Surveillance Update TISWGMay, 2011

Rachel Wiseman, MPHEpidemiologistEmerging and Acute Infectious DiseasesMay 18, 2011

VPDs in Texas, 2005-20102005 2006 2007 2008 2009 2010

Hep A 461 330 264 259 184 139

Hep B 742 833 741 562 420 394

Peri Hep B 8 1 3 8 1 2

HIB 8 11 14 11 7 12

Measles 3 0 7 0 1 0

Meningo-coccal

61 45 55 70 53 59

Mumps 25 58 21 20 40 121

Pertussis 2,224 954 1,051 2,046 3,358 2,848

Pneumo-coccal

735 901 1,417 1,884 1,952 1,912

Tetanus 0 1 0 3 1 0

Varicella 8,336 11,768 10,061 7,839 4,445 2,760

2010 Deaths Pertussis: NONE!! Meningococcal: 3 (lower than expected) Pneumococcal: 123 (expected) Varicella: 2 All other VPDs: NONE!!

Unfortunately we did recently have a 2011 pertussis death Too young for vaccination No contacts with pertussis

Correctional Mumps Outbreaks, 2010-11

July-September 2010 Primarily Central, NE Texas 30 cases

October 2010 Valley 9 cases

December 2010-March 2011 Most of the state except N Texas, W Texas 35 cases

Measles 2011

89 cases reported to CDC in 2011 Annual average ~50

Outbreaks in Europe Endemic areas Outbreaks in multiple US states Texas has 6 cases in 2011

Most characterized by delays in diagnosis and/or reporting

2011 Measles Cases—Texas

Case 1. Unvaccinated 23 mo from Houston area Travel to Philippines Parents “too busy” to vaccinate

Case 2. Unvaccinated 7 mo from Houston area Travel to India, probably exposed on flight home

Children as young as SIX months can receive MMR if they are going to be traveling abroad

2011 Measles Cases—Texas (2)

Exposed at Trade Show in Orlando Florida

Case 3. Adult with 1 MMR

Case 4. Unvaccinated spouse of above

Case 5. Unvaccinated adult

Case 6. Unvaccinated 11 month old child

No secondary transmission except from 4 to 5. Two cases identified in other states, not Florida.

0%

2%

4%

6%

8%

10%

12%

14%

16%

40 41 42 43 44 45 46 47 48 49 50 51 521 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept

Pe

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of V

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MMWR week

Percentage of Visits Due to Influenza-Like IllnessReported by Texas Participants in ILINet, 2007-2011 Seasons

2007-2008 2008-2009 2009-2010 2010-2011

Peak: week 7

Texas Flu Summary, 2010-2011

Predominant influenza type: A Subtype: H3N2

Seasonal peaks ILINet peak: mid

February Laboratory peaks:

mid to late January

mid February

2009 influenza A (H1N1)

16%

Influenza A (H3N2)

29%Influenza B27%

Influenza A (not subtyped)

28%

Influenza Types and Subtypes, DSHS and LRN Labs, 2010-2011 Season

CDC Grant Objectives (1)

90% of VPD investigations are sent to CDC within 30 days of receiving report Texas reality: <80% within 30 days

Why timeliness is important Many interventions have time restrictions Detect state-wide or national trends/outbreaks

Improvement Plan Provide semi-annual feedback to locals/regions on

timeliness Improve turn around time at Central Office

CDC Grant Objectives (2)

Known vaccination status for at least 90% of cases Texas reality

100% HIB <5 years 36% meningococcal

75% in <18 age group 70% mumps

93% in <18 age group 79% pertussis

92% in <18 age group

CDC Grant Objectives (2)

Capturing vaccination status is important to assess control measures, vaccine efficacy/schedule, vaccination policies, etc

Giving feedback to local and regional health departments on semi-annual basis Include reminders about all possible ways to

capture vaccine information Exploring ways to streamline data capture (can

Immtrac talk to our database?)

Questions?