By Dr. Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDP, Greenwich Health Dept.
America is a nation on the move and Connecticut is a very mobile state. People crisscross to other countries, states and regional areas, many on a daily basis.
During flu season, in the absence of the common-sense-use of masks, staying home when ill, environmental safeguards, and good respiratory and handwashing hygiene the influenza-infected among us will spread infected viral droplets with every breath, everywhere they go.
This puts protecting you and those you love into your own hands because diseases like influenza spread easily from person to person.
The young, the old, and those with compromised health are at higher risk. Some viruses like influenza (and COVID and RSV) can be deadly. Being vaccinated against influenza and pneumonia is your best protection against an adverse outcome during seasonal flu. If you have not had your flu vaccine, now is the time to get it.
Misinformation kills; you cannot get the flu from the flu vaccine.
There are 10 Essential Services of Public Health (CDC, 2019). Assessing and monitoring population health tops the list along with investigating, diagnosing and addressing health problems. This is done to safeguard the public against, among other things, contagious and transmittable illnesses such as our current triad of concerns; influenza, COVID-19, and respiratory syncytial virus (RSV). Surveillance, prevention, mitigation, and treatment all impact the intensity of seasonal flu outbreaks as well as the budding tridemic. Public health aims to put fact-based health and safety information into people’s hands so they can make the best choices for them, their families, and their communities.
The Greenwich Department of Health, other local health departments, the Connecticut Dept of Public Health, the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO) collaborate with each other, with hospitals and other healthcare facilities, with laboratories, and with our health, medical, dental, and veterinary clinicians through complex networks of surveillance systems that traverse the globe. Public Health and medical-based healthcare are collaborative fields, but they are not the same. Each has its own distinct body of knowledge, roles, and skills. Some people get degrees or certifications in both.
Effective influenza monitoring requires vigilance. We need to know when each new flu season begins and which strain/strains are involved. Viruses don’t emerge one-at-a-time and make things easy for us.
This current flu season began early and is coinciding with three new mutated COVID-19 viruses. We are also simultaneously experiencing high pediatric hospitalization rates due to RSV, as well as some adult hospitalizations (CDC, 2022). We have safe and effective vaccines against influenza, pneumonia, and COVID, and Pfizer reports they are getting close to a vaccine for RSV, but having life-saving measures at our disposal and people taking advantage of them are two different things. Our vaccination rates have not been stellar in regard to flu shots or to the latest mRNA COVID booster. We have a lot of room for improvement. Influenza-focused public health activities include providing essential information to the public about the illness and how to protect ourselves, and running vaccine clinics; thus our continuous messaging is that the best flu-protection for us and our families is to get vaccinated.
It is critical for scientists and public health professionals to rapidly detect changes in the influenza virus structure. Mutations can impact detection, prevention, and treatment. We have four main viral influenza strains; A, B, C and D, each with many subtypes. Our seasonal flu outbreaks are attributed to the Human Influenza A and B viruses. To date only Influenza type A has resulted in pandemics. As the influenza virus mutates, we need to adjust public health guidance and vaccine composition just as has happened with COVID, and with the annual reconfiguration of flu vaccines (CDC, 2021).
The scope and reach of our country’s surveillance system is vast. The CDC regularly posts reports on the data obtained from its multi-surveillance influenza sources. CDC reporting on the nation is divided into 10 Health and Human Services Regions with Connecticut in Region 1 along with Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Reports also come out based on data from our Sentinel Provider Surveillance System, which is broken down into 9 Census Divisions with Connecticut falling into the New England Census Division, again along with those same aforementioned states.
In addition to the CDC monitoring influenza and influenza-like illnesses (ILI) in this country, the World Health Organization (WHO) leads our global monitoring system. Widespread influenza can and has led to pandemics, which by definition, are world-wide events (i.e.: the Spanish Flu pandemic of 1918 and the Avian Flu pandemic of 2014/15). The WHO has about 110 collaborating laboratories, and 270 National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories, which includes both public health and clinical laboratories.
So how do public health agencies fight a public health battle? Local public health agencies are the lead agencies in their community’s collaborative Public Health System. They are led by public health professionals with at least a Public Health Master’s Degree and experience in the field. In regard to influenza they plan, organize, coordinate and direct activities to:
Monitor their communities and prepare for routine and emergency planning around public health emergencies, including pandemic responses
Educate the public about safety, symptoms, warning signs, and preventive measures
Organize and hold flu and pneumonia immunization clinics
Teach symptom-recognition, warning signs-recognition, and self-care
Provide public health guidance on the importance of getting vaccinated, staying home when ill and wearing a mask to reduce transmission, and using proper respiratory and hand hygiene.
When medically necessary, monitor and treat people in the community.
Collaborate with other members of the public health system including healthcare practitioners, laboratories, and hospital EDs and ICUs, as well as funeral parlors.
Collaborate with other local Connecticut departments of health as well as with the public health systems of other states
Connecticut feeds into national and worldwide influenza surveillance data. All positive flu-tests are reported to the Connecticut Department of Public Health. The website of the Connecticut Association of Directors of Health (2022) identifies that we currently have 65 local health departments and health districts monitoring and acting on public health issues (https://cadh.org/public-health/).
The Centers for Disease Control and Prevention (CDC) collaborates with all U.S. States and Territories,
their local health departments, and with clinical and public health laboratories across the country.
Anyone in the public, the scientific community, or the clinical or public health communities can access CDC information online at any time from http://www.cdc.gov/flu/weekly/.
• In Connecticut the voluntary Sentinel Provider Surveillance System is comprised of outpatient clinicians who include Connecticut’s ILINet network. These providers notify the state when they see a patient with an Influenza-like Illness (ILI), which is defined as a patient having a cough or sore throat in the absence of a known cause, and the presence of a fever above 100° F. CT-DPH also receives weekly reports from these outpatient providers on the proportion of their patient visits where a case of ILI was seen in their office.
• The Emergency Departments of about half of Connecticut’s 32 acute care hospitals send daily information to Connecticut’s Hospital Emergency Department Syndromic Surveillance System (HEDSS). These hospital emergency departments (EDs) provide the Connecticut’s HEDSS with listings of all patients seen, the chief complaint behind their ED visit, and the calculated percentage of people who visited their ED that week because of fever and flu.
• The State of Connecticut’s Hospital Admissions Syndromic Surveillance System (HASS) receives daily e-reports from all 32 of Connecticut’s acute care hospitals. This report obtains data on anyone who required an unscheduled hospital admission, as well as on patients who required an unscheduled admission specifically due to a pneumonia diagnosis. The Connecticut DPH noted an association noted between severe influenza activity and pneumonia (https://portal.ct.gov/DPH/Immunizations/Seasonal-Influenza
Signs of influenza. Please note that they are similar to what we see with COVID. There are tests your care provider can use that can test for both influenza and COVID-19 (CDC,2022):
1) Fever/feeling feverish/chills
2) A cough
3) Sore throat
4) A runny or stuffy nose
5) Muscle or body aches
7) Feeling tired
8) Nausea, vomiting, or diarrhea may be present
Possible flu complications can include, but are not limited to, difficulty breathing, pneumonia, a viral or bacterial co-infection on top of the influenza illness, inflammation of the heart, brain, muscles or other organs, a systemic infection (sepsis), an inflammatory response, and multi-organ involvement (CDC, 2022). If complications appear or appear to be emerging, seek medical assistance. Flu Symptoms and Complications (CDC)