1. 1 INFLUENZA (AND OTHER RESPIRATORY VIRUS) SURVEILLANCE IN WISCONSIN Thomas Haupt M.S. Wisconsin Influenza Surveillance Coordinator

2. 2 Greetings and Thank You From Wisconsin!

3. 3 Population approximately 5.6 million Average high temperature (July) 82 degrees WISCONSIN THE “BADGER” STATE

4. 4 Population approximately 5.6 million >6,000 Confirmed and Probable Cases WISCONSIN THE “SWINE-FLU” STATE

5. 5 Surveillance Methods Current and Future Current Virologic (Lab) Rapid Test Site (RTS) ILINET (Influenza-like illness) Future Enhanced ED monitoring Hospitalizations Enhance Antiviral Resistance Monitoring

6. 6 PANDEMIC INFLUENZA VIROLOGIC SURVEILLANCE IN PERSPECTIVE Confirmed % cases Cases (worldwide) WORLDWIDE 94,500 100% UNITED STATES 37,250 39% WISCONSIN 6,300 7%

7. 7 4 Labs Certified to do Pandemic Influenza Confirmation

8. 8 Week Ending April 25 th " Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

9. 9 Week Ending May 2 nd Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

10. 10 Week Ending May 9th Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

11. 11 Week Ending May 16th Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

12. 12 Week Ending May 23rd Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

13. 13 Week Ending May 30th Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

14. 14 Week Ending June 6th Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

15. 15 Week Ending June 13th Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

16. 16 Week Ending June 20th Legend APRIL 25 MAY 2 MAY 9 MAY 16 MAY 23 MAY 30 JUNE 6 JUNE 13 JUNE 20

17. 17 WISCONSIN PANDEMIC INFLUENZA LAB SURVEILLANCE

18. 18 WISCONSIN SEASONAL and PANDEMIC INFLUENZA LAB SURVEILLANCE

19. 19 Virologic Surveillance Need to determine a median between testing everyone and those needed to be tested – Severely ill – High risk patients, and – Residents of LTC, Corrections and other Institutions Need a more streamline, accurate (yet simple) method of reporting data i.e.. “Electronic lab reporting”

20. 20 Rapid Test Site (RTS) Surveillance Done for several years very informally 2008-09 CSTE Grant to Enhance Influenza Surveillance

21. 21 Geographic Distribution of Laboratory Surveillance Contributors Rapid Test Site Green Bay Milwaukee

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24. 24 Rapid Test Site (RTS) Surveillance Advantages Many more sites (Data) Consistent with both PCR and Culture Can be easily broken down by regions of the state Disadvantage Use early and late in season (Low PVP) Use during Pandemic Influenza

25. 25 Wisconsin had 66 Sentinel Clinicians, 50 of which were regular reporters – 30 of which do year-round surveillance Data analyzed by Public health Region and statewide – Baseline and threshold levels of ILI “Traditional” state – Limited electronic ILI, more syndromic ILINet – WI Outpatient ILI surveillance

26. 26 ILINet – WI Outpatient ILI surveillance network, through Jun 27

27. 27 ILINet – WI Outpatient ILI surveillance network, through Jun 27

28. 28 Continue to recruit/maintain clinicians Gear toward more electronic ILI reporting – Hospital ED surveillance – Validate criteria for surveillance Chief Complaint/ discharge diagnosis etc ILINet – WI Outpatient ILI surveillance network

29. 29 Future Surveillance Enhance and develop “severity” surveillance – Hospitalizations from flu – ED data – Deaths Antiviral Resistance

30. 30 Hospitalizations and ED Data Intra –state pilot program to identify admissions due to ILI and ED visits due to ILI on a daily/weekly basis – By age group (0-4,5-24,25-49,50-64, >64) – Web based reporting system (WI-Trac) – early results varied 10 minutes to 1 hour of ICP time ability of hospitals to do it also varied

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32. 32 Wisconsin Health Information Exchange (WHIE) Network Currently in Milwaukee County only 16 hospitals Plan to expand to larger hospitals, hospital corporations this fall Uses chief complaint “Fever” or “Flu” Daily, weekly monthly Hospital Death reporting being considered

33. 33 Weekly ED visits with chief complaint of “fever” or “flu” at 11 Milwaukee area hospitals, by age-group, Jan 2008 – Jul 4, 2009 Wisconsin Health Information Exchange (WHIE) data

34. 34 Wisconsin Health Information Exchange (WHIE) Network Use in local areas is better than ILINet Use in statewide or regional areas is being reviewed Data needs to be validated for use in ILINet

35. 35 Wisconsin Health Information Exchange (WHIE) Network Chief Complaint Categories Fever Flu Respiratory Asthma Sepsis Diarrhea Rash Other

36. 36 Antiviral Resistance Wisconsin State Lab currently tests for seasonal influenza resistance to adamantanes and neuraminidase inhibitors Beginning July 2009 will test Pandemic H1N1 for resistance to adamantanes and neuraminidase inhibitors using CDC methodology

37. 37 What we don’t do Statewide school absenteeism – Some local surveillance that varies greatly Large Business absenteeism Long term care (Except for clusters)

38. 38 “Other” Respiratory Viruses Surveillance Statewide and Regionally RSV (Rapid tests) Statewide Parainfluenza (1-4) Adenovirus Rhinovirus Human metapneumovirus Coronavirus (OC-43 and others) Enterovirusus

39. 39 VIRUS CULTURE Based on 206 tests RAPID TESTSSELECT PCR TESTS Virus% Positive Virus# Tests % PositiveVirusPositive/ total number Total % Positive16.0%Influenza A & B44/206 Influenza (Tot.) Influenza A Influenza B hMPV 9.7% 1.5% 8.2% 0% Influenza (Tot)95713.6% Influenza A3.6% # A/H18 Influenza B9.9% # A/H30 Influenza Unk.*0.1% # B34 RSV1.9%RSV2079.2%RSV6/122 Adenovirus1.0%Adenovirus550.0%Adenovirus1/38 Parainfluenza3.4%Parainfluenza6/76 Rhinovirus0.0% *Influenza unknown (Unk) are positive influenza test results that cannot be distinguished between Type A and B Rhinovirus3/38 Enterovirus0.0%Enterovirus0/38

40. 40 Again… Thank you for invitation and hospitality !! Questions and comments … Please