ABSTRACT: The Internet has revolutionized the way public health surveillance is conducted. Georgia has used it for notifiable disease reporting, electronic outbreak management, and early event detection. We used it in our public health response to the 125,000 Hurricane Katrina evacuees who came to Georgia.
We developed Internet-based surveillance forms for evacuation shelters and an Internet-based death registry. District epidemiologists, hospital-based physicians, and medical examiners/coroners electronically completed the forms. We analyzed these data and data from emergency departments used by the evacuees.
Shelter residents and patients who visited emergency departments reported primarily chronic diseases. Among 33 evacuee deaths, only 2 were from infectious diseases, and 1 was indirectly related to the hurricane.
The Internet was essential to collect health data from multiple locations, by many different people, and for multiple types of health encounters during Georgia's Hurricane Katrina public health response.
Preventing chronic disease 11/2008; 5(4):A133. · 1.82 Impact Factor
ABSTRACT: Although influenza is common among children, pediatric mortality related to laboratory-confirmed influenza has not been assessed nationally.
During the 2003-2004 influenza season, we requested that state health departments report any death associated with laboratory-confirmed influenza in a U.S. resident younger than 18 years of age. Case reports, medical records, and autopsy reports were reviewed, and available influenza-virus isolates were analyzed at the Centers for Disease Control and Prevention.
One hundred fifty-three influenza-associated deaths among children were reported by 40 state health departments. The median age of the children was three years, and 96 of them (63 percent) were younger than five years old. Forty-seven of the children (31 percent) died outside a hospital setting, and 45 (29 percent) died within three days after the onset of illness. Bacterial coinfections were identified in 24 of the 102 children tested (24 percent). Thirty-three percent of the children had an underlying condition recognized to increase the risk of influenza-related complications, and 20 percent had other chronic conditions; 47 percent had previously been healthy. Chronic neurologic or neuromuscular conditions were present in one third. The mortality rate was highest among children younger than six months of age (0.88 per 100,000 children; 95 percent confidence interval, 0.52 to 1.39 per 100,000).
A substantial number of influenza-associated deaths occurred among U.S. children during the 2003-2004 influenza season. High priority should be given to improvements in influenza-vaccine coverage and improvements in the diagnosis and treatment of influenza to reduce childhood mortality from influenza.
New England Journal of Medicine 01/2006; 353(24):2559-67. · 53.30 Impact Factor
ABSTRACT: In the United States, influenza epidemics occur nearly every winter and are responsible for substantial morbidity and mortality, including an average of approximately 114,000 hospitalizations and 20,000 deaths/year.
This report summarizes both actively and passively collected U.S. influenza surveillance data from October 1997 through September 2000.
During each October-May in the period covered, CDC received weekly reports from 1) approximately 120 World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories in the United States regarding influenza virus isolations; 2) approximately 230, 375, and 430 sentinel physicians during 1997-98, 1998-99, and 1999-00, respectively, regarding their total number of patient visits and the number of visits for influenza-like illness (ILI); and 3) state and territorial epidemiologists regarding estimates of local influenza activity. WHO collaborating laboratories also submitted influenza isolates to CDC for antigenic analysis. Throughout the year, the vital statistics offices in 122 cities reported weekly on deaths related to pneumonia and influenza (P&I).
During the 1997-98 influenza season, influenza A(H3N2) was the most frequently isolated influenza virus type/subtype. Influenza A(H1N1) and B viruses were reported infrequently. The proportion of respiratory specimens testing positive for influenza peaked at 28% in late January. The longest period of sustained excess mortality (when the percentage of deaths attributed to P&I exceeded the epidemic threshold) was 10 consecutive weeks. P&I mortality peaked at 9.8% in January. Visits for ILI to sentinel physicians exceeded baseline levels for 7 weeks and peaked at 5% in mid-January through early February. A total of 45 state epidemiologists reported regional or widespread activity at the peak of the season. During the 1998-99 season, influenza A(H3N2) viruses predominated; however, influenza B viruses were also identified throughout the United States. Influenza A(H1N1) viruses were identified rarely. The proportion of respiratory specimens testing positive for influenza peaked at 28% in early February. P&I mortality exceeded the epidemic threshold for 12 consecutive weeks and peaked at 9.7% in early March. Visits for ILI to sentinel physicians exceeded baseline levels for 7 weeks and peaked at 5% in early through mid-February. Forty-three state epidemiologists reported regional or widespread activity at the peak of the season. During the 1999-00 season, influenza A(H3N2) viruses predominated, but influenza A(H1N1) and B viruses also were identified. The proportion of respiratory specimens testing positive for influenza peaked at 31% in mid- to late December. The proportion of deaths attributed to P&I exceeded the epidemic threshold for 13 consecutive weeks and peaked at 11.2% in mid-January. Visits to sentinel physicians for ILI exceeded baseline levels 4 consecutive weeks and peaked at 6% in late December. Forty-four state epidemiologists reported regional or widespread activity at the peak of the season.
Influenza A(H1N1), A(H3N2), and B viruses circulated during 1997-2000, but influenza A(H3N2) was the most frequently reported virus type/subtype during all three seasons. Influenza A(H3N2) is the virus type/subtype most frequently associated with excess P&I mortality. Influenza activity during all three seasons occurred at moderate to severe levels, and excess P&I mortality was reported during > or = 10 weeks each year.
CDC conducts active national surveillance during each October-May to detect the emergence and spread of influenza virus variants and to monitor influenza-related morbidity and mortality. Surveillance data are provided weekly throughout the influenza season to public health officials, WHO, and health-care providers and are used to guide vaccine strain selection, prevention and control activities, and patient care. Influenza vaccination is the most effective means for reducing the yearly effect of influenza. Typically, one or two of the influenza vaccine component viruses are updated each year so that vaccine strains will closely match circulating viruses. Surveillance data will continue to be used to select vaccine strains and to monitor the match between vaccine strains and the currently circulating viruses.
MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries / CDC 11/2002; 51(7):1-10.
ABSTRACT: Through retrospectively analyzing billions of internet search queries, Ginsberg et al. identified a collection of specific searches that track the course of influenza-like illness (ILI) reported by the US Centers for Disease Control and Prevention (CDC). Prospective monitoring during 2007-2008 found high correlation between Google estimates and CDC-reported ILI, with next-day timeliness compared to the 1-2 week delay reported in traditional CDC ILI surveillance. The assertion by Ginsberg et al., however, that internet search term estimates enable public health officials to respond better to seasonal and pandemic influenza does not take into account the current practice of public health, or the state of the art in electronic disease surveillance.