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October 18 - October 24, 2015 (MMWR Week 42)
Highlights
Flu activity is ‘low’ for 3rd straight week. The flu rating scale is here: https://ccbh-new.squarespace.com/flu-weekly-reports/?rq=flu
Pneumonia-related deaths accounted for 3.7% of all deaths. No flu related deaths occurred this week.
One confirmed case of flu associated hospitalization was reported this week as well as week 41.
2.4% of emergency room visits were due to flu like illness this week.
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 1
Feb
2
3
4
5
6
Mar
7
8
Apr
May
9 10 11 12 13 14 15 16 17 18 19 20
Table 1. Cuyahoga County Influenza Data Dashboard
Influenza (Flu) Indicator
Current
Activity Level
Pneumonia: 3.7%
Flu: 0 deaths
Cuyahoga: N/A
Activity Compared
to Last Week
#Weeks1234
(26.0%)
Stable
N/A
29.4%
Stable
5.6%
(9.5%)
N/A
(30.0%)
97.7%
35.3%
N/A
2015-2016 Season
Total/Trend
Emergency room visit due to ILI [Fig 5]
2.4%
8.8%
1
2
N/A
1
2
2
2
N/A
1
1
1
N/A
1
2
Sales of over-the-counter medications
used to treat ILI. [Fig 6]
Congestion & cough complaints [Fig 8}
Vomiting & nausea complaints [Fig 9]
310
1.0%
2
Trend data will begin week 45.
11.2%
9.4%
2.3%
11.4%
(0.7%)
(7.4%)
1
2
2
Trend data will begin week 45.
Trend data will begin week 45.
Percent of pneumonia deaths & number
of flu related deaths - [Fig 1]
Influenza like illness (ILI) doctor
visits [Fig 2]
Flu associated hospitalizations [Fig 3]
School absenteeism due to ILLNESS
ONLY – [Fig 4A]
School absenteeism due to ALL
CAUSES – [Fig 4B]
Diarrhea complaints [Fig 10]
athenahealth: 0.17%
1
Northeast:
Northwest:
Southeast:
Southwest:
Northeast:
Northwest:
Southeast:
Southwest:
1.9%
1.9%
N/A
2.1%
8.7%
2.3%
N/A
4.6%
1
∞
Trend data will begin in week
45.
Trend data will begin in week
45.
N=3. Trend data begin week 45.
Trend data will begin in week
45.
Trend data will begin in week
45.
Trend data will begin week 45.
Trend data will begin week 45.
Due to small percentages, caution should be used while interpreting the ‘Activity Compared to Last Week’ box.
For figures 1-2, 4-5 & 8-10, = (Increase > 20%), = (Decrease > -20%), = Stable (-19.9% to +19.9%)
3
For figure 6, = (Increase > 10%), = (Decrease > -10%), = Stable (-9.9% to +9.9%)
4
For flu related deaths (Fig 1) & Fig 3, = (Increase # of deaths/cases), = (Decrease # of deaths/cases), = Stable (Same # of deaths/cases)
2
Page 1 of 8
October 18 - October 24, 2015 (MMWR Week 42)
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-reports/?rq=flu
Note: Data are provisional and subject to change. Updates will be included in future reports.
Pneumonia and Influenza (P&I) Mortality
3.7% of all deaths reported to the Cleveland Bureau of Vital Statistics were due to pneumonia. Adults 45 to 64 years
old accounted for 54.6% of all pneumonia related deaths. No influenza related deaths occurred this week (Figure 1).
Influenza-Like Illness (ILI) Reports
Athenahealth reported that 0.17% of patients had flu-like symptoms this week. No sentinel providers reported this
week. (Figure 2). ILI is defined as a fever (≥ 100◦ F), and cough and/or sore throat.
Influenza-Associated Hospitalizations and Influenza-Associated Pediatric Mortality
One confirmed case of influenza-associated hospitalization in Cuyahoga County was reported this week and during
week 41 (Figure 3). Nineteen statewide confirmed influenza associated hospitalizations in week 41. No statewide
pediatric flu related deaths has occurred so far this flu season.
School Absenteeism
Participating schools in Cuyahoga County reported the percentage (median = 2.0%) of absenteeism due to any illness
on Tuesday (Figure 4A). Figure 4B shows the total absenteeism due to any reason (median = 4.5%).
Emergency Department (ED) visits and Over-the-Counter Medication Sales
2.4% of all ED visits were for fever + ILI symptoms. Approximately 70 more patients visited EDs for fever and ILI
symptoms this year compared to the 5-year median (Figure 5). Figure 6 shows approximately 55 more OTC products
per drugstore were purchased this year than the 5-year median for products purchased in the same time period.
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
Page 2 of 8
Figure 1. Percentage of Deaths Due to Pneumonia and Influenza (P&I)
Cleveland Bureau of Vital Statistics
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
40 41 42 43 44 45 46 47 48 49 50 51 52 1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20
MMWR Week
Percent Pneumonia
Percent Influenza
5-Yr Median 2010-11 - 2014-15
Figure 2. Percent of Influenza-Like Illness (ILI) Visits U.S. Influenza Sentinel
Provider Surveillance Network and ILI visits data via athenahealth
3.0%
2.7%
2.4%
2.1%
1.8%
1.5%
1.2%
0.9%
0.6%
0.3%
0.0%
40 41 42 43 44 45 46 47 48 49 50 51 52 1
2 3 4 5 6
MMWR Week
Cuyahoga County
7
8
9 10 11 12 13 14 15 16 17 18 19 20
athenahealth
Figure 3. Number of Influenza-Associated Hospitalizations in
Cuyahoga County (using event date)
120
110
100
90
80
70
60
50
40
30
20
10
0
40 41 42 43 44 45 46 47 48 49 50 51 52 1
Current Year
2
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
MMWR Week
5 Year Median 2010-2011 - 2014-2015
Page 3 of 8
Figure 4a. School Absenteeism (Due to any Illness) in Cuyahoga County
6%
N
O
5%
4%
S
C
H
O
O
L
3%
2%
1%
0%
40 41 42 43
44 45 46 47 48 49
5-year Median (2010-11 - 2014-15)
50 51 52
1
2
Northeast Suburbs
3 4
5 6
MMWR Week
7
8
Northwest Suburbs
9
10 11 12 13 14
Southeast Suburbs
15 16 17 18 19 20
Southwest Suburbs
Figure 4b. School Absenteeism (Due to any Reason) in Cuyahoga County
11%
10%
N
O
9%
8%
7%
S
C
H
O
O
L
6%
5%
4%
3%
2%
1%
0%
40 41
42
43 44
45
46 47
48
49 50
5-year Median (2010-11 - 2014-15)
51
52
1
2
3
4
5
6
MMWR Week
Northeast Suburbs
Page 4 of 8
7
8
9
Northwest Suburbs
10 11
12
13 14
15
Southeast Suburbs
16
17 18
19
20
Figure 5. Cuyahoga County Hospital ED Visits for ILI & Fever Symptoms by Age Group
300
250
200
150
100
50
0
40 41
42
43
44 45
46
47
48 49
50
51
52
1
2
3
4
5
6
7
8
9
10
11 12
13
14
15 16
17
18
19 20
MMWR Week
O - 4 Years Old
5 - 24 Years Old
25 - 49 Years Old
50 - 64 Years Old
65 Years and Older
5 Year Median (2010-11 - 2014-15)
Figure 6. Comparison of Average Weekly OTC Products Sold in Cuyhaoga County Drugstores
330
300
270
240
210
180
150
120
90
60
30
0
40 41 42 43 44 45 46 47 48 49 50 51 52
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
MMWR Week
Antifever
Cold_liquid_ped
Cold_tablet_ped
Cough_syrup_ped
Page 5 of 8
Electrolytes_ped
Thermometers
5 Year Median 2010-11 - 2014-15
Figure 7 Rate of Fever and Influenza-Like
Illness Complaints per 100,000 by Zip Code
October 18th - October 24th 2015 - MMWR Week 42
Frequency
0 - 8.6
8.7 - 23.0
44140
44107
44116
44145
44111
44126
44070
23.1 - 41.9
42.0 - 78.0
44142
44138
44017
44129
44105
4412344132
45.6 - 97.7
44140
44145
44116
44126
44070
44138
97.8 - 161.9
162.0 - 350.9
44107
44111
44135
44142
44017
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44144
44129
4411444103 44106
44133
44105
44125
44134 44131
44147
44139
44128
4
Miles
44143
44040
44124
44022
44137
44146
44141
Ü
0 1 2
44121
44118
44115
44113
44104
44102
44120
44122
44127
44130
44149 44136
44119
44117
44110
44108 44112
44109
44022
Map created and analysis performed
by Epidemiology, Surveillance, and
Informatics at the Cuyahoga County
Board of Health. Data are preliminary.
44141
October 18th - October 24th 2015 - MMWR Week 42
0 - 45.5
44124
44146
Figure 8 Rate of Congestion and Cough
Complaints per 100,000 by Zip Code
Frequency
44040
44137
44134 44131
44133
4
Miles
44143
44128
44125
44147
0 1 2
44121
44118
44115
44113
44104
44102
44120
44122
44127
44130
44149 44136
4411444103 44106
44144
44135
44119
44117
44110
4410844112
44109
Ü
4412344132
44139
Map created and analysis performed
by Epidemiology, Surveillance, and
Informatics at the Cuyahoga County
Board of Health. Data are preliminary.
Figure 9 Rate of Vomiting and Nausea
Complaints per 100,000 by Zip Code
4412344132
October 18th - October 24th 2015 - MMWR Week 42
Frequency
54.0 - 87.3
14.4 - 32.1
87.4 - 331.4
32.2 - 53.9
44140
44107
44116
44145
44126
44070
44111
44135
44142
44138
44017
4410844112
44114 44103 44106
44109
44144
44129
44133
44105
44147
7.3 - 13.4
44140
44145
44116
44126
44070
44138
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19.0 - 94.0
44107
44111
44135
44142
44017
44119
44117
44110
4411444103 44106
44144
44129
44133
44105
44125
44134 44131
44147
44128
Ü
4
Miles
44143
44040
44124
44022
44137
44146
44141
0 1 2
44121
44118
44115
44113
44104
44102
44120
44122
44127
44130
44149 44136
4412344132
44108 44112
44109
44139
Map created and analysis performed
by Epidemiology, Surveillance, and
Informatics at the Cuyahoga County
Board of Health. Data are preliminary.
44141
13.5 - 18.9
44022
44146
October 18th - October 24th 2015 - MMWR Week 42
0 - 7.2
44124
44137
44134 44131
Figure 10 Rate of Diarrhea Complaints
per 100,000 by Zip Code
Frequency
44040
44121
44128
44125
4
Miles
44143
44118
44115
44113
44104
44102
44120
44122
44127
44130
44149 44136
44119
44117
44110
Ü
0 1 2
44139
Map created and analysis performed
by Epidemiology, Surveillance, and
Informatics at the Cuyahoga County
Board of Health. Data are preliminary.
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, anti-fever 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. Rates for chief complaints regarding fever + ILI and other symptoms commonly
detected during the winter are analyzed.
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