In a Government Shutdown, Who’s Tracking the Flu?

Oct 9, 2013, 4:25 PM

Add flu surveillance to the list of casualties of the current government shutdown.

Every flu season, states collect data on flu cases — including case reports and viral specimens — and send those to the Centers for Disease Control and Prevention (CDC) in Atlanta for recording and tracking. That tracking is critical in order to:

  • provide information on how well-matched the seasonal flu vaccine is to the flu viruses found in the community;
  • identify severe outbreaks that require increased supplies of antiviral medicines for people who contract the flu; and
  • identify emerging strains that might require a new vaccine to be developed this season, which is what happened several years ago when CDC identified the H1N1 influenza virus toward the end of the flu season, and quickly ramped up for a new vaccine.

Flu season generally runs October through April, with the peak from about January to March. If the shutdown continues then, “as the flu season goes on, our knowledge of what’s happening will be impaired,” says William Schaffner, MD, Professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine, and the immediate past president of the National Foundation for Infectious Diseases.

CDC director Thomas Frieden, MD, MPH, underscored his concern in a tweet on the first day of the government shutdown: “CDC had to furlough 8,754 people. They protected you yesterday, can't tomorrow. Microbes/other threats didn't shut down. We are less safe.”

Information provided by CDC’s analysis of state and local flu data also helps communities plan capacity such as hospital beds that might be needed for a severe outbreak. Dr Schaffner says having the information curtailed “means that in many instances we are flying blind or certainly have one eye closed and the other squinting,” and says that because of the backlog of specimens and state data to review, it would take the CDC about a week and a half to get completely up to date once the government shut down ends. Schaffner added that the epidemiology community already knows that the earliest influenza cases this season have been a good match to the strains in this season’s flu vaccine—whose components are generally decided on by late spring or early summer each year. “But,” says Schaffner, “as you get more influenza [cases], the possibility for more strain variation occurs, and so you need constant monitoring.”

Public health officials rely on the CDC’s FluView reports for updated accounts in their communities and across the country, but the site has not been updated this week and a notice on the site reads: “Due to the lapse in government funding, only web sites supporting excepted functions will be updated unless otherwise funded.” So far, FluView is not an excepted site. Google maintains a Flu Trends tracking report, which aggregates search query data on flu terms. Research has found a close relationship between the number of people searching for flu-related topics and the number of people who have the flu. However, experts says the Google data is limited because it doesn't provide any information on flu strains circulating, or mortality rates. [Read more in an article from the Augusta Chronicle.]

At least one private firm has stepped into the vaccuum to provide some flu-related data to communities. Athenahealth, a provider of cloud-based health services, said earlier this week that during the government shutdown it will “monitor and share population health information from across its national health care 'big data' asset,” which includes anonymous clinical data from nearly 44,000 medical providers and 40 million patient records nationwide.

“The CDC normally provides weekly reports on flu activity across the country. This information is critical to effectively track outbreaks and encourage public vaccination," said Josh Gray, Vice President of athenaResearch at athenahealth. "Every season is unpredictable. We hope the CDC is restored to full capacity as soon as possible. In the meantime we'll leverage athenahealth's cloud-based technology to report on disease patterns across our national network,” said Gray.

Most flu vaccine supplies are handled by the private sector and plenty of vaccine is being distributed around the country, says Dr. Schaffner. But athenahealth’s Gray said one motivation for sharing the company’s flu data is that news reports on flu activity often motivate consumers to get their flu shots. Although it is not currently being updated during the government shutdown, the vaccine finder site is still available online and a check of several communities on the site found the information up to date and accurate, though consumers should be advised to call and make sure vaccine supplies are on hand.

This commentary originally appeared on the RWJF New Public Health blog.