Brammer and her team publish FluView every Friday, providing influenza data to state public health officials, epidemiologists, clinicians and the public.
“This is a lot of information that comes from a lot of different people — physicians, people at state health departments and state labs and in hospitals and vital statistics offices,” Brammer said. “Sometimes you step back and look at it and think it’s pretty amazing that this system keeps running week after week, and it always does.”
In addition to patient information on viruses from 140 labs across the country, Brammer helps analyze data from vital statistics offices in 122 cities. Her team looks at death certificates that get filed to see how many people had flu or pneumonia — often a complication of flu— and compare them to a model baseline.
“It gives us a way to tell fairly quickly when we’re seeing more deaths due to influenza circulation than we would expect to see that time of year,” she said.
This year’s influenza surveillance system includes data from pediatric deaths related to flu and unusual flu cases. Brammer had a hand in creating nearly all of the systems to track these data.
“Many of these systems are her own design,” said Lyn Finelli, chief of Influenza Surveillance and Outbreak Response and Brammer’s supervisor. “Most of these systems would not be where they are today without her.”
Last summer, there was an unusual virus outbreak among people who had attended state fairs in Indiana and Ohio, where 4H members had been showing their animals. “We knew it wasn’t a normal human virus,” Brammer said. “We knew something was a little different.”
Her team worked with the states to investigate and learn the extent of the transmission. If the majority of the cases involved transmission from pigs to people, it would be different than if the virus was going person to person, which could indicate a pandemic and the need to start vaccine production. It was determined that in almost all of the cases, people had been exposed to pigs.
The surveillance system has grown over the years. In the late 1990s, the CDC was running it on its own with about 200 physicians calling or faxing in information from about 500,000 patient visits over the course of the flu season. States ran parallel systems. In 1996, the year after Brammer joined the epidemiology group, the idea of collaborating with states took hold.
Now, the CDC gets information on 700,000 patients in a single week from about 2,000 physicians. Health care providers send specimens to state labs for testing and some of the positive samples are sent to the CDC for more testing by the Virus Surveillance and Diagnostics Branch to see whether a new vaccine component is needed. The information then goes into the weekly FluView.
The seasonal process for discovering flu outbreaks and preparing a vaccine has changed dramatically since Brammer has been in the CDC influenza group, she said. It used to take from one to two weeks to grow viruses to determine if they were flu, and if so, what type. Now molecular diagnostic testing can be done in hours.
Each flu season is different. It sometimes hits all parts of the country and lasts one to two months. In other years, it spreads at a low level, but continues to spread for months and even into the summer. “There’s no typical flu season,” Brammer said. “They’re all different.”
To prepare, Brammer and her team watch what flu activity in the Southern Hemisphere, which has its winter while the United States has summer. When Australia and New Zealand had bad flu seasons, it put Brammer’s team on alert. “We thought we might be coming up on a bad year and we were.”
Before joining the CDC, Brammer worked in a hospital lab in Atlanta and would drive by the agency’s building and think how she’d like to work there. “I always heard of the cool things people at CDC were doing and I wanted to be a part of that.”
She eventually got a job at the agency, helping with an investigation of an Ebola virus in monkeys and plotting out where they had gotten it. She quickly became fascinated by the more analytical, epidemiologic side of the work and went back to school for a master’s degree in epidemiology so she could pursue it.
This article was jointly prepared by the Partnership for Public Service, a group seeking to enhance the performance of the federal government, and washingtonpost.com. Go to http://washingtonpost.com/wp-srv/politics/fedpage/players/ to read about other federal workers who are making a difference.