Influenza Surveillance Protocol 2015/2016 Influenza Season

Transcription

1 Government of Newfoundland and Labrador Department of Health and Community Services Influenza Surveillance Protocol 2015/2016 Influenza Season 1

2 CONTENTS Introduction... 4 Purpose... 4 Objectives... 4 Surveillance Reports... 4 Other Influenza-Related Information... 5 Reporting Guidelines... 6 CASE LEVEL REPORTING... 6 CASES, Community and Hospitalized... 6 Deaths... 7 LABORATORY INDICATORS... 8 Other Respiratory Viruses... 8 Influenza Strain Characterizations... 9 Antiviral Resistance OUTBREAKS Outbreak Summaries (CNPHI) SENTINEL SURVEILLANCE FluWatch (CNPHI) Immunization Monitoring Program Active (IMPACT) SYNDROMIC SURVEILLANCE HealthLine UNKNOWN OR EMERGING/RE-EMERGING RESPIRATORY INFECTIONS Severe Acute Respiratory Infections (SARIs)/Novel Influenza Viruses, Emerging Respiratory Pathogens Unusual Respiratory Clusters/Events APPENDIX A APPENDIX B H-subtype Characterization (PHL) APPENDIX C

3 Antigenic Subtyping and Antiviral Resistance Testing (PHL) APPENDIX D Unusual Respiratory Clusters/Events

4 INTRODUCTION Timely and accurate surveillance data provided by regional partners is crucial to the overall surveillance of influenza. Influenza surveillance in Newfoundland and Labrador (NL) is achieved by integrating information from an extensive network of surveillance partners. These partners each provide a piece of the provincial influenza picture, allowing us to form comprehensive assessments of influenza activity in the province. Provincial guidance and reporting recommendations for influenza surveillance will help to ensure that data submitted provincially and nationally are standardized to allow for comparison between and among jurisdictions and also to allow NL to meet national reporting requirements. PURPOSE This document aims to provide reporting guidance to the regional surveillance partners in order to support standardized submission of data. OBJECTIVES The objectives of influenza surveillance are to continually monitor and assess the progression of influenza virus so that effective public health measures can be adopted and evaluated to best reduce the burden of illness and societal disruption attributed to the disease. These objectives are based on the Public Health Agency of Canada s (PHAC) National Influenza Surveillance Guidance Document 1. Specifically, the surveillance objectives are: early detection of influenza activity in NL; provision of timely and up-to-date information on influenza activity, including intensity, severity, risk factors for severe illness, trends and geographic spread in NL; rapid detection and reporting of unusual respiratory events or novel viruses; and monitoring of circulating strains of influenza virus, including new sub-types and changes in antiviral resistance. SURVEILLANCE REPORTS Influenza Surveillance reports are updated on a weekly basis during the influenza season and are located on the Surveillance and Disease Reports section of the Government of Newfoundland and Labrador website: National Influenza Surveillance Guidance Document-FluWatch. Retrieved September 5, 2014, from: 4

5 Regional Health Authorities may produce region specific influenza reports that include data gathered from other surveillance tools not covered in this protocol. OTHER INFLUENZA-RELATED INFORMATION Influenza immunization information is published in the Newfoundland and Labrador Immunization Manual: Section 3 Routine Immunizations Products ducts.pdf Influenza management documents are located on the Government of Newfoundland and Labrador website: 5

6 REPORTING GUIDELINES CASE LEVEL REPORTING CASES, COMMUNITY AND HOSPITALIZED In order to continue influenza surveillance and early identification of a novel virus, regions are required to continue to report information on all laboratory-confirmed influenza cases. Laboratory data, follow up with client or Infection Control Practitioner (ICP) NL Influenza Surveillance Tool Method of Data Transfer Virtual Private Network (VPN) transmission Data Elements Routine variables 2 Additional variables: influenza subtype, hospitalization status 3, ICU status, deaths 4 Immunization status to be collected for hospitalizations and deaths only. Aboriginal status collected as per pilot project. Pilot project in Labrador-Grenfell Health: aboriginal status, First Nations living on-reserve, co-morbid conditions of hospitalized clients Weekly during the influenza season. More frequent reporting may be required during outbreaks. Reporting Responsibility 5 Communicable Disease Control Nurse (CDCN) or designate, in coordination with the ICP Cases to be reported by midday Wednesday of each week. If there are no cases reported by Wednesday this indicates there were no cases for that reporting period. Dissemination by DHCS Provincial Weekly Influenza Report, PHAC Weekly Influenza Report, Provincial Seasonal Influenza Report Associated Documents Laboratory-confirmed influenza case definition page 4.5: trol/s4_diseases_preventable_by_routine_vaccination.pdf NL Influenza Surveillance Tool (Appendix A) 2 Routine variables are those that are normally collected for all diseases including demographics and laboratory details. 3 Any person admitted to hospital with laboratory-confirmed influenza or a person who develops influenza while hospitalized. 4 A death occurring in any person with laboratory-confirmed influenza with no period of complete recovery between illness and death (within 14 days of onset of symptoms) 5 These roles may vary among the RHAs. 6

7 DEATHS Method of Data Transfer Data Elements Reporting Responsibility 6 Dissemination by DHCS In order to continue influenza surveillance and early identification of novel virus, regions are required to report information on deaths of laboratory-confirmed cases. CDCN or designate, in collaboration with the ICP NL Influenza Surveillance Tool Notify by and submit data through VPN transmission Routine variables. Additional variables: influenza subtype, hospitalization status, ICU status, deaths, immunization status, and aboriginal status. As they occur and in the weekly report CDCN or designate As soon as possible from date of death Provincial Weekly Influenza Report, PHAC Weekly Influenza Report, Provincial Seasonal Influenza Report Associated Documents Laboratory-confirmed influenza case definition page 4.5: trol/s4_diseases_preventable_by_routine_vaccination.pdf NL Influenza Surveillance Tool (distributed separately) 6 This role may vary among the RHAs 7

8 LABORATORY INDICATORS OTHER RESPIRATORY VIRUSES The Public Health Laboratory (PHL) serves as the provincial testing site for the laboratory diagnosis of respiratory viruses. Testing is done for the following respiratory viruses: influenza A and B, respiratory syncytial virus (RSV), human metapneumovirus (hmpv), parainfluenza virus I, II, and III, and adenovirus. The PHL also reports nationally to the Respiratory Virus Detections Surveillance System (RVDSS) on the following respiratory viruses: influenza A and B, respiratory syncytial virus (RSV), adenovirus, parainfluenza virus I, II, and III, coronavirus and human metapneumovirus (hmpv). This information is used to confirm arrival and presence of influenza and by type/subtype; to monitor trends in the spread of the influenza virus and; to monitor trends in the proportion positive for influenza compared to other respiratory viruses. Public Health Lab (PHL) daily reports and weekly summary RVDSS weekly reports from PHAC NL Influenza Surveillance Tool (Influenza) CDC Surveillance System Method of Data Transfer Daily from PHL via confidential fax, weekly summary via Weekly from PHAC via Data Elements PHL: Number positive (all), number tested (Influenza) PHAC: Number positive, number tested (RVDSS) Reporting Responsibility Daily/Weekly (PHL) Weekly (PHAC) PHL/ PHAC PHL lab reports daily CDCN or designate reports weekly: NL Influenza Surveillance Tool (Wednesday noon) and CDC Surveillance System (Thursday) PHAC RVDSS weekly Dissemination by DHCS Weekly Influenza Report, Seasonal Influenza Report, and Communicable Disease Surveillance Monthly Disease Report Associated Documents Respiratory Virus Detections in Canada: 8

9 INFLUENZA STRAIN CHARACTERIZATIONS A proportion of the weekly influenza detections across Canada are referred to the National Microbiology Laboratory (NML) for further testing to provide strain characterization, antigenic changes as well as antiviral resistance in the circulating influenza virus strains. This is used to identify the influenza strains circulating in Canada or in each P/T and determine whether circulating strains are a good match to current season's vaccine components; to monitor changes in antigenicity of circulating influenza viruses. PHL: Influenza typing and sub-typing NML: Strain characterization and antiviral resistance Method of Data Transfer Data Elements Reporting Responsibility Dissemination by DHCS N/A Number of influenza viruses by strain (NML) Weekly during the influenza season NML Weekly during influenza season Weekly Influenza Report, Seasonal Influenza Report Associated Documents Appendix B: PHL Strategy for H-subtype Characterization Appendix C: PHL Strategy for Antigenic Subtypes and Antiviral Resistance 9

10 ANTIVIRAL RESISTANCE A proportion of the weekly influenza detections across Canada are referred to the National Microbiology Laboratory (NML) for further testing to provide strain characterization, antigenic changes as well as antiviral resistance in the circulating influenza virus strains. This is used to monitor trends in antiviral resistance among circulating influenza viruses. PHL, NML Method of Data Transfer Data Elements Reporting Responsibility Dissemination by DHCS N/A Number of influenza viruses susceptible and resistant to amantadine, oseltamivir and zanamivir by influenza type/subtype Weekly during the influenza season NML Weekly during influenza season Weekly Influenza Report, Seasonal Influenza Report Associated Documents Appendix C: PHL Strategy for Antigenic Subtypes and Antiviral Resistance 10

11 OUTBREAKS OUTBREAK SUMMARIES (CNPHI) Monitoring of outbreaks of respiratory viruses in hospitals, long-term care (LTC) facilities, schools and workplaces. Used for infection control and response. Method of Data Transfer Data Elements Reporting Responsibility Dissemination by DHCS CDCNs or designate, ICPs, PHL, Medical Officer of Health, Public Health Information Surveillance (PHIS) representatives Outbreak Summaries is a Canadian Network for Public Health Intelligence (CNPHI) application that allows for summarizing outbreak information in a systematic and standardized manner. It is a secure, web-based module. Regions are required to submit initial and final outbreak reports for all provincially notifiable diseases, including influenza, via this online application. Web-based Outbreak-specific details. Refer to Outbreak Summaries training documents As they occur CDCN or designate, ICP, PHIS representative As they occur Via CNPHI notification (by outbreak lead) Outbreaks of Influenza: Weekly Influenza Report, Seasonal Influenza Report Associated Documents NL Disease Control Manual, Chapter 1: trol/s1_introduction_to_communicable_disease_control.pdf CNPHI site: 11

12 SENTINEL SURVEILLANCE FLUWATCH (CNPHI) Method of Data Transfer Data Elements Reporting Responsibility Dissemination by DHCS This weekly surveillance tool collects information to create influenza-like illness (ILI) activity level maps, and to identify localized or widespread activity and outbreaks among the regional health authorities (RHAs). Sentinel sites include all acute and long-term care facilities as well as select schools, childcare centres, and workplaces in the province. This information will include all ILI as it is not always possible to stratify by the type of respiratory virus that is circulating. Sentinel partners (acute healthcare facilities, LTC, schools, childcare centres, workplaces) FluWatch Module in CNPHI Web-based The level of influenza activity is based on laboratory reports of influenza detections, physician consultations for ILI and reported outbreaks of ILI/influenza. Activity level is characterized as no activity, sporadic, localized or widespread. Aggregate ILI/absenteeism, total facility population, laboratoryconfirmations All sentinel site information will be collected on the Wednesday of each week and data entry must be completed by close of business on the following Wednesday. The information is transferred to the PHAC through CNPHI. CDCN/designate and/or PHIS representative, in conjunction with the sentinel site representatives Close of business each Wednesday Weekly Influenza Report, Seasonal Influenza Report Associated Documents FluWatch case definitions and Activity Level descriptions: eng.php CNPHI site: 12

13 IMMUNIZATION MONITORING PROGRAM ACTIVE (IMPACT) The Immunization Monitoring Program Active (IMPACT) is a paediatric hospital-based national active surveillance network for adverse events following immunization, vaccine failures and selected infectious diseases that are, or will be, vaccine preventable. IMPACT conducts surveillance of, and provides detailed information on, hospitalizations and deaths due to influenza. Method of Data Transfer Data Elements Reporting Responsibility Dissemination by DHCS The IMPACT site in NL is the Janeway Children s Health and Rehabilitation Centre. Only laboratory-confirmed cases of respiratory symptoms will be included. IMPACT Nurse Monitor at Janeway Children s Health and Rehabilitation Centre Secure web portal An on-line secure database Detailed case information is collected, but only aggregate age group information is provided to DHCS. These reports provide detailed clinical information about the patient, such as the presence of underlying medical conditions, occurrence of secondary bacterial infections, and information on vaccination history and antiviral treatment. Weekly Janeway Nurse Monitor reports to the national IMPACT centre. IMPACT reports to PHAC. Fridays (via PHAC) N/A Associated Documents Immunization Monitoring Program Active: 13

14 SYNDROMIC SURVEILLANCE HEALTHLINE Method of Data Transfer Data Elements Reporting Responsibility Dissemination by DHCS Monitors the number of calls related to influenza or ILI to NL s public health toll-free hotline (HealthLine). Used as an early warning/alert of increasing ILI or respiratory illness in the community. HealthLine N/A HealthLine reports the number of calls received and the number of callers that report respiratory symptoms consistent with influenza-like-illness. Included in this information is demographic variables (age, sex, RHA) and the final recommendation by the HealthLine nurse (follow up with family physician, self-care at home, E.R. visit, etc.). Weekly HealthLine Monday, all year Weekly Influenza Report, Seasonal Influenza Report Associated Documents HealthLine: 14

15 UNKNOWN OR EMERGING/RE-EMERGING RESPIRATORY INFECTIONS SEVERE ACUTE RESPIRATORY INFECTIONS (SARIS)/NOVEL INFLUENZA VIRUSES, EMERGING RESPIRATORY PATHOGENS Method of Data Transfer Data Elements Reporting Responsibility Dissemination by DHCS The investigation and control of SARIs, Novel Influenza viruses and emerging respiratory pathogens is shared among the local health authorities, P/T Ministries of Health and PHAC. Health care and public health professionals, including local health authorities and laboratories, are responsible for the identification of cases or outbreaks of SARI, as well as cases of infection with novel viruses and emerging respiratory pathogens. PHL Emerging Respiratory Pathogens and SARI Case Report Form Outbreak Summaries/Public Health Alerts Module in CNPHI Regions are asked to notify their Regional Medical Officer of Health (RMOH) and the Chief Medical Office of Health (CMOH) in real-time. A detailed case-report is to be submitted via fax to the RMOH and to the DHCS/CMOH: fax # (709) Web-based (CNPHI). As per Emerging Respiratory Pathogens and SARI Case Report Form Upon case identification or upon assessment of an unusual respiratory event. CDCN or designate, in coordination with ICP/RMOH Real-time notification via Outbreak Summaries and/or Public Health Alerts Associated Documents Emerging Respiratory Pathogens and SARI Case Report 15

16 UNUSUAL RESPIRATORY CLUSTERS/EVENTS Communication with non-traditional surveillance partners (emergency departments, networks of ICU physicians, HealthLine leads, or media) is necessary to ensure rapid identification and reporting of these events. Reporting of unusual activity is subjective as there may not be an established threshold upon which to judge current activity. Method of Data Transfer Non-traditional surveillance partners (emergency departments, networks of ICU physicians, HealthLine leads, or media) Varies with the event. Regions are asked to notify their RMOH/CMOH in real-time of all reports of an unusual respiratory cluster or event. Web-based (CNPHI). Data Elements Reporting Responsibility Dissemination by DHCS Associated Documents As required As they occur CDCN or designate, RMOH, CMOH, in coordination with the ICP and non-traditional surveillance partners. Real-time notification via Outbreak Summaries and/or Public Health Alerts (by lead investigator, not necessarily DHCS). Appendix D Examples of Unusual Respiratory Clusters/Events 16

17 APPENDIX A NL Influenza Surveillance Tool 17

18 APPENDIX B H-SUBTYPE CHARACTERIZATION (PHL) In addition to providing routine diagnostic testing, the PHL monitors influenza A hemagglutinin (H) subtype prevalence in the province through ongoing surveillance activities. Molecular characterization of H subtypes is performed with real-time RT-PCR for seasonal H1, H3, 2009 pandemic H1, and H5 strains. The following will be selected for H-subtype characterization. 1. Preseason isolates, initial seasonal isolates and 10% of subsequent isolates. 2. Isolates from persons whose influenza illness is related to international travel. To facilitate this, information on international travel must be provided. 3. Isolates obtained during peak season, usually mid-january, that are representative of the season 4. Late season isolates after the peak is over. 5. Isolates obtained during in-depth investigations of outbreaks occurring in immunized populations. To facilitate this, information on immunization history must be provided. 6. Isolates from cases of suspected animal-to-human transmission of influenza virus. To facilitate this, appropriate information must be provided. APPENDIX C ANTIGENIC SUBTYPING AND ANTIVIRAL RESISTANCE TESTING (PHL) In collaboration with the National Microbiology Laboratory, the PHL will undertake the following approach for surveillance of antigenic subtypes and antiviral resistance: 1. Preseason isolates and the first isolates of season and 10% of subsequent isolates. 2. Isolates from persons whose influenza illness is related to international travel. To facilitate this, information on international travel must be provided. 3. Isolates obtained during peak season, usually mid-january, that are representative of the season 4. Late season isolates after the peak is over. 5. Isolates obtained during in-depth investigations of outbreaks occurring in immunized populations. To facilitate this, information on immunization history must be provided. 6. Isolates from cases of suspected animal-to-human transmission of influenza virus. To facilitate this, appropriate information must be provided. 7. Isolates of a type or subtype representing a minor component (10% or less) of the season. 18

19 8. Influenza isolates that the PHL is unable to type in-house 9. Isolates from persons receiving antiviral agents or from their contacts who become ill. To facilitate this, information on case history must be provided. 19

20 APPENDIX D UNUSUAL RESPIRATORY CLUSTERS/EVENTS Reporting of unusual events may require collaboration with non-official influenza surveillance partners or groups in your area. Some examples of unusual activity include the following: Cluster or severe respiratory disease or pneumonia in families, work places or social networks Respiratory disease in humans that is associated with illness in animals Human cases of infection with any influenza virus not currently circulating in human populations An unexpected pattern of respiratory disease or pneumonia such as an increase in apparent mortality, a shift in the age group associated with severe influenza, or a change in the pattern of clinical presentation of influenza-associated disease Cluster of epi-linked SARI cases admitted to ICU or deaths. 20