Georgia's rise in serious H1N1 cases worries CDC

[Shiloh]

Source: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/mar2910georgia.html


Georgia's rise in serious H1N1 cases worries CDC

Maryn McKenna * Contributing Writer

Mar 29, 2010 (CIDRAP News) ? Public health officials are so concerned by an uptick of serious cases of H1N1 flu in the southeastern United States that they called a short-notice press briefing today to urge Americans to be vaccinated against the pandemic strain.

Surgeon General Dr. Regina Benjamin and Dr. Anne Schuchat, director of the Centers for Disease Control and Prevention's (CDC's) National Center for Immunization and Respiratory Diseases, told reporters on a conference call that they are particularly concerned about the "worrisome trend" in Georgia, where "more than 40" people were hospitalized in the past week for lab-confirmed flu.

Since mid-February, Georgia has had more flu-related hospitalizations than any other state, as well as more than that state has seen since its flu peak in October, Schuchat said.

Last week, the CDC said that Georgia, Alabama, and South Carolina were experiencing regional activity, the second-highest level of flu activity, and the American College Health Association said that campuses in southeastern states were reporting increased cases of flu.

Schuchat said the new cases are occurring in adults with chronic medical conditions, a group that health officials have consistently urged to take the H1N1 shot. The new victims were not vaccinated, she said, adding that Georgia had one of the lowest rates of flu-vaccine acceptance last fall.

The CDC is sufficiently concerned about the Georgia cases that it has loaned a team of its disease detectives to the state Division of Public Health to investigate the cases and help crunch data. A full analysis is expected shortly, Schuchat said, but the CDC felt the Georgia signal was so concerning that they went ahead with a briefing in advance of the analysis's delivery.

"Seeing an increase in cases again in Georgia is unusual," Schuchat said. "Does that mean we're going to see that in other states? I really don't know."

Asked whether the Georgia cases might be the first blip in a feared third wave of flu, Schuchat said: "I can't say whether we'll have another wave of infection, but I'm worried about a different possibility. I'm worried that additional cases will be happening day in and day out in people who thought there was no risk anymore."

She and Benjamin both urged people who have not yet received the H1N1 vaccine to take it. "We need to get the vaccination message out to minority groups. They're not participating in the national vaccination at the rate that other population groups are," Benjamin said. "It's important to remind minority groups to get the H1N1 vaccine because we know that minorities experience higher rates of . . . chronic diseases."

About 124 million doses of H1N1 vaccine have been shipped, the two officials said, and more than 30 million remain unused.

Since the beginning of the pandemic almost a year ago, 265,000 Americans have been hospitalized for H1N1 infections and 12,000 have died, according to CDC estimates. In an average year, 36,000 Americans die of flu?but Schuchat said people should not therefore conclude the pandemic has been mild.

"Ninety percent of those people, about 11,000, are people under 65," in contrast to a normal season in which most victims are elderly, she said. "We estimate that the rate of death in young people is probably five times higher than what we would typically see with seasonal influenza."

See also:

Mar 29 CDC briefing transcript
http://www.cdc.gov/media/transcripts/2010/t100329.htm

Mar 26 CDC FluView
http://www.cdc.gov/flu/weekly/

Mar 26 CIDRAP News story "CDC sees sustained H1N1 activity in Southeast"

 

[Vibrant62]

Re: Georgia's rise in serious H1N1 cases worries CDC

Of note is that Google flu trends is not showing any especial uptick for the region over the march period.

http://www.google.org/flutrends/us/#US-GA The current incidence level shown on this tool is far below the fall peak

Therefore either GFT is not sufficiently sensitive to notice anything other than major shifts, or we could have a severity increase i.e a higher proportion of individuals affected are contracting severe disease. More data is required on this. Does anyone have access to Georgias %ILI data to cross link here?

 

[Vibrant62]

Re: Georgia's rise in serious H1N1 cases worries CDC

Hat tip GSGS (PFT)

Concerning. At this stage, hard data on the vaccination status (what proportion had been vaccinated of those currently hospitalised) would be helpful.

 

[gsgs]

Re: Georgia's rise in serious H1N1 cases worries CDC

for a pandemic it's clearly mild. Compare with other pandemics,
compare with the predictions.

Most important is now to kill the old strains (IMO),
I wonder whether vaccination against newflu might hinder this.

But then, this is probably decided in Asia anyway.
How can we support it ?
Better surveillance and vaccinating against oldflu in countries where
there is still oldflu.


Georgia ILI:
http://isds.cirg.washington.edu/distribute/countstimeseries.php?period=daily#GA
last upate March,28

Region 4: AL,FL,GA,KY,MS,NC,SC,TN

CDC region 4 (weekly):

doesn't look like a wave, but plateau at higher level

 

[Vibrant62]

Re: Georgia's rise in serious H1N1 cases worries CDC

Its the proportion of hospitalisations vs ILI that is of interest here, as well as the %ILI reports. Frankly I am more concerned by the absence of a discenable peak in %ILI to explain the (currently) high level of hospitalisations.

 

[gsgs]

Re: Georgia's rise in serious H1N1 cases worries CDC

did they eamine the viruses for genetical changes ?
presumably they did.

So, the mere fact that CDC gave a press-briefing, is it evidence
already for their concern for possible genetical changes or such ?

but then, this correlation of CDC-briefings with worrying
developments didn't work so well last year

 

[gsgs]

Re: Georgia's rise in serious H1N1 cases worries CDC

Atlanta:
deaths from P+I week 4-11 , 2010 = 98
deaths from P+I week 4-11 , 2009 = 54
total deaths week 4-11 , 2010 = 1130
total deaths week 4-11 , 2009 = 1117

average 14 years, weeks 4-11 , 1996-2009:
992,568,248,104,36,28,28
2010:
1130,737,264,79,27,23,98

Atlanta, weeks 4-11

year   all  >64  >44  >24  >1  >0  P+I
-----------------------------------------
2001:  1558  917  367  191  49  34  38 
2002:  1344  813  321  136  28  46  38 
2003:  1519  907  356  165  41  50  64 
2004:  1505  899  372  138  53  43  65 
2005:  1115  661  300   93  34  27  39 
2006:  1311  735  361  113  46  56  42 
2007:  1481  880  388  132  36  45  54 
2008:  1098  613  309  107  39  30  29 
2009:  1117  652  322   85  14  44  54
2010:  1130  737  264   79  27  23  98
------------------------------------------
 
Savannah,Ga.
--------------------------------------
2001:  429  312   71  25  14   7  38 
2002:  457  322   96  24   8   7  30 
2003:  440  299   98  15  12  16  44 
2004:  515  348  112  25  16  14  34 
2005:  514  349  123  29   6   7  40 
2006:  540  359  122  29  10  20  35 
2007:  472  315   95  42  12   8  28 
2008:  507  329  127  26  12  13  39 
2009:  495  325  119  31   5  15  38 
2010:  515  360  114  26   8   7  30
------------------------------------

so, we are seeing excess deaths from P+I in Atlanta, but not in Savannah.
And deaths from all causes are relatively low for this period of the year

 

[Vibrant62]

Re: Georgia's rise in serious H1N1 cases worries CDC

Is there similar data for hospitalisations, and by age group?

 

[gsgs]

Re: Georgia's rise in serious H1N1 cases worries CDC

see also this thread:
http://www.flutrackers.com/forum/showthread.php?t=143760

state health websites often give hospitalizations


> Laboratory-confirmed influenza-associated hospitalizations are monitored
> using a population-based surveillance network that includes the
> 10 Emerging Infections Program (EIP) sites (CA, CO, CT, GA, MD,
> MN, NM, NY, OR and TN) and 6 new sites (IA, ID, MI, ND, OK and SD).

we had a thread earlier with links
http://www.flutrackers.com/forum/showthread.php?t=110975



----------------------

4. Hospitalization Surveillance — Laboratory confirmed influenza infections in children and adults are monitored through the Emerging Infections Program (EIP).

Emerging Infections Program (EIP) —The EIP Influenza Project conducts surveillance for laboratory-confirmed influenza related hospitalizations in children (persons less than 18 years) and adults in 60 counties covering 12 metropolitan areas of 10 states (San Francisco CA, Denver CO, New Haven CT, Atlanta GA, Baltimore MD, Minneapolis/St. Paul MN, Albuquerque NM, Las Cruces, NM, Albany NY, Rochester NY, Portland OR, and Nashville TN). Cases are identified by reviewing hospital laboratory and admission databases and infection control logs for children and adults with a documented positive influenza test (viral culture, direct/indirect fluorescent antibody assay (DFA/IFA), reverse transcription-polymerase chain reaction (RT-PCR), or a commercial rapid antigen test) conducted as a part of routine patient care. EIP estimated hospitalization rates are reported every week during the influenza season.
--------------------------------

http://health.state.ga.us/eip/

http://health.state.ga.us/eip/eipConference10.asp
Emory Conference Center on March 31, 2010
8:50-9:30 am Influenza—Tony Fiore

 

[gsgs]

Re: Georgia's rise in serious H1N1 cases worries CDC

http://health.state.ga.us/epi/graphs/ILI 2009-10.gif
http://health.state.ga.us/epi/graphs/Syndromic Surveillance feverflu 2009-10.gif
http://health.state.ga.us/epi/graphs/Influenza weekly report-2009.doc
(is there a chart for EIP here ? I get an error when loading this)

 

[Vibrant62]

Re: Georgia's rise in serious H1N1 cases worries CDC

Thanks GSGS

To visualise - but we should note that data from the last couple of weeks - which are the cause of concern, are not yet included in these charts. Still it will give us a comparator when that data is made available.

Still not giving hospitalisation stats, and I am getting error too.

No increase in %ILI it would seem up to the beginning of March in any event.

 

[gsgs]

Re: Georgia's rise in serious H1N1 cases worries CDC

bump

(March updated)