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SHIVERS Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance Nikki Turner March 2012.

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Presentation on theme: "SHIVERS Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance Nikki Turner March 2012."— Presentation transcript:

1 SHIVERS Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance Nikki Turner March 2012

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3 I have flu doctor……. How do we recognise flu o How much is really in the community In hospital presentations o What are its characteristic presentations o Are we diagnosing it all o Is there subclinical/asymptomatic? How effective are current flu vaccines o In subpopulations o In different years with shifting strains

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

5 CDCs 9 objectives 1.Understand severe respiratory diseases caused by influenza & other pathogens 2.Assess influenza vaccine effectiveness 3.Investigate interaction between influenza & other pathogens 4.Understand causes of respiratory mortality 5.Understand non-severe respiratory diseases caused by influenza & other pathogens 6.Estimate influenza infection by conducting serosurvey 7.Identify & quantify risk factors (age, ethnicity, SES etc) for getting influenza 8.Assess immune response among individuals with varying disease spectrum 9.Estimate healthcare, societal economic burden caused by influenza and vaccine cost-effectiveness

6 Project Team – multi-centre and multi-disciplinary collaboration ESR—leading organization o Sue Huang—Principle investigator (PI) o Graham Mackereth – Project manager o Ruth Seeds – Project Officer Science teams: o 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 o Nikki Turner/Heath Kelly/Nevil Pierse/Ange Bissielo/Michael Baker/Don Bandaranayake/Sue Huang: objective 2 Vaccine Effectiveness o Michael Baker: objectives 3 & 7 o Colin McArthur/Sally Roberts: objective 4 o Sue Huang/Nikki Turner: objective 5 Primary Care Surveillance o Sue Huang/Don Bandaranayake: objective 6 o Richard Webby: objective 8 o 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 o Auckland and Middlemore Hospitals Community-based surveillance: enhanced, active, (4 yrs), population based surveillance for community ILI (Influenza-like illness) cases caused by influenza o 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 o Flu vccination hx o High risk medical conditions o Medication lists o Pneumococcal vaccination hx Utilise this data for VE measures

9 Objective 5 – Community- based surveillance Sue Huang and Nikki Turner SHIVERS Researchers Identify the aetiologies of acute presentations to the general practice with respiratory symptoms, including influenza o Cough o 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 o 60 GPs: ~ 180,000 registered patients (14% Auckland population) ?All year round All acute respiratory illnesses presenting if possible: o Swab o Questionnaire (brief, advanced form) o PMS data extraction

11 Gains for General Practice Improved understanding of causes of respiratory illnesses Rapid feedback of swab results to the involved practices o flu o Anther virus Information on spread of flu in the community in real time Yearly Vaccine Effectiveness measures o 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 o Enrolled populations o Excellent systems o 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 Study area (Auckland) population in ADHB & CMDHB : 837,696 Hospital study populationGP based study population 2 VE 7 Risk factor impact 9 Economics Specimen flow Data flow All ILI patients (respiratory specimen) All SARI patients (respiratory specimen) Some SARI patients’ blood Some ILI patients (Blood) Strat. random sample Cases + controls Cases + subcohort Cases + controls 8 Immune response 6 Infection risk 5 Mild disease 1 Severe disease 3 Interactions 4 Mortality Objectives 1Severe disease 2VE 3Interactions 4Mortality 5mild disease 6Infection risk 7Risk factor impact 8Immune response 9Economics


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