1. Lesley Bullion Influenza Surveillance Coordinator Infectious Disease Control Unit Swine Novel Pandemic Influenza A (H1N1) in Texas …OR How I Spent My Summer Vacation

3. Not the Same Old Swine Flu April 13-17: Two California novel swine influenza H1N1 cases identified –Both cases detected through seasonal flu surveillance –One of these patients and his brother traveled to Texas on April 3 April 21: CDC notifies DSHS of 2 unsubtypeable flu A’s in HSR 8

4. Novel Flu Surveillance Basics Flu is suddenly notifiable Participation in surveillance increases Everyone wants to be tested Guidance changes frequently We don’t have time to report anything else And…

5. Flu Reports in the Summer?!

6. Texas Novel Flu Surveillance New –Increased culture/PCR surveillance –Individual case and contact investigations Short form(s) Long form(s) Addenda –Weekly Regional and County Aggregate Reports –Airline investigations (DGMQ) –More thorough institutional outbreak investigations –Various studies Routine –Culture/PCR Surveillance –NREVSS –ILINet –Reports from Regional Flu Surveillance Coordinators –Investigations of institutional outbreaks (e.g., schools)

7. ILINet & Novel Flu CDC: ‘ILINet was best system for detecting the novel flu’ 11 additional Texas providers recruited/re- recruited Weekly or daily reporting to CDC website or by fax –13 daily reporters (Texas) 143 total Texas ILINet providers as of 7/13/09 –Average of 54 reporters each week since week 21

10. Specimens for Influenza Testing Submitted to DSHS Austin Lab Since 4/16/09 (N=9,401*) HSRTotal 127 2/31141 4/5N899 6/5S497 73020 81000 9/10117 112700 Grand Total9401

14. Influenza-Associated Pediatric Mortality – Novel Flu 2 deaths “out of season” Ages 12 and 13 years –Both novel flu A H1N1 –Only one with significant underlying medical conditions Total of 13 pediatric flu deaths for 08-09 to date

15. Where are we now? Investigations of severe illnesses (ICU) and deaths County and Regional Aggregate reports –Reported to CDC via web Returning to “regular” surveillance –Weekly flu reports –ILINet –NREVSS –PCR/culture surveillance - limited Workgroups: Flu-related topics under discussion Lots of questions to answer for fall

18. Putting it in Perspective Texas DataSeasonal flu, annual estimates* Novel flu to date Cases1.2-4.9 million4,463 Hospitalizations16,000+183 Deaths2,88020 *Based on CDC estimates of national annual flu burden