2011-2012 Influenza Season Week 2 ending January 14, 2012

All data are preliminary and may change as more reports are received.

Synopsis:

During week 2 (January 8-14, 2012), influenza activity in the United States remained relatively low.

• U.S. Virologic Surveillance: Of the 3,771 specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division, 138 (3.7%) were positive for influenza.
• Pneumonia and Influenza (P&I) Mortality Surveillance: The proportion of deaths attributed to P&I was below the epidemic threshold.
• Influenza-associated Pediatric Mortality: No influenza-associated pediatric deaths were reported.
• Outpatient Illness Surveillance:The proportion of outpatient visits for influenza-like illness (ILI) was 1.2%, which is below the national baseline of 2.4%. All 10 regions reported ILI below region-specific baseline levels. New York City and all 50 states experienced minimal ILI activity and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: The geographic spread of influenza in one state was reported as regional; eight states reported local activity; Puerto Rico and 38 states reported sporadic activity, and the District of Columbia, Guam, the U.S. Virgin Islands, and three states reported no influenza activity.

*HHS regions (Region 1 CT, ME, MA, NH, RI, VT; Region 2: NJ, NY, Puerto Rico, US Virgin Islands; Region 3: DE, DC, MD, PA, VA, WV; Region 4: AL, FL, GA, KY, MS, NC, SC, TN; Region 5: IL, IN, MI, MN, OH, WI; Region 6: AR, LA, NM, OK, TX; Region 7: IA, KS, MO, NE; Region 8: CO, MT, ND, SD, UT, WY; Region 9: AZ, CA, Guam, HI, NV; and Region 10: AK, ID, OR, WA).
† Elevated means the % of visits for ILI is at or above the national or region-specific baseline
‡ National data are for current week; regional data are for the most recent three weeks
§ Includes all 50 states, the District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. The results of tests performed during the current week are summarized in the table below.

	Week 2
No. of specimens tested	3,771
No. of positive specimens (%)	138 (3.7%)
Positive specimens by type/subtype
Influenza A	132 (95.7%)
2009 H1N1	15 (11.4%)
Subtyping not performed	52 (39.4%)
(H3)	65 (49.2%)
Influenza B	6 (4.3%)

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Antigenic Characterization:

CDC has antigenically characterized 197 influenza viruses [20 2009 H1N1, 160 influenza A (H3N2) viruses, and 17 influenza B viruses] collected by U.S. laboratories since October 1, 2011.

2009 H1N1 [20]

• Nineteen (95%) of the 20 viruses were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2011-2012 influenza vaccine for the Northern Hemisphere.
• One virus (5%) tested showed reduced titers with antiserum produced against A/California/7/2009.

Influenza A (H3N2) [160]

• One hundred fifty-eight (98.8%) of the 160 viruses were characterized as A/Perth/16/2009-like, the influenza A (H3N2) component of the 2011-2012 influenza vaccine for the Northern Hemisphere.
• Two viruses (1.2%) tested showed reduced titers with antiserum produced against A/Perth/16/2009.

Influenza B (B/Victoria/02/87 and B/Yamagata/16/88 lineages) [17]:

• Victoria Lineage [8]: Eight of the 17 influenza B viruses tested belong to the B/Victoria lineage of viruses and were characterized as B/Brisbane/60/2008-like, the recommended influenza B component for the 2011-12 Northern Hemisphere influenza vaccine.
• Yamagata Lineage [9]: Nine of the 17 influenza B viruses tested belong to the B/Yamagata lineage of viruses.

It is too early in the influenza season to determine how well the seasonal influenza vaccine strains and circulating strains will match.

Antiviral Resistance:

Testing of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B virus isolates for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) is performed at CDC using a functional assay. Additional 2009 influenza A (H1N1) clinical samples are tested for a single mutation in the neuraminidase of the virus known to confer oseltamivir resistance (H275Y). The data summarized below combine the results of both testing methods. These samples are routinely obtained for surveillance purposes rather than for diagnostic testing of patients suspected to be infected with antiviral resistant virus.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among 2009 influenza A (H1N1) and A (H3N2) viruses (the adamantanes are not effective against influenza B viruses). As a result of the sustained high levels of resistance, data from adamantane resistance testing are not presented in the table below.

Neuraminidase Inhibitor Resistance Testing Results on Samples Collected Since October 1, 2011

	Oseltamivir		Zanamivir
	Virus Samples tested (n)	Resistant Viruses, Number (%)	Virus Samples tested (n)	Resistant Viruses, Number (%)
Influenza A (H3N2)	173	0 (0.0)	173	0 (0.0)
Influenza B	30	0 (0.0)	30	0 (0.0)
2009 H1N1	28	0 (0.0)	28	0 (0.0)

All viruses tested for the 2011-2012 season since October 1, 2011 have been susceptible to the neuraminidase inhibitor antiviral medications oseltamivir and zanamivir as were the majority of viruses tested last season; however, rare sporadic cases of oseltamivir resistant 2009 influenza A (H1N1) and A (H3N2) viruses have been detected worldwide. Antiviral treatment with oseltamivir or zanamivir is recommended as early as possible for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at greater risk for influenza-related complications. Additional information on recommendations for treatment and chemoprophylaxis of influenza virus infection with antiviral agents is available at (http://www.cdc.gov/flu/antivirals/index.htm).

Pneumonia and Influenza (P&I) Mortality Surveillance:

During week 2, 7.6% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 7.7% for week 2.

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Influenza-Associated Pediatric Mortality:

No influenza-associated pediatric deaths were reported to CDC during week 2 and no influenza-associated pediatric deaths have been reported to CDC so far for the 2011-12 season.

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Influenza-Associated Hospitalizations:

The Influenza Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza related hospitalizations in children <18 years of age (since 2003-04 influenza season) and adults (since 2005-06 influenza season).

The FluSurv-NET covers over 80 counties in the 10 Emerging Infections Program (EIP) states (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) and additional Influenza Hospitalization Surveillance Project (IHSP) states. The IHSP began during the 2009-10 season to enhance surveillance during the 2009 H1N1 pandemic. IHSP sites included IA, ID, MI, OK and SD during 2009-2010 season; ID, MI, OH, OK, RI, and UT during the 2010-2011 season; and MI, OH, RI, and UT during the 2011-2012 season. The rates provided are likely to be a vast underestimate of the actual number of influenza-related hospitalizations. First, the FluSurv-NET is not nationally representative, and second, influenza-related hospitalizations can be missed, either because testing is not performed, or because cases may be attributed to other causes of pneumonia or other common influenza-related complications.

Between October 1, 2011 and January 14, 2012, 141 laboratory-confirmed influenza hospitalizations were reported, a rate of 0.5 per 100,000 population. Among cases, 98 (69.5%) were influenza A, 35 (24.8%) were influenza B, and 2 (1.4%) were influenza A and B co-infections; 6 (4.3%) had no virus type information. Among those with influenza A subtype information, 41 were H3N2 and 1 was 2009 H1N1. The most commonly reported underlying medical conditions among hospitalized adults were chronic lung diseases, metabolic disorders, asthma and obesity. Among children, a quarter did not have any prior underlying medical conditions identified. The most common underlying medical conditions in hospitalized children were neurologic disorders, asthma, chronic lung disease, and obesity.

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Outpatient Illness Surveillance:

Nationwide during week 2, 1.2% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is below the national baseline of 2.4%. (ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat.)

The increase in the percentage of patient visits for ILI in previous weeks may be influenced by a reduction in routine healthcare visits during the holiday season, as has occurred in previous seasons.

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On a regional level, the percentage of outpatient visits for ILI ranged from 0.9% to 2.0% during week 2. All 10 regions reported a proportion of outpatient visits for ILI below their region-specific baseline levels.

ILINet State Activity Indicator Map:

Data collected in ILINet are used to produce a measure of ILI activity* by state. Activity levels are based on the percent of outpatient visits in a state due to ILI and are compared to the average percent of ILI visits that occur during spring and fall weeks with little or no influenza virus circulation. Activity levels range from minimal, which would correspond to ILI activity being below the average, to intense, which would correspond to ILI activity being much higher than average. Because the clinical definition of ILI is very general, not all ILI is caused by influenza; however, when combined with laboratory data, the information on ILI activity provides a clear picture of influenza activity in the United States.

During week 2, the following ILI activity levels were experienced:

• New York City and all 50 states experienced minimal ILI activity.
• Data were insufficient to calculate an ILI activity level from the District of Columbia.

*This map uses the proportion of outpatient visits to health care providers for influenza-like illness to measure the ILI activity level within a state. It does not, however, measure the extent of geographic spread of flu within a state. Therefore, outbreaks occurring in a single city could cause the state to display high activity levels.
Data collected in ILINet may disproportionately represent certain populations within a state, and therefore, may not accurately depict the full picture of influenza activity for the whole state.
Data displayed in this map are based on data collected in ILINet, whereas the State and Territorial flu activity map are based on reports from state and territorial epidemiologists. The data presented in this map is preliminary and may change as more data is received.
Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists:

The influenza activity reported by state and territorial epidemiologists indicates geographic spread of influenza viruses, but does not measure the intensity of influenza activity.

During week 2, the following influenza activity was reported:

• Regional influenza activity was reported by one state (Colorado).
• Local influenza activity was reported by eight states (California, Kansas, Kentucky, Maine, Massachusetts, New Hampshire, Texas, and Virginia).
• Sporadic influenza activity was reported by Puerto Rico and 38 states (Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, Wisconsin, and Wyoming).
• No influenza activity was reported by the District of Columbia, Guam, the U.S. Virgin Islands, and three states (Delaware, Oklahoma, and West Virginia).