Influenza Surveillance Update Health and Medical Subpanel Meeting July 13, 2010 Diane Woolard, VDH.

Influenza Surveillance

Update

Health and Medical Subpanel MeetingJuly 13, 2010

Diane Woolard, VDH

Flu Surveillance Update World

2009 H1N1 H5N1 (Avian)

Nation Virginia Flu Policy

WHO News Pandemic (H1N1) 2009 – still at Phase 6 >214 countries, territories, communities

have confirmed cases >18,239 deaths Pandemic and seasonal flu activity low Seeing H1N1 2009, H3N2, B

WHO Map of Flu Activity, June 2010

H5N1 (Avian) Flu Cumulative 500 cases as of July 5, 2010,

including 296 deaths (59%) Countries with activity in 2009 and 2010

include Cambodia, China, Egypt, Indonesia, Viet Nam

Confirmed Cases & Deaths, H5N1 Influenza, 2003-July 5, 2010

0

20

40

60

80

100

120

2003 2004 2005 2006 2007 2008 2009 2010

Cases

Deaths

Synopsis: During week 20 (May 16-22, 2010), influenza activity decreased in the U.S.

• Two (0.2%) specimens … were positive for influenza.• Both subtyped influenza A viruses were 2009 influenza A (H1N1).• The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.• Three influenza-associated pediatric deaths were reported and were associated with 2009 influenza A (H1N1) virus infection.• The proportion of outpatient visits for influenza-like illness (ILI) was 1.0%, which is below the national baseline of 2.3%. All 10 regions reported ILI below region-specific baseline levels.• No states reported widespread or regional influenza activity. One state reported local influenza activity. Guam, Puerto Rico, and 13 states reported sporadic influenza activity. The District of Columbia and 34 states reported no activity.

Flu Surveillance Methods, CDC Virologic Surv (WHO and NREVSS labs) Antigenic char and antiviral resistance

(CDC lab) P&I Mortality – 122 cities Flu-Assoc Pediatric deaths Flu-Assoc Hospitalizations in 16 states

Did P&I hosps & deaths from 8/30/09 – 4/3/10 Outpatient Illness surveillance (% ILI) State Weekly Flu Activity Reports

Flu Surveillance Methods, VAMethod 2008-9 2009-10 2010-11

ILI, % Visits X X X

Lab, Sentinel X X X

Outbreaks X X X

Ped. Deaths X X X

Morbidity Repts. X- X- Need ELR

ILI, Admit X ?

School Absence X If automated

School Closure X Consult

Flu Surveillance Methods, VAMethod 2008-9 2009-10 2010-11

Death certif. X

Indiv. Death X

Indiv. Hosp. X

Indiv. Preg. X

Antiviral Rx X ?

BRFSS etc X

GBS X

Case Series X

2010-2011 Flu Vaccine A/California/7/2009-like (2009 H1N1) A/Perth/16/2009-like (H3N2) B/Brisbane/60/2008-like

Does not include seasonal H1N1 H3N2 component has changed

CDC Updated Guidance: Prevention Strategies for Seasonal Influenza in Healthcare Settings

CDC posted proposed new guidance in the Federal Register on June 22 (vol. 75, no. 119)

Applies to spectrum of healthcare settings, but not settings outside healthcare

Focus on vaccination, minimizing exposure, management of ill workers, precautions for certain procedures, surveillance, environmental controls

Accepting comments until July 22. Final guidance will be posted before the 2010-11 flu season

Some Notable Contents of Interim Guidelines Use of a facemask (surgical mask) when entering

the room of a person suspected or diagnosed with influenza

Use of an N-95 respirator or higher level of protection, and a negative pressure room when performing aerosol-generating procedures

Promotion of vaccination programs for healthcare personnel which emphasize communication and education, providing the vaccine at no cost, improving access to the vaccine, and tracking influenza vaccination coverage

In Summary …cautiously returning to near-normal