SHIVERS Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance

1. SHIVERSSouthern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance Nikki Turner March 2012

2. http://www.grabonestore.co.nz/man-flu-joke-set?utm_source=GrabOne+Store+New+Zealand&utm_campaign=ET_18393_nz-store_new-zealand_20120321&utm_medium=emailhttp://www.grabonestore.co.nz/man-flu-joke-set?utm_source=GrabOne+Store+New+Zealand&utm_campaign=ET_18393_nz-store_new-zealand_20120321&utm_medium=email http://www.vaccineinfo.net/immunization/vaccine/influenza/index.shtml http://fnp2011.wordpress.com/2011/03/04/having-influenza/ http://www.briancombs.net/tag/swine-flu/

3. I have flu doctor……. • How do we recognise flu • How much is really • in the community • In hospital presentations • What are its characteristic presentations • Are we diagnosing it all • Is there subclinical/asymptomatic? • How effective are current flu vaccines • In subpopulations • In different years with shifting strains http://www.extension.org/pages/24425/avian-influenza-homepage

4. Influenza and other respiratory diseases in southern hemisphere • CDC Announcement: 27 Dec 2010 • Application Due date: 14 Mar 2011 • Research for 9 objectives: • Two primary objectives • Seven additional objectives • Study period: • 1st year: Two primary objectives • 2nd – 5th years: Two primary objectives + additional objectives • Notice of award: Oct 2011

5. CDCs 9 objectives • Understand severe respiratory diseases caused by influenza & other pathogens • Assess influenza vaccine effectiveness • Investigate interaction between influenza & other pathogens • Understand causes of respiratory mortality • Understand non-severe respiratory diseases caused by influenza & other pathogens • Estimate influenza infection by conducting serosurvey • Identify & quantify risk factors (age, ethnicity, SES etc) for getting influenza • Assess immune response among individuals with varying disease spectrum • Estimate healthcare, societal economic burden caused by influenza and vaccine cost-effectiveness

6. Project Team – multi-centre and multi-disciplinary collaboration • ESR—leading organization • Sue Huang—Principle investigator (PI) • Graham Mackereth – Project manager • Ruth Seeds – Project Officer • Science teams: • Sue Huang/Sally Roberts/Colin McArthur/Cameron Grant/Debbie Williamson/Adrian Trenholme/Conroy Wong/Susan Taylor/Graham Mackereth/Don Bandaranayake/Diane Gross/Marc-Alain Widdowson: objective 1 • Nikki Turner/Heath Kelly/Nevil Pierse/Ange Bissielo/Michael Baker/Don Bandaranayake/Sue Huang: objective 2 Vaccine Effectiveness • Michael Baker: objectives 3 & 7 • Colin McArthur/Sally Roberts: objective 4 • Sue Huang/Nikki Turner: objective 5 Primary Care Surveillance • Sue Huang/Don Bandaranayake: objective 6 • Richard Webby: objective 8 • Des O’Dea: objective 9

7. Tools: Two surveillance systems • Hospital-based surveillance: enhanced, active, year-round (5 yrs), population based surveillance for hospital SARI (sudden acute respiratory) cases • Auckland and Middlemore Hospitals • Community-based surveillance: enhanced, active, (4 yrs), population based surveillance for community ILI (Influenza-like illness) cases caused by influenza • Recruitment of 50 – 100 ‘sentinel’ General Practices in greater Auckland (200,000 – 400,000 patients)

8. Objective 1 – Hospital-based surveillance • Identify the aetiology of hospitalised severe acute respiratory infections, including influenza • Describe possible risk factors eg asthma high BMI, pregnancy etc • Will need to access some practice data ?PMS extraction • Flu vccinationhx • High risk medical conditions • Medication lists • Pneumococcal vaccination hx • Utilise this data for VE measures

9. Objective 5 – Community-based surveillanceSue Huang and Nikki TurnerSHIVERS Researchers • Identify the aetiologies of acute presentations to the general practice with respiratory symptoms, including influenza • Cough • Fever • Describe possible risk factors eg asthma high BMI, chronic conditions,pregnancy, ethnicity, age, ses • Utilise this data for VE measures

10. Needs….. • Sentinel GP surveillance starting in 2013 • 60 GPs: ~ 180,000 registered patients (14% Auckland population) • ?All year round • All acute respiratory illnesses presenting if possible: • Swab • Questionnaire (brief, advanced form) • PMS data extraction

11. Gains for General Practice • Improved understanding of causes of respiratory illnesses • Rapid feedback of swab results to the involved practices • flu • Anther virus • Information on spread of flu in the community in real time • Yearly Vaccine Effectiveness measures • If numbers large enough, in subpopulations • Better understanding of symptomatic presentation of flu/nonflu • Hope to build into a Cornerstone indicator/ MOPS • Showcase NZ General practice to the world • Enrolled populations • Excellent systems • Ability to utlilise PMS data/data extraction

12. Thank you

13. Data requirement (PMS) • Influenza vaccination record: this year and previous years; type and date; batch number • Pneumococcal vaccination record: type of vaccine, date • Read codes: high risk medical conditions. • Read codes: current, ex or non-smoker • Read codes: last recorded BMI or body weight • Medication list: identify medications associated with chronic disease (asthma, heart disease, COPD, cancer, immunosuppression) • Outbox: count all hospital admissions, ED visits, A&M visits in the past 12 months • Count number of GP and practice nurse visits in the past 12 months • Any prescription issued for antivirals in the past 12 months (Tamiflu or Relenza)

14. Data requirement (Questionnaire) • Clinical symptoms and history of current illness • Additional risk factor information • Treatment • Disease course • Employment condition • Living condition • BMI (if not available on PMS) • Pregnancy

15. Laboratory testing

16. Objective 6 – Serosurvey for seasonal influenza infection Don Bandaranayake, Sue Huang

17. Specific aims • estimate the annual incidence of infection with seasonal influenza in the Auckland region. • To collect information on host, environmental, behavioral factors and health service utilization. • To estimate the disease burden of all seasonal influenza infections [from asymptomatic, mild and severe infections to deaths].

18. Some ILI patients (Blood) Strat. random sample Some SARI patients’ blood All SARI patients (respiratory specimen) All ILI patients (respiratory specimen) • 6 • Infection risk • 8 • Immune response Cases + subcohort • 3 • Interactions • 5 • Mild disease Cases + controls 1 Severe disease Cases + controls • 2 • VE • 4 • Mortality Cases + controls Cases + controls • 7 • Risk factor impact Specimen flow • 9 • Economics Data flow