak week• 1999-2000: December 4th week.
• 2000-2001: February 2nd week.
• 2001-2002: March 2nd week.
• 2002-2003: March 1st week.
• 2003-2004: December 2nd week.
• 2004-2005: February 3rd week.
• 2005-2006: March 2nd week.
• 2006-2007: February 3rd week.
• 2007-2008: February 4th week.
• 2008-2009: March 1st week.
• 2009-2010: October 2nd week.
• 2010-2011: February 3rd week.
• 2011-2012: March 2nd week.
• 2012-2013: January 2nd week.
• 2013-2014: January 1st week.
• 2014-2015: January 1st week. 20
Oct7%
Dec17%
Jan21%
Feb29%
Mar29%
0
1
2
3
4O
ct 1
Oct
2
Oct
3
Oct
4
No
v 1
No
v 2
No
v 3
No
v 4
Dec
1
Dec
2
Dec
3
Dec
4
Jan
1
Jan
2
Jan
3
Jan
4
Feb
1
Feb
2
Feb
3
Feb
4
Mar
1
Mar
2
Mar
3
Mar
4
Weeks of influenza seasons
Influenza vaccination 2015-2016 season
• Trivalent influenza vaccines will contain: – A/California/7/2009 (H1N1)-like virus– A/Switzerland/9715293/2013 (H3N2)-like virus New**– B/Phuket/3073/2013-like (Yamagata lineage) virus. New**
(same lineage as B Massachusetts as we saw in SD last season)
• Quadrivalent influenza vaccines will also contain: – B/Brisbane/60/2008-like (Victoria lineage) virus (which is the
same Victoria lineage virus recommended for quadrivalent formulations in 2013–14 and 2014–15). We did see this virus in SD last season as well.
Currently, 6 influenza vaccine manufacturers are projecting that as many as 171-179 million doses of influenza vaccine will be available for use in the United States during the 2015-2016 influenza season..
www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm21
Questions???
22