%ILI for ER visits is really high

[JimO]

http://isdsdistribute.org/

I can't find any current information on the Minnesota Health Dept. website to confirm this, but, according to this chart, %ILI in the ER is at the highest levels seen in more than a year. I know that sometimes the last data point isn't reliable; however, ILI has been somewhat elevated since early July.

[Laidback Al]

Re: %ILI for ER visits is really high

Good catch JimO. According to the graph below the recent data for MN is clearly trending up.



Also, I wanted to check surrounding states for increases, but I could not find any data for Iowa in Region 7.

[JimO]

Re: %ILI for ER visits is really high

It looks like the 9/17 data point was accurate. It's still rising in Week 37. I think that it's significant that this represents %ILI in ER visits.

[Missouriwatcher]

Re: %ILI for ER visits is really high

How would one differentiate ILI flu symptoms vs ILI symptoms of listeriosis in ER surveillance data?

According to CDC: Persons in the high-risk category, including older adults, persons with weakened immune systems, and pregnant women, who experience flu-like symptoms within 2 months after eating contaminated food should seek medical care and tell the physician or health care provider about eating the contaminated food.

The recalled cantaloupes were shipped from July 29 through September 10, 2011 to the following states: Arizona, Arkansas, California, Colorado, Idaho, Illinois, Kansas, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Virginia, and Wyoming.

http://www.cdc.gov/listeria/outbreaks/cantaloupes-jensen-farms/092711/index.html

[JimO]

Re: %ILI for ER visits is really high

I don't think we can differentiate. Also, ILI symptoms could have many other causes as well. Right now they aren't doing much flu testing since the season hasn't officially begun, so I suppose we'll know more in a couple of weeks after data from Week 40 and beyond are published.

There are some minor indicators that flu is showing up early in some parts of the country, but surveillance hasn't really started up yet, so it's hard to tell how widespread flu is versus other infectious agents. We also don't have much in the way of flu subtype data, other than the cases from August in PA, which were first reported by CDC as trH3N2 and now are showing up in FluView as seasonal H3N2, if I read it correctly.

My concern is that since the vaccine is the same as last season, and it had minimal protection against seasonal H3N2 and Flu B, that both will be severe again this year where they were not widespread last season. For example, Louisiana had a terrible season last year, dominated by Flu B, but less H3N2 or pH1N1; thus, even with the vaccine, there are large numbers of folks who might still be vulnerable to H3N2. The opposite was the case in other parts of the country, where H3N2 dominated, with little Flu B. Also, the dominant B strain killed a number of young, healthy people last season.

Finally, if pH1N1 has drifted from prior immunity, as appeared to be the case in the UK last season, and seems to have been the case in the southern hemisphere, the vaccine might provide limited protection from it this season.

Either way, I believe it'll be another severe season, with the normal fatalities seen in the elderly and other vulnerable groups, plus 100 to 200 pediatric deaths. I hope I'm wrong, and I hope we have a better flow of information this season.

How would one differentiate ILI flu symptoms vs ILI symptoms of listeriosis in ER surveillance data?

According to CDC: Persons in the high-risk category, including older adults, persons with weakened immune systems, and pregnant women, who experience flu-like symptoms within 2 months after eating contaminated food should seek medical care and tell the physician or health care provider about eating the contaminated food.

The recalled cantaloupes were shipped from July 29 through September 10, 2011 to the following states: Arizona, Arkansas, California, Colorado, Idaho, Illinois, Kansas, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Virginia, and Wyoming.
http://www.cdc.gov/listeria/outbreak...711/index.html

[alert]

Re: %ILI for ER visits is really high

How would one differentiate ILI flu symptoms vs ILI symptoms of listeriosis in ER surveillance data?

According to CDC: Persons in the high-risk category, including older adults, persons with weakened immune systems, and pregnant women, who experience flu-like symptoms within 2 months after eating contaminated food should seek medical care and tell the physician or health care provider about eating the contaminated food.

The recalled cantaloupes were shipped from July 29 through September 10, 2011 to the following states: Arizona, Arkansas, California, Colorado, Idaho, Illinois, Kansas, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Virginia, and Wyoming.
http://www.cdc.gov/listeria/outbreak...711/index.html

Listeriosis is a very severe illness. I believe that of the 72 or so confirmed cases, 16 have died. If Listeria were contributing significantly to the %ILI, the hospitals would be overwhelmed with deaths.

The fact that they aren't aruges that Listeria is not contributing significantly to the %ILI.

The same is true for many severe illnesses; while many illnesses can be described as flu-like, severe illnesses such as meningitis, plague, VHF, etc. do not significantly contribute to ILI surveillance because of their rarity and severity; if enough cases were occurring to affect the %ILI surveillance, we would know about it in other ways. Non-flu seasonal pathogens, which are of similar severity to flu, such as RSV, rhinovirus, adenovirus, etc. will affect the %ILI, of course. That is why the US and other develpoed countries perform virological surveillance as well as monitoring %ILI.

[JimO]

Re: %ILI for ER visits is really high

I must apologize, but my print screen function isn't working on my laptop, so I can't print the latest graph, but ILI for Week 38 is up again, to approximately 0.28. Now, that number is shown as the "proportion of ILI cases" relative to total ER visits. If I'm not mistaken, that would mean that, for Week 38, ~28% of all ER visits are attributed to ILI. If so, that seems awfully high to me. If flu isn't widespread in MN, then some other respiratory agent most certainly must be.

[Laidback Al]

Re: %ILI for ER visits is really high

Here is the MN graph for ILI through Oct 1, 2011. As noted by JimO above the numbers are still increasing.

[DataMom]

Re: %ILI for ER visits is really high

This wildfire is quite large (close to 93,000 acres burned), started August 18th, and is still only 70% controlled. Might it be an aggravating factor?

http://inciweb.org/incident/article/2534/13536

[JimO]

Re: %ILI for ER visits is really high

I wouldn't think so, because one of the conditions for classifying an ER visit as ILI is a fever of 100F or higher.

This wildfire is quite large (close to 93,000 acres burned), started August 18th, and is still only 70% controlled. Might it be an aggravating factor?

http://inciweb.org/incident/article/2534/13536

[DataMom]

Re: %ILI for ER visits is really high

Older individuals tend to have more difficulty clearing particles from their lungs. As a result, pollutants to irritate the lungs for longer periods of time and can cause more damage. In addition, particulate pollution can compromise the immune system, increasing the susceptibility to bacterial or viral respiratory infections. This can lead to an increase incidence of pneumonia and other complications among the elderly.
Children. Children, even those without any preexisting conditions, are considered a sensitive population because their lungs are still developing, making them more susceptible to environmental threats than healthy adults.

From the Montana Dept. of Environmental Quality report on Wildfire Smoke (a guide for public health officials)

https://www.deq.mt.gov/FireUpdates/d...SmokeGuide.pdf ? PDF file.

[Laidback Al]

Re: %ILI for ER visits is really high

Although the MN Pollution Control Agency reported locally high pollution levels from the Pagami Creek fire in mid-September (see below) the most recent air quality reports for the state on October 3 are all green with AQI below 50 (see map below) including Ely which is only 13 miles from the fire.

It is unlikely that pollution from wildfires in the state of Minnesota are causing the incremental increases in %ILI that are being reported.

Friday, September 16, 2011 13:31 Very Unhealthy Levels of Pollution Detected Overnight Near BWCA Fire Have Dropped, but MPCA Continues to Urge People to Exercise Caution


Contact: Ralph Pribble, 651-757-2657
St. Paul, Minn. ― The Minnesota Pollution Control Agency has received a number of reports of heavy smoke and the deposition of ash in northeastern Minnesota. The smoke and ash are from the Pagami Creek fire, which has expanded significantly in the last week.
Between midnight and 8:00 a.m. on Friday, Sept. 16, hourly pollution measurements at the air-monitoring station near Ely reported fine particle pollution at levels considered very unhealthy. This monitor is about 20 miles east of Ely and two miles northwest of the current western fire boundary. The increase in pollution levels at the air monitor near Ely is consistent with the southerly shift in wind direction.

http://www.pca.state.mn.us/index.php...e-caution.html

http://aqi.pca.state.mn.us/

[JimO]

Re: %ILI for ER visits is really high

http://isdsdistribute.org/

Although the ED %ILI in Minnesota dropped a couple of weeks ago, it shot up again and was up to 40%!!!

If flu isn't the cause, then there are some other pretty severe respiratory infections spreading quickly in Minnesota.

[Laidback Al]

Re: %ILI for ER visits is really high

SOtrH3N2?????

[JimO]

Re: %ILI for ER visits is really high

I cannot even guess what is causing such high ED %ILI, but the ISDS data indicate that a respiratory illness(es) is spreading in MN that is severe enough to send people to the ER in large numbers.

After reviewing data from the MN DoH website, I'm even more confused. While ED %ILI is shown by ISDS to be at 40%, the state shows that over the past five weeks, outpatient %ILI has been between 0.5-2%.



Furthermore, rapid testing for flu only resulted in 8 postive cases (1.4%) and PCR testing resulted in 3 positive cases (1.2%). That means that about 570 rapid tests and 250 PCR tests were completed in Week 46, which seems like a reasonable number.




So, either there is a respiratory pathogen, perhaps bacterial, that has not yet been identified that is sending a lot of people to the ER, there is a particularly severe enterovirus circulating, or there is a widespread novel strain of flu that does not give positive results using the existing tests, which seems improbable. Even trH3N2 will result in a positive Type A flu using the rapid test, right?