Published Date: 2012-04-16 23:23:30
Subject: PRO/EDR> Influenza (31): USA (WA, NV, CO) surveillance
Archive Number: 20120416.1103337
INFLUENZA (31): USA (WASHINGTON STATE, NEVADA, COLORADO), SURVEILLANCE
A ProMED-mail posthttp://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseaseshttp://www.isid.org
Date: Tue 10 Apr 2012 [ProMED-mail apologises for an inadvertent delay in posting this report]
From: James Wilson [edited]
Physicians reporting across several hospitals in King County [WA] report an abrupt increase in patient volume of both pediatric and adult patients where tests were positive for type A (mostly) and some type B influenza. A substantial portion of these patients were previously vaccinated. Additionally, their house staff were vaccinated for influenza at the 90 percent level. At the same time, they saw an abrupt influx of patients; they saw many of their vaccinated healthcare staff infected and off duty. This was significant enough to engage infection control to issue an internal advisory.
1. Our sources in King County are board-certified, astute, practicing clinicians. We also have sources in nursing, clinical laboratories, infection control, veterinary medicine, wildlife medicine, and a multitude of others throughout the Pacific NW including Canada.
2. The sources that reported influenza activity in King County are scattered across 7 medical campuses and 5 emergency departments, including both adult and pediatric ones.
3. Our clients are healthcare providers who receive our forecasts as 30-60 day pre-event products, rolling on a monthly basis. What this does is prompt them to review (e.g. CME) for topics such as human metapneumovirus, review infection control protocols, order laboratory diagnostic tests based on the forecast and what they are seeing clinically, and ask the right questions at the right time if what is forecasted does not match what they are seeing. The latter is how we rapidly recognized one of the worst hMPV/RSV [human metapneumovirus/respiratory syncytial virus] seasons ever documented at our hospital. The clinicians in King County were responding to one of these forecast reports. It is a highly agile social network of astute clinicians, a network designed like the one that supported reporting in Haiti (i.e. the Haiti Epidemic Advisory System).
4. The tests used are rapid tests backed by EIA, with samples forwarded to the state lab. They are aware of the low sensitivity of these tests and suspect much higher case counts.
5. Vaccination history is recorded in EPIC and is therefore retrievable/credible.
6. Case presentation has been within 24 hours of initial symptoms, with T105 and intractable coughing. There has been a large demand for Tamiflu.
7. They have been dealing -- like many in the area -- with the pertussis epidemic, in which they have had infant fatalities, and also with a substantial case load of RSV.
We have received similar reporting from Spokane (WA) and now Las Vegas (NV). A fatality in the Western Slope (CO) was previously reported.
James M. Wilson V, M.D.
Delta County Memorial Hospital
Co-Founder, Ascel Bio LLC
Chief of Station
Ascel Bio Black Canyon Infectious Disease Forecast Station
Ascel Bio Haiti Infectious Disease Forecast Station
Ascel Bio SE Asia Infectious Disease Regional Forecast Station
[James Wilson added the following: "Ongoing dialog with public health officials indicate some degree of frustration interpreting this information. The reason is that there is no real-time surveillance capability to do so in a manner that enables one to rapidly compare baseline statistics. The US CDC and WHO do not report this information in their weekly updates. From a medical point of view, this information is crucial when attempting to forecast medical infrastructure strain and when communicating with patients."
The interactive HealthMap of the United States of America can be accessed at: http://healthmap.org/r/01bw
. - Mod.CP]
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