On August 16, 2012 the then-named Black Canyon Infectious Disease Forecast Station began to produce a series of forecasts for the upcoming 2012-2013 influenza season in the United States. Subsequent forecasts on August 17th, October 12th, and October 28th provided concern regarding vaccine drifted A/H3N2 that would pose a problem for the unvaccinated. However, for those who chose to vaccinate, the vaccine was an excellent match for at least the first 2/3 of the season.
Since these forecasts, we have seen reports from the Pacific NW of early influenza activity, as well as reports from multiple states such as North and South Dakota, Wyoming, and here on the Western Slope in a county of less than 30k, we have seen a pediatric hospitalization with RSV/influenza co-infection. Illness serious enough to warrant Tamiflu. Totally unsual given this was two full months ahead of our usual influenza season. This was the second RSV- and second influenza-positive in the county- these first cases were seen a month ago.
But none of these signatures have been surprising given the forecast.
It is therefore curious for us to see ProMED confused about report of early and significant influenza activity in Georgia’s southwest, where the moderator stated today:
Is this an early warning of an impending outbreak of influenza virus infection in the Northern hemisphere? The most recent World Health Organization (WHO) Global Update concluded that there was no evidence of this as yet: see ProMED-mail post: Influenza (104): WHO update 20121109.1402543.
Likewise, the current EuroFlu Bulletin (<http://www.euroflu.org/cgi-files/bulletin_v2.cgi>) states that: "Influenza activity in the WHO European Region remains at a pre-season level, with several countries reporting sporadic detections of influenza A(H1N1)pdm09, A(H3N2), and type-B viruses. The influenza positivity rate is relatively stable, as is usual for this time of the year. The number of hospitalizations due to severe acute respiratory infection remains stable, with none of the cases reported this week due to influenza."
Georgia is associated with one of the worst influenza vaccine coverage rates in the nation.
We know that from an official public public health perspective, if the sample is not received and processed by their approved network of laboratories, then the “situation” does not exist. This is particularly true when it comes to influenza. How unfortunate for the multiple medical facilities experiencing mild to moderate strain, who are dealing with a localized crisis not formally recognized by public health. Indeed, it can take days to weeks before a sample (and the data associated with it) reaches CDC. What would be interesting to ask the local physicians involved in the outbreak is, “did you know about this situation first or public health?” The answer is obvious, of course.
It should be noted this remains a top concern to monitor in the post-Sandy relief environment. ... A concern that was completely missed by some of our country's top public health subject matter experts.
… And so the disconnect between medical response reality and hierarchical public health processing becomes apparent again.