1. 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

2. National Geographic Spread For Week 1
Source:

3. National Activity Level For Week 1
Source:
*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.

4. 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

5. Sentinel Surveillance Comparison between seasons
Source: I:\EPI Data\EMermel\Influenza\ season\ILI\ILI analysis 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

6. Sentinel Surveillance Geographic Spread and ILI
Source: I:\EPI Data\EMermel\Influenza\ season\ILI\ILI analysis 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

7. 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\ season\ILI\ILI analysis xls
Comparison TAB
Generic Source (for future): I:\EPI Data \ Influenza epidemiologist name \ Influenza \ 20xx-20yy season \ ILI \ ILI analysis 20xx-20yy.xls

8. Sentinel Surveillance Comparison among RI Counties
Source: I:\EPI Data\EMermel\Influenza\ 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

9. 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.

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

11. 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 
State Bar Chart (under Laboratory Surveillance Data)
This tends to be one week behind

12. 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

13. Hospital Data (Inpatient and Outpatient) By Strain (Through Week 2)
Strains of Influenza
Flu A (not subtyped)
Flu A H3
Flu A 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\ 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

14. 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\ 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

15. Hospital Data (Inpatient ONLY) By Week and Strain Through Week 2
Source: I:\EPI Data\EMermel\Influenza\ 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

16. Hospital Data (Inpatient and Outpatient) Age Groups, Cumulative Season Through Week 2
Source: I:\EPI Data\EMermel\Influenza\ 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

17. 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

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

19. 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

20. 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.

21. 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

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