Flu Update and Overview of Flu Surveillance in RI Daniela Quilliam, MPH Chief, Center for Acute Infectious Disease Epidemiology Division of Preparedness, Response, Infectious Disease, and Emergency Medical Services January 19, 2017

National Geographic Spread For Week 1 Source: http://www.cdc.gov/flu/weekly/

National Activity Level For Week 1 Source: http://www.cdc.gov/flu/weekly/ *This map uses the proportion of outpatient visits to health care providers for influenza-like illness to measure the ILI activity level within a state. It does not, however, measure the extent of geographic spread of flu within a state. Therefore, outbreaks occurring in a single city could cause the state to display high activity levels. Data collected in ILINet may disproportionally represent certain populations within a state, and therefore, may not accurately depict the full picture of influenza activity for the whole state. Data displayed in this map are based on data collected in ILINet, whereas the State and Territorial flu activity map is based on reports from state and territorial epidemiologists. The data presented in this map is preliminary and may change as more data are received. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

Sentinel Provider Surveillance (ILI Net) 17 Community Based Practices Year round reporting to CDC Submit weekly report of influenza-like illness Fever >= 100º F Cough and/or sore throat Report to RIDOH Total number of patient visits Number of patient visits for ILI by age Submit swabs for laboratory testing to the state lab to provide information on circulating strains Keep the text of this file

Sentinel Surveillance Comparison between seasons Source: I:\EPI Data\EMermel\Influenza\2014-2015 season\ILI\ILI analysis 2014-2015.xls ILI_4_years TAB Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ ILI \ ILI analysis 20xx-20yy.xls

Sentinel Surveillance Geographic Spread and ILI Source: I:\EPI Data\EMermel\Influenza\2014-2015 season\ILI\ILI analysis 2014-2015.xls ILI_4_years TAB Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ ILI \ ILI analysis 20xx-20yy.xls

Sentinel Surveillance Comparison between US, New England & RI (note: regional and US data are 1 week behind RI data) Source: I:\EPI Data\EMermel\Influenza\2014-2015 season\ILI\ILI analysis 2014-2015.xls Comparison TAB Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ ILI \ ILI analysis 20xx-20yy.xls

Sentinel Surveillance Comparison among RI Counties Source: I:\EPI Data\EMermel\Influenza\2014-2015 season\ILI\Weekly ILI analysis.xls Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ ILI \ Weekly ILI analysis.xls NOTE: One sentinel in Providence County did not report on during Week 2

Respiratory Outbreaks Within a long term care facility or assisted living facility, a respiratory outbreak is defined as: One lab-confirmed case of influenza or B. Two cases of influenza-like illness (ILI) within 72 hours of each other Influenza-like illness (ILI) definition: fever/abnormal temperature* AND cough AND/OR sore throat *NOTE: Elderly individuals may present “abnormal temperature” (higher or lower than normal baseline) rather than a very high fever All respiratory outbreaks are reportable to RIDOH. RIDOH monitors outbreaks, and provides infection control recommendations. The Rhode Island State Health Laboratory tests specimens for influenza.

Respiratory Outbreaks 2016-2017, Through Week 2 Oct 8, 2016 May 20, 2017

State Laboratory Data (Through Week 1) Sentinel sites, hospital laboratories, and institutions with respiratory outbreaks send specimens to the State Lab throughout the year for influenza testing and subtyping. ILINet  http://www2a.cdc.gov/ilinet/ State Bar Chart (under Laboratory Surveillance Data) This tends to be one week behind

Hospital Data Rhode Island’s eleven acute care hospitals report all positive influenza laboratory tests weekly. Line list of all patients testing positive for influenza (inpatient and outpatient) Summary of the total number of patients tested for influenza

Hospital Data (Inpatient and Outpatient) By Strain (Through Week 2) Strains of Influenza Flu A (not subtyped) Flu A H3 Flu A 2009 H1N1 Flu B (not subtyped) Flu A & B Flu B Yamagata Flu B Victoria Inconclusive Flu A/B Not Distinguished Total Week 2 65 3 8 76 Cumulative 370 14 38 1 424 Strain data source: Novell > Influenza Tracking > Report Menu % Positive source: I:\EPI Data\EMermel\Influenza\2013-2014 season\Positive tests (Inpt AND Outpt).xls Strain Data (2) TAB Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ Positive tests (Inpt AND Outpt).xls MMWR Week 52 1 2 % Positive Influenza Tests 7.74 11.88 8.07

Hospital Data (Inpatient and Outpatient) By Week and Strain Through Week 2 Oct 8, 2016 May 20, 2017 % Positive source: I:\EPI Data\EMermel\Influenza\2014-2015 season\Positive tests (Inpt AND Outpt).xls Strain Data (2) TAB and Lab_graphic (2) TAB Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ Positive tests (Inpt AND Outpt).xls Oct 8, 2016 May 20, 2017

Hospital Data (Inpatient ONLY) By Week and Strain Through Week 2 Source: I:\EPI Data\EMermel\Influenza\2014-2015 season\Inpatient ONLY.xls Strain Data TAB Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ Inpatient ONLY.xls Oct 8, 2016 May 20, 2017

Hospital Data (Inpatient and Outpatient) Age Groups, Cumulative Season Through Week 2 Source: I:\EPI Data\EMermel\Influenza\2014-2015 season\Positive tests (Inpt AND Outpt).xls Age TAB Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ Positive tests (Inpt AND Outpt).xls

Syndromic Surveillance Realtime Outbreak Detection Surveillance System (RODS) All hospital emergency rooms report through web-based system Report chief complaint “Constitutional” symptoms most closely resemble those of influenza Fever, myalgia, or chief complaint of flu Keep this text

RI RODS Constitutional Syndrome Through MMWR Week 2 Dr. John Fulton emails me this slide Oct 8, 2016 May 20, 2017

School Absenteeism Data from RI Department of Education Schools report number of students absent each day RIDOH analyzes data weekly, comparing % absent each day to recent and historical baselines Weeks with school vacations are omitted from analysis If a school reports high absenteeism for 3+ days, RIDOH calls school nurse to assess situation and learn of any clustering of illness

School Absenteeism Through MMWR Week 1 (Vacation weeks omitted) The School Absenteeism epi sends this slide to me Increases above normal trends in school absenteeism can serve as a surrogate measure of widespread influenza circulation. This surveillance system is being monitored. Trends by school are being populated and data displays are under development.

Acknowledgements RIDOH Partners Abby Berns, MPH Hart Shuford, MPH Bridget Teevan, MPH Diane Brady, MS, RN Casandra Calcione Partners Sentinel Providers Hospitals Long-term Care Facilities

Daniela.Quilliam@health.ri.gov 401-222-3284 Questions? Daniela.Quilliam@health.ri.gov 401-222-3284