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INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

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Page 1: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

INFLUENZA SURVEILLANCE

Julie L Freshwater, MPH PhD

Influenza Surveillance Coordinator

Page 2: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Objectives2

Define public health surveillance List the importance and uses of

surveillance data Identify data quality issues Discussion to identify strategies to

improve data and data quality issues

Page 3: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

“Ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health”Centers for disease control and prevention, 2001

PUBLIC HEALTH SURVEILLANCE3

Page 4: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Components of West Virginia’s Influenza Surveillance System

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Local Health Department (LHD) Schools Providers

ILINet Providers (ILINet) Sentinel Providers

Laboratories (Labs) Sentinel Hospital Commercial Office of Laboratory Services (OLS)

Page 5: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Local HealthDepartments (LHD)

Sentinel Providers(ILINet)

Office of Laboratory Services (OLS)

Hospital/referral laboratories

DIDE

CDC

Influenza-like Illness (ILI)

Laboratory Data

Feedback to Stakeholders

Influenza Surveillance in West Virginia

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Page 6: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

System Objectives6

Identify earliest case of influenza A in the state

Estimate duration of season Identify outbreaks Determine if circulating types of

influenza are vaccine-strain

Page 7: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Surveillance Data Use7

Inform the stakeholders by

Graphs

Maps

Newsletters

Page 8: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Influenza Data Use8

Healthcare providers and hospitals Public health departments General public CDC WHO FDA Vaccine manufacturers

Page 9: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

SURVEILLANCE FOR INFECTIOUS DISEASES

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Surveillance method Flexible Sensitive

Surveillance data Representative Timely Accurate and complete

Page 10: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

THREATS TO DATA QUALITY10

1. Lack of representativeness

2. Under-reporting

3. Inconsistent case definitions

4. Poor data quality

5. Lack of timeliness

Page 11: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

1. LACK OF REPRESENTATIVENESS

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Data does not reflect the entire population under surveillance

Page 12: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Representativeness of West Virginia Influenza Surveillance Data 201012

Local health departments’ data 5 smallest counties data from 90% of

providers 5 largest counties data from 29% of providers

ILINet 61% from rural 36% from small town

Page 13: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Provider Demographics13

Family practice (61%) Emergency Department (16%); Urgent Care (8%) Internal Medicine and Pediatrician (5%

ea) Student Health (3%) Infectious Diseases and Health

Department (1% ea)

Page 14: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Improving Representativeness of ILINet Data in your region

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Population of your county?

Demographics? ILINet providers see a representative

sample of the population?

How would you improve

representativeness?

Page 15: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Improving Representativeness of LHD ILI Data in your region

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The state now has access to school absentee data, is there another source of data that could be collected at the local level?

Can the method of data collection be improved?

Page 16: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

2. UNDERREPORTING16

Lack of awareness to report

Negative attitude toward reporting

Misconceptions that arise from lack of

knowledge or negative attitude

Page 17: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Improving Reporting of West Virginia Influenza Surveillance Data 201017

Provide frequent feedback

Could lack of knowledge of how data is used be a barrier?

How do you communicate with your providers?

Page 18: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

3. INCONSISTENT DEFINITIONS

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Providers may use clinical criteria that differs from the public health case definition

Case definition may change over time and not all reporters use most current version

Page 19: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Case Definition Use in West Virginia Influenza Surveillance Data 201019

ILINet Providers 53% use CDC case definition exclusively

Some use multiple case definitions

Page 20: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Improving Case Definition Use for ILINet West Virginia Surveillance Data20

Does your sentinel provider use the CDC case definition exclusively to report ILI?

What strategies have been used in your region to improve the use of the ILI case definition?

What recommendations do you have to improve the use of the ILI case definition by sentinel providers?

Page 21: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

4. POOR DATA QUALITY21

Incorrect information

Missing data elements

Duplicate records

Inconsistent information

Across geographic areas

Across reporters

Page 22: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Improving Data Quality for West Virginia Influenza Surveillance Data22

Is the data complete to ILINet? Does the sentinel provider send 2

specimens a week to OLS for testing?

Page 23: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

5. LACK OF TIMELINESS23

Disease dependent reasons

Procedure dependent reasons

Time of report submission/processing

Delay in surveillance analysis

Delay in dissemination

Page 24: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Timeliness of influenza reporting January through May 2011 in West Virginia24

LHD <2 weeks of missing data :36 Reported late <2 times: 34

ILINet <2 weeks of missing data :12 Reported late <2 times: 17

Page 25: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Improving Timeliness for West Virginia Influenza Surveillance Data25

Issues with timeliness of reporting by sentinel providers?

Issues with timeliness of reporting by your LHD?

Any strategies to improve timeliness?

Recommendations for improving timeliness?

Page 26: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Specimens26

Isolates provide specific information

Compare

Guide

Formulate

Monitor

Page 27: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

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“A robust sentinel provider system is

one of the best and most efficient means

to staying prepared for novel and

seasonal influenza because the

combination of surveillance for ILI and

laboratory confirmation carries

preparedness to the local level.  We

recognize this may not be feasible in

some of the smallest counties, however

the track record of success for many

counties is readily apparent from the

data.”

Page 28: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

For Discussion28

List of questions

ILINet reporting data

LHD reporting data

Specimen submissions to OLS

County population data

Page 29: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

Thanks to29

Dr. Dee Bixler Dr. Tegwin Taylor UNC Center for Public Health Preparedness Local Health Departments Sentinel providers and those in the office

that compile and report the data Laboratories OLS Grant from the CDC

Page 30: INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator

QUESTIONS?

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