1. Texas Influenza Surveillance Lesley Bullion Influenza Surveillance Coordinator Infectious Disease Control Unit

2. Flu Surveillance Basics Flu is not a notifiable condition* Participation in surveillance is voluntary “Official” flu season is approximately October to May (MMWR week 40 to MMWR week 20)

4. Texas Flu Surveillance Sentinel Provider Surveillance Network (SPSN) Influenza-like illness (ILI) data Culture Surveillance Network Clinics, hospitals, public health labs, health departments Recruited by CO/RHD/LHD Limited cultures from some SPSN providers Research and Hospital Laboratories Culture data from NREVSS, WHO, Baylor Virology, USAFSAM Reports from Regional Flu Surveillance Coordinators ILI, school closures, institutional outbreaks, laboratory results, rapid flu test results, pediatric flu deaths

5. Sentinel Provider Surveillance Network (SPSN)

6. Texas SPSN Basics Voluntary nationwide network of healthcare providers sponsored by the Centers for Disease Control and Prevention (CDC) Each state health department actively recruits Weekly reports of influenza-like illness (fever ≥100°F AND cough and/or sore throat in the absence of a known cause other than influenza) Some providers also submit specimens to DSHS

7. SPSN Reporting Forms

8. SPSN Data

9. Texas Sentinel Provider Surveillance Network (SPSN) Participants (N=120), 2007-08 HSRTotal 19 2/325 4/5N7 6/5S16 711 85 9/1020 1127 Grand Total120

10. Culture Surveillance Sites

11. Culture Surveillance Sites, 1998-1999

12. 2007-08 Influenza Surveillance Specimens Submitted to DSHS Austin Lab (N=1,570*) HSRTotal 161 2/3466 4/5N63 6/5S125 7201 8179 9/1068 11407 Grand Total1570

13. Additional Laboratory Data

14. Weekly Reports by Individual Labs Texas Children’s Hospital: +cultures Scott & White Hospital Laboratory: +tests (culture, PCR, antigen) USAFSAM: +cultures

15. NREVSS Laboratory Data NREVSS Flu Reporters in 2007-08 season: Baylor Medical Center at Garland Children’s Medical Center of Dallas Connally Memorial Medical Center Cook Children’s Medical Center Covenant Medical Center Doctors Hospital of Laredo Driscoll Children’s Hospital Ennis Regional Medical Center Hunt Memorial Hospital District Medical Center of Mesquite Medical Center of Plano Methodist Hospital Mother Frances Hospital Santa Rosa Health Care Scott & White Memorial Hospital South Texas Regional Medical Center Tarrant County Public Health Texas Children’s Hospital Texas Department of State Health Services Tomball Regional Hospital University Hospital/South Texas Medical Center University of Texas Medical Branch – Children’s Hospital University Medical Center USMD Hospital at Arlington NREVSS Flu Reporters in 2007-08 season: Baylor Medical Center at Garland Children’s Medical Center of Dallas Connally Memorial Medical Center Cook Children’s Medical Center Covenant Medical Center Doctors Hospital of Laredo Driscoll Children’s Hospital Ennis Regional Medical Center Hunt Memorial Hospital District Medical Center of Mesquite Medical Center of Plano Methodist Hospital Mother Frances Hospital Santa Rosa Health Care Scott & White Memorial Hospital South Texas Regional Medical Center Tarrant County Public Health Texas Children’s Hospital Texas Department of State Health Services Tomball Regional Hospital University Hospital/South Texas Medical Center University of Texas Medical Branch – Children’s Hospital University Medical Center USMD Hospital at Arlington

16. Regional Flu Reports

17. Flu Activity Levels No Activity: –Overall clinical activity remains low and there are no lab confirmed cases † Sporadic: –Isolated cases of lab confirmed influenza in the state; Influenza-Like-Illness* (ILI) activity is not increased. OR –A lab confirmed outbreak in a single institution‡ in the state; ILI activity is not increased. Local: –Increased ILI within a single region** AND recent (within the past 3 weeks) laboratory evidence of influenza in that region. ILI activity in other regions is not increased. OR –Two or more institutional outbreaks (ILI or lab confirmed) within a single region AND recent (within the past 3 weeks) lab confirmed influenza in that region. Other regions do not have increased ILI and virus activity is no greater than sporadic in those regions. Regional: –Increased ILI in ≥2 but less than half of the regions AND recent (within the past 3 weeks) lab confirmed influenza in the affected regions. OR –Institutional outbreaks (ILI or lab confirmed) in ≥ 2 and less than half of the regions AND recent lab confirmed influenza in the affected regions. Widespread: –Increased ILI and/or institutional outbreaks (ILI or lab confirmed) in at least half of the regions AND recent (within the past 3 weeks) lab confirmed influenza in the state.

18. Flu activity level Regional reports Lab data Outbreaks SPSN ILI data Link to national report Texas Weekly Flu Report

20. How does Texas surveillance contribute to national surveillance?

21. National Flu Surveillance Centers for Disease Control (CDC) components of influenza surveillance in the U.S. –Viral Laboratory Surveillance –Outpatient Illness Data –Mortality Surveillance –Hospitalization Surveillance –State and Territorial Epidemiologists Reports

22. 2007–2008 Influenza Season in Texas

24. Texas Flu Summary, 2007–08 First isolate of the season (DSHS Lab) –Flu A Specimen collected in week 41 (week ending October 13) Flu A/Brisbane/10/2007-like (H3N2) Nueces County –Flu B Specimen collected in week 49 (week ending December 8) B/Florida/04/2006-like Galveston County Influenza A (H3N2) - predominant

26. Texas Flu Summary, 2007–08 Early appearance of A (H1N1) and A (H3N2) Late flu B wave –Predominated beginning in week 9 –Peaked in week 10 (week ending March 8, 2008)

27. Texas Flu Summary, 2007-08 CDC week 45 report: Florida, Hawaii, and Texas account for 78.6% of 248 influenza viruses reported Seasonal peak: late January to early February –186 specimens collected, 121 (65%) positive for flu during week 4 (week ending January 26, 2008) –Highest influenza-like illness (ILI) activity (10.04%) reported by SPSN in week 5 –NREVSS-Texas peak at 33.9% of specimens positive for flu in week 5 –“Widespread” designation for 9 weeks Influenza-Associated Pediatric Mortality: 10*

28. Influenza-Associated Pediatric Mortality Reportable in 2007 in Texas Laboratory-confirmed influenza death in a person under 18 years of age 9 deaths “in season”, 1 death after week 20 –Age range: 1 month to 14 years –8 Flu A, 2 Flu B –Known MRSA or MSSA co-infection: 1/10 (10%) –Significant underlying medical condition: 7/10 (70%) –Not vaccinated for flu: 4/5 (80%)

30. Review of 2007–08 Vaccine Components (Northern Hemisphere) A/Solomon Islands/3/2006-like (H1N1) A/Wisconsin/67/2005-like (H3N2) B/Malaysia/2506/2004-like (B/Victoria lineage)

31. 2008-09 Vaccine Composition (Northern Hemisphere) A/Brisbane/59/2007-like (H1N1) A/Brisbane/10/2007-like (H3N2) B/Florida/4/2006-like (B/Yamagata lineage)

32. Texas Flu Surveillance 2008-2009 Season Continue funding all packaging, shipping, and testing related to flu surveillance Increase SPSN participants & culture surveillance sites PCR at LRNs? Streamline VTM ordering process Expecting 4,000 VTM from Media Preparation Web sign up for flu reports http://www.dshs.state.tx.us/idcu/disease/ influenza/surveillance/2008/

33. Questions? Thank you!