INFLUENZA ( AND OTHER RESPIRATORY VIRUS ) SURVEILLANCE IN WISCONSIN

1. INFLUENZA (AND OTHER RESPIRATORY VIRUS) SURVEILLANCE IN WISCONSIN Thomas Haupt M.S. Wisconsin Influenza Surveillance Coordinator

2. Greetings and Thank You From Wisconsin!

3. WISCONSIN THE “BADGER” STATE Average high temperature (July) 82 degrees Population approximately 5.6 million

4. WISCONSIN THE “SWINE-FLU” STATE >6,000 Confirmed and Probable Cases Population approximately 5.6 million

5. Surveillance MethodsCurrent and Future Current • Virologic (Lab) • Rapid Test Site (RTS) • ILINET (Influenza-like illness) Future • Enhanced ED monitoring • Hospitalizations • Enhance Antiviral Resistance Monitoring

6. PANDEMIC INFLUENZA VIROLOGIC SURVEILLANCEIN PERSPECTIVE Confirmed % cases Cases (worldwide) WORLDWIDE 94,500 100% UNITED STATES 37,250 39% WISCONSIN 6,300 7%

7. 4 Labs Certified to do Pandemic Influenza Confirmation

8. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending April 25th "

9. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending May 2nd

10. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending May 9th

11. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending May 16th

12. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending May 23rd

13. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending May 30th

14. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending June 6th

15. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending June 13th

16. Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20 Week Ending June 20th

17. WISCONSIN PANDEMIC INFLUENZA LAB SURVEILLANCE

18. WISCONSIN SEASONAL and PANDEMIC INFLUENZA LAB SURVEILLANCE

19. Virologic Surveillance • Need to determine a median between testing everyone and those needed to be tested • Severely ill • High risk patients, and • Residents of LTC, Corrections and other Institutions • Need a more streamline, accurate (yet simple) method of reporting data i.e.. “Electronic lab reporting”

20. Rapid Test Site (RTS) Surveillance • Done for several years very informally • 2008-09 CSTE Grant to Enhance Influenza Surveillance

21. Bayfield Douglas Ashland Iron Vilas Sawyer Washburn Burnett Price Florence Oneida Forest Barron Rusk Marinette Polk Lincoln Taylor Langlade Oconto Chippewa Dunn St. Croix Menominee Marathon Clark Pierce Shawano Eau Claire Door Pepin Waupaca Wood Portage Kewaunee Buffalo Outagamie Trempealeau Jackson Brown Manitowoc Juneau Waushara Winnebago Adams Monroe Calumet LaCrosse Marquette Fond du Lac Sheboygan Vernon GreenLake Sauk Columbia Dodge Richland Washington Ozaukee Crawford Virology Laboratory Dane Jefferson Waukesha Milwaukee Iowa Grant Green Walworth Racine LaFayette Rock Kenosha Geographic Distribution of Laboratory Surveillance Contributors Green Bay Rapid Test Site Milwaukee

24. Rapid Test Site (RTS) Surveillance Advantages • Many more sites (Data) • Consistent with both PCR and Culture • Can be easily broken down by regions of the state Disadvantage • Use early and late in season (Low PVP) • Use during Pandemic Influenza

25. ILINet – WI Outpatient ILI surveillance • Wisconsin had 66 Sentinel Clinicians, 50 of which were regular reporters • 30 of which do year-round surveillance • Data analyzed by Public health Region and statewide • Baseline and threshold levels of ILI • “Traditional” state • Limited electronic ILI, more syndromic

26. ILINet – WI Outpatient ILI surveillance network, through Jun 27

27. ILINet – WI Outpatient ILI surveillance network, through Jun 27

28. ILINet – WI Outpatient ILI surveillance network • Continue to recruit/maintain clinicians • Gear toward more electronic ILI reporting • Hospital ED surveillance • Validate criteria for surveillance • Chief Complaint/ discharge diagnosis etc

29. Future Surveillance • Enhance and develop “severity” surveillance • Hospitalizations from flu • ED data • Deaths • Antiviral Resistance

30. Hospitalizations and ED Data • Intra –state pilot program to identify admissions due to ILI and ED visits due to ILI on a daily/weekly basis • By age group (0-4,5-24,25-49,50-64, >64) • Web based reporting system (WI-Trac) • early results varied • 10 minutes to 1 hour of ICP time • ability of hospitals to do it also varied

32. Wisconsin Health Information Exchange (WHIE) Network • Currently in Milwaukee County only • 16 hospitals • Plan to expand to larger hospitals, hospital corporations this fall • Uses chief complaint “Fever” or “Flu” • Daily, weekly monthly • Hospital Death reporting being considered

33. Weekly ED visits with chief complaint of “fever” or “flu” at 11 Milwaukee area hospitals, by age-group, Jan 2008 – Jul 4, 2009Wisconsin Health Information Exchange (WHIE) data

34. Wisconsin Health Information Exchange (WHIE) Network • Use in local areas is better than ILINet • Use in statewide or regional areas is being reviewed • Data needs to be validated for use in ILINet

35. Wisconsin Health Information Exchange (WHIE) Network Chief Complaint Categories Fever Flu Respiratory Asthma Sepsis Diarrhea Rash Other

36. Antiviral Resistance • Wisconsin State Lab currently tests for seasonal influenza resistance to adamantanes and neuraminidase inhibitors • Beginning July 2009 will test Pandemic H1N1 for resistance to adamantanes and neuraminidase inhibitors using CDC methodology

37. What we don’t do • Statewide school absenteeism • Some local surveillance that varies greatly • Large Business absenteeism • Long term care (Except for clusters)

38. “Other” Respiratory Viruses Surveillance Statewide and Regionally • RSV (Rapid tests) Statewide • Parainfluenza (1-4) • Adenovirus • Rhinovirus • Human metapneumovirus • Coronavirus (OC-43 and others) • Enterovirusus

40. Again… Thank you for invitation and hospitality !! Questions and comments … Please