Oklahoma Influenza and Respiratory West Nile Virus Virus Surveillance 2006-07 Summary
August 18, 2007 Good Morning.
Renee Powell, MPH Epidemiologist Communicable Disease Division Oklahoma State Department of Health
Discussion Objectives
West Nile Virus
• Provide a brief description of Influenza Surveillance mechanisms in Oklahoma • Discuss rationale for year-round surveillance • Provide influenza and respiratory virus data on a state and regional level • Provide 2006-2007 Season Summary
Oklahoma Influenza Surveillance Objectives
• Detection of early influenza • Identify the circulating influenza strains • Determine the geographic distribution and intensity of disease
• Determine the age distribution of disease
West Nile Virus
The Oklahoma Respiratory Surveillance Program: Year-round Objectives West Nile Virus
• Create group of frontline clinicians
– Physicians – Laboratorians
• View trends and patterns for influenza and respiratory virus activity:
– Seasonal (October-May) – Non-seasonal (June-September)
• Detect outbreaks of respiratory and non-respiratory nature • Detect emergence of novel influenza strains and/or other severe respiratory pathogens
The Oklahoma Respiratory Surveillance West Nile Virus Program
• Influenza Outbreak Reporting and Management
• Sentinel Laboratory Reporting: 10 year-round • OK-HAN and website updates weekly
The Oklahoma Respiratory Surveillance Program
• Sentinel Surveillance for Influenza-like Illness West Nile Virus (ILI):
– 21 agreed to year-round – Annual Training Held
– Sentinel physicians use electronic report
– Rapid antigen kits and Viral Transport Media – Submission of specimens to PHL – Hospitalizations Sentinel Laboratory Reporting: 10 year-round
Febrile and Respiratory Illness Case Definition
Influenza-like Illness (ILI):
– Fever 100oF (37.8oC) oral or equivalent AND
West Nile Virus
– Cough
WITH or WITHOUT – Sore throat
– In absence of known cause other than influenza
Participating Sentinel Physician and Laboratory Sites 2006-2007
Cimarron
Texas Beaver Harper Woods Alfalfa Grant Kay
Osage
Washington
Nowata
Craig
Ottawa
Major Payne
Dewey Blaine Kingfisher Logan Lincoln Custer Canadian Washita Oklahoma Okfuskee Pottawatomie Okmulgee Pawnee Creek Tulsa
Mayes
Roger Mills
Region 1-Northwest Region 2-Northeast Region 3-Southwest Region 4-East Central Region 5-Southeast Region 6-Central Region 7-Tulsa County Region 8-Oklahoma County
Harmon Beckham
Muskogee
Cleveland
Seminole
West Nile Virus
Caddo Grady Greer Kiowa McClain
McIntosh
Sequoyah Haskell
Hughes Pittsburg Latimer
Le Flore
Comanche
Jackson Tillman Cotton Jefferson
Garvin
Pontotoc
Coal Pushmataha Atoka McCurtain
Stephens
Johnston Carte r Love Marshall Bryan
Choctaw
Physician
Laboratory
Adair
Regions
Cherokee
Wagoner
Delaware
Rogers
Ellis
Woodward
Garfield
Noble
Oklahoma Respiratory Virus Surveillance Summary 2006-2007
Oklahoma Influenza Activity Level No Activity
Oklahoma Weekly Report
Influenza activity as measured by sentinel physician reporting and laboratory testing in Oklahoma is no activity for the week ending May 26, 2007. The activity level was no activity due no positive influenza culture tests and a very low prevalence of influenza-like illness. The percentage of visits to sentinel physicians due to influenza-like illness conWest Nile Virus tinued to stay low with 1% (20/1939) last week 0.6% (8/1448) for this reporting period. The percentage of positive laboratory tests for influenza from sentinel laboratories remained at 0% (0/43). The percent positivity of respiratory syncytial virus (RSV) from sentinel laboratories increased slightly from 1.3% (1/77) to 2.3% (1/44) this past week. Adenovirus and parainfluenza activity was detected in the Tulsa and Oklahoma County areas. This summary will be the last weekly report of the influenza and respiratory virus season. Between June and September, reports will be provided on a monthly basis.
United States Influenza Activity Map
National Map of Weekly Activity Level Estimates CDC Influenza Summary Update
Weekly Influenza Activity Levels, Oklahoma, 2006-07
Week Oct 7 Oct 14 Level No Activity No Activity Week Dec 16 Dec 23 Level Week West Nile Virus Regional Regional Feb 24 Mar 3 Level Widespread Widespread Week May 5 May 12 Level No Activity No Activity
Oct 21 Oct 28 Nov 4 Nov 11 Nov 18 Nov 25 Dec 2
Dec 9
No Activity No Activity No Activity No Activity No Activity No Activity Sporadic
Local
Dec 30 Jan 6 Jan 13 Jan 20 Jan 27 Feb 3 Feb 10
Feb 17
Regional Regional Regional Regional Widespread Widespread Widespread
Widespread
Mar 10 Mar 17 Mar 24 Mar 31 Apr 7 Apr 14 Apr 21
Apr 29
Widespread Regional Local Local Sporadic Sporadic Sporadic
Sporadic
May 19 May 26
No Activity No Activity
West Nile Virus
Oklahoma Influenza and Respiratory Laboratory Surveillance Data
Percent Influenza-like Illness from Sentinel Physician Patient Visits by Week, Oklahoma, 2006-2007
20 18
West Nile Virus
Percent Influenza-like Illness
16 14 12 10 8 6 4 2 0
7 4 2 9 6 3 3 7 14 21 28 11 18 25 16 23 30 13 20 27 10 17 24 10 17 24 31 14 21 28 5 12 19 26
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
Week Ending May 26, 2007
Figure1. Weekly Percent of Influenza-like Illness Based on Total Sentinel PhysicianI Patient Visits and Percent of Positive Influenza Tests from Sentinel LaboratoriesII by Specimen Collection Date, Oklahoma, October 7, 2006-May 26, 2007
14
100 90 80
Percent Positive
Percent Influenza-like Illness
12 10 8 6 4 2 0
7 14 21 28 4 11 18 25 2 9 16 23 30 6 13 20 27 3 10 17 24 3 10 17 24 31 7 14 21 28 5 12 19 26 27
70
West Nile Virus
60 50 40 30 20 10 0
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
%ILI
† II
% Positive
30 sentinel physicians geographically distributed among 18 coun ties in Oklahoma. Ten Sentinel laboratories located across Oklahoma.
Number and Percent of Sentinel Laboratory Viral Tests Positive for Influenza by Week, Oklahoma 2006-2007
275 250
Number of Isolates
175 150 125 100 75 50 25 0
7 14 21 28 4 11 18 25 2
West Nile Virus
9 16 23 30 6 13 20 27 3 10 17 24 3 10 17 24 31 7 14 21 28 5 12 19 26
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007 A (UNK)*
†
A (H3N2)
A (H1N1)
B
% Positive
Oklahoma sentinel physicians and laboratories submit a sample of specimens to the Oklahoma Public Health Laboratory during influenza season for viral identification.
*Influenza type A (UNK) - Sub-typing not performed or results pending
Percent Positive
225 200
48 44 40 36 32 28 24 20 16 12 8 4 0
Weekly Percent of Influenza-like Illness Based on Total Sentinel Physician Patient Visits and Percent of Positive Influenza Tests from Sentinel Laboratories by Specimen Collection Date, Northwestern Oklahoma, October 7, 2007-May 26, 2007
Percent Influenza-like Illness
20 18 16 14 12 10 8 6 4 2 0
7 4 2 9 14 21 28 11 18 25 16 23 30 13 20 27 10 17 24 10 17 24 31 14 21 28 12 19 26
West Nile Virus
6 3 3
60 55 50 45 40 35 30 25 20 15 10 5 0
7 5
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
% ILI
% Positive
Percent Positive
Weekly Percent of Influenza-like Illness Based on Total Sentinel Physician Patient Visits and Percent of Positive Influenza Tests from Sentinel Laboratories by Specimen Collection Date, Northeastern Oklahoma, October 7, 2006-May 26, 2007
Percent Influenza-like Illness
10 9 8 7 6 5 4 3 2 1 0
7 4 2 9 6 3 3 7 14 21 28 11 18 25 16 23 30 13 20 27 10 17 24 10 17 24 31 14 21 28 5 12 19 26
West Nile Virus
50 45 35 30 25 20 15 10 5 0 40
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
% ILI
% Positive
Percent Positive
Weekly Percent of Influenza-like Illness Based on Total Sentinel Physician Patient Visits and Percent of Positive Influenza Tests from Sentinel Laboratories by Specimen Collection Date, Southwestern Oklahoma, October 7, 2006-May 26, 2007
Percent Influenza-like Illness
40 35 30 25 20 15 10 5 0
7 4 2 9 6 3 3 7 14 21 28 11 18 25 16 23 30 13 20 27 10 17 24 10 17 24 31 14 21 28 5 12 19 26
West Nile Virus
55 50 45 40 35 30 25 20 15 10 5 0
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
% ILI
% Positive
Percent Positive
Weekly Percent of Influenza-like Illness Based on Total Sentinel Physician Patient Visits and Percent of Positive Influenza Tests from Sentinel Laboratories by Specimen Collection Date, East Central Oklahoma, October 7, 2006-May 26, 2007
Percent Influenza-like Illness
12 10 8 6 4 2 0
7 4 2 9 6 3 3 7 14 21 28 11 18 25 16 23 30 13 20 27 10 17 24 10 17 24 31 14 21 28 5 12 19 26
West Nile Virus
65 60 55 50 45 40 35 30 25 20 15 10 5 0
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
% ILI
% Positive
Percent Positive
Weekly Percent of Influenza-like Illness Based on Total Sentinel Physician Patient Visits and Percent of Positive Influenza Tests from Sentinel Laboratories by Specimen Collection Date, Southeastern Oklahoma, October 7, 2006-May 26, 2007
Percent Influenza-like Illness
20 18 16 14 12 10 8 6 4 2 0
7 4 2 9 6 3 3 7 14 21 28 11 18 25 16 23 30 13 20 27 10 17 24 10 17 24 31 14 21 28 5 12 19 26
West Nile Virus
50 45 35 30 25 20 15 10 5 0 40
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
% ILI
% Positive
Percent Positive
Weekly Percent of Influenza-like Illness Based on Total Sentinel Physician Patient Visits and Percent of Positive Influenza Tests from Sentinel Laboratories by Specimen Collection Date, Central Oklahoma, October 7, 2006-May 26, 2007
Percent Influenza-like Illness
10 9 8 7 6 5 4 3 2 1 0
7 4 2 9 6 3 3 7 14 21 28 11 18 25 16 23 30 13 20 27 10 17 24 10 17 24 31 14 21 28 5 12 19 26
West Nile Virus
35 30 25 20 15 10 5 0
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
% ILI
% Positive
Percent Positive
Weekly Percent of Influenza-like Illness Based on Total Sentinel Physician Patient Visits and Percent of Positive Influenza Tests from Sentinel Laboratories by Specimen Collection Date, Tulsa County, October 7, 2006-May 26, 2007
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0
7 4 2 9 14 21 28 11 18 25 16 23 30
West Nile Virus
75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0
7 31 14 21 28 5 12 19
Percent Influenza-like Illness
6
3
13
20
27
10
17
24
3
10
17 24
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
% ILI
% Positive
26
Percent Positive
Weekly Percent of Influenza-like Illness Based on Total Sentinel Physician Patient Visits and Percent of Positive Influenza Tests from Sentinel Laboratories by Specimen Collection Date, Oklahoma County, October 7, 2006-May 26, 2007
Percent Influenza-like Illness
8 7 6 5 4 3 2 1 0
7 14 21 28 4 11 18 25 2 9 16 23 30 6 13 20 27 3 10 17 24 3 10 17 24 31 7 14 21 28 5 12 19 26
West Nile Virus
30 25 20 15 10 5 0
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Week Ending May 26, 2007
% ILI
% Positive
Percent Positive
Weekly Percent of Positive RSV based on Total Sentinel Laboratory Testing for Oklahoma 2006-2007
60 55 50 45 40 35 30 25 20 15 10 5 0
7 4 2 9 6 3 3 7 14 21 28 11 18 25 16 23 30 13 20 27 10 17 24 10 17 24 31 14 21 28 5 12 19 26
West Nile Virus
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
Week Ending May 26, 2007
Percent of Influenza-Like Illness from Sentinel Physician Patient Visits for Oklahoma 2004-2007
20 18 16
Percent Influenza-like Illness
0
14 12 10 8 6 4 2 0
1 2 3 4 5 6 7 8 39 40 41 42 43 44 45 46 47 48 49 50 51 52 9 10 11 12 13 14 15 16 17 18 19 20 21
8
6
West Nile Virus
4
2
0
8
6
4
2
0
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
Week Ending May 26, 2007
2004-2005 %ILI Positive 2005-2006 %ILI 2006-2007
Threshold Limit Baseline
Percent of Sentinel Laboratory Viral Tests Positive for RSV by Week, Oklahoma 2004-2007
Week Ending May 26, 2007
70 65 70
Percent RSV Positive
60 65
60 55 55 50 50 45
40 35 30 25
45 40 35 30 25
West Nile Virus
20 20 15 15 10 10 5 5
0 0
42 43 41 41 40 39 39 45 47 44 45 43 48 51 47 49 46
1 49
52 5 51 3 50
3 9 2 7 1
7 15 6 13 5 11 4
10 19 9 17 8
11
12
13
14
15
16
17
18
19
20
21
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
2004-2005 %RSV Positive 2006-2007 %RSV Positive
2005-2006 %RSV Positive Threshold Baseline
West Nile Virus
Oklahoma Influenza and Respiratory Laboratory Surveillance Season Summary
2006-2007 Season Summary
• Activity low from October-January, increased in early February, and peaked in mid-February
• Relatively Similar to 2005-06 season earlier peak • Circulation of both A and B viruses through out season: – Predominant Strain Type A (H1N1) New Caledonialike (75%)
West Nile Virus
• Pediatric and young adult population primarily affected (ages 0-4 and ages 5-24)
2006-2007 Season Summary: Geographic Distribution
• Sustained Activity: • Early Activity: Various peaks and • Northwest (Peak Feb) West Nile Virus persistent activity • Tulsa • Tulsa County • Oklahoma County • Oklahoma County • Central • Southeast
• Later Activity: (Peak Feb to March) • North Central • Northeast • East Central • Southwest
2006-2007 Season Summary
• Public Health Laboratory (PHL) Summary (N=181):
– 55 positive tests for influenza: West Nile Virus • 75% (41)Type A (H1N1) New Caledonia • 4% (2) Type A (H3N2) California-like • 12 (21.4%) Type B Shanghai-like with one Malaysia-like (Not Vaccine Strain) – 3 Adenovirus – 4 Rhinoviruses – 1 Cytomegalovirus, Coxsackie virus, Echovirus – 1 HSV 1
The End
Any Questions? Thank you.
West Nile Virus
Please feel free to contact me at any time with any questions or concerns about the surveillance program.
Renee J. Powell, MPH Communicable Disease Division Oklahoma State Department of Health reneejp@health.ok.gov Phone: (405)271-4060