Spotty data suggest slow start to US flu season

The United States is seeing little sign of rising flu indicators, though some areas are reporting sporadic activity, according to health groups that are working this week to fill gaps in national flu surveillance because of the government shutdown slated to end today.

At this point in the flu season, public health workers are looking over their shoulders to see if the disease is bearing down on their cities and states, as they launch their flu immunization campaigns and ready their efforts to respond to outbreaks.

Flu activity is already unpredictable from year to year, but it can also vary dramatically between regions within a single flu season—not only in intensity, but also in the strains that are circulating. States do their own monitoring and testing, but local and state health officials depend on federal weekly flu surveillance reports as a central repository for the most recent information on flu hot spots and to learn if there are notable changes in disease severity.

Last week Centers for Disease Control and Prevention (CDC) officials said that during the shutdown, respiratory patient specimens that would normally be sent to the CDC for testing would be diverted to three state public health laboratories, in Utah, California, and Wisconsin.

Charla Haley, a public information specialist with the Utah Department of Health, said today that the Utah lab has seen no influx of samples suggesting an increase in flu activity. "We're not seeing anything out of the ordinary for this time of year," she told CIDRAP News.

No information was available at this writing from the state labs in California and Wisconsin concerning their volume of samples for testing.

With flu surveillance activities at the CDC shuttered by the lapse in federal funding, the Association of State and Territorial Health Officials (ASTHO) this week conducted a scan of state influenza Web sites to provide its members with some situational awareness to share with states.

Paul Jarris, MD, MBA, ASTHO's executive director, told CIDRAP News that there are low numbers of lab-confirmed flu illnesses being reported across the country. "States are reporting 'no' to 'sporadic' activity as of October 15th," he said, adding that the group has asked states to share any additional information they have so that ASTHO can fine-tune its information. The organization is also compiling news reports describing local flu activity to share with its members.

"We cannot begin to replace or replicate the depth of surveillance and analysis that CDC provides and remain hopeful that they will return soon to provide this critical information," he said.

Claire Hannan, MPH, executive director of the Association of Immunization Managers (AIM) said the group has also queried its members about flu activity in their areas in an effort to gauge current flu activity. So far there's not a lot of activity, she said. AIM compiled the results of its queries and sent a report to its members today.

Responses indicate that Tennessee isn't seeing any signs of notable flu activity, and Rhode Island saw no flu activity for the previous week, which a state official there said was consistent for the same time last year.

Kentucky and West Virginia health officials told AIM that those states have no confirmed flu cases so far this year. Illinois reported no activity as of last week.

An official from the Arizona Department of Health Services (ADHS) pointed to its surveillance report for the week ending Sep 27, which showed sporadic activity, with four confirmed cases reported from two counties. Flulike activity at sentinel schools showed a slight decrease from the previous week.

New Hampshire officials told AIM that its status for the week ending Oct 12 will be "no activity," with no lab-confirmed flu and no increase in acute respiratory illness.

A health official from Louisiana told AIM that for the week ending Oct 5, which marks the first report for the 2013-14 season, the state is reporting sporadic activity.

FluTrackers, an international infectious disease message board that has been operating since 2006, has about 30 regular volunteer contributors who spend part of their time routinely monitoring flu activity in all 50 states, plus US territories.

Sharon Sanders, FluTrackers editor-in-chief, told CIDRAP News that Web traffic to the group's site has been running a little above average for this time of year. She said interest in novel coronavirus and H7N9 is driving some of the spike in activity, but interest about flu in the United States is also higher than normal.

Sanders said FluTrackers analysts, who sift through state health department reports and news stories, are in a good position to offer an assessment of current US flu activity. "Both Texas and Florida are starting to trend up for influenza in weeks 39 and 40, respectively," she said, adding that volunteers are also following up on flu statuses reported by California and Florida.

She noted that the government shutdown has also affected some of the group's state coverage; the team usually uses information from CDC's FluView and Morbidity and Mortality Weekly Report (MMWR) to form the baseline of its US coverage.

Other groups have also stepped forward to help fill some of the flu surveillance void. A private company called athenaResearch, a unit of a firm that provides electronic health records, is posting its own weekly flu reports based on insurance claims filed by about 15,000 primary care providers in 49 states. It uses cloud-based software to monitor trends in the practices.

For the week ending Oct 13, the company said in a blog post today that it sees no signs of a flu outbreak and that the number of patients getting vaccinated continues to increase. The current report shows that 4.9 in 10,000 patients were diagnosed with flu by primary care providers, a very slight increase from 4.8 per 10,000 reported the previous week.

Direct Relief, a nonprofit charitable group that distributes prescription medications to all 50 states, on Oct 12 issued a report that it produced on current flu patterns, based on information from open-source tools such as Google Flu Trends and information from nonprofit community health centers and clinics.

The report says flu activity is slightly lower than at the same point last year, but with risks higher in Southern states from New Mexico to Arkansas and Louisiana, with Nevada also showing higher levels of activity compared with this time last year.

Direct Relief also issued a list of 10 cities that may be at higher risk, considering current flu activity and populations of younger and older people that might be at higher risk of flu complications.  The first five metropolitan areas on the list are Dallas-Ft Worth, Oklahoma City, San Antonio, Tulsa, and Albuquerque.

Looking north of the US border, Canada saw flu levels remain at interseasonal levels for the week ending Oct 5, according to an Oct 11 update from the Public Health Agency of Canada (PHAC). Though doctor's visits for flulike illness have increased over the past 3 weeks, few flu viruses have been detected, according to the report.

South of the border, Mexico has reported a recent rise in respiratory virus activity, according to an Oct 9 update from the Pan American Health Organization (PAHO). Of 240 samples testing during epidemiologic week 38, 10.4% were positive for influenza. About 58% of those were H3N2, and 29% were the 2009 H1N1 virus.

Meanwhile, the Oct 14 flu surveillance update from the World Health Organization (WHO) offered few clues about flu activity in the United States, aside from what the CDC had already reported before the government shutdown.

Gregory Hartl, a spokesman for the WHO, said member states are required to report unusual events or novel influenza viruses to the WHO under International Health Regulations, but there is no obligation to report seasonal flu activity.

News editor Robert Roos contributed to this story.

See also:

ADHS flu activity report

Oct 12 Direct Relief press release

Oct 16 AthenaHealth blog post

Oct 11 PHAC weekly flu report

Oct 9 PAHO flu surveillance update

FluTrackers US seasonal flu forum

Oct 11 CIDRAP News story "Suspension of CDC flu tracking raises concern"

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