As the US national influenza season peaks out, it is important to review the importance of operational forecasting, "live" situational awareness, and proactive response in the local community setting.
The Ascel Bio National Infectious Disease Forecast Center resides on the Western Slope of Colorado and issues monthly forecasts and "live" advisories covering approximately 100 infectious diseases. The director of the center is a practicing pediatrician whose patients voluntarily sign up for access to the forecasts. These forecasts are distrbuted electronically to local healthcare providers, school nurses, veterinarians, public health officials, pharmacists, EMS, and other members of the networked healthcare community.
The lay community is sharply polarized between those who vaccinate their children versus those who refuse the influenza vaccine only or the entire pediatric vaccination series (e.g., DTaP, HIB, IPV, Rota, etc). This belief system does not fall squarely within one political bias or another such as liberal versus conservative. However, the anti-vaccination belief system is firmly rooted in this rural community and is extremely difficult to counteract through clinical guidance.
Forecast Warning Sequence
The forecast warning sequence for the 2012-2013 influenza season has been previously described here. This is the second time our team has successfully forecasted a vaccine drift season of influenza.
Forecasts were issued to the local community as such:
- The community was pre-sensitized in the first week of September to the topic of influenza as a result of advisories issued by the Center regarding the local county agriculture fair (i.e. the concern of emerging A/H3N2 variant).
- This was followed by the general forecast, which again emphasized concern for emerging A/H3N2 variant in late September.
- In October, concern about a vaccine drift season of influenza was shared with patient families in the clinic, with emphasis on the need to vaccinate with the seasonal vaccine. It was expressed the vaccine was expected to be well-matched to the drifted strains. Limitations of vaccine efficacy overall were known to the clinician and expressed to patient families such as the vaccine is thought to prevent hospitalization, severe morbidity, and mortality. This face to face dialog was maintained with every family that came to the clinic, regardless of chief complaint, throughout the season.
- On October 25th, the November-December forecast was released to the community, which emphasized the same points described in bullet #3 above.
- On November 14th, an advisory was issued that described the first hospitalization of a combined RSV/influenza B patient.
- The December-January forecast was released on December 2nd, again emphasizing the need to vaccinate for influenza.
- Another advisory issued on December 12th with the second hospitalization of RSV/influenza B.
- On January 7th, the January-February forecast was issued, again with emphasis on vaccination.
Results Thus Far
- All hospitalizations have been of children either incompletely or totally unvaccinated with this season's influenza.
- We have "converted" 4 families (each with between 1-3 children) who previously were staunch opponents to the influenza vaccine.
- Only 2 families (x2 children) refused influenza vaccination. We estimate >99% compliance.
- The pediatric service has not been overwhelmed by influenza hospitalizations. We have seen less than 5 children who presented at the outpatient level that were previously vaccinated. None of these children had serious disease.
- Development of trust with the receiver community was paramount to successful deployment of infectious disease forecasts.
- Issuance of operational forecasts coupled to updated "live" advisories drove compliance.
- Full transparency about vaccine efficacy directly relates to maintenance of trust with patient families.
- Issuance of operational forecasts coupled to updated "live" advisories that were trusted by the public ultimately resulted in mitigation of surge within a fragile pediatric healthcare infrastructure.
- Prevention of hospitalization or transfer out of facility due to influenza is more cost-effective than lack of an aggressive vaccination education campaign facilitated by forecast and tactical warning.