Influenza, a vaccine preventable disease Carina Blackmore, DVM, PhD, - PowerPoint PPT Presentation

Influenza, a vaccine preventable disease Carina Blackmore, DVM, PhD, Dipl.ACVPM State Epidemiologist Florida Department of Health a HEALTH

Objectives  The viruses  The vaccines  The surveillance methods a HEALTH Division of Disease Control & Health Protection 2

Influenza virus Hemagglutinin Neuraminidase Nucleic Acid

I ii • , , !fj I I ... --· ·-• ""• 1 • -•- E IIJ • '!! ti ill I! I • • Ii I I ii ii ... ill! • '

Influenza A: a promiscuous virus! HA  Orthomyxovirus ◦ Envelope NA ◦ Surface spikes  Hemagglutinin protein (HA) (18 types) 1 2 3 4 5 6 7 8  Neuraminidase protein (NA) (9 types) ◦ SS(-) RNA ◦ 8 segmented genes

Why are we concerned?  The only infectious disease on the top 10 list of leading causes of death in the United States (# 8, 2016) ◦ 57,000 flu and pneumonia deaths in 2016  High risk groups ◦ Children under 5 years (2 years) ◦ Adults 65 years and older ◦ Pregnant women ◦ American Indians and Alaska Natives ◦ People with underlying medical conditions (lung, heart, etc) a HEALTH Division of Disease Control & Health Protection 6

e d a fo r ·nf· · ctic Jus , d ases ----- United tates , · 90 0--- 1 · 1 9 rate t .. In Pa mi 000 600 00 t 2 00 0 ------------------------------------1 900 92 0 2 Year mortaH~ i

zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Cycles of the Asian H5N1Virus in Animals and Humans ·, Waterfowl ' ' \ Humans \ I I I : ---- I ,~ ,.,,, ' / Domestic /1 JI. birds Mammals Waterfowl (primarily swine)

Interactions On the Farm and the Market

Potential for Influenza Pandemics  All influenza viruses can mutate  Avian flu can cause illness in humans  Little to no herd immunity to avian strains among humans  If avian viruses acquire human genes ◦ Facilitate efficient person-to-person transmission a HEALTH

Federation . I" .J . I - Areas reporting occurence in poultry Division of Disease Control & Health Protection 11 - Areas reporting occurence only in wild birds 1,200 2,400 Kilomete rs

Cumulative number of confirmed human cases for avian influenza A(H5N1) reported to WHO, 2003-2018 2003 2009* 2010 2014- 2015 2016 2017 2018 Total cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths Azerbai ijan 8 5 8 5 Bangladesh 1 6 1 1 0 0 0 0 8 1 I Cambodia 9 7 47 30 0 0 56 37 0 0 Canada 1 1 0 1 1 0 0 I China 38 25 9 5 6 1 0 0 0 53 31 Djibouti 1 ('\ 1 I Egypt 90 27 120 50 136 39 10 3 3 1 359 120 Indonesia 162 35 31 2 2 1 1 200 168 1341 V V Iraq 3 2 0 0 3 2 u V Lao People's Democratic Republi ic 2 2 0 0 0 0 0 0 2 2 . Myanmar 1 1 - 0 0 0 0 0 0 0 0 Nigeria 1 0 0 0 0 1 1 1 I Pakistan 3 1 0 0 0 0 0 0 3 1 Thailand 25 0 0 0 0 0 0 25 17 171 0 0 0 0 Turkey 12 4 0 12 4 Viet I Nam 112 57 15 7 0 0 0 0 0 127 64 Total 468 282 145 42 10 3 0 860 454 233 125 4 2 I

Nine days in April, 2009  April 17, Swine influenza H1N1 confirmed in 2 CA children ◦ Strain not seen in U.S. swine ◦ No swine-human contact  April 22, T wo TX adolescents +  April 23, Respiratory outbreak in Mexico confirmed as novel H1N1  April 28, Cases reported in 5 states, 4 countries

. 1"HE 1 PIG AND BIRO ~

Swine influenza  Common respiratory illness in swine  Usually mild  1-2 human cases/ year  Swine infected by human influenza viruses  Swine flu vaccines

~ Swine Influenza in North America \, H3N2 ~ 4N6 H3N~ H2N3 ~ 1930 8 11 - J/lJ 19m 2003-05 ~ Current 1918 H1 N1 evolves cH1N1 Double Triple huH1N1 rH2N3 H3N2 huH1N2 Spanish Flu Reassortant Reassortant H1N2 Pandemic H3N2 H3N2 rH1N1 cH1N1 huH1N1 huH1N2 H3N2

How do we know this was a pandemic?  Spread fast around the globe  Affecting younger individuals (healthy adults)  Mortality seen in healthy adults (pregnant women)  Although morbidity and mortality not higher than seasonal flu, could change… a HEALTH

p d . HlNl ,( As of an ermc 14 Juliy 2009 i..,: , Inten1ational , Case and Information Tracking osoo EDT International Map -- Oh ile 7 2'1 t-- ----; r.- l-----------+---- 2 -tl 1 11 - 100 Cases These data are , oonsidered provisional and pre li nn inary and wi ll not be officially re leased by the CDC until 11 00 E DT - 101 - 1 000 Ca ses - > 1000 Cases - ~co n - edco untries (nol ye t WHO c o:nfiime d) Da ta Source CcMn tries w ith m ed ia ~po riedl'rumrt"s GD OC and ln il ue;nz.a D ivis jori I ~ e m8' ·a nal Te ' "S uspected C ases NO IE.: Case • co u nts a ppesa 1r as i;e,parted - by W O un le ss a erw;ise · nd ic ate d. Countries. w iih No Repoliied Gases

Influenza isolates by subtype, FL 2008-2009 • A (H1N1) Novel 600 • A (H3) Seasonal • 500 A (H1) Seasonal • A (Unspecified) 400 • B 300 200 100 0 40 42 44 46 48 50 52 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 Week Week

2009 H1N1 influenza in swine (and other critters)  May 2, commercial swine herd,Alberta  July, show pig, Minnesota  August, turkey farm, Chile  October, ferret Oregon  November, commercial swine herd, Indiana, cat, Iowa, cat, Oregon, dogs, China,  turkey farm, Virginia   December, cheetah, California

Influenza A H3N2v  12 human cases from 5 states in 2011  309 cases from 12 states in 2012 16 hospitalizations  1 death  80-90% in swine exhibitors+families   Swine management practices changed  25 cases in 2013-15  79 cases in 2016-17 a HEALTH

State and County Fairs Exposures Trock 2012

Wild bird surveillance A tl a nti c Fl yw ay ,,. Mi s.s. i s.s. i pp i Fl yw ay • . ~ , , Ce ntr a I Fl yw ay P ac ifi c Fl yw ay

Highly Pathogenic Influenza A (HPAI) in birds  HPAI Eurasian (EA) H5N8  H5 gene derived from EA clade 2.3.4.4 H5N1  EA H5N8 in Washington State in Dec 2014  HPAI North American (NA) H5N2, Dec 2014  HPAI NA H5N1, Jan 2015 a HEALTH

Influenza A H7N9, China  1567 human cases (39% case fatality rate) since March 2013  About 50% of cases occurred in 2016-2017  Poultry contact  14 clusters of limited human to human transmission 27

Human Influenza A H7N9 cases, March 2018 • Cases Deaths 50 I I a I II I II 'I ' Count 1 1 1 1 1 II Ill 1111 1111 11 1 1 Ill 1111 1 11 1 1 11 1 1111 1111 11 111 I Ill 1 111 1 I Ill 1111 1 I Ill 11111 I 20 I ll 1 111 11 I Ill 1111 11 Il l 11 1 1 11 1 11 1 11 1 Ill 11111 1 II 111 1 111 1 1 1 1 11 1 I 111 1 1 11 111 I 111 1 1 1 11 1 1 111 1 1 I IJ III I 111 1 1111 11 1 1111 1 111 11 11 11111 1 I 1 111 11 1 1 11 1 llllllll 1 1 111 11 1 1 1 10 1 Ill 11 111 1 11 1 1111 111 1 1 1 IILl ll. 11 1 1 1 1 1 1 tllll JII I 11 1 1 llllll lt l 11 111 1 1 11 1 1 1 1 111 11111 1 1111 11 1 11 11 1 1 1111 1 11111111 1 111 1 11 111 1 11 1 11 1 111 1 1 llllll 11111111 1 11 1 11 I 1 II 11111 1 11 1 111 11; 1 11 11111111 lll lll 1 1 1 11 11 1 11 1 111 1 11 111 1 I 1 1111 IIJIJI I III II I 11 111 11 llll I II II IJI IIIIIIIIII 11111 11 1 1 11 I I l ll l llllllll l ll ll lllllll 0 08 18 28 38 8 06 16 26 36 6 03 13 23 33 3 01 11 21 31 1 51 09 19 29 39 '9 2013 2014 2016 2015 2017 2018 Week and Year 28

Division of Disease Control & Health Protection ___ j 1 -• L 29

Canine flu : . ---·•·-" ;j  It started with 6 dead greyhounds…

Cat flu Division of Disease Control & Health Protection 31

Animal-human interface

Influenza Surveillance Goals 1. Identify and characterize flu viruses; pandemic potential 2. Situational awareness: onset, peak, and duration of flu season 3. Track geographic spread and detect outbreaks 4. Monitor severity of season: track visits to emergency departments and deaths 5. Describe clinical infection and those at risk 6. Guide decisions for interventions and prevention 1. high-risk populations (children, adults aged 65 and older, and pregnant women) a HEALTH 33

ESSENCE-FL Facilities April 2018 ili Reporti ng , Statu 252 of 259 H , n: SJ I R ,r i in Emergency [tt al est in Ha Departments [H a ~tan participate j 11.e [E • , at O en Stan • ne [E 1 ~tan ~ at Rep: rti n: Submit data daily + em t Ca re Re; IJI rt inc

Emergency Department & Urgent Care Center Visits (n=322 facilities) 12 2014-15 10 Peak activity this Percent of Visits 2015-16 season occurred in 8 2016-17 early-February - 2017-18 6 4 2 0 40 42 44 46 48 50 52 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 Week 35

Emergency Department and Urgent Care Center Visits Among PregnantWomen 120 Activity has returned 100 to normal levels for Number of Visits 80 this time of the season 60 40 20 0 40 44 48 52 3 7 11 15 19 23 27 31 35 39 Week - 2014 -15 2015- 16 2016-17 2017-18 36