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Pandemic Influenza: What Occurred in Wisconsin? Spring and Summer 2009

Pandemic Influenza: What Occurred in Wisconsin? Spring and Summer 2009. Shaun Truelove Bachelor of Science, Biology Master of Public Health Candidate University of Wisconsin-Madison Graduate Intern Bureau of Communicable Disease Wisconsin Division of Public Health. Overview. Background

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Pandemic Influenza: What Occurred in Wisconsin? Spring and Summer 2009

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  1. Pandemic Influenza: What Occurred in Wisconsin?Spring and Summer 2009 Shaun Truelove Bachelor of Science, Biology Master of Public Health Candidate University of Wisconsin-Madison Graduate Intern Bureau of Communicable Disease Wisconsin Division of Public Health

  2. Overview • Background • Significance • Methods • Findings • Discussion • Conclusion

  3. Background:2009 H1N1 Influenza Outbreak Outbreak in the U.S. • April 15: First confirmed case in U.S. • April 25: WHO declares “Public Health Emergency” • April 15-July 31: 9,000 to 21,000 hospitalizations in U.S. Outbreak in WI • April 23: First confirmed hospitalization (Milwaukee) • July 15: Outbreak peaks in WI • >6,000 confirmed or probable cases through July 31 • April 23-August 15: 253 hospitalizations in WI

  4. Significance of Hospitalized Patient Surveillance 2009 H1N1 Surveillance • Emerging pandemic due to novel influenza virus • Symptoms, risk factors, and severity of illness • Poor historical surveillance of influenza outbreaks and seasonal Hospitalized Patients • Effective measure of the disease • Consistent testing and confirmation • Accurate depiction of illness severity • Most reliable sources of illness info in this pandemic

  5. Project Methods Study Type • Prospective surveillance of WI / Case series Data collection • 16-page CDC case report form • Collaboration with Infection Control Practitioners Subjects • 253 Hospitalized WI Residents • Hospitalized due to H1N1 virus • RT-PCR confirmed 2009 H1N1 Influenza A infection • ≥24 hour hospitalization

  6. Findings Demographics • 57% Female • 37% of patients <18 yr old • 89% of cases from Madison or Milwaukee • 48% African American, 29% non-Hispanic white, 16% Hispanic, and 8% Asian Symptoms • Fever - 79% • Influenza-like illness - 66% • Nausea, vomiting, or diarrhea - 35% Diagnostics • 11% with positive bacterial cultures • 54% with abnormal radiographic imaging, suggestive of pneumonia

  7. FindingsUnderlying Conditions

  8. FindingsImportance of Timely Antiviral Treatment

  9. Discussion Limitations • Surveillance-based data • Only hospitalized cases • Lack of laboratory data Strengths • Prospective study • Statistically significant findings • Influenza outbreak data • Use of standardized case report forms and guidelines • Substantial laboratory testing capacity • Complete data for the state

  10. Conclusion • Highly concentrated outbreak in WI • Epidemiologic shift in age of patients • Traditional risk factors highly prevalent in 80% • Importance of effective and accurate surveillance • Early empiric antiviral treatment • Additional antiviral therapy for critically ill patients needed

  11. Acknowledgments • Amit Chitnis, MD, MPH • Richard Heffernan, MPH • Jeffrey Davis, MD • Jeannie Druckenmiller, SM(NRM), CIC • WI Division of Public Health • All of the ICPs who made this surveillance possible

  12. References • Reed C, Angulo F, Swerdlow D, et al. Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April-July 2009. Emerg Infect Dis 2009. • Louie J, Acosta M, Winter K, et al. Factors Associated With Death or Hospitalization Due to Pandemic Influenza A (H1N1) Infection in California. Jama 2009;302(17):1896-902. • Jain S, Kamimoto L, Bramley AM, et al. Hospitalized Patients with 2009 H1N1 Influenza in the United States, April-June 2009. N Engl J Med 2009. • Vila PM, Swain GR, Baumgardner DJ, Halsmer SE, Remington PL, Cisler RA. Health disparities in Milwaukee by socioeconomic status. Wmj 2007;106(7):366-72. • Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361(7):680-9. • Hanshaoworakul W, Simmerman JM, Narueponjirakul U, et al. Severe human influenza infections in Thailand: oseltamivir treatment and risk factors for fatal outcome. PLoS One 2009;4(6):e6051. • McGeer A, Green KA, Plevneshi A, et al. Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario, Canada. Clin Infect Dis 2007;45(12):1568-75. • Lee N, Chan PK, Choi KW, et al. Factors associated with early hospital discharge of adult influenza patients. Antivir Ther 2007;12(4):501-8. • Serum cross-reactive antibody response to a novel influenza A (H1N1) virus after vaccination with seasonal influenza vaccine. MMWR Morb Mortal Wkly Rep 2009;58(19):521-4. • Vaillant L, La Ruche G, Tarantola A, Barboza P. Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009. Euro Surveill 2009;14(33). • Nicholson KG. Clinical features of influenza. Semin Respir Infect 1992;7(1):26-37. • Babcock HM, Merz LR, Fraser VJ. Is influenza an influenza-like illness? Clinical presentation of influenza in hospitalized patients. Infect Control Hosp Epidemiol 2006;27(3):266-70.

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