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Influenza Hospitalization and Death Surveillance in New Mexico

Influenza Hospitalization and Death Surveillance in New Mexico. Carmela Smith, MS Epidemiologist. Objectives. Describe New Mexico Department of Health (NMDOH) influenza surveillance prior to 2009 H1N1 Pandemic Review H1N1 timeline Review differences in 2009-10 NMDOH influenza surveillance

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Influenza Hospitalization and Death Surveillance in New Mexico

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  1. Influenza Hospitalization and Death Surveillance in New Mexico Carmela Smith, MS Epidemiologist

  2. Objectives • Describe New Mexico Department of Health (NMDOH) influenza surveillance prior to 2009 H1N1 Pandemic • Review H1N1 timeline • Review differences in 2009-10 NMDOH influenza surveillance • Review descriptive epidemiology of 2009-10 H1N1 influenza hospitalizations and deaths in New Mexico

  3. Influenza Surveillance Background • Influenza as a reportable disease • Lab-confirmed influenza hospitalization reportable • Pediatric influenza deaths reportable since 2004 • Novel influenza reportable • Influenza-like illness Network (ILI Net) • ILI is fever and cough and/or sore throat • 26-28 sentinel sites throughout the state • ILI reporting since 1990’s • Laboratory testing • Summary reporting of tests performed and # positive

  4. Influenza Surveillance Background • Influenza deaths – Vital Records and Office of the Medical Investigator (OMI) • Death certificates from Bureau of Vital Records and Health Statistics • Viral cultures on suspicious deaths • Border surveillance • 2nd season • 16 sites along the US/Mexico border • Share data weekly on visits for influenza-like illness • Specimens transported across border for testing • Emerging Infections Program (EIP) • Started with pediatric cases in Bernalillo County, 2004 • Expanded to 6 counties (50% of population) in 2008

  5. April 26 - Release of 25% of the Strategic National Stockpile April 15 & 17 – In CA 2 cases H1N1 June 11, 2009 WHO declares a pandemic TIME April 23, 2009 additional H1N1 cases* in TX & CA May 2 - NM’s first confirmed case H1N1Timeline * TX & CA viruses were genetic matches with genetic material from swine, avian, and human influenza strains =a novel influenza virus

  6. What is Different About 2009-10 Influenza Surveillance? • Statewide reporting of influenza hospitalizations • Case investigations for every confirmed influenza hospitalization • Standardized case investigation form • Demographics, type of care, antiviral treatment, immunization history, underlying medical conditions • Deaths reported for lab-confirmed influenza cases • Enhanced lab surveillance • PCR at no charge through State Lab (SLD) • Lab testing encouraged for all suspect hospitalized patients • Greater data sharing with Emerging Infections Program • Enhanced provider/public education

  7. 2009-2010 H1N1 Influenza Hospitalization Surveillance Details • September 2009 - letter sent to all NM hospital Chief Executive Officers (CEOs) and Infection Preventionists (IPs) • Regular conference calls with IPs • IPs report cases weekly • Suspect line lists • Confirmed case investigation forms/medical records • Weekly laboratory reporting • TriCore and Scientific Laboratory Division (SLD) or state lab • Individual level lab results • All data entered into New Mexico Electronic Disease Surveillance System (NMEDSS), the database for case tracking and analysis

  8. Case Definitions • Confirmed influenza hospitalization • NM resident • Hospital admission • Admission to inpatient ward • Overnight stay not required • Positive flu PCR or culture (9/1/09-10/11/09), any positive flu test (10/12/09 and thereafter) • Suspect influenza hospitalization • Hospital admission for Influenza-Like Illness or other suspicious symptoms for influenza • Lacking positive flu test

  9. Data Analysis • Timeframe: • Mid-September, 2009- February 9, 2010 for hospitalizations • August, 2009- February 9, 2010 for deaths • Data from NMEDSS imported into SAS version 9.1 • Univariate and bivariate analysis performed • Rates calculated using U.S. Census Bureau July 1, 2008 population estimates

  10. Lab-confirmed Influenza Hospitalization by Admission Date 200 Number of hospitalizations 100 Week Ending

  11. New Mexico Lab-Confirmed Influenza Hospitalizations and Deaths • NM Influenza Hospitalizations • Total: 969 • Rate: 48.8 per 100,000 • Females: 51.1% Males: 48.9% • NM Influenza Deaths • Total: 53 • Rate: 2.7 per 100,000 • Females: 41.5% Males:58.5%

  12. Influenza Hospitalization Rates by Age Group

  13. Influenza Hospitalizations by Treatment

  14. Influenza Death Rates by Age Group Rate per 100,000

  15. Influenza Deaths by Treatment

  16. What has been done with this data? • Morbidity and Mortality Weekly Report (MMWR) publication 12/11/2009 – Deaths Related to Pandemic Influenza A (H1N1) Among American Indians/Alaska Natives– 12 States • Health Alert Network (HAN) notifications • Weekly media updates • Policy development

  17. The Future • Current discussion and planning for future influenza surveillance • Comparisons between 2009-10 influenza season and past/future seasons • Planning additional data analysis

  18. Thank you! • Infection Preventionists • NM DOH staff including Infectious Disease Epidemiology Bureau and Bureau of Vital Records and Health Statistics • Health care providers, administrators, and staff • Emerging Infections Program • Office of the Medical Investigator • Laboratories

  19. Resources • Slides used with permission from Dr. Deb. Thompson’s previous presentation. • CDC: www.cdc.gov/h1n1flu • New Mexico Vaccine and Influenza Hotline: 1-877-304-4161 • NM DOH: http://nmhealth.org/H1N1

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