HTH Transmissibility (Illness Rate in the Pop) Pandemic Influenza Surveillance Low Rare Medium 5%-20% High 20%-40% Pandemic Severity Index (Case Fatality Ratio) Activities 1 Low <0.1 CFR 2 and 3 Medium 0.1 - <1.0 CFR 4 and 5 High 1.0- = >2.0 CFR Outpatient surveillance ILINet – outpatient providers that report into the federal system EARS – daily data feeds from Emergency rooms, urgent care clinics, and outpatient providers Weekly reporting Consider daily reporting Daily reporting Daily Review Daily Review Daily Review Hospital Surveillance Sentinel Hospitals – hospitals that report aggregate counts of admission due to pneumonia or influenza and total number of admissions All Hospitals – reporting of lab confirmed influenza in hospitalized patients Weekly reporting Consider daily reporting Consider daily reporting Recommend Recommend Recommend Mortality surveillance EDRS – electronic death registry system Weekly report Consider daily report Daily report/ ad hoc reporting Laboratory surveillance HETL – Maine’s public health lab Maine Reference Labs – ALI and NorDx Weekly report Consider daily reporting Daily report / ad hoc reporting Weekly aggregate report Consider individual reporting Individual reporting General Surveillance Case investigation Outbreak surveillance Novel or antiviral resistant only Consider investigating all pandemic Consider limiting investigations to target groups Follow up on all outbreaks Follow up on outbreaks as able Follow up on outbreaks as able
Service / Function: Influenza Surveillance Inter-Pandemic Period: Awareness Mitigation/ Preparedness ME 0, I, II Pandemic Alert Period: Standby Heightened Preparedness ME Levels III, IV Pandemic Period: Activate Response Plan Response ME Levels V, IV Post Pandemic Recovery Period Recovery ME Levels VII ILINet Enroll new ILINet sites, validate and monitor existing sites Consider daily reporting Return to weekly reporting, provide education to maintain new providers EARS Enroll new EARS sites, validate and monitor existing sites Provide education to maintain new sites Sentinel hospitals Enroll new sentinel hospitals, validate electronic sources of data Consider requesting daily reporting Return to weekly reporting, provide education to maintain new sentinel sites All hospitals Encourage reporting, validate electronic sources of data Consider daily contact to determine burden EDRS Review weekly reports Consider daily or ad hoc reports, consider daily contact with morgues, funeral homes, hospitals, nursing homes, EMS and home health agencies Return to weekly reports HETL Maine Reference Labs Perform weekly data extracts, review pyrosequencing data Recommend PCR testing for persons with ILI Consider limiting or triaging testing, implementing submission forms, and limiting testing to the most commonly circulating strain Remove limits on testing, return to weekly reports
Maine Reference Labs Review weekly aggregate data counts, facility submission of positive samples for pyrosequencing Recommend all samples that are unable to be subtyped be forwarded to HETL Communicate all HETL decisions, coordinate submission of samples to HETL, consider daily reporting Communicate all HETL changes, return to weekly reports Case Investigation Only investigate cases of novel, or antiviral resistant influenza Consider investigating all pandemic related influenza Consider limiting investigations to target groups Return to investigating only cases of novel, or antiviral resistant influenza Outbreak surveillance Follow up on all influenza related outbreaks Follow up on all influenza related outbreaks as able Surveillance Report Produce weekly report during influenza season Consider daily reporting Return to weekly reporting State influenza assessments Provide weekly assessment code