1. Dr Helen Carter Specialist Registrar Public Health Health Protection Agency Regional Surveillance Unit West Midlands Influenza Surveillance Key Health Data 2007

2. Brief introduction to influenza Signpost sources of influenza surveillance information Consultation for proposed daily pandemic surveillance bulletin Aims

3. Anyone involved with influenza planning?

4. Influenza Influenza: A respiratory illness associated with infection by influenza virus. Symptoms:Headache, fever, cough, sore throat, aching muscles and joints. Pathogen: Virus first identified in 1933 Virus types:Two main types. Influenza A and B. Influenza A usually causes a more severe illness Illness: Wide spectrum of illness ranging from minor symptoms to pneumonia and death.

5. Seasonal Influenza Avian

6. Avian Influenza First recognised in 1878, Italy Current H5N1 outbreak started in 2003 Predominately affecting Indonesia 19 th August 2007 Human cases n=321 Deaths n=194

7. Pandemic Influenza New strain of virus Easy to transmit between people No immunological resistance in people High mortality rate Can happen at any time of year

8. Major influenza A sub-types of 20 th Century 1920195019802000 1918 Spanish 1957 H1N1 19681957 Asian H2N2 1968 Hong Kong H3N2 H1N1 1977 Russian Shortest interval = 11 years Longest interval = 39 years Current interval = 37 years 1889-1892? H2N2 1900 ? H3N8

9. WHO Pandemic Influenza Phases

10. A pandemic is thought most likely to start outside the UK, and to become established in other countries before reaching the UK. For the UK, four alert levels are described in the DH and HPA Plans: Alert level 1Cases due to pandemic virus only outside the UK Alert level 2New pandemic virus isolated in the UK (pandemic imminent in the UK) Alert level 3Outbreak(s) due to new pandemic subtype in the UK Alert level 4Widespread pandemic activity across UK UK Alert Levels

11. Sources of surveillance information- animals Sampling of live caught wild birds Sampling of wild birds shoot dead during normal wildfowling activities Sampling of wild birds found dead

12. Sources of surveillance information- humans Royal College of General Practitioners QFLU NHS Direct Schools- Medical Officers for Schools & HPA pilot Death certificates

13. Royal College of General Practitioners Established 1957 100 spotter GP practices Consultations for influenza like illness NICE utilise baseline for antivirals dispensing decisions

14. RCGP new consultations for influenza-like illness

15. QFLU Developed by EMIS and Nottingham University Based upon GP computer systems ~3,300 practices participating Population coverage ~25.5 million PCT level data available

16. NHS Direct Nurse-led telephone service, established 1997 Syndromic surveillance Clinical algorithms Answers half a million calls per month

17. NHS Direct Data

18. Schools Medical Officers for Schools Association 400 members HPA School absenteeism pilot

19. Death certificates Depends upon doctor writing influenza as cause Time delay

20. Information flows Primary Care Surveillance Team based in West Midlands Regional Surveillance Unit Weekly bulletin: all ready produced

21. Background proposed daily bulletin; surveillance during a pandemic Conjunction with: Health Protection Agency, West Midlands Regional Surveillance Unit, Government Office for the West Midlands NHS West Midlands, Strategic Health Authority

22. Purpose of bulletin To provide a region wide overview Provide comparisons to the national situation Manage the data demands and expectations of data providers during a pandemic

23. Who is it for? Regional Civil Contingency Committee Strategic Coordinating Groups Primary Care Trusts Health Protection Units Acute Trusts Local Authorities & potentially media and public It is anticipated that PCT level data will be available via the Pandemic Influenza Portal and in a complementary weekly bulletin

24. Contents Health: GP and morbidity data NHS data Societal impacts Pragmatic approach

25. Consultation for daily surveillance bulletin

26. Consultation Who did we consult? West Midlands Influenza Pandemic Planning Group; all trust’s pandemic influenza leads & all LRFs. Questions: 1.Does the concept of a daily surveillance bulletin appear useful to you? 2.Are the proposed contents items that would be helpful during a pandemic? If not then 3.If any different or additional information is required what information can be omitted to keep the bulletin to one side of A4?

27. Results (1) Responses so far n=15 covering all apart from one Local Resilience Forum area 12 via e-mail 2 verbal 1 visit to a planning group meeting [Responses encompassed multiple views]

28. Results (2) “We consider the bulletin of huge importance” PCT “Very positive start” Multi- agency planning group “This is so straight forward and sensible no one could argue with it.” PCT All positive & supportive of the concept

29. Results (3) Three most requested additional information: 1.Modelled data to aid forecasting demand over next 7-10 days 2.National call centre information 3.Timely mortality data

30. Summary Variety of sources of influenza surveillance data: animal and human Information for action Daily bulletin consultation

31. More details, comments & questions helen.carter@HPA.org.uk