DFM Partners with State Agencies to Identify Patterns of Influenza and Rotavirus in Wisconsin

Careful prevention, surveillance, and reporting of communicable diseases are essential to public health. State and federal agencies, the medical community, and the public all need timely and accurate data on the patterns of disease—data that is often first captured in the primary care setting.

Since 1994, the Department of Family Medicine (DFM) has collaborated with the Wisconsin State Laboratory of Hygiene (WSLH) and the Wisconsin Division of Public Health (WDPH) to collect and report data on viral diseases.

This collaboration continues with two new statewide pilot research projects: one that maps the incidence of influenza, and one that investigates the effectiveness of the rotavirus vaccine.

Project 1: Influenza Incidence

The first project, a grant funded by the Council of State and Territorial Epidemiologists, aims to accurately estimate the incidence of influenza in outpatient settings across Wisconsin.

To accomplish this, investigators will gather the following data:

• Estimates of "influenza-like illness," as extracted from the DFM's Clinical Data Warehouse (CDW). The CDW holds records from all 26 of the DFM's statewide clinics, which represents approximately 2.5% of Wisconsin's total population
• Reports of "influenza-like illness," as identified at the following DFM clinics:
  • Belleville Family Medical Center
  • Northeast Family Medical Center
  • Verona Family Medical Center
  • Wingra Family Medical Center
• Confirmed cases of influenza from the four clinics listed above, as identified by both rapid testing at the clinic and comprehensive specimen testing at the WSLH.

Data collection at the five DFM clinics will begin once Institutional Review Board (IRB) approval is attained, and will continue through May 28, 2010. Each week, the data will be tallied, reviewed by investigators, and reported to the Centers for Disease Control and Prevention (CDC).

"This project will combine the power of primary care with the power of a public health laboratory that has the gold standard in testing," said Jonathan Temte, MD, PhD, a DFM professor and the grant's program coordinator.

"Not only will we be able to identify patients with influenza, we also will be able to very accurately determine the sensitivity, specificity, and performance of rapid testing in real-life clinical settings. This will allow us to quickly send out assessments and analysis to a variety of stakeholders."

Project 2: Rotavirus Vaccine Effectiveness

The group's second project is examining trends associated with the rotavirus vaccine (a new vaccine first recommended by the CDC in 2006). Specifically, the project is looking at utilization of the vaccine, related increases or decreases in rotavirus detection, and related rotavirus hospitalizations.

The project pulls together information from the Wisconsin Immunization Registry,
hospital discharge data from the WDPH, and surveillance data provided by the WSLH. Representatives from each group are meeting regularly to evaluate the data and start to draw preliminary conclusions.

Although the project is still in the exploratory stages, Dr. Temte said initial findings are promising. "We're seeing declines in statewide rotavirus detections, hospitalizations, and clinic visits," he said. "It appears that there are some profound effects from this vaccine, and we hope can pursue a more formal research project in the future."

The DFM's Role in an Important Collaboration

The DFM's collaboration with the WSLH began over 15 years ago. According to Dr. Temte, it arose from the realization that the WSLH has powerful laboratory diagnostic tools, and the DFM has access to a large, differentiated patient base. Over time, the relationship expanded to include closer collaboration with the WDPH.

"Our patient group is very broad in terms of age, gender, health and wellness, disease category, and socioeconomic status—and is the closest thing we have to an accurate statewide patient sample," he said. "Working together, we have a nice approach for looking at communicable diseases in real-life patient populations."

Dr. Temte also chairs the Wisconsin Council on Immunization Practices and is vice chair of the CDC's Advisory Committee for Immunization Practices.