Whats New with Flu? Han Ha Youn, M.S. Influenza Surveillance and - - PowerPoint PPT Presentation

What’s New with Flu?

Han Ha Youn, M.S. Influenza Surveillance and Response Coordinator Disease Investigation Branch Hawaii Department of Health

History

History

• 1918 Spanish Flu Pandemic
• Approximately 500 million people (one third of the word’s

population) became infected

• At least 50 million deaths worldwide
• About 675,000 in the United States
• High mortality in healthy people

History

• 2009 H1N1 (Swine Flu) Pandemic
• First detected in the United States and

quickly spread across the country and the world.

• 60.8 million cases
• 274,000 hospitalizations
• 12,500 deaths in the United States
• Estimated between 151,700 and 575,400

deaths worldwide

Background

• Arguably most common respiratory viral infection worldwide
• Causes serious disease annually in US with 5-20% infected
• Usual targets: extremes of ages, those with underlying

medical conditions

• Transmission
• Usually spread person-to-person via large respiratory

droplets

• May pick up from contaminated surfaces and then touch

mucosal areas

Symptoms

• Clinical presentation
• Symptoms develop after an incubation period of

approximately 2 days (ranges from 1-4 days)

• Contagious approximately 1 day before and up to 7 days

after symptom onset

• Illness duration 3 to 7 days

Day 1 2 3 4 5 6 7 8 9 10 >>> Flu symptoms lasting 3-7 days Contagious Period From 1 day before to 7 days after symptoms Incubation Period 2 days

Symptoms

• Abrupt onset of nonspecific constitutional and respiratory signs and symptoms
• Fever
• Nonproductive cough
• Sore throat
• Fatigue
• Body aches
• Headache
• Runny nose
• May exacerbate underlying medical conditions
• Complications
• Dehydration
• Pneumonia
• Ear/sinus infections

Prevention and Control

Preventing and controlling a flu infection requires many steps including:

• 1. Vaccination
• 2. Hand hygiene
• 3. Antiviral treatment and prophylaxis

4. Avoid touching your eyes, nose, and mouth 5. Routine cleaning of surfaces

Flu Season

When is flu season? First week of October to last week of September (MMWR week

• 40 to 39)

Seasonal flu outbreaks can happen as early as October and as late as May.

• CDC. Key Facts About Seasonal Flu Vaccine

Influenza Vaccine

2018-2019 Influenza vaccine composition

A/Michigan/45/2015 (H1N1)pdm09-like virus A/Singapore/INFIMH-16-0019-2016 (H3N2)-like virus B/Colorado/06/2017-like virus (Victoria Lineage) B/Phuket/3073/2013-like virus (Yamagata Lineage)

• CDC. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2018-19 Influenza Season.

MMWR Morb Mortal Wkly Rep. 2018 Aug 24; 67(3).

Influenza Vaccines – 2018-2019 Season

• CDC. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2018-19 Influenza Season.

MMWR Morb Mortal Wkly Rep. 2018 Aug 24; 67(3).

Influenza Vaccine

Why get vaccinated against influenza (flu)?

The best way to protect against flu is to get a flu vaccine every flu season.

• Flu viruses are constantly changing, so flu vaccines may be updated from one season to the
• next to protect against the viruses that research suggests will be most common during the

upcoming flu season. A person

• ’s immune protection from the flu vaccine declines over time. Yearly vaccination is

needed for the best protection

What are the benefits of getting the flu vaccine?

The flu vaccine can provide: Protection for yourself (reduce your risk of getting sick or being hospitalized)

• Protection for others at high risk of developing serious complications from flu
• Protection for children too young to be vaccinated
• Protection for pregnant women and their newborns
• Protection for patients
• CDC. Key Facts About Seasonal Flu Vaccine

Influenza Vaccine

When to get vaccinated?

• Fall is the time to get your annual flu vaccine. If possible, get our flu vaccine by the end of October!
• However, as long as flu viruses are circulating, it is not too late to get vaccinated.
• The timing of flu outbreaks is unpredictable. Seasonal flu outbreaks can happen as early as October

and as late as May. It is best to get vaccinated before influenza viruses start to spread in the community since it takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.

• CDC. Key Facts About Seasonal Flu Vaccine

Influenza Vaccine

How well do flu vaccines work?

• Flu vaccine reduces the risk of doctor visits due to flu by ~50-60%
• A flu vaccination does not guarantee protection against the flu and some vaccinated people may still

get sick. However, people who get a flu vaccine are less likely to get sick with flu or hospitalized than someone who does not

• Efficacy of the vaccine changes every year depending on the match between the circulating strains and

the ones included in the vaccine

• CDC. Key Facts About Seasonal Flu Vaccine

Flu Vaccination in Healthcare Personnel

Flu Vaccination in Hawaii’s Healthcare Personnel

• CDC. FluVaxView

Flu Vaccination in Hawaii’s Healthcare Personnel

Flu Vaccination in Hawaii’s Healthcare Personnel

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percent Vaccinated

Percent of workers vaccinated National Goal — 90% (Healthy People 2020) National Average — 88% (2016/2017) Hawaii Average — 82% (2016/2017)

Flu Vaccination in Hawaii’s Healthcare Personnel

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18

Percent (%) Vaccinated Influenza Season Vaccination Rates by HCW Category

Volunteers Employees LIPs

Flu Vaccination in Hawaii

Influenza Vaccination Coverage ≥18 Years

• CDC. FluVaxView

38.5%

Flu Vaccination in Hawaii

Influenza Vaccination Coverage 6 Months – 17 Years

• CDC. FluVaxView

61.0%

Stop Flu at School (SFAS)

Free

• flu vaccines

Kindergarten through

• 8th grade at

participating eligible schools

October

• 15 – December 7, 2018

177

• public schools statewide

For more information on the SFAS program: http://health.hawaii.gov/docd/about-us/programs/stop-flu-at-school/

A review of last season…

High severity season

• High levels of outpatient clinic and emergency department visits for ILI
• High influenza
• related hospitalization rates

Elevated and geographically widespread activity across the country for an extended

• period of time

Activity began increasing in November and reached an extended period of high activity during

• January and February

Influenza A(H

• 3N2) viruses predominated overall

Influenza B viruses were reported more frequently than influenza A viruses from early

• March until mid-June

The majority of circulating viruses were similar to the cell

• grown reference viruses

representing the 2017-2018 influenza vaccine viruses

Season Severity Assessment

Laboratory-Confirmed Influenza Associated Hospitalizations

• CDC. Weekly U.S. Influenza Surveillance Report

Influenza Season Trends

Percentage of Influenza-like Illness (ILI) Visits Reported to CDC for Selected Previous Seasons From All US States 2017-2018 Flu Season Key messages:

• 1. Timing and length of

influenza illness varies from season to season

• 2. Influenza varies in

severity from season to season

• CDC. Weekly U.S. Influenza Surveillance Report

Surveillance in Hawaii

Percentage of Influenza-like Illness (ILI) Visits Among All Outpatient Visits Reported by Hawaii Sentinel Providers

Hawaii Department of Health Weekly Influenza Surveillance Report

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% 13% 14% 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38

% Visits MMWR Week

% ILI (3 WEEK MOVING AVERAGE) NATIONAL BASELINE NAT IO N A L ILI HAWAII BASELINE

2017 ̶ 18 Influenza Season (N=51,222)

Surveillance in Hawaii

Influenza Positive Results by Confirmatory Testing by MMWR Week

Hawaii Department of Health Weekly Influenza Surveillance Report

50 100 150 200 250 300 350 400 450 500 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38

Number of Positive Specimens MMWR Week

2017 ̶ 2018 Influenza Season (N=21,912)

B (Yamagata) B (Victoria) B (Not Genotyped) A (H3) A (2009 H1N1) A (H1) A (Unsubtyped)

Surveillance in Hawaii

Pneumonia & Influenza (P&I) Related Mortality in Honolulu

Hawaii Department of Health Weekly Influenza Surveillance Report

0% 5% 10% 15% 20% 25% 30% 40414243444546474849505152 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839 % Total Deaths

HAWAII BASELINE 3 WEEK MOVING AVERAGE NCHS MO R TA LIT Y NCHS EPI THRESHOLD

MMWR Week

2017 ̶ 2018 Influenza Season

Thank you! Questions?

Contact information: Email: hanha.youn@doh.hawaii.gov Phone: (808) 587-6572