As most are aware, influenza or the ‘flu’ peaks dramatically in the fall and winter. According to the Centers for Disease Control and Prevention (CDC), “The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year.”

‘Tis the season.’

The severity of a flu season depends on a number of difficult-to-predict factors, including specific virus types, when and how much vaccine is available, how well the vaccine is matched to the latest strains, and how many people get vaccinated. In fact, the CDC notes that from 1976 to 1996, the estimated annual flu-related deaths in the United States ranged from a low of 3,000 to high of 49,000.

Unfortunately, the U.S. government is already sick. Preventative care hasn’t done a lot to head off a government shutdown. The CDC, a government agency, is responsible for nationwide flu surveillance. In the wake of U.S. politicians’ impish squabbling, they’ve managed to squeeze off funding that would normally go to monitoring key flu data that streams in from sources all around the country, including each state government. Typically, the CDC will provide a weekly report that compiles this information to provide useful data dashboards showcasing statistics such as hospitalization rates, mortality, and positive specimens reported. Much of this information can be pinpointed to a specific state or even one of the 122 cities involved in the surveillance program. As of October 11, 2013, the last weekly report covers the week of September 21.

Behind the Scenes

When the government is humming along, the general public may not be aware of the complex disease surveillance network managed by the CDC. Media campaigns to raise awareness for the importance of vaccination against the flu (and it is indeed important) are just the tip of the iceberg. There are five major categories of flu surveillance managed by the CDC that result in rich data, which under normal circumstances, is produced on a weekly basis:

Viral surveillance: Laboratories around the country feed data about the number of positive flu tests by virus type/subtype to the CDC. In some cases, epidemiological patient information is collected. The CDC will also perform tests on a subset of positive samples that may involve gene sequencing, antiviral resistance, and antigenic characterization.

Outpatient Illness Surveillance: Information regarding ‘influenza-like’ illness, stratified by age and region, flows into the CDC from approximately 1,800 outpatient centers representing all 50 states. This network, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), reports more than 30 million patient visits per year. For reporting purposes, all represented states and territories are grouped into 10 regions.

Mortality Surveillance: Deaths associated with the flu are reported for all ages groups through a pediatric mortality reporting system and a 122 US city reporting program.

Hospitalization Surveillance: Influenza-associated hospitalizations that have been confirmed by lab results are also reported to the CDC. The influenza hospitalization network (FluSurv-NET) conducts surveillance in areas of emerging disease, which include up to 15 states.

Summary of the Geographic Spread of Influenza: State and territorial epidemiologist reports provide information to the CDC based on no, sporadic, local, regional, or widespread activity.

Eight data sources feed information from all around the country into this weekly surveillance program in order to ‘find out when and where influenza activity is occurring, track influenza related illnesses, determine what influenza viruses are circulating, detect changes in influenza viruses, and measure the impact influenza is having on hospitalizations and deaths in the United States’.

What does this mean today?

The good news is local and state health departments will continue to monitor flu activity in their respective areas. Local vaccination campaigns will continue, and the ability to locate free or cheap inoculation in your area will not likely be affected. The strong network channeling information to the CDC still exists and operates, but the CDC, without critical government funding, is unable to gather, interpret, analyze, and disseminate valuable flu surveillance data. Additionally, the CDC’s capacity to respond to outbreaks is diminished. For another take, check out this article about how the shutdown affects salmonella outbreaks.

As mentioned above, the greatest factor determining the country’s flu well-being, is uncertainty, as it is every year. Preparedness counts, so getting this year’s updated flu shot is everyone’s best defense against the virus, government or no government.   

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