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athenaResearch Tracking Flu Activity During the CDC Furlough

by Iyue Sung, PhD, Director of athenaResearch

The initiative described below was led by Matt Nix, athenahealth Manager of Core Analytics, who also produced the analyses for this report.

As Washington remains deadlocked on the implementation of the Affordable Care Act (ACA), the US government’s shutdown has resulted in the furlough of nearly 70% of the Centers for Disease Control‘s (CDC’s) workforce. CDC Director Tom Frieden recently shared his thoughts in this tweet:

@DrFriedenCDC
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.

We agree wholeheartedly. Although it’s all too easy to take the CDC staff for granted, they are the frontline sentinels (and gold standard) for monitoring disease outbreaks. Their ramp-down could have serious public health consequences.

At athenahealth, we are particularly concerned about the apparent temporary discontinuation of the CDC’s flu surveillance program, which normally provides weekly reports on flu activity. Although flu season typically begins in late fall, outbreaks have occurred earlier in previous years.

In 2009, flu cases started accumulating in late summer/early fall. And given the potential for unique variants, such as the swine or avian flu, every season is unpredictable, making regular CDC flu reports essential. We therefore hope to see the CDC restored to full capacity as soon as possible.

In the meantime, we would like to help by sharing data we have on communicable diseases, starting with the flu. Because the athenahealth database is built on a single-instance, cloud-based architecture, we have the ability to report data in real time. And, as we have described in earlier posts, the physicians we serve are dispersed around the country with good statistical representation across practice types and sizes.

To get a read on influenza vaccination rates so far this season, we looked at more than two million patients who visited a primary care provider between August 1 and September 28, 2013 (Figure 1). We did not include data on vaccinations provided at retail clinics, schools or workplaces.

This year’s rates are trending in parallel to rates over the last four years, and slightly below those of the 2012-2013 season. However, immunizations accelerate when the CDC, and consequently the media, announce disease outbreaks and mount public awareness campaigns.


Proportion of Patients Receiving Flu Vaccination

As for the government shutdown, nearly everyone hopes for a quick end. Should the standoff drag on, detection of the flu (or other diseases) may be delayed, in theory endangering the public. Fortunately, we currently see no evidence of an early influenza outbreak but recent history shows that the flu can begin spreading at any time, and once it does begin, it spreads very quickly, as shown in Figure 2.


Proportion of Patients with Flu

We believe that our data provides a reliable view of seasonal flu trends. Last year, we wrote about the 2012-2013 flu season and found that patterns in our patient population (consisting of a large proportion of patients receiving immunizations in primary care settings) closely mirrored CDC trends. With that in mind, we believe that sharing our 2013-2014 data will be valuable to the health care community.

Whether our nation’s politicians can come to an agreement tomorrow or next month, we will continue to deliver reports that monitor population health and look ahead to contributing any information we can. If you have any suggestions or comments — on the flu or other diseases where up-to-date data would be valuable — please leave a comment here or e-mail me directly at isung@athenahealth.com.

As a statistician, Iyue is responsible for methodology, analytic infrastructure, and extracting data-driven insights from the athenahealth patient database. 

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