Issue 28 - With Dearth of Influenza Vaccine, Early Event Detection is Invaluable

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With Dearth of Influenza Vaccine, Early Event Detection is Invaluable
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A few months ago, who would have thought that the United States could have an influenza vaccine shortage this year? In fact, October is nearly over, and we have only half the expected amount of influenza vaccine available for the 2004-2005 season.

While rumblings of problems were being emitted from Chiron Corporation as early as August (and the USDA was warned September 13th that problems of contamination with Serratia marcescens were not resolved) the crisis wasn’t recognized until October 5th, when Chiron announced the UK had suspended its license to produce Fluviron ®, and no doses would be available for US customers. (1)(2)

Whether this vaccine shortage results in increased influenza morbidity and mortality remains to be seen, but public health departments and hospitals that have early warning systems such as syndromic surveillance are in a much better position to gauge the extent of the outbreak and take appropriate measures to control the spread of this virus.

Fortunately, influenza is one of the diseases that can be recognized easily and early by syndromic surveillance. As reported in this newsletter in April 2004 (3), a number of agencies have found that syndromic surveillance is particularly useful for staying on top of the influenza season as it develops, allowing them to alert the medical community to test for influenza, heighten infection control measures in hospitals and doctors’ offices, and treat high-risk patients appropriately.

Not included in the April 2004 RedBat Alert discussion, several additional articles discuss the benefits of various types of early event detection, including syndromic surveillance. Recently, researchers at the Minnesota Department of Health using the HealthPartners Medical group data reported that when persons > 65 were placed in a separate influenza-like illness category, a statistically significant signal could be identified 3 weeks before the first positive influenza isolate. (4)

Also, a report studying web site usage for “influenza-related” articles, and another one using emergency room telephone triage (TT) data offer possibilities for additional early warning data sources. The study using telephone triage data found that that emergency room TT data is “one to five weeks ahead of surveillance data collected by the CDC”. (5) (6)

Thus, in the situation we now face with lack of influenza vaccine, health systems that have current data through early event detection will be able to prove what their influenza caseload is and argue more effectively for what little vaccine remains and for additional doses when more becomes available in January. They can work with hospitals on surge capacity preparedness issues. They should also alert the public when a local outbreak begins and encourage hand washing, respiratory etiquette, and staying home from work when ill.

The national influenza surveillance and control programs in the United States can still be improved. In fact, a recently released draft of the Pandemic Influenza Preparedness and Response Plan (7) (8) makes it clear that the U.S. Department of Health and Human Services (HHS) feels it is critical that we strengthen US surveillance for influenza by expanding it to ‘year-around’ surveillance and developing hospital-based surveillance of severe respiratory illness. Doing so will help alert us to the next pandemic strain, and could save many lives when that occurs.

(1) Frankel, Glenn et al. The Washington Post. Saturday October 8, 2004. Page A01. Accessed at: http://www.washingtonpost.com/wp-dyn/articles/A18795-2004Oct8.html

(2) http://www.chiron.com/investors/pressreleases/press_release100504.pdf

(3) www.redbatalert.com

(4) Miller, Benjamin et al, Syndromic Surveillance for Influenzalike Illness in Ambulatory Care Settings. Emerging Infectious Diseases. October 2004. Accessed at: http://www.cdc.gov/ncidod/EID/vol10no10/03-0789.htm

(5) Johnson, Heather et al. Analysis of Web Access Logs for Surveillance of Influenza. Technical Report. November 2003. Accessed at:
http://cmbi.bjmu.edu.cn/news/report/2004/medinfo2004/pdffiles/papers/5485Johnson%20H.pdf

(6) Espino, Jeremy et al. Telephone Triage: A Timely Data Source for Surveillance of Influenza-like Diseases. Proc AMIA Fall Symposium., Omni Press CD, pp 215-219, 2003. Accessed at http://rods.health.pitt.edu/LIBRARY/AMIA_2003_TelephoneEspino.pdf

(7) http://www.hhs.gov/nvpo/pandemicplan/finalpandemiccore.pdf

(8) American Health Consultants. Hospital Infection Control. Real Threat of Pandemic Flu Makes Influenza Draft Report Plan a Page Turner. October 2004 31: 10. pp 121-126

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