Download Table 1. Cuyahoga County Influenza Data Dashboard

November 9 - November 15, 2014 (MMWR Week 46)
Highlights
For the 7th straight week, local flu activity is considered ‘low’. The local activity rating scale definition can be found
http://www.ccbh.net/storage/flu/Cuyahoga%20County%20Flu%20Activity%20Level%20Definitions%2011.06.14.pdf
Pneumonia related deaths accounted for 3.6% of all deaths. No flu related deaths so far this flu season.
One confirmed case of flu associated hospitalization were reported this week.
Percentage of doctor’s visits for flu like symptoms provided by athenahealth increased for 4th straight week.
Number of emergency room visits due to flu like illness increased this week; 4rd straight week total was above the 5-year median.
Local Flu Activity Dashboard
Current Week Flu Activity
X
Low
Mod
High
(All data are preliminary and may change as updated information are received.)
Oct
Weekly
Intensity
Nov
Dec
Jan
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1
Feb
2
3
4
5
Mar
6
7
Apr
May
8
9 10 11 12 13 14 15 16 17 18 19 20
# Weeks123
2014-2015 Season
Total/Trend
Trending slightly above 5
year median. No flu deaths.
Table 1. Cuyahoga County Influenza Data Dashboard
Influenza (Flu) Indicator
Percent of pneumonia deaths & number
of flu related deaths - [Fig 1]
Influenza like illness (ILI) doctor
visits [Fig 2]
Current
Activity Level
Pneumonia: 3.6%
Flu: 0 deaths
Cuyahoga: 1.71%
32.6%
26.1%
(5)
Athenahealth: 0.29%
1
Flu associated hospitalizations [Fig 3]
School absenteeism due to ILLNESS
ONLY – [Fig 4A]
Cleveland:
Northeast:
Northwest:
Southeast:
Southwest:
School absenteeism due to ALL
CAUSES – [Fig 4B]
Northeast: 2.2%
Northwest: 3.9%
Southeast: N/A
Southwest: N/A
Sentinel: 3.9%
N/A
2.1%
2.7%
1.8%
2.7%
N/A
N/A
N/A
(5.3%)
(14.8%)
2
N/A
N/A
N/A
3
1
N/A
1
N/A
N/A
4
1
Emergency room visit due to ILI [Fig 5]
2.8%
Sales of over-the-counter medications
used to treat ILI. [Fig 6]
Congestion & cough complaints [Fig 8}
Vomiting & nausea complaints [Fig 9]
341
(1.7%)
1
668
633
196
(2.9%)
(2.5%)
3.7%
1
1
1
Due to small percentages in figures 1-2, 4A, & 4B, caution should be used while interpreting the ‘Activity Compared to Last Week’ box.
3
1
6
2
1
1
N/A
30.0%
N/A
N/A
8.3%
7.7%
Diarrhea complaints [Fig 10]
1
Activity Compared
to Last Week
47.1%
Stable
For figures 1,2,4a & 4b,
= (Increase > 20%),
= (Decrease > -20%),
= Stable (-19.9% to +19.9%)
For figures 5-6 & 8-10,
= (Increase > 10%),
= (Decrease > -10%),
= Stable (-9.9% to +9.9%)
Page 1 of 8
athenahealth ILI visits slightly
increasing since week 40.
N=14. Close to 5 yr median.
All locations trending below
the 5 year median.
All locations trending below
5 year median.
Above 5 year median.
Above 5 year median.
Avg ~ 330
Near 3 yr median. Avg ~ 605
Above 3 yr median. Avg ~ 595
Above 3 yr median. Avg ~ 150
November 9 - November 15, 2014 (MMWR Week 46)
Flu Summary
This report is intended to provide an overview of influenza related activity occurring in Cuyahoga County while
providing some information on state activity that is one week behind the current week. It will be published on a
weekly basis and can be found at the following website: http://www.ccbh.net/flu-weekly-surveillance-report/
Note: Data are provisional and subject to change. Updates will be included in future reports.
Pneumonia and Influenza (P&I) Mortality
3.6% of all deaths reported to the Cleveland Bureau of Vital Statistics were due to pneumonia. Adults 75 years old
and older accounted for 55.6% of the pneumonia related deaths. No influenza related deaths occurred this week
(Figure 1).
Influenza-Like Illness (ILI) Reports
One ILI sentinel provider reported no patients had ILI symptoms this week. Athenahealth reported that 0.29% of
patients had flu-like symptoms this week and 0.23% for week 44 (Figure 2). ILI is defined as a fever (≥ 100◦ F), and
cough and/or sore throat.
School Absenteeism
Participating schools in Cuyahoga County reported the percentage (median = 2.7%) of absenteeism due to any illness
on Tuesday (Figure 3A). Figure 3B shows the total absenteeism due to any reason (median = 3.8%).
Influenza-Associated Hospitalizations and Influenza-Associated Pediatric Mortality
One confirmed case of influenza-associated hospitalization in Cuyahoga County was reported this week and 6 cases
for week 45 (Figure 4). Twenty-two statewide confirmed influenza associated hospitalizations this week. No pediatric
flu related deaths have occurred so far this season.
Emergency Department (ED) visits and Over-the-Counter Medication Sales
2.8% of all ED visits were for fever + ILI symptoms. Approximately 55 more patients visited EDs for fever and ILI
symptoms this year compared to 2013 (Figure 5). Figure 6 shows approximately 190 more OTC products per
drugstore were purchased this year than in the same period in 2013. Figure 7 shows the frequency of ED visits for
fever and ILI by zip code.
Three other maps show, by zip code, the frequency of ED visits for three symptoms that are common during the fall
and winter seasons and are of interest to the general public: congestion and cough (Figure 8), vomiting and nausea
(Figure 9), and diarrhea (Figure 10).
Descriptions of data sources used to complete the weekly influenza write-up can be found on the last page of this
report.
Additional Influenza Activity Links
 Weekly U.S. Influenza Surveillance Report – http://www.cdc.gov/flu/weekly
 Ohio Influenza Surveillance – http://www.odh.ohio.gov/features/odhfeatures/seasflu/ohfluactivity.aspx
 Google flu trends – http://www.google.org/flutrends
Page 2 of 8
Figure 1. Percentage of Deaths Due to Pneumonia and Influenza (P&I)
Cleveland Bureau of Vital Statistics
10.0%
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1
Percent Pneumonia
2 3 4 5 6
MMWR Week
Percent Influenza
7
8
9 10 11 12 13 14 15 16 17 18 19 20
5 Yr Median P&I 2009/2010-2013/2014
Figure 2. Percent of Influenza-Like Illness (ILI) Visits U.S. Influenza Sentinel
Provider Surveillance Network and ILI visits data via athenahealth
2.00%
1.75%
ILI Visits
1.50%
1.25%
1.00%
0.75%
0.50%
0.25%
0.00%
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 2 3 4 5
MMWR Week
Cuyahoga County
6 7
8
9 10 11 12 13 14 15 16 17 18 19 20
athenahealth
Hospitalizations
Figure 3. Numbe r of Influenza-Associated Hospitalizations in
Cuyahoga County (using ev ent date)
20
18
16
14
12
10
8
6
4
2
0
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20
MMWR Week
Current Year
5 Year Median 2009-2010 - 2013-2014
Page 3 of 8
Figure 4a. School Absenteeism (Due to any Illness) in Cuyahoga County
6.0%
N
O
Median Percent
5.0%
4.0%
S
C
H
O
O
L
3.0%
2.0%
1.0%
0.0%
40
41 42
43
44
45 46
47
48
49
50 51
52
53
1
4-year Median
Northwest Suburbs
2
3
4
5
6
MMWR Week
Cleveland
Southeast Suburbs
7
8
9
10
11
12
13
14 15
16
17
18 19
20
Northeast Suburbs
Southwest Suburbs
Figure 4b. School Absenteeism (Due to any Reason ) in Cuyahoga County
8.0%
7.0%
N
O
Median Percent
6.0%
5.0%
S
C
H
O
O
L
4.0%
3.0%
2.0%
1.0%
0.0%
40
41
42
43
44
45 46
47
48
49
5-year Median (Sentinel Sites)
50
51
52
53
Sentinel Sites
1
2
3
4
5
MMWR Week
Northeast Suburbs
Page 4 of 8
6
7
8
9
10
Northwest Suburbs
11
12
13
14 15
16
Southwest Suburbs
17
18
19
20
Figure 5. Cuyahoga County Hospital ED Visits for ILI & Fever Symptoms by Age Group
240
210
ED Visits
180
150
120
90
60
30
0
40
41
42
43
O - 4 Years Old
44
45
46
47
48 49
5 - 24 Years Old
50
51
52
53
1
25 - 49 Years Old
2
3
4
5
MMWR Week
6
50 - 64 Years Old
7
8
9
10
11
12 13
65 Years and Older
14
15
16
17
18
19
20
5 Year Median (2009/2010 - 2013/2014)
Figure 6. Comparison of Average Weekly OTC Products Sold in Cuyhaoga County Drugstores
400
350
OTC Products
300
250
200
150
100
50
0
40
Antifever
41
42
43
44
45
Cold_liquid_ped
46
47
48
49
50
Cold_tablet_ped
51
52
53
1
2
3
4
5
MMWR Week
Cough_syrup_ped
6
Electrolytes_ped
Page 5 of 8
7
8
9
10
11
Thermometers
12
13
14
15
16
17
18
19
20
5 Year Median (2009/2010 - 2013/2014)
Figure 7 Frequency of Fever and Influenza-Like
Illness Complaints by Zip Code
Frequency
0-2
3-8
44140
44107
44116
44145
44111
44126
44070
44138
44119
44117
44110
9 - 16
17 - 29
44108 44112
44114 44103 44106
44144
44135
44142
44017
44129
44130
44105
0-8
44140
44145
44116
44126
44070
44138
21 - 43
44107
44111
44135
44142
44017
44114 44103 44106
44144
44129
44133
44105
44125
44134 44131
44147
44128
44143
44040
44124
44022
44137
44146
44141
Ü
44121
44118
44115
44113
44104
44102
44120
44122
44127
44130
44149 44136
4412344132
4410844112
44109
44139
44141
44119
44117
44110
44 - 69
9 - 20
44022
44146
Figure 8 Frequency of Congestion and Cough
Complaints by Zip Code
Frequency
44124
44137
44134 44131
44147
44040
44121
44128
44125
44133
44149 44136
44143
44118
44115
44113
44104
44102
44120
44122
44127
44109
Ü
4412344132
44139
Page 6 of 8
Figure 9 Frequency of Vomiting and
Nausea Complaints by Zip Code
Frequency
0-8
44140
44145
44116
44126
44070
44138
4410844112
44114 44103 44106
44107
44111
44135
44142
44017
44119
44117
44110
21 - 41
42 - 65
9 - 20
44144
44129
44130
44149 44136
44105
44147
44133
44140
44145
44116
44126
44070
44138
44107
44111
44135
44142
44017
Page 7 of 8
44108 44112
4411444103 44106
44139
4412344132
Ü
44144
44129
44133
44105
44125
44134 44131
44147
44128
44040
44124
44022
44137
44146
44141
44143
44121
44118
44115
44113
44104
44102
44120
44122
44127
44130
44149 44136
44146
44119
44117
44110
44109
44022
44141
8 - 14
15 - 21
44124
44137
44134 44131
Frequency
3-7
44040
44121
44128
44125
Figure 10 Frequency of Diarrhea
Complaints by Zip Code
0-2
44143
44118
44115
44113
44104
44102
44120
44122
44127
44109
Ü
4412344132
44139
Sources of Influenza Surveillance Data
Six types of data sources are examined on a weekly basis to help determine the influenza activity level for
Cuyahoga County:
1) Ohio Department of Health (ODH) Seasonal Influenza Activity Summary : The ODH influenza
summary provides state-wide data . Data used from this report include: frequency of fever plus influenzalike illness (ILI) associated hospitalizations, number of influenza-associated pediatric mortalities, and
number of lab-confirmed influenza cases.
A) Influenza-associated Hospitalizations (ODRS): Influenza-associated hospitalizations are reported
by the Cuyahoga County Board of Health (CCBH) and hospitals using the Ohio Disease Reporting
System (ODRS). Hospitalizations can be used as an indicator of the severity of illness during a
particular influenza season. This condition became reportable in January 2009.
B) Influenza-associated Pediatric Mortality (ODRS): Influenza-associated pediatric mortalities are
reported into ODRS by CCBH and hospital staff. Pediatric deaths can be an indicator of the severity
of illness during the influenza season. This condition became reportable in 2005.
C) Sentinel Providers (ILINet): Sentinel providers, through the US Influenza-like Illness Surveillance
Network (ILINet), collect outpatient influenza-like illness (ILI) data. ILI is defined as a fever (> 100
F), and cough and/or sore throat without another known cause. Providers report the total number of
patients seen, by age group, on a weekly basis. Sentinel providers also submit specimens for influenza
testing to the ODH laboratory throughout the influenza season. There are 3 sentinel providers enrolled
in Cuyahoga County for the 2014-2015 season.
D) ODH Laboratory Surveillance: The Ohio Department of Health Laboratory reports the number of
specimens that test positive for influenza each week. Generally, specimens are submitted by sentinel
provider participants. A subset of the positive specimens is sent to CDC for further testing during the
season.
2) Mortality Reporting System (Cleveland’s Vital Statistics): Cleveland Vital Statistics office reports on
deaths that occur in 55 of 59 municipalities in Cuyahoga County (excludes Lakewood, Bedford, Euclid, &
Parma) regarding pneumonia & influenza.
3) ILI data (athenahealth) "ILI estimates are based on insurance claims diagnoses, documented in athenahealth's database. athenahealth is a healthcare technology and services company for electronic health
records, medical billing, patient engagement, and care coordination."
4) School Absenteeism data (due to illness and due to any reason): More than 50 Cuyahoga County
schools provide absenteeism data for each Tuesday on the number children absent due to any illness or
due to any reason as well as sentinel schools that report week absenteeism data.
5) National Retail Data Monitor (NRDM)-OTC Drug Purchases: The NRDM collects over-the-counter
(OTC) drug sales information from Cuyahoga County chain drug stores and grocery stores. Pediatric cold
products, antifever products, and thermometer sales are monitored on a weekly basis.
6) Emergency Department Visits (EpiCenter): EpiCenter collects emergency department chief complaint
data from hospitals and urgent care facilities across Cuyahoga County and classifies them into symptom
and syndrome categories. Chief complaints regarding fever + ILI symptoms are analyzed.
Page 8 of 8