Mapping of the US Domestic Influenza Virologic Surveillance Landscape.

Barbara Jester,Tricia Aden,Joy Schwerzmann,Pete Shult,Rosemary Humes,Xiyan Xu,Lynnette Brammer,Shahram Shahangian,Desiree Mustaquim,Daniel Jernigan,Joseph Miller,Larisa Gubareva

doi:10.3201/eid2407.180028

Abstract

Influenza virologic surveillance is critical each season for tracking influenza circulation, following trends in antiviral drug resistance, detecting novel influenza infections in humans, and selecting viruses for use in annual seasonal vaccine production. We developed a framework and process map for characterizing the landscape of US influenza virologic surveillance into 5 tiers of influenza testing: outpatient settings (tier 1), inpatient settings and commercial laboratories (tier 2), state public health laboratories (tier 3), National Influenza Reference Center laboratories (tier 4), and Centers for Disease Control and Prevention laboratories (tier 5). During the 2015–16 season, the numbers of influenza tests directly contributing to virologic surveillance were 804,000 in tiers 1 and 2; 78,000 in tier 3; 2,800 in tier 4; and 3,400 in tier 5. With the release of the 2017 US Pandemic Influenza Plan, the proposed framework will support public health officials in modeling, surveillance, and pandemic planning and response.

Highlights

Influenza virologic surveillance is critical each season for tracking influenza circulation, following trends in antiviral drug resistance, detecting novel influenza infections in humans, and selecting viruses for use in annual seasonal vaccine production
To characterize the specimen and data flow used to inform influenza virologic surveillance, we conducted open-ended interviews with clinicians, state public health laboratory (PHL) directors, epidemiologists, and laboratorians from Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories (APHL) staff, asking them to share their understanding of all aspects of the data and specimen flow with which they were familiar
To capture the volume and type of tests performed at clinical laboratories contributing to influenza virologic surveillance and at PHLs, we analyzed reports submitted to CDC from clinical providers, and state and local public health authorities participating in influenza surveillance

Summary

Introduction

Influenza virologic surveillance is critical each season for tracking influenza circulation, following trends in antiviral drug resistance, detecting novel influenza infections in humans, and selecting viruses for use in annual seasonal vaccine production. Influenza viruses cause a substantial burden of illness each year in the United States, estimated at 9.2–35.6 million cases of infection, 4.3–16.7 million clinic visits, 140,000– 710,000 hospitalizations, and 12,000–56,000 deaths (1) To monitor these constantly changing viruses, the Centers for Disease Control and Prevention (CDC), in collaboration with public health partners, collects and analyzes data from multiple surveillance systems (2). These efforts track currently circulating influenza viruses, identify novel influenza viruses of public health importance, monitor antiviral drug susceptibility, and characterize circulating seasonal viruses for guiding influenza vaccine virus selection. Our proposed framework will support these efforts, providing a common diagnostic operating picture for all levels of influenza testing

Methods

Results

Conclusion