§         Influenza & RSV: There have been no laboratory reports of influenza or RSV positives since the week of May 31, 2008. 

• Negative predictive values are at their highest levels.
• Positive predictive values are at their lowest levels.
• Reminder to testing sites:  Please submit specimens to the WSLH for confirmatory testing from all positive influenza cases through autumn. 
• The “Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008” is available at the CDC MMWR website at http://www.cdc.gov/mmwr/early_release.html

§         Respiratory Viruses:  Parainfluenza viruses and adenoviruses continue to be reported sporadically. 

§         Rotavirus: There were no positive antigen detection tests for rotavirus reported for the week ending July 19, 2008.  This is the first week of no reported positives for rotavirus since October, 2007.

§         See the June 27, 2008 MMWR article on decreased rotavirus activity at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a6.htm.  Wisconsin data also demonstrated a decreased level of activity and delay in peak level of activity during this past season. 

§         Measles and Rubella:  Healthcare providers should continue to remain alert for measles cases.  Information about measles and rubella is available at http://dhfs.wisconsin.gov/immunization. 

§         Avian Influenza:  Enhanced surveillance for avian influenza remains in effect in Wisconsin.  Contact Division of Public Health (608-266-5326 7:45-4:30 Monday-Friday; after-hours, call 608-258-0099 and ask for "Communicable Disease Epidemiologist on-call”) prior to submitting specimens for fee-exempt transport and testing of persons with influenza-like illness that have returned from a country affected with human cases of avian influenza.  Call the WSLH emergency number (608-263-3280) if you need assistance. 

§         See the following page for information about Arbovirus and Lyme disease surveillance in Wisconsin

§         Arbovirus Surveillance (including WNV) In Wisconsin:   As of July 23, 2008, Wisconsin has no human cases of West Nile Virus (WNV), but does have 5 counties with reported WNV activity in birds or horses.  For WNV surveillance information, see the Wisconsin Division of Public Health (DPH) website at http://dhs.wisconsin.gov/communicable/WestNileVirus/

• 2008 Surveillance for Human Cases in Wisconsin:  In 2008, Wisconsin will be reporting all confirmed and probable cases of arbovirus infection to CDC (previously reported only confirmed cases).  Real-time reporting and case follow-up are especially important. 

§         A positive IgM result indicates that a patient may have an acute infection.  Results of testing at private laboratories are considered as presumptive positive, and samples should be forwarded to WSLH for confirmatory testing, due to the non-specific reactions and cross-reactivity among the different agents in the arbovirus group that often occurs.  

§         Please call all positive IgM results to the Vectorborne Disease Epidemiologist at the Division of Public Health (608-267-9000).  Once the epidemiologist is notified, a letter requesting the sample to be sent to WSLH for confirmatory testing and a fee-exempt form will be faxed to your department. 

o        One of the following criteria must be met for a patient to qualify for fee-exempt testing:

§         Confirmatory testing of positive results at laboratories other than the WSLH;

o        All presumptive positive laboratory specimens at other laboratories should be sent to the WSLH for confirmatory testing. 

§         Patients aged 65 or greater with signs and symptoms of meningitis (fever, headache and stiff neck) or encephalitis (fever, headache, and altered mental status ranging from confusion to coma) with no other diagnosis;

§         Patients diagnosed with Guillain-Barré syndrome with no other laboratory diagnosis;

§         Patients for whom the local health department requests testing due to lack of insurance or inability to pay.

o        For patients who do not meet the above criteria, fee for service testing is available at the WSLH on serum and CSF specimens for WNV/St. Louis Encephalitis, Eastern Equine Encephalitis, La Crosse Encephalitis, and the Arbovirus IgM Panel. 

o        Virus PCR and culture testing of CSF is also recommended for patients with aseptic meningitis.  

§         Lyme Disease Surveillance in Wisconsin:  Reporting of cases of Lyme disease is required by statute in Wisconsin, so laboratories must report all positive results.

§         CDC revised the Lyme disease national surveillance case definition effective January 1, 2008.  One major change in the national case definition is that Lyme disease cases can now be classified into three different categories (confirmed, probable, and suspect) based on the laboratory test results and the clinical signs and symptoms.

§         Another change established the following laboratory criteria to meet the surveillance case definition:

(1) A positive culture for B. burgdorferi, or

(2) “Two-tier” testing by Western immunoblot (WB) of enzyme immunoassay (EIA) or

                 indirect immunofluorescence (IFA) results, with an IgM immunoblot seropositive result for

                specimens collected within 30 days of onset date, or

§         “Two-tier” testing includes an initial screen by enzyme immunoassay (EIA) or indirect immunofluorescence assay (IFA), followed by confirmatory testing by Western immunoblot (WB) on any equivocal or positive results. 

(3) Positive IgG immunoblot using established criteria.

(4) Additional assays including PCR will be considered on a case by case basis.

§         For specific information on Wisconsin Lyme disease surveillance requirements, refer to the Wisconsin EpiNet manual (http://www.hanplus.wisc.edu/epinet/) and the Wisconsin Lyme disease case report form (CDES#107-revised 07/08).  The Division of Public Health (DPH) will post the updated version on the Health Alert Network (HAN). 

§         For further information, contact Diep (Zip) Hoang Johnson (608-267-9000) at DPH.