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Sunday

2013/2014 Flu Update #3


Update #3 for December 28, 2013

ILI activity climbing fast, HAN Alert Issued

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 51 for the period ending December 21, 2013. In this period flu cases are described as "widespread" and Health Alert Network advisory published.

The  CDC's Heath Alert Network (HAN) has published an official CDC Health Advisory alerting clinicians to reports of severe respiratory illness/infection with influenza A (H1N1). According to the HAN Advisory, the H1N1 pdm09 virus has resulted in numbers pH1N1 hospitalizations and ICU admissions. Some fatalities have bee reported. The alert also notes "While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far.

According to the CDC Flu View site:
During week 51 (December 15-21, 2013), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 6,813 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 51, 1,639 (24.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: One influenza-associated pediatric death that occurred during the 2012-2013 season was reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 4.3 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.0%, above the national baseline of 2.0%. Eight regions reported ILI at or above region-specific baseline levels. Six states experienced high ILI activity; eight states experienced moderate ILI activity; six states experienced low ILI activity; 28 states experienced minimal ILI activity, and the District of Columbia, New York City, and two states had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 10 states was reported as widespread; Guam and 23 states reported regional influenza activity; 12 states reported local influenza activity; the District of Columbia, Puerto Rico, and four states reported sporadic influenza activity, and the U.S. Virgin Islands and one state did not report.
Timeline Comparison
Below are CDC FluView maps that compare the prior two reporting periods against the corresponding weeks of 2012/2013 influenza season. They indicate ILI activity increasing steadily through weeks 48 to week 51, 2013. There is a noticeable difference in ILI activity between week 51 2013 when compared to week 51 2012. The 2013 CDC map demonstrates a much lower geographical impact of High ILI activity compared to the current year at this time.

2013/2014 CDC Flu Interactive Map for week 51 2013


2013/2014 CDC Flu Interactive Map for week 50 2013


Comparison: 2012/2014 CDC Interactive Map for week 51, 2012 

Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high between December 15 to December 22, 2013. 

Monday

Scheduling Your Mandated Vaccines

 When is voluntary compliance not enough?

Joint Policy Statement endorses mandated vaccine schedule.

The Infectious Disease Society of America, the Society of Heatlhcare Epidemiology of America, and the Pediatric Infectious Diseases Society have collectively endorsed recommendations made by the Advisory Committee on Immunization Practices (ACIP) concerning universal immunization of health care workers.

The joint statement issued December, 2013, called for voluntary immunization programs to be discontinued in favor of mandates when compliance falls below 90%. ACIP further recommends that healthcare workers provide "documentation of receipt of ACIP-recomended vaccinations as a condition of employment, unpaid service, or receipt of professional privileges." Full text of the joint statement can be found with the link below.

Mandated vaccine against seasonal influenza has been hotly debated for several years (see Mandate the Shot or Not). While this debate continues to grind on there has been little attention given to the non-pharmacologic strategies that go hand-in-hand with vaccinations.

Pharmaceutical shortages have occurred and are certain to play a role in vaccine production in the future. Requirement or not, if vaccine is not available, you won't get it. What about when no vaccine has been created to fight a given pathogen? To both situations healthcare workers should turn to personal protective equipment to help prevent the spread of disease (see Best Disease Prevention is Action).

Saturday

2013/2014 Flu Update #2


Update #2 for December 14, 2013

Modest increases in ILI activity 

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 49 for the period ending December 7, 2013. In this reporting period flu cases are continuing to increase but remain behind last year at this time.

According to the CDC Flu View site:
During week 49 (December 1-7, 2013), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 6,219 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 49, 830 (13.3%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 2.0 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.1%, above the national baseline of 2.0%. Three regions reported ILI above region-specific baseline levels. Four states experienced high ILI activity, five states and New York City experienced low ILI activity, 41 states experienced minimal ILI activity and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 14 states was reported as regional; 18 states reported local influenza activity; the District of Columbia, Guam, Puerto Rico, and 16 states reported sporadic influenza activity; the U.S. Virgin Islands and two states reported no influenza activity.

Timeline Comparison

Below are CDC FluView maps that compare the last two reporting weeks and 2012/2013 week 49 to this year at week 49. They indicate a modest increase in ILI activity from the week 48 to week 49, 2013. There is a noticeable difference in ILI activity between week 49 this year versus week 49 2012.

2013/2014 CDC Flu Interactive Map for week 49 2013

2013/2014 CDC Flu Interactive Map for week 48 2013

Comparison: 2012/2014 CDC Interactive Map for week 49, 2012 

Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data.

Monday

2013/2014 Flu Update #1


Update #1 for the week ending December 9, 2013

Flu activity increases slightly, but will we follow the 2012/13 pattern?

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 48 for the period ending November 30, 2013. In this reporting period flu cases are starting to increase most notably in the south and south east.

According to the CDC Flu View site:

During week 48 (November 24-30, 2013), influenza activity increased slightly in the United States.
  • Viral Surveillance: Of 5,306 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 48, 536 (10.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: One influenza-associated pediatric death was reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 1.2 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.9%, below the national baseline of 2.0%. Two regions reported ILI above region-specific baseline levels. Two states experienced high ILI activity, two states experienced moderate ILI activity, two states and New York City experienced low ILI activity, 44 states experienced minimal ILI activity and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in nine states was reported as regional; 13 states reported local influenza activity; the District of Columbia, Guam, Puerto Rico, and 27 states reported sporadic influenza activity, and the U.S. Virgin Islands and one state reported no influenza activity.

Comparison to last year at this time.

In the 2012/2014 flu season public health emergencies were not declared in New York and Boston until well after high numbers of ILI cases and intensity had been experienced. By looking at the  trends displayed between these two maps, can we predict and prepare for increased flu numbers in the coming weeks? The following images compare the Influenza Like Illness (ILI) activity for week 48 of 2012 and 2014. Both maps indicate ILI concentrations in the South and Southeastern United States. By reviewing last years data we know that with in four-weeks high ILI activity had progressed to the Northeast. Can we predict the same for 2013?  

2013/2014 CDC Flu Interactive Map for week 48 2013




Comparison: 2012/2014 CDC Interactive Map for week 48, 2012 


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data.