| Friday, December 12, 2003
"The reason for collecting, analyzing and disseminating information on a disease is to control that disease. Collection and analysis; should not be allowed; to consume resources if action does not follow."
Foege WH et al.
International Journal of Epidemiology
Epi Update Managing Staff:
John Agwunobi, MD, MBA, Secretary, Department of Health
Landis Crockett, MD, MPH, Director, Division of Disease Control
Acting Bureau Chief,
Epi Update Managing Editor
Jaime Forth, Copy Editor/ Writer
| This Week in the
►Florida Influenza Surveillance
for the Week Ending November 29
►Florida Sentinel Providers -
the Backbone of Flu Surveillance
|A R T I C L E S|
Angela Fix, MPH, Respiratory Disease Surveillance Epidemiologist, Melissa Covey, Influenza Surveillance Coordinator
Angela Fix, MPH, Respiratory Disease Epidemiologist, Bureau of Epidemiology
Melanie Black, MPH, Professional Training Coordinator, Bureau of Epidemiology
Roberta H. Hammond, Ph.D., and Mike Friedman, MPH, Food and Waterborne Disease Program, Bureau of Community Environmental Health
Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology
Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology
Caroline Collins, Arbovirus Surveillance Coordinator and Carina Blackmore, DVM, Ph.D., Acting State Public Health Veterinarian, Bureau of Community Environmental Health
Florida influenza-like illness (ILI) activity continues to increase statewide. Eleven counties are reported as having high ILI% activity for the week ending November 29 (Week 48). Significance testing is not done for these percentages. Of the 13,652 patients seen by the sentinel providers during the week ending November 29, 344 were seen for influenza-like illnesses (overall state ILI activity of 2.59%). The number of specimen submissions and positive laboratory results increased during the week ending November 29. Thirty specimens were received by the state laboratories for influenza isolate testing during this week, of which nine were positive for Influenza A (H3N2). With a new variant circulating it is increasingly more important to subtype any Influenza A isolates. The Bureau of Epidemiology continues to encourage the county influenza coordinators to contact their sentinel providers to promote submission of laboratory specimens. While the current vaccine is expected to provide some cross-protection against this drift variant, the level of protection is not known. The CDC encourages vaccination because the current vaccine continues to protect against other types of influenza. Health care workers and care givers are encouraged to get vaccinated in an effort to decrease transmission of the virus to patients who may be at high risk for complications.
Florida Influenza-Like Illness (ILI) Summary
Seventy-six sentinels from 69 public clinics and private offices submitted reports for 29 counties during the week ending November 29, 2003 (Week 48). Counties with the highest percentage of patients with ILI were Okaloosa (2.02%, with 3 of 4 sentinel locations reporting); Leon (2.12%, 2 of 2); Brevard (2.43%, 2 of 3); Duval (2.50%, 5 of 9); Alachua (2.71%, 1 of 2); Broward (4.41%, 7 of 7); Walton, (4.82%, 1 of 1); Polk (4.96%, 4 of 4); Orange (5.32%, 6 of 9); Palm Beach (5.70%, 5 of 5); Indian River (6.08%, 3 of 5). Eight counties reported a low percentage of patients with ILI, and 10 counties reported no cases of ILI. A breakdown of ILI% reported for weeks ending November 29 by county is listed in Table 1.
Laboratory Specimen Testing in Florida
Nine of the 30 specimens received by the Jacksonville Central and Tampa Branch laboratories for influenza isolate testing during the week ending November 29, 2003 (Week 48) were found positive for influenza A (H3N2). These viruses came from Alachua (31), Indian River (1), Leon (1), Palm Beach (1), Pinellas (1), and Polk (1) counties.
From September 28, 2003 to November 29, 2003, the Florida laboratories tested a total of 102 specimens and found 23 positive for influenza A (H3N2). The remaining specimens were negative for influenza. Table 2 details isolates found since September 28, 2003 by county.
Rapid Testing Performed by Private Laboratories in Florida
Reports received from one clinic, three hospitals and one private laboratory since September 28, 2003 are summarized in Table 3.
National Influenza Surveillance
This section summarizes the weekly influenza report from the Centers for Disease Control and Prevention. More detailed information can be found at their website: http://www.cdc.gov/ncidod/diseases/flu/weekly.htm and at http://www.cdc.gov/ncidod/diseases/flu/vacfacts.htm#01
Influenza-Like Illness Report for the Week ending November 29, 2003.
The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) was 5.1% nationwide. This is above the national baseline of 2.5%. On a regional level**, the percentage of visits for ILI was highest in the West South Central region (14.6%), followed by the Pacific (7.2%), Mountain (5.8%), and South Atlantic (4.2%) regions. All other regions were below 4%. Due to wide variability in regional level data, it is not appropriate to apply the national baseline to regional level data. National percentage and regional percentages of patient visits for ILI are weighted on the basis of state population.
Antigenic Characterization: CDC has antigenically characterized 157 influenza A (H3N2) viruses submitted by U.S. laboratories since October 1. Of the 157 A (H3N2) viruses tested, 45 (29%) were similar antigenically to the vaccine strain A/Panama/2007/99 (H3N2), and 112 (71%) were similar to the drift variant, A/Fujian/411/2002 (H3N2).
Influenza drift variant, A/Fujian/411/2002 (H3N2), found in the United States and Europe
The influenza A drift variant, A/Fujian/411/2002 (H3N2) predominated the Australian and New Zealand outbreaks that peaked in mid-to-late August 2003. Two of the influenza A (H3N2) viruses submitted to the CDC from Florida in mid-October were A/Fujian/411/2002 (H3N2). The CDC expects the current U.S. vaccine will offer some protective immunity against the A/Fujian/411/2002-like viruses because these viruses are related to the vaccine strain, A/Panama/2007/99. Antibodies produced against the vaccine virus cross-react with A/Fujian/411/2002-like viruses, but at a lower level. A/Fuijan/411/2002 (H3N2)-like isolates have also been identified in Denmark (4), England (14), Ireland (8), The Netherlands (8), Northern Ireland (1), Norway (11), Portugal (9), Scotland (4), Spain (16), and Switzerland (3).
U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratories Report.
Since September 28, 2003, 4,992 (25.6%) of the 19,469 specimens tested for influenza viruses were positive. One thousand fifteen influenza A (H3N2) viruses, one influenza (H1) viruses and 19 influenza B viruses have been identified. Of the specimens submitted to date, 2,194 (44%) were reported from the West South Central region and 1,793 (35.9%) were from the Mountain region.
Weekly ratios rather than proportions are presented in the 2003-2004 Summary By Region because specimens reported positive for influenza virus each week may include specimens submitted for testing during an earlier week.
122 US Cities Vital Statistics Mortality Report.
The percentage of all deaths due to pneumonia and influenza was 6.5%. This percentage is below the epidemic threshold of 7.5% for the week ending November 29, 2003.
International Influenza Activity
WHO Collaborating Centre for Reference and Research on Influenza, Melbourne Australia
Australia’s winter months are from May to October. One of Australia’s biggest influenza seasons since 1998 peaked from mid to late August 2003, and by October cases of influenza had generally subsided. Influenza A (H3) viruses were cited as the primary cause of outbreaks, with little A (H1) or B viruses isolated during the season. For more information about Australian influenza, please visit the Melbourne, Australia Branch website at http://www.influenzacentre.org/ (specific article can be found at http://www.influenzacentre.org/flunews.htm#subsiding).
FluWatch Report from the Canadian Centre for Infectious Disease Prevention and Control
For the week ending November 15, 2003, widespread influenza activity was reported in all regions in Saskatchewan and 1 region in Ontario, localized influenza activity was reported in all regions of the North West Territories, 2 regions of Nunavut, 1 region of Alberta, Manitoba and Nova Scotia, and sporadic influenza activity was reported Alberta, Manitoba, Nova Scotia, Nunavut, Quebec and the Yukon.
Four Influenza outbreaks were reporting in schools in Nova Scotia (3) and Alberta (1); long-term care facilities in Alberta (2), British Columbia (1), Manitoba (1), Ontario (2), and Saskatchewan (2); and a hospital in British Columbia. Influenza related deaths were reported in Ontario (2 seniors, and a 10-year-old child with co-morbidities).
For more information about the FluWatch report, please visit their website at http://www.hc-sc.gc.ca/pphb-dgspsp/fluwatch/index.html
Report from the European Influenza Surveillance Scheme (EISS)
The EISS reports influenza activity in west Europe is slowing down, however widespread activity and outbreaks were reported during the week ending November 22, 2003 (Week 47). Of the 22 European countries that are members of the EISS, widespread influenza activity was reported in England, Ireland, Norway, Portugal, Scotland and Spain; France reported regional activity; and Belgium and Northern Ireland reported local outbreaks for the week ending November 22, 2003. Countries located in east Europe reported sporadic or no activity. For more information about the EISS report, please visit their website at http://dev.eiss.org/cgi-files/bulletin_v2.cgi.
2002-2003 Influenza Surveillance Summaries
An international summary of the 2002-2003 influenza surveillance season (October-September) can be found on page 303 in the November 7, 2003 edition of the WHO’s Weekly Epidemiological Record (Vol. 78) at http://www.who.int/wer/2003/wer7845/en/.
WHO Recommended composition of influenza virus vaccines for use in the 2004 influenza season. http://www.who.int/csr/disease/influenza/recommendations2004/en/
*Reporting is incomplete for this week. Numbers may change as more reports are received.
Conference Call Highlights Outbreak News
EIS Recruitment 2004. Dr. Rowan announced the opening of the third year of recruiting for Fellows in the Epidemiological Intelligence Service program. Professionals with a graduate degree and experience in epidemiology, statistics and similar backgrounds should contact him at firstname.lastname@example.org. The two-year program enables participants to receive advanced training in epidemiology, practical experience in disease control and perform a variety of investigative and consulting work in the public health arena. The new class will begin in May or June.
Outbreaks. Angela Fix recapped the latest national figures and
emphasized that certain states do not require reporting of individual flu cases;
Florida is one of them. She
suggested encouraging sentinel providers to submit specimens to labs for
confirmation of flu cases, and also encouraged wider use of EpiCom for
communications. All updates will be broadcast via EpiCom.
Training Dates. Melanie Black announced a December 16th Ground Rounds, offering CEUs for nurses on the topic, Investigation of Infant Mortality in Brevard County. The next Grand Rounds will be held on January 27th featuring David Atrubin on the topic, Investigation into Cases of Inspiratory Stridor at a Tampa High School.
The bureau is seeking a host facility for a epidemiology training seminar in late January-early February in South-Central Florida. If you would like to offer your facility or you know of a suitable venue, please contact Melanie at 850.245.4444, ext.2448.
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The network is a collaborative effort between the Centers for Disease Control and Prevention, state and local health departments, and health care providers. The collaboration began in 1997 and has seen steady growth in participation. States are asked to enroll a group of sentinel providers that would serve as a representative sample of the state’s population. The minimum goal for sentinel recruitment is one regularly reporting sentinel provider for every 250,000 residents.
Participation in the surveillance program is voluntary. Since the purpose of the sentinel system is to monitor influenza activity, each state Department of Health tries to recruit providers that see a broad mix of patients. Family practice, internal medicine, pediatrics, infectious disease, OB/GYN, emergency room practitioners and others are encouraged to participate. In addition to private offices, urgent care centers, college/university student health centers and HMOs can participate in the surveillance network.
Traditionally, sentinel providers would report activity from October to mid May of each year. However, sentinel providers are now being encouraged to report year round. The year round data can be used to provide a baseline of activity during the off-season and can be an early detection device for pandemics or unusual occurrences of ILI. Providers can report their data via Internet (the preferred method), touch-tone phone or fax. This data is then stored in a central database at CDC. Most providers report that it takes them less than 30 minutes to compile and submit their weekly data. Sentinel providers may also submit laboratory specimens for influenza virus isolation and strain typing, free of charge, to the Florida Department of Health Bureau of Laboratories.
Sentinel providers submit summary data to the CDC each week for the total number of patient visits for any reason that week, and the total number of patient visits for Influenza-like Illness (ILI) broken down by age groups. From this data the percentage of patient visits for ILI are reported. For the purpose of this surveillance system, ILI is defined as a fever >100°F AND a cough and/or sore throat in the absence of another known cause.
Goals for this program include establishing the beginning of the influenza
season in order to guide vaccination practices, monitor the antigenic
changes of circulating influenza virus strains, develop a surveillance
system that provides an early warning and adequate monitoring capabilities
in the event of the next influenza pandemic or outbreak of any severe
respiratory disease and provide medical practitioners and other Florida
residents with current and accurate information regarding the incidence
and severity of the disease in our state.
Tuesday, December 16, 2003 11:00 a.m. – 12:00 p.m., EST
Investigation of Infant Mortality in
Brevard County 2002