Travis County

Agenda Item

Receive update from the Epidemiology and Disease Surveillance Unit of the Austin
Public Health Department on the incidence of influenza and other respiratory illnesses in Travis County. (Commissioners Shea & Gómez)


Department:CC Agenda requestSponsors:
Category:General Government

Meeting History

Feb 12, 2019 9:00 AM Video Commissioners Court Voting Session
draft Draft

Members of the Court heard from:

Sherri Fleming, County Executive, HHS

Janet Pichette, Chief Epidemiologist, Austin Public Health

Jeff Taylor, Manager ,Epidemiology Surveillance Unit, Austin Public Health



Feb 12, 2019 9:00 AMVideo (Windows Media) MP4 VideoCommissioners CourtVoting Session

10:45 AMThis is how many peace officers that cut would represent, because we know that that's not where we would take all of it. So we can work on that.
County executive, planning and budget. We can work on that for sure. I would like to highlight with a 2. 5% revenue cap as proposed you would be looking at reductions across the board. No, it would not all come from public safety. But there would be an impact in the public safety arena. I just want to point that out. But we are happy to look at what some of those scenarios are, along with what those projections are over the next three to four years. We've done some of that work already.
10:46 AMDeece, more?
I think that's all we have at this time.
Awesome. [ laughing ]
There are 105 days remaining in the session.

10:46 AMAny other questions? Thanks so much.
Thank you.
Next, we'll go to agenda item number 9, which is to receive update from the epidemiology and disease surveillance unit of the austin public health department on the incidents of influenza and other respiratory illnesses in travis county. This one's for you, bridget. [ laughing ]
Might be a couple weeks late.
Good morning judge, commissioners, sherri fleming, county executive for health and human services. And as you are aware, we meet our public health mandate via an interlocal agreement with the city of austin. And so with that, I will turn you over to staff from austin public health who will introduce themselves while I get their presentation up.
10:47 AMIf anyone needs hand sanitizer -- [ laughing ]
Good morning, i'm janet, chief epidemiologist with austin public health.
I'm jeff taylor, the manager of the epidemiology and disease surveillance unit in austin public health. Did you want us -- first, I wanted to tell you about influenza activity. But first I thought i'd give you a quick primer. First, there are a number of respiratory viruses that circulate during the flu season. Some of these, cold virus, influenza, start circulating before influenza virus impacts the community. Once influenza virus is in the community, the other viruses seem to go away. And then later in the flu season, they'll start re-affairing. Reappearing. Right now we are having a typical influenza season. First, influenza is not the stomach flu. It doesn't cause nausea and vomiting. It causes a respiratory illness. And it's highly contagious from person to person. Some strains, h33n2 in particular, cause a more severe illness in those in older age groups. It has a sudden onset. What characterizes influenza is a high fever. The other viruses typically don't cause a fever. They May cause a runny nose and a cough, but influenza illnesses have a fever with a headache, muscle aches and pains, and a cough and sore throat. It's spread by that coughing and sneezing. When somebody has the flu, it's infecting their respiratory tract. When they talk, cough, and sneeze, they expel virus into the atmosphere. You can acquire influenza by breathing those droplets circulating in the atmosphere that contain virus. You can get influenza from kissing your spouse or others, from contaminated surfaces. The incubation period from when you're exposed can be one to two days. And it's communicable before the person May have onset. So if a person had onset today, they May have been communicable yesterday and spreading virus to others. Kids or school children are actually greater shedders than adults, and typically in a community, lots of studies have shown that the incubator of influenza in the community is at the schools and daycares where the kids spread it around among themselves and then take it home and spread it to their parents. Next slide. There are a number of groups that are at high risk of complication, including those under five years of age, those in older age groups, pregnant women are at higher risk of complications. We see more complications in those who live in long-term care facilities. And those who are overweight or obese who have a body index mass of over 40 are at higher risk of complications of the flu. So, the county and the states -- all counties in the united states and the states do influenza surveillance during the season. This is a network of looking at primary care providers, urgent care centers, hospital emergency departments, laboratories, looking for influenza virus present within the community. Typically our flu season or our flu week is a Sunday through a saturday. It starts the first week of October and ends through may, which can be the n flu citizen, but in the united states it typically peaks in January or february, after the christmas vacation. There are some years when we'll see an elevated flu season peaking in late November and some years in early march. But typically it's after christmas break when the kids get back in school that we'll see our peak season. Right now we're at a typical season. We're at widespread activities right now. Next. This is just the typical iceberg of what we do during flu. In a normal flu season about 10% of the population will be sick during that five-month period. So in austin-travis county, that would be over a hundred thousand. In severe flu seasons when a new virus is introduced, it can be as high as 30 or 40%. So in our county that May be a half a million. Right now all the indications are we're having a typical or a mild flu season. We look at some care providers. We don't try to count all the people that have flu. We'll look at those who are presenting to primary care providers or urgent care clinics, those who May be hospitalized. We'll look at laboratory test results from the major clinic, austin diagnostic or austin regional clinic being two in particular. And then we also do surveillance for mortality. Next slide. So, what does surveillance tell us? When the virus is present within the community. It tells us through cultural results which virus is circulating -- ah3n2, h1n1, b, or do we have a totally new virus appearing. It also tells from the cultural results, the cdc will do studies to say are the components of the vaccine protective. Are the viruses circulating in the community similar to the ones in the vaccine. We'll also use it to track -- it helps us track illnesses within the community. So, how do you prevent flu? We say you have to get vaccinated before the virus starts circulating. But the vaccine can also be important at any time in the flu season because you don't know when you're going to be exposed. You May be exposed tomorrow. So it would have been advantageous to be vaccinated in january. But before the flu citizen season starts, usually the first week of november. If you're sick you need to stay home. If your children have a febrile illness, they need to stay home. Covering your mouth when you cough or sneeze with your elbow or on your shoulder. Wash your hands or use those hand sanitizers that Judge Eckhardt has up there are all important in stopping transmission of flu, but also those other respiratory viruses, and also norovirus. Next. There are a number of influenza vaccines on the market. Some have three virus strains, some have four. There are some for older age groups that are more concentrated. There's a live virus. But most of the vaccines we use have dead viruses. You don't get the flu from getting your flu vaccination. It doesn't matter how much we try to educate the public that you don't get flu from the flu vaccine. It still is a misconception. And a lot of people use it about not getting vaccinated but it's important. You've got to get vaccinated to protect yourself from the flu and the vaccine doesn't cause an influenza virus infection. There are a number of antivirals on the market that have been on the market for over 20 years that protect somebody if they are exposed to a flu virus from getting the flu, but are used, also, when somebody has the flu to reduce the severity and duration of illnesses. Some of those are noted there. So currently what we're seeing in travis county, we're having what a typical, mild flu now. Last flu season was much more severe. We had over 50 deaths in travis county last year. So far this year we've had three. We always look at outbreaks at our long-term care facility. Last year we had over 24 noted. This year right now to date about 15. And we also track the outbreaks within the schools. Last year we had three. So far this year we've identified three schools that had major outbreaks where the absentee level approaches 30% on any given day. Next. So, being an epidemiologist, I wanted to show you some graphs. Through the state of texas and a number of other states also use a influenza-like illness network where we recruit providers who report the total number of patients seen that week and then the number that had an influenza-like illness. If you look at the gold and yellow bar, the 2017-2018 season when we had a number of deaths here in travis, that is a very high flu season. You see that over 10% of the patients seen at clinics had a flu-like illness. And that peak lasted for over three months. So that was a very intense flu season. The red line is what we're seeing right now. We're seeing a mild flu season. It's tracking the blue line, the 2016-2017 season. So we're starting to see an increase now. If I had extended that line for the next two weeks in February it's around 8% now. This doesn't tell us when we're going to peak, but once we do peak it's a good indication of when it'll start to drop. And if you look at those lines you'll always see that there's a drop in late december/early january. That's when the kids are out of school. That's when the universities are having their christmas break. So there's less transmission. But once everybody gets back into school, then you'll start seeing the peak go up. So again, the schools and universities are the incubators where a lot of transmission is occurring and then spreading to the general population. Next. We also look at -- we get data from austin diagnostic clinic, austin regional clinic and the family hospitals on a number of tests they perform each week. Right now it's over 2,000 tests that are performed by those three clinics or systems of clinics and we look at whether they're positive, a rapid antigen test for a or b. A viruses are circulating this season. When you look at the percentage of the right, during the intense activity, over 30 to 40% of the people they test are testing positive for influenza virus. And you can see in early october, it's a very small percentage, less than 5%. So we're during the peak of our flu season right now in january. And then we do also and this graph or bar just basically said those red bars or components of those red bars are components so it's telling us, and then the yellowish color or golden, h1n1, it's telling us this year it's an a flu season. Typically what has happened at the end of the season, we'll see other viruses emerging, february, March we'll start to see more b viruses than a. Those are indicators what viruses will appear next year. We're having a widespread outbreak, a typical flu season and primarily called by a viruses, two viruses, and both viruses by studying ice cdc has already done are typical to what's in this year's vaccine. If you got vaccinated, you should be pretty well protected. Any questions?
10:59 AMNope.
Does a mask help?
Yes, it does.
And on an airplane especially because i'm about to get on an airline and my wife said oh, I see the subject matter you are going to hear today so ask that.
More importantly, were you vaccinated. You don't have to tell me, but yes, we would say always mask somebody who is sick so when they are coughing or sneezing or talking, then those droplet particles are being trapped by the mask. Even that mask, it's not 100% effective, but it will reduce some things and help protect you.
In an airplane with the circulation of air it May be a good idea.
Yeah, we've been at the airport. There are hundreds of thousands of people go through abia every day and so you think there's lots of opportunities for viral transmission at that airport. So yes, if you want, wear a mask, but more importantly get vaccinated every fall.
11:00 AMThey could fit you for a bubble. [laughter]
Medical professionals i've been told refer to planes as germ tubes.
Yes, they are. obviously the air circulation is reduced, they don't bring in -- and you have a lot of people talking and you are very packed in there. In fact, for pertussis or measles outbreaks we'll look at the surrounding three or four rows of where effective transmission could occur. It doesn't take much to get infected with some of these viruses.
Sounds like wear a mask. thank you so much for the presentation.

11:00 AMHave a fever. Thank you very much. Next let's take up agenda item number -- first of all, agenda item number 15, which my bad I left off the consent motion. That is the budget amendments and transfers.
11:01 AMMove approval.
We have a motion by Commissioner Daugherty. Seconded by Commissioner Gomez.
On item 15, t1, they are requesting to use 5,000 of discretionary funds within the election fund to hire a temporary employee to research additional or replacement voting site locations. We -- we as the commissioners court have been publicly criticized for not doing more to assure I guess greater access to more polling places, particularly at the university of texas.