EPI-Surveillance

December 14, 2018 Shawnee County Health Department Volume 3, Issue 6

EPI-SURVeillance

100 Years of Influenza

INSIDE THIS ISSUE

100 Years of Influenza ………….. 1

November Disease Summary … 3

Shawnee County Health Department Source: Public Health Weekly Reports for NOVEM- Source: CDC Commemorating 100 years BER 15, 1918. (1918). Public health reports since 1918 Influenza Pandemic. WIC and Administrative Offices (Washington, D.C. : 1896), 33(46), 1969-2030. 2600 SW East Circle Drive This year marks the 100 year centenary of the 1918-1919 influenza pandemic, more com- Topeka, Kansas 66606 monly known as the Spanish Influenza. Even though influenza epidemics and pandemics 785.251.5600 have been a part of human history dating back to the Middle Ages, the 1918 Spanish Influ- enza is considered to be the most devastating pandemic thus far, with the highest death Immunization/ record in history. Communicable Disease Clinic 2115 SW 10th Street No one knows for certain where the 1918 influenza virus originated; however, the epide- Topeka, Kansas 66604 miologic evidence suggests Haskell County, Kansas as the most likely site of origin. The 785.251.5700 earliest record of the influenza outbreak was first reported by Dr. Lohring Miner, a local physician practicing in western Kansas. Dr. Miner notified the U.S. Public Health Services Environmental Health of severe influenza cases with fatalities in Haskell County, Kansas, and his findings were 1515 NW Saline, Suite 221 published in the Public Health Reports (now Morbidity and Morality Weekly Report) on Topeka, Kansas 66618 April 5, 1918. 785.251.5608

The influenza outbreak might not have had the rapid global impact, had it not been for the war. It has been suggested soldiers traveling to and from Haskell County may have NEED TO REPORT A brought the virus back to Camp Funston, army base located in Fort Riley, Kansas. Camp COMMUNICABLE DISEASE? Funston was the second largest military station in the country, housing and training an average of 56,000 troops. With winter weather, poor sanitation, and overcrowding, the conditions of wartime was conducive to the rapid spread of disease. At that time, there were no influenza vaccines, antiviral, or antibiotics to treat secondary bacterial pneumo- Call the Health Department nia infections, since penicillin was not discovered for another ten years. Soon after cases 24/7 of severe influenza were seen at Camp Funston, reports of influenza outbreaks at other 785. 806. 6297 military bases started to appear. Call the Kansas Department of It has been suggested the influenza virus followed the soldiers to war, traveling and mu- Health and Environment tating from the United States to France and then across the world. During the spread of Epidemiology Hotline 24/7 influenza across Europe, the virus picked up the name “Spanish Influenza” because Spain was a neutral country in the war, therefore the press could freely report on the number of 877. 427. 7317 influenza cases seen in Spain. It is estimated the 1918-1919 influenza pandemic infected one-third of the world’s population and killed 675,000 in the United States and 21 million Disease Reporting Information: to 50 million people worldwide. An equivalent death toll today would be 175 to 350 mil- List of Reportable Diseases lion people. Disease Reporting Information There has been three other influenza pandemics since 1918 (1957, 1968, and 2009), but Kansas Reportable Disease Form none rivaled the death toll of the Spanish Influenza. To better understand the virology of the 1918 influenza virus, Centers for Disease Control and Prevention (CDC) researchers Disease Investigation Guidelines reconstructed the 1918 influenza virus from lung tissue taken from an Alaskan influenza victim who was buried in permafrost in November 1918.

100 Years of Influenza Continues...

In addition to the millions of lives the 1918 influenza claimed worldwide, what sets the 1918 influenza pandemic apart from more recent pandemics is the impact the 1918 virus had young healthy adults. The death rate was highest among adults aged 20-40 years. The death toll among this age group was so high, it reduced the life expectancy in the United States by twelve years.

Even though we have made advances in influenza prevention and treat- ment with vaccines and antiviral drugs, people still die every year from influenza and influenza complications. The burden of influenza illness varies from year to year. During 2017-2018 flu season, roughly 79,400 people died from influenza and pneumonia with the highest number of death in the 65 and older age group. Utilizing the Vital Statistics death records from the Kansas Department of Health and Environment (KDHE), we see a similar trend in Kansas and Shawnee County. Over the last ten years, pneumonia and influenza was the cause of death for 6,229 Kansans with 398 deaths in Shawnee County. Roughly 84.4% of pneumonia and influenza deaths in Shawnee County were in people 65 and older.

Table 1. Pneumonia and Influenza Deaths in Kansas, 2008-2017

Cause of Death 2008-2017 Shawnee County Kansas

Influenza 29 467 Source: Annual Report of State Board of Health and the Pneumonia 369 5762 State Health Commissioner to the Governor of Virginia for Total Pneumonia & Influenza 398 6229 the Fiscal year Ending September 30,1919. Source: KDHE, Kansas Information for Communities, 2008-2017

Although 100 years has passed since the 1918 influenza pandemic, sci- entists are still studying the 1918 influenza virus today. Continued influenza research supports with vaccine, drug developments, and pandemic influenza preparedness. Influenza surveillance is ongoing. The CDC is one of 114 member states who take part in the World Health Organization’s global health influenza surveillance system. The CDC also partners with state and local health departments to support with influenza surveillance.

The CDC’s commemorative motto for the 100th centenary of 1918 flu pandemic is, “We Remember. We Prepare.”

For more information on the current 2018-2019 influenza surveillance, visit the following websites below. Source: Published by the Topeka Health Service of KDHE, Kansas Weekly Influenza Surveillance Shawnee County. Kansas State Historical Society CDC, Weekly U.S. Influenza Surveillance Report

References:

1. Barry, J. M. (2004). The great influenza: The epic story of the deadliest plague in history. New York: Viking. 2. Barry J. M. (2004). The site of origin of the 1918 influenza pandemic and its public health impli- cations. Journal of translational medicine, 2(1), 3. doi:10.1186/1479-5876-2-3 3. Centers for Disease Control and Prevention. (2018) The 1918 Flu Pandemic: Why it Matters 100 Years Later. Retrieved from https://blogs.cdc.gov/publichealthmatters/2018/05/1918-flu/. Ac- cessed December 12, 2018. 4. Centers for Disease Control and Prevention. (2018) Reconstruction of the 1918 Influenza Pan- demic Virus. Retrieved from https://www.cdc.gov/flu/about/qa/1918flupandemic.htm. Accessed December 12, 2018. 5. Centers for Disease Control and Prevention. (2018) Estimated Influenza Illness, Medical Visits, Hospitalizations, and Deaths in the United States– 2017-2018. Retrieved from https:// www.cdc.gov/flu/about/burden/estimates.htm. Accessed December 12, 2018. 6. Institute of Medicine. 2005. The Threat of Pandemic Influenza: Are We Ready? Workshop Sum- mary. Washington, DC: The National Academies Press. https://doi.org/10.17226/11150. 7. Jester, Barbara & Uyeki, Timothy & Jernigan, Daniel. (2018). Readiness for Responding to a Severe Pandemic 100 Years After 1918. American journal of epidemiology. 10.1093/aje/kwy165. 8. Taubenberger, J. K., & Morens, D. M. (2010). Influenza: the once and future pandemic. Public Source: Halt The Epidemic, 1918, poster, health reports (Washington, D.C.: 1974), 125 Suppl 3(Suppl 3), 16-26. United States Shipping Board Emergency Temple University Libraries 2 NOVEMBER COMMUNICABL E DISEASE SUMMARY

Last month, there were 58 new reports of notifiable diseases and conditions in Shawnee County. Of the 58 new reports, 41 have been classified as Confirmed or Probable Cases by the Shawnee County Health Department and/or the Kansas Department of Health and Environment based on standardized case definitions. The chart below shows the number of disease reports which met the criteria of Confirmed or Probable. These are preliminary numbers and may change as case status changes with new information or further investigation. Below is a summary of select reports investigated in the month of November of 2018.

SUMMARY OF NEWLY CONFIRMED CASES OF Bloodborne : The Health Department inves- REPORTABLE DISEASES IN SHAWNEE COUNTY, KANSAS tigated seven Hepatitis B, Chronic reports, five of the seven were confirmed cases and the oth- NOVEMBER er two reports are currently under investigation. All 19 Hepatitis C reports received were Case Report Counts* confirmed cases. Respiratory: The one Haemophilus influen- 2015-2017 3 Year zae report was a confirmed case. The Health Diseases 2018 Nov 2017 Nov November Department investigated five Streptococcus Average pneumoniae reports, four adult and one pedi- Bloodborne atric report. Of the five Streptococcus pneumoniae reports, two were confirmed cases. Hepatitis C, Chronic 19 9 10.67 The other three reports are currently under Foodborne and Waterborne investigation. The Varicella pediatric report Campylobacteriosis 6 2 2.33 received was a confirmed case. The adult Tu- Cryptosporidiosis 1 2 1.33 berculosis Latent Infection report is still under Vibriosis (non-cholera Vibrio investigation. 1 0 0 species infections) Food or Waterborne: Of the eight Campyl- Salmonellosis 1 5 4 obacteriosis reports investigated, six were Shiga toxin-producing 3 2 1.33 confirmed cases and one report is still under Escherichia coli (STEC) investigation. The pediatric Cryptosporidiosis Respiratory report was a confirmed case. Of the three Sal- Haemophilus influenzae, 1 0 0.33 monellosis reports, only one report was a con- invasive disease (Including Hib) firmed case. The one Vibriosis non-cholera Streptococcus pneumoniae, 2 2 2.67 report, and three Shiga toxin-producing Esch- invasive disease erichia coli (STEC) reports were confirmed Vaccine Preventable cases. Hepatitis B, Chronic 5 0 0.33 Other: The Health Department received one Varicella (Chickenpox) 1 0 0.67 pediatric elevated blood lead level report. The Sexually Transmitted Infections elevated blood lead report was a confirmed Chlamydia 102 106 83.33 case. The Health Department is currently in- Gonorrhea 57 61 43.67 vestigating two Transmissbale spongioform Syphilis 3 2 2.67 encephalophathy (TSE) disease reports and Other one Toxic-shock syndrome (streptococcal) report. Both TSE disease and Toxic-shock syn- Blood lead poisoning (All ages) 1 3 1.33 drome reports were in adults. Grand Total 203 194 154.66

* Case report counts are provisional numbers. Case statuses may change with new information or further investigation. Leading the way to a healthier Shawnee County 3