Download 22 April 2016 Earth Day Wisconsin: Wisconsin`s influenza activity

22 April 2016
Earth Day
Wisconsin:
Wisconsin’s influenza activity peaked five weeks ago and is decreasing. To date, there have
been 1,708 reported influenza-associated hospitalizations across Wisconsin (41% were for
individuals aged 65+ years and 33% for those aged 50—64 years), 345 ICU admissions (39%
were for individuals aged 65+ years) and 104 patients requiring mechanical ventilation.
Influenza A[H1N1] has accounted for most of the positives reported by Wisconsin clinical labs
performing PCR.
The prevalence of influenza-like illness [fever of 100oF or higher and either cough or sore
throat] in Wisconsin's primary care patients is at 1.7% and is declining.
7.1% of last week's primary care patients had all-cause respiratory infections.
The prevalence of acute diarrheal illness (ADI) in Wisconsin's primary care patients is at 1.5%
Primary Care Snapshot:
The most commonly identified viral cause of Acute Respiratory infections (ARI) in Wisconsin is
Rhinovirus and human metapneumovirus. Over the past 4 weeks the typical ARI case
presenting for primary care has been 37.2 years old and 64% of patients have been
female. 59% of patients identified a sick contact 1-to-3 days before illness onset and typically
present to the clinic 3.9 days after illness onset. 25% of illnesses are characterized as mild,
with 66% having moderate symptoms and 6% having severe symptoms.
The typical symptoms reported include:
cough
- 90%
sore throat
- 70%
fever
nasal congestion
nasal discharge
myalgia
headache
malaise
- 63%
- 63%
- 60%
- 59%
- 58%
- 55%
CLINICAL NOTES:
Prophylaxis - Continue to vaccinate as an estimated 6% of cases are yet to occur
- Influenza vaccine is recommended universally
everyone over the age of 6 months, including pregnant women
- Pneumococcal vaccine PPSV23 is indicated for smokers,
people with asthma and other chronic lung conditions
as well as a number of other chronic conditions
- ACIP routinely recommends PCV13 for individuals 65 years and older
PPSV23 should be given 12 months after PCV13
Diagnosis
Performance of Rapid Influenza Diagnostic Tests (RIDTs) depends on age and time from
symptom onset
Higher sensitivities are attained at younger ages and within the first 3 days of symptoms
Clinical judgment is essential in diagnosis
- influenza infections are at low levels at this time
- PPV of rapid antigen tests at this time is moderate
- NPV of rapid antigen tests at this time is high
Treatment:
Antivirals need to be started with 48 hours of symptom onset to be effective against influenza
Antivirals started after 48 hours may be effective for hospitalized patients with confirmed
influenza
Resistance Patterns:
- 485 influenza A[H3N2], 1,469 influenza A[H1N1] and 737 influenza B viruses have been tested
eleven H1N1 viruses (0.7%) were resistant to oseltamivir and to peramivir
all other isolates have been sensitive to oseltamivir, zanamivir and peramivir
- high levels of adamantane antiviral resistance exist in influenza A isolates from around the
world
Adamantanes include amantadine and rimantadine; there are ineffective for influenza B
Other
- Rhinovirus/enterovirus and human metapneumovirus are dominating Wisconsin’s respiratory
viruses; adenovirus and coronaviruses are also co-circulating in Wisconsin
- RSV detections continue to decline.
Across the U.S.:
2,544 (14.0%) respiratory specimens during week 14 (April 3-9, 2016) were positive for
influenza.
For the 2015-2016 season-to-date (last week):
- 72.7% (58.2%) of subtyped isolates have been type A
17.7% (19.3%) of A viruses have been H3N2
82.3% (80.7%) of all sub-typed A viruses have been 2009 H1N1
- 27.3% (41.8%) of isolates have been type B
70.5% (60.5%) have been of the Yamagata lineage (TIV strain)
29.5% (39.5%) have been of the Victoria lineage (additional strain in QIV)
- 7.4% of deaths during week 14 (April 3-9, 2016) were due to pneumonia or influenza [above
the seasonally-adjusted epidemic threshold of 7.1%]
- ten additional pediatric deaths were reported this week, including one child from Wisconsin; 2
deaths were due to A[H1N1], 1 due to influenza A[H3N2]; 1 due to influenza A (no subtyping
performed), and 6 due to influenza B. There have been 50 pediatric deaths reported this
season; 1 death was attributed to untyped influenza; 11 deaths were attributed to influenza A
(no subtyping performed), 2 to AH3, 18 to AH1, and 18 to influenza B.
Global News [from the WHO and CDC]:
Zika: Zika virus disease and Zika virus congenital infection are now nationally notifiable
conditions. Zika virus disease is advancing in the Americas. As of last count, 388 cases—all
acquired elsewhere—were reported in the US (of which 31 were pregnant women, 7 were
sexually transmitted, and 1 had Guillain-Barré syndrome); 500 cases in Puerto Rico and the US
Virgin Islands, however, were locally acquired (see: http://www.cdc.gov/zika/geo/unitedstates.html)
For a good, concise resource, see: Zika Virus For Health Care Providers
http://www.cdc.gov/zika/hc-providers/index.html
Ebola: Since the initial case in December 2013, there have been 28,652 reported cases of, and
11,325 deaths (CFR = 39.5%) due to Ebola Virus Disease, primarily in the coastal West African
nations of Guinea, Liberia and Sierra Leone.
A nice graphical representation of epidemic potential of Zika, Ebola and other infectious
diseases is provided: http://www.vox.com/2016/4/19/11450396/zika-virus-contagious-ebolameasles
Other Observations:
April 22nd Phenology: Today’s photoperiod is 13 hours and 45 minutes, and daylength is
increasing by 2 minute and 42 seconds per day.
A Brief History of Earth Day: Earth Day began as a grassroots movement in 1970.
Wisconsin Senator Gaylord Nelson, after seeing the damage done by the 1969 Santa Barbara oil
spill, organized a national "teach-in" that focused on educating the public about the
environment. Nelson recruited Denis Hayes, a politically active recent graduate of Stanford
University, as national coordinator, and persuaded U.S. Rep. Pete McCloskey of California to be
co-chairman. With a staff of 85, they were able to rally 20 million people across the United
States on April 20, 1970. Universities held protests, and people gathered in public areas to talk
about the environment and find ways to defend the planet. Earth Day created public support
for the creation of the Environmental Protection Agency (EPA) and contributed to the passage
of the Clean Air Act, the Water Quality Improvement Act, the Endangered Species Act and
several other environmental laws (all of which are under threat at present).
Reflecting on the 10th anniversary of Earth Day, Nelson wrote, "It was on that day that
Americans made it clear that they understood and were deeply concerned over the
deterioration of our environment and the mindless dissipation of our resources." In 1995,
President Bill Clinton awarded Nelson the Presidential Medal of Freedom for being the founder
of Earth Day. This is the highest honor given to civilians in the United States.
Calvin and Hobbes Science Fiction Story: poetry for Earth Day
http://i.imgur.com/ddU50.jpg
The Blue Marble
https://upload.wikimedia.org/wikipedia/commons/9/97/The_Earth_seen_from_Apollo_17.jpg
The Blue Marble is likely the most famous photograph of the Earth, taken on December 7,
1972, by the crew of the Apollo 17 spacecraft, at a distance of about 45,000 kilometers (28,000
miles). It is among the most widely distributed images in existence and is one of few to show
an almost fully illuminated Earth disk. To the astronauts, Earth had the appearance and size of
a glass marble, hence the name.
The photograph was taken after Apollo 17 left its parking orbit around the Earth, to begin its
trajectory to the Moon. This was the last manned lunar mission. No human since has been far
enough from Earth to photograph a whole-Earth image such as The Blue Marble, but wholeEarth images have been taken by many unmanned spacecraft missions.
The Apollo 17 image released during a surge in environmental activism during the 1970s,
became a symbol of the environmental movement, as a depiction of Earth's frailty, vulnerability,
and isolation amid the vast expanse of space.
Jonathan L. Temte, MD/PhD
Chair, Wisconsin Council on Immunization Practices
Professor, Department of Family Medicine and Community Health
University of Wisconsin School of Medicine and Public Health
1100 Delaplaine Court
Madison, Wisconsin 53715
Telephone: 608-263-3111
Fax: 608-263-6663
email: [email protected]