This report is intended to provide an overview of influenza related activity occurring within Cuyahoga County while providing some general information on the state activity. It will be published on a weekly basis and can be found at the following web site: http://www.ccbh.net/flu-weekly-surveillance-report/ Note : Data are provisional and subject to change. Updates will be included in future reports. Ohio’s Activity Level: Sporadic Activity Small numbers of laboratory-confirmed influenza cases or a single laboratory-confirmed influenza outbreak has been reported, but there is no increase in cases of ILI. Pneumonia and Influenza (P&I) Mortality 4.9% of all deaths reported to the Cleveland Bureau of Vital Statistics were due to pneumonia. Adults 75 years old and older accounted for 81.8% of the pneumonia related deaths. One influenza related death has occurred this season (Figure 1). Influenza-Like Illness (ILI) Reports One ILI Sentinel Provider in Cuyahoga County reported no patients had ILI symptoms this week. Statewide ILI Sentinel Providers reported 0.66% of patients had flu-like symptoms (Figure 2). ILI is defined as a fever (≥ 100◦ F), and cough and/or sore throat. School Absenteeism Participating schools in Cuyahoga County reported the percentage (median = 2.3%) of absenteeism due to any illness on Tuesday (Figure 3A). Figure 3B shows the total absenteeism due to any reason during the school week (median = 3.4%). Data were reported by sentinel sites and other participating schools throughout Cuyahoga County. Influenza-Associated Hospitalizations and Influenza-Associated Pediatric Mortality No confirmed cases of influenza-associated hospitalizations in Cuyahoga County were reported this week but four cases were reported for week 18 (Figure 4). The state of Ohio reported 33 confirmed hospitalizations due to influenza, but no pediatric influenza related mortalities. Emergency Department (ED) visits and Over-the-Counter Medication Sales 2.1% of all ED visits were for fever + ILI symptoms. Approximately 15 fewer patients visited EDs for fever and ILI symptoms this year compared to 2011 (Figure 5). Figure 6 shows approximately 10 more of OTC products per drugstore were purchased this year than in the same period in 2011. Figure 7 shows the frequency of ED visits for fever and ILI by zip code. Three other maps show, by zip code, the frequency of ED visits for three symptoms that are common during the fall and winter seasons and are of interest to the general public: congestion and cough (Figure 8), vomiting and nausea (Figure 9), and diarrhea (Figure 10). Descriptions of data sources used to complete the weekly influenza write-up can be found on the last page of this report. More information on national and world surveillance can be found at the Centers for Disease Control and Prevention website at www.cdc.gov/flu/weekly. Influenza Surveillance 2011-2012 Weekly Summary MMWR Week 19 (5/06/2012-5/12/2012) Cuyahoga County Public Health Collaborative
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This report is intended to provide an overview of influenza related activity occurring within Cuyahoga County while providing some general information on the state activity. It will be published on a weekly basis and can be found at the following web site: http://www.ccbh.net/flu-weekly-surveillance-report/ Note: Data are provisional and subject to change. Updates will be included in future reports. Ohio’s Activity Level: Sporadic Activity Small numbers of laboratory-confirmed influenza cases or a single laboratory-confirmed influenza outbreak has been reported, but there is no increase in cases of ILI. Pneumonia and Influenza (P&I) Mortality 4.9% of all deaths reported to the Cleveland Bureau of Vital Statistics were due to pneumonia. Adults 75 years old and older accounted for 81.8% of the pneumonia related deaths. One influenza related death has occurred this season (Figure 1). Influenza-Like Illness (ILI) Reports One ILI Sentinel Provider in Cuyahoga County reported no patients had ILI symptoms this week. Statewide ILI Sentinel Providers reported 0.66% of patients had flu-like symptoms (Figure 2). ILI is defined as a fever (≥ 100◦ F), and cough and/or sore throat. School Absenteeism Participating schools in Cuyahoga County reported the percentage (median = 2.3%) of absenteeism due to any illness on Tuesday (Figure 3A). Figure 3B shows the total absenteeism due to any reason during the school week (median = 3.4%). Data were reported by sentinel sites and other participating schools throughout Cuyahoga County. Influenza-Associated Hospitalizations and Influenza-Associated Pediatric Mortality No confirmed cases of influenza-associated hospitalizations in Cuyahoga County were reported this week but four cases were reported for week 18 (Figure 4). The state of Ohio reported 33 confirmed hospitalizations due to influenza, but no pediatric influenza related mortalities. Emergency Department (ED) visits and Over-the-Counter Medication Sales 2.1% of all ED visits were for fever + ILI symptoms. Approximately 15 fewer patients visited EDs for fever and ILI symptoms this year compared to 2011 (Figure 5). Figure 6 shows approximately 10 more of OTC products per drugstore were purchased this year than in the same period in 2011. Figure 7 shows the frequency of ED visits for fever and ILI by zip code. Three other maps show, by zip code, the frequency of ED visits for three symptoms that are common during the fall and winter seasons and are of interest to the general public: congestion and cough (Figure 8), vomiting and nausea (Figure 9), and diarrhea (Figure 10). Descriptions of data sources used to complete the weekly influenza write-up can be found on the last page of this report. More information on national and world surveillance can be found at the Centers for Disease Control and Prevention website at www.cdc.gov/flu/weekly.
Influenza Surveillance 2011-2012 Weekly Summary
MMWR Week 19 (5/06/2012-5/12/2012)
Cuyahoga C
ounty Public Health C
ollaborative
Table 1. Summary of Cuyahoga County Influenza Data
Influenza (Flu) Indicator Current Activity Level
General Trend for the Season
Percentage of deaths due to influenza & pneumonia - Cleveland [Figure 1]
Pneumonia: 4.9% Influenza: 0.0%
Significantly more pneumonia related deaths in first half of 2011-2012 flu season (avg. ~ 5.9%).
Influenza like illness (ILI) doctor visits [Figure 2]
Cuyahoga: 0.0% Ohio: 0.66%
Ohio sentinel providers are seeing 0.50% of doctor visits are due to ILI.
School absenteeism due to ILLNESS ONLY – sites recruited within last three years [Figure 3A]
Northeast: 2.3% Northwest: 2.2% Southwest: 2.7%
The number of influenza absences has steadily increased throughout Cuyahoga County to about 3.5%.
School absenteeism due to ALL CAUSES – sentinel sites [Figure 3B] 5.9%
Sentinel sites’ absenteeism rates are close to 4.0% .
School absenteeism due to ALL CAUSES – sites recruited within last three years [Figure 3B]
Northeast: 4.3% Northwest: 4.4% Southwest: 3.1%
Absenteeism rates due to any reason tend to be higher in the northwestern and southeastern suburbs with overall median trending over 4%.
Influenza associated hospitalizations [Figure 4] 0
Approximately 3 out of 4 cases occurred during weeks 9-16 (N=153).
Emergency room visits due to ILI [Figure 5] 2.1%
Number of ED visits trending slightly above last year’s total (avg. ~ 160).
Sales of over-the-counter medications used to treat ILI. [Figure 6] 143
Low sales of OTCs early in season, now close to last year. (avg. ~ 180).
# Weeks12
1
10 1
1 N/A 1 2
2
1 1 2
1
1
4
Activity Compared to Last Week
(13%)
Stable Stable
(31%) N/A
(4.8%) 23%
44%
4.9% 9.1% Stable
(4)
(4.5%)
(8.3%)
Congestion and cough complaints [Figure 8} 420 (13%) 1
ED visits due to cough and congestion has been fairly consistent (avg. ~ 650)
Vomiting and nausea complaints [Figure 9] 576 (1.7%) 7
ED visits due to vomiting and nausea has been fairly consistent (avg. ~ 660)
Diarrhea complaints [Figure 10] 124 5.1% 2
ED visits due to diarrhea has been fairly consistent (avg. ~ 150)
2For figures 1 – 6 & figures 8-10, = (Increase > 10%), = (Decrease > -10%), = Stable (-9.9% to +9.9%)
Figure 1. Percentage of Deaths Due to Pneumonia and Influenza (P&I) Cleveland, Ohio 2011-2012
0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%
10.0%
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
MMWR WeekPercent Pneumonia Percent Influenza 5 Yr Median P&I 2006/2007-2010/2011
1Due to small percentages in figures 1-3b & figure 5, caution should be used while interpreting the ‘Activity Compared to Last Week’ box.
Figure 2. Percent of Influenza-Like Illness (ILI) Visits, U.S. Influenza Sentinel Provider Surveillance Network 2011-2012
0.00%0.50%1.00%1.50%2.00%2.50%3.00%3.50%4.00%4.50%
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20MMWR Week
ILI V
isits
Cuyahoga County Ohio
Figure 3A. School Absenteeism (Due to any Illness) in Cuyahoga County 2011 - 2012
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20MMWR Week
Med
ian
Per
cent
Northeast Suburbs Northwest Suburbs Southwest Suburbs
Figure 3b. School Absenteeism (Due to any Reason ) in Cuyahoga County 2011-2012
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
MMWR Week
Med
ian
Perc
ent
5-year Median (Sentinel Sites) Sentinel Sites Northeast Suburbs Northwest Suburbs Southwest Suburbs
V A C A T I O N
V A C A T I O N
Figure 4. Number of Influenza-Associated Hospitalizations in Cuyahoga County (using reported to ODH date) 2011-2012
02468
101214161820
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20MMWR Week
Hosp
italiz
atio
ns
Influenza A Influenza B
Figure 5. Comparison of Cuyahoga County Hospital ED Visits for ILI and Fever Symptoms by Age Group 2010-11 vs. 2011-12
0
50
100
150
200
250
300
350
400
450
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20MMWR Week
ED V
isits
O to 4 Years Old 5 to 24 Years Old 25 to 49 Years Old 50 to 64 Years Old 65 Years and Older Total ED Visits (10-11)
Figure 6. Comparison of Average Weekly OTC Products Sold in Cuyhaoga County Drugstores
0
40
80
120
160
200
240
280
320
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20MMWR Week
OTC
Pro
duct
s
Antifever Cold_liquid_ped Cold_tablet_ped Cough_syrup_ped Electrolytes_ped Thermometers Total OTC Products (10-11)
44139
44022
44133 44141
4414644130
44131
44145
44124
44125
44143
44138
44136
44122
4414744149
4407044135
44040
44134
4410544128
44142
44109
44118
44111
44017
44121
44102
44129
44144
4410744120
44137
4410444116
44106
44140 44113
44103
44108
44110
44112
44123
44126
44117
44114
44132
44119
44115
44127
44139
44022
44133 44141
4414644130
44131
44145
44124
44125
44143
44138
44136
44122
4414744149
4407044135
44040
44134
4410544128
44142
44109
44118
44111
44017
44121
44102
44129
44144
4410744120
44137
4410444116
44126
44106
44140 44113
44103
44108
44110
44112
44123
44117
44114
44132
44119
44115
44127
Figure 7 Frequency of Fever and Influenza-LikeIllness Complaints by Zip Code
Figure 8 Frequency of Congestion and CoughComplaints by Zip Code
Ü
Ü
Frequency
Frequency0.0 - 3.0 7.1 - 16.0
16.1 - 29.0
3.1 - 5.05.1 - 8.0
0.0 - 1.01.1 - 3.0
3.1 - 7.0
44139
44022
44133 44141
4414644130
44131
44145
44124
44125
44143
44138
44136
44122
4414744149
4407044135
44040
44134
4410544128
44142
44109
44118
44111
44017
44121
44102
44129
44144
4410744120
44137
4410444116
44106
44140 44113
44103
44108
44110
44112
44123
44126
44117
44114
44132
44119
44115
44127
44139
44022
44133 44141
4414644130
44131
44145
44124
44125
44143
44138
44136
44122
4414744149
4407044135
44040
44134
4410544128
44142
44109
44118
44111
44017
44121
44102
44129
44144
4410744120
44137
4410444116
44126
44106
44140 44113
44103
44108
44110
44112
44123
44117
44114
44132
44119
44115
44127
Figure 9 Frequency of Vomiting and Nausea Complaints by Zip Code
Figure 10 Frequency of DiarrheaComplaints by Zip Code
Ü
Ü
Frequency1.0 -5.05.1 - 10.0 20.1 - 30.0
10.1 - 20.0
Frequency3.1 - 5.05.1 - 8.0
0.0 - 1.01.1 - 3.0
Sources of Influenza Surveillance Data
Six types of data sources are examined on a weekly basis to help determine the influenza activity level for Cuyahoga County: 1) Ohio Department of Health (ODH) Seasonal Influenza Activity Summary : The ODH influenza
summary provides state-wide data . Data used from this report include: influenza activity level, frequency of fever plus influenza-like illness (ILI) associated hospitalizations, number of influenza-associated pediatric mortalities, and number of lab-confirmed influenza cases.
A) Influenza Activity Level: ODH reports the state influenza activity level on a five point ranking system: no activity, sporadic, local, regional, and widespread.
B) Influenza-associated Hospitalizations (ODRS): Influenza-associated hospitalizations are reported by the Cuyahoga County Board of Health (CCBH) and hospitals using the Ohio Disease Reporting System (ODRS). Hospitalizations can be used as an indicator of the severity of illness during a particular influenza season. This condition became reportable in 2009 due to the H1N1 pandemic virus.
C) Sentinel Providers (ILINet): Sentinel providers, through the US Influenza-like Illness Surveillance Network (ILINet), collect outpatient influenza-like illness (ILI) data. ILI is defined as a fever (> 100 F), and cough and/or sore throat without another known cause. Providers report the total number of patients seen, by age group, on a weekly basis. Sentinel providers also submit specimens for influenza testing to the ODH laboratory throughout the influenza season. There are 2 sentinel providers enrolled in Cuyahoga County for the 2011-2012 season. D) ODH Laboratory Surveillance: The Ohio Department of Health Laboratory reports the number of specimens that test positive for influenza each week. Generally, specimens are submitted by sentinel provider participants. A subset of the positive specimens is sent to CDC for further testing during the season. 2) Mortality Reporting System (Cleveland’s Vital Statistics): Cleveland and seven other cities in Ohio
participate in this reporting on a weekly basis. Vital statistics offices from across the country report the number of death certificates received, along with how many of those have pneumonia or influenza listed as an underlying or contributing cause of death.
3) School Absenteeism data (due to illness and due to any reason): Approximately 50 Cuyahoga County
schools provide absenteeism data for each Tuesday on the number children absent due to any illness or due to any reason.
4) Influenza-associated Pediatric Mortality (ODRS): Influenza-associated pediatric mortalities are reported into ODRS by CCBH and hospital staff. Pediatric deaths can be an indicator of the severity of illness during the influenza season. This condition became reportable in 2005. 5) National Retail Data Monitor (NRDM)-OTC Drug Purchases: The NRDM collects over-the-counter (OTC) drug sales information from Cuyahoga County chain drug stores and grocery stores. Pediatric cold products, antifever products, and thermometer sales are monitored on a weekly basis. 6) Emergency Department Visits (EpiCenter): EpiCenter collects emergency department chief complaint data from hospitals and urgent care facilities across Cuyahoga County and classifies them into symptom
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