Influenza

Monitoring Influenza in Kent County

In General

In the beginning of the 20th century, infectious diseases were the leading cause of death worldwide. During the 1918 influenza pandemic, 20 million deaths occurred with 500,000 of those deaths in the United States. Due to public health achievements such as sanitation and hygiene, the use of vaccinations, and the discovery of antibiotics, many diseases that once affected the United States, such as cholera, yellow fever, and tuberculosis, are no longer an issue. Currently, the only infectious diseases on the list of leading causes of death in the U.S. include influenza and pneumonia, which together cause an average of 56,979 deaths per year. In Kent County, there were 106 deaths in 2014 from influenza or pneumonia; 83 percent of these deaths occurred in the population 65 years of age and older. Influenza/pneumonia was the 7th most common cause of death in Kent County in 2014.

It is difficult to estimate an average number of influenza deaths per year because the number varies, but within the past four decades, flu-associated deaths have ranged between 3,000 and 49,000 annually. Influenza is an infectious respiratory illness which can range from mild to severe. There are three categories of individuals who are at high-risk for serious flu complications; older people, younger children, and people with certain health conditions. Receiving an annual influenza vaccine is the most effective way to prevent infection, especially among those in the high-risk categories.

Last Year

Data from the Michigan Syndromic Surveillance System are useful in providing an indication of local influenza-like illness (ILI) activity. The percentage of people visiting local emergency departments each week for ILI are compared to data from the previous four seasons to indicate how the current season’s activity compares to what is “expected” during each week (Figure 1). During the 2012-2013, 2013-2014 and 2014-2015 influenza seasons in Kent County, the peak level of ILI activity occurred during the last week of December or first week of January (MMWR Week 52). During the 2015-2016 season, activity peaked during the week ending March 12, 2016 (MMWR Week 10) when 12.2% of emergency departments in the county were for ILI. Data from the Centers for Disease Control and Prevention (CDC) for the past 34 influenza seasons (1982-1983 to 2015-2016) indicate that flu activity most often peaked in February (14 seasons), followed by December (7 seasons), March (6 seasons) and January (5 seasons). During the most recent 18 influenza seasons, only two other seasons have peaked in March (2005–2006 and 2011–2012).

According to the CDC, influenza activity was less severe overall in 2015-2016 compared to the previous three seasons. CDC deemed influenza activity as moderate, due to a lower percentage of outpatient visits, lower hospitalization rates and a lower percentage of deaths attributed to pneumonia and influenza. Overall, influenza A (H1N1)pdm09 was the predominant circulating strain, although H3N2 viruses circulated during October and November and influenza B viruses were more commonly identified from mid-April to mid-May. Most circulating viruses were determined to be well-matched to the components of the 2015–16 influenza vaccine.

Figure 1. Percentage of Patients Presenting to Kent County Emergency Departments with Complaints of Influenza-like Illness (ILI), 2015-2016 Influenza Season compared to the 4-year average

This Year

Although it is impossible to predict how this year’s influenza season will compare to last year’s, the Kent County Health Department will continue using its three-part comprehensive plan that will focus on surveillance, prevention/control of influenza, and public education.

The Epidemiology unit is responsible for conducting effective and timely influenza surveillance in Kent County. This entails collecting, analyzing, interpreting, and disseminating influenza data. Epidemiologists study the frequency, pattern and causes of influenza and influenza outbreaks in the Kent County population. They ask and try to answer the “who, what, when, where, why, and how” questions.

Surveillance

There are three main goals of influenza surveillance:

  1. To provide epidemiologic information during the annual influenza season to measure the development and seriousness of each influenza season;
  2. To monitor changes in circulating viruses;
  3. Determine the magnitude of influenza illness in the county in order to guide the actions of county public health officials.

KCHD monitors influenza in several ways:

  • Physician reports of influenza- Influenza is an officially reportable condition that is required by state law to be reported to the KCHD.
  • Laboratory reports of influenza- Influenza is also a state mandated reportable disease. Labs are required by law to report confirmed results to the local health department
  • Infection Control Departments - The KCHD has requested that local hospital Infection Control Departments report confirmed cases of influenza to the KCHD.
  • Daycares, schools and camps - are required by law to report the weekly total number of cases of influenza to the KCHD.
  • “Sentinel” providers - physicians who have agreed to report cases of “influenza-like” illness visits by age group, and the total number of “influenza-like” visits per week
  • Emergency Departments – KCHD has access to chief complaint data from Kent County emergency departments, which allows for tracking of patients visiting the EDs for influenza-like symptoms.

The Kent County Health Department also monitors influenza activity at the state, national, and global levels. Information that is collected in Kent County is reported to the state health department. The data is then forwarded on to the CDC.

Data collection, analysis, interpretation, and dissemination

Following the receipt of confirmed cases of influenza from labs, physicians, and hospital infection control departments, the data will be entered into a database. From October through May, surveillance information will be updated weekly. Aggregate data on confirmed cases and school reporting data will be available on the Kent County Health Department’s influenza website. An epidemiologist will analyze and interpret data and determine how the data relates to trends seen at the state and national levels.

Information For Health Care Providers

Conclusion

While no intervention is likely to eradicate influenza, the KCHD’s plan provides a comprehensive methodology for educating and informing the public about the prevention/control of influenza in Kent County. This plan was developed as a tool for guiding individual and community actions in order to reduce the risk of influenza.