Influenza Surveillance

in Washington

Anthony A Tellez-MarfinWashington State Department of Health

Making Sausage

How does tradition disease surveillance work in most states?

Traditional Disease Surveillance

Health Eventsof Interest

HCFs HCPs LabsReporters

Traditional Disease Surveillance

Health Eventsof Interest

HCFs HCPs LabsReporters

Traditional Disease Surveillance

Health Eventsof Interest

HCFs HCPs LabsReporters

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Traditional Disease Surveillance

Health Eventsof Interest

HCFs HCPs LabsReporters

County

Traditional Disease Surveillance

Health Eventsof Interest

HCFs HCPs LabsReporters

County

Traditional Disease Surveillance

Health Eventsof Interest

HCFs HCPs LabsReporters

County

Traditional Disease Surveillance

PHIMS

Why Isn’t Influenza Notifiable?

• Significant PH problem

• Leading cause of mortality

• Transmission interruption possible

• Preventable (vaccine)

• Lots of cases ….every year

• Traditional surveillance for flu resource-demanding for yield

• Annual reports (hospitalization & death certificate data) to

evaluate vaccine delivery & identify at-risk groups

• Never been need for real-time surveillance

Goals of Influenza Surveillance Changing• Start & stop of annual epidemic

• Cost, morbidity, & mortality of influenza

• Measure vaccine / vaccine delivery effectiveness &

make corrections

• Evaluate public health outreach to high-risk groups

• Monitor emergence of anti-viral resistance

• Emergence of significant viral mutations

• Anticipate impact on healthcare & HCFs

• Bed availability

• Ventilator availability

• Anti-viral availability

How Much Data Do We Really Need for Flu Surveillance?

• For annual epidemic influenza, not so much data needed to answer these new, pressing questions

• Minimize reported data for each case• Basic demographics

• Age• Gender• County of residence• Date of illness onset or sample collection

• Lab result

New / Enhanced Influenza Surveillance(Post-Pandemic)

7 new surveillance systems (largely automated)• Sentinel lab network (typing, resistance)• Mandatory influenza death reporting• Pneumonia & influenza mortality eDR (in 2010-11,

6 counties; in 2011-12, all counties)• Statewide sentinel ER ILI surveillance• ELR: Messaging individual records (PHRED)• ELR: Web-based aggregate data entry (PHRAID)• Limited flu hosp surveillance using HIE (Spokane)

PHRED & PHRAID

• Use ELR for surveillance• Developed during 2009 flu pandemic• PHRED: Centralized reporting from labs to DOH

with distribution to local health jurisdictions• PHRAID: Centralized reporting aggregate data from

labs to DOH (influenza A, influenza B, RSV)• Next step? More complete lab data to populate web-

based notifiable condition reporting system (PHIMS)• Changes in WA administrative code to improve

content of lab-submitted reports

LABSWA DOH PHRED

Flu Lab Results

WA DOHCDES

Weekly surveillance report

LABSWA DOH PHRAID

Aggregate Flu Lab Results

WA DOHCDES

PHRED-to-PHIMS

• Under development• Use content of the PHRED data message to pre-

populate PHIMS case report• Distribute pre-populated PHIMS records to local

health jurisdictions• LHJs to handle as per available resources• Entry into PHIMS or identification as a case does

not mean mandatory investigation

LABSWA DOH PHRED

Flu Lab Results

WA DOHPHIMS

Lab datapre-populatesPHIMS record

PHRED-to-PHIMS

Next Step: Health Information Exchange

• Move data from EHR → “cloud” (“hub”)

• Data messaging (HL7)

• Inland Northwest Health Services

• 21 hospitals in 14 WA & ID counties

• Inpatient, emergency department, & lab data since

• Massive amounts of data transmitted every 20 minutes

(“sipping from a fire hose”)

• UW staff package data; DOH staff link data for use

• 2010, greater data utilization

• Start with influenza

LABS HIE Data Hub

HCV Lab Results

WA DOHPHRED

WA DOHPHIMS

Lab datapre-populatesPHIMS record

HIE Use in 2010-2011*

• Within 2-3 days of occurrence:

• Identified first lab-confirmed flu cases in E Washington

• Cluster primarily comprised of unvaccinated Latinos

from an agricultural community

• Identified that more than 70% women presenting for

delivery in December 2010 not vaccinated against

influenza

• Information distributed to local public health and healthcare

providers

* Kathy Lofy, Natasha Close, Tracy Sandifer, & Marisa D’Angeli

Summary

• 2010-2011: Flu surveillance emphasized centralized ELR system with local distribution of results

• Model emerged in Spring 2009 Influenza Pandemic

• Applicable to other high volume diseases where traditional surveillance is too resource-intense (e,g., Campylobacter, RSV, pneumococcus, hepatitis C)

• Next step, more integration of HIE data to identify potential points for intervention in real-time

Thank you!!