If one examines every CDC Flu Weekly report since the 1997-1998 season, one notices stretches of editorial errors and careless data transcription in the early years. It is almost as if those filling out the reports intuitively knew most people didn't bother to read the deeper complexity of the information- specifically that describing antigenic testing and compatibility with vaccine strains.
After SARS, H5N1 emergence in Asia, and the 2009 H1N1 influenza pandemic, many more are paying attention to the information. Here in Operational Biosurveillance and elsewhere people noticed the emergence of A/H3N2v being reported and viewed it as an opportunity to tell CDC "here's your chance to make right". Indeed that appears to be happening, with seed stock being moved to the vaccine manufacturers and very quickly thereafter movement to clinical trials. These are good measures of progress for an agency we've grown quite frustrated with over the years.
We are pleased to finally see guidance for clinicians trying to make the difficult decision in the context of an economic recession whether to test for influenza in their patients (i.e. children):
Currently, while there are low levels of circulating seasonal influenza viruses, CDC recommends increasing collection of specimens from patients with influenza-like illness (ILI) , and having these specimens sent to the state or local laboratory for prioritization for rRT-PCR testing. States should specifically consider increasing collection of specimens from patients presenting with ILI in the following high priority areas:
- ILI outbreaks, particularly among children in child-care and school settings, since these have been the settings associated with human-to-human influenza A(H3N2)v virus transmission.
- Unusual or severe presentations of ILI, especially among children.
- Medically attended ILI and ARI in children under 18 years of age
Our only nit-pick with the recommendations (albeit an important one) is to suggest that pediatricians should at least test medically attended ILI and ARI in children under 18 years of age who were vaccinated for this season's influenza. This is a loose call at this point given the low number of cases identified so far, however it may overcome social reluctance to test.
We have pinged several physician and pediatric social networks to raise this issue to their attention- that testing children with influenza-like illness may enable quicker decision-making for response. That we have an opportunity to shorten the time delta to having a vaccine if we need it for our patients. However we still see "pandemic fatigue" and desensitization to anything related to the word "pandemic". And yes, with all the talk of healthcare spending cuts physicians do appear to hesitate to test for fear of denial of coverage by insurance. In our patient population, we hesitate to test because our patients are at poverty level already, without insurance, without Medicaid, and may be paying in cash. Often these are our sickest patients and the very ones we should test.
But this entire phenomenon of holding public health accountable for faster reporting of A/H3N2v, transparency in the decision process to move vaccine through trials just in case, and enhanced media visibility to, let's face it, a bare few cases that would have escaped notice just a few short years ago. Technology does make us more vulnerable because we don't have as much ignorance to be blissful about. But social media holds us nevertheless responsible for this information and the actions implied by that information. One only needs to see the hashtag "H3N2" on Twitter to see the wave of social sensitization.
Here we are hopeful that the convergence of better laboratory diagnostics, risk communication, transparency in response operations, and the accountability provided by social media brings positive change in public health. And positive change improves our nation's resilience in the face of infectious disease crises.