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FluView: A Weekly Influenza Surveillance Report Prepared by the Influenza Division

2013-2014 Influenza Season Week 18 ending May 3, 2014


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

Synopsis:

During week 18 (April 27-May 3, 2014), influenza activity continued to decrease in the United States.

  • Viral Surveillance: Of 3,692 specimens tested and reported during week 18 by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 460 (12.5%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A season-cumulative rate of 35.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.2%, which is below the national baseline of 2.0%. All regions reported ILI below region-specific baseline levels. One state experienced low ILI activity; 49 states and New York City experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in Guam and four states was reported as widespread; two states reported regional influenza activity; eight states reported local influenza activity; the District of Columbia, Puerto Rico, and 32 states reported sporadic influenza activity, and the U.S. Virgin Islands and four states reported no influenza activity.

A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/overview.htm

National and Regional Summary of Select Surveillance Components

HHS Surveillance Regions* Data for current week Data cumulative since September 29, 2013 (Week 40)
Out-patient ILI† % positive for flu‡ Number of jurisdictions reporting regional or widespread activity§ 2009 H1N1 A (H3) A(Subtyping not performed) B Pediatric Deaths
Nation Normal 12.5% 7 of 54 28,242 2,653 14,794 5,582 91
Region 1 Normal 25.2% 4 of 6 1,652 624 512 442 3
Region 2 Normal 17.4% 2 of 4 1,895 424 1,177 1,142 7
Region 3 Normal 25.0% 0 of 6 4,573 330 459 600 9
Region 4 Normal 15.3% 0 of 8 2,042 54 5,189 1,274 19
Region 5 Normal 12.8% 0 of 6 3,239 140 614 231 6
Region 6 Normal 6.3% 0 of 5 3,169 280 4,211 994 30
Region 7 Normal 4.9% 0 of 4 1,331 88 56 65 4
Region 8 Normal 6.5% 0 of 6 4,633 183 1,318 291 2
Region 9 Normal 4.5% 1 of 5 3,349 387 1,121 422 10
Region 10 Normal 5.2% 0 of 4 2,359 143 137 121 1

*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, Puerto Rico, and Washington D.C. report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza virus type and influenza A virus subtype. The results of tests performed during the current week are summarized in the table below.

Region specific data can be found at http://gis.cdc.gov/grasp/fluview/fluportaldashboard.html.

Week 18
No. of specimens tested 3,692
No. of positive specimens (%) 460 (12.5%)
Positive specimens by type/subtype
  Influenza A 202 (43.9%)
             2009 H1N1 5 (2.5%) 
              H3 80 (39.6%) 
            Subtyping not performed 117 (57.9%) 
  Influenza B 258 (56.1%)

INFLUENZA Virus Isolated
View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation




Antigenic Characterization*

CDC has antigenically characterized 2,644 influenza viruses [1,929 2009 H1N1 viruses, 421 influenza A (H3N2) viruses, and 294 influenza B viruses] collected by U.S. laboratories since October 1, 2013 by hemagglutination inhibition (HI).

2009 H1N1 [1,929]:

  • 1,926 (99.8%) of 1,929 2009 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2013-2014 Northern Hemisphere influenza vaccine. Three (0.2%) viruses showed reduced titers with antiserum produced against A/California/7/2009.

Influenza A (H3N2) [421]:

  • 406 (96.4%) of the 421 influenza A (H3N2) viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2013-2014 Northern Hemisphere influenza vaccine. Fifteen (2.3%) viruses showed reduced titers with antiserum produced against A/Texas/50/2012.

Influenza B [294]: 206 (70.1%) of the 294 influenza B viruses tested belong to B/Yamagata/16/88-lineage and the remaining 88 (29.9%) influenza B viruses tested belong to B/Victoria/02/87 lineage.

  • Yamagata Lineage [206]: 205 (99.5%) of the 206 influenza B/Yamagata-lineage viruses were characterized as B/ Massachusetts/2/2012-like, which is included as an influenza B component of the 2013-2014 Northern Hemisphere trivalent and quadrivalent influenza vaccines. One (0.5%) virus showed reduced titers with antiserum produced against B/Massachusetts/2/2012.
  • Victoria Lineage [88]: 88 influenza B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, which is included as an influenza B component of the 2013-2014 Northern Hemisphere quadrivalent influenza vaccine.

*For more information see the section on antigenic characterization in the MMWR “Update: Influenza Activity — United States and Worldwide, May 19–September 28, 2013”.



Composition of the 2014-2015 Influenza Vaccine

The World Health Organization (WHO) has recommended vaccine viruses for the 2014-2015 Northern Hemisphere influenza vaccines, and the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) has made recommendations for the composition of the 2014-2015 influenza vaccines to be used in the United States. Both agencies recommend that trivalent vaccines contain an A/California/7/2009-like (2009 H1N1) virus, an A/Texas/50/2012-like (H3N2) virus, and a B/Massachusetts/2/2012-like (B/Yamagata lineage) virus. It is recommended that quadrivalent vaccines containing an additional influenza B virus contain a B/Brisbane/60/2008-like (B/Victoria lineage) virus in addition to the viruses recommended for the trivalent vaccines. These recommendations were based on global influenza virus surveillance data related to epidemiology and antigenic characteristics, serological responses to 2013-2014 seasonal vaccines, and the availability of candidate strains and reagents.


Antiviral Resistance

Testing of 2009 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 H1N1 and influenza A (H3N2) clinical samples are tested for mutations of the virus known to confer oseltamivir resistance. 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). Therefore, data from adamantane resistance testing are not presented below.

Neuraminidase Inhibitor Resistance Testing Results on Samples Collected Since October 1, 2013

Oseltamivir Zanamivir
Virus Samples tested (n) Resistant Viruses, Number (%) Virus Samples tested (n) Resistant Viruses, Number (%)
Influenza A (H3N2) 554 0 (0.0) 554 0 (0.0)
Influenza B 409 0 (0.0) 409 0 (0.0)
2009 H1N1 5,071* 59 (1.2) 1,867 0 (0.0)

*Includes specimens tested in national surveillance and additional specimens tested at public health laboratories in 19 states (AZ, CA, CO, DE, FL, GA, HI, ID, MA, ME, MD, MI, MN, NY, PA, TX, UT, WA, and WI) who share testing results with CDC.


The majority of currently circulating influenza viruses are susceptible to the neuraminidase inhibitor antiviral medications, oseltamivir and zanamivir; however, rare sporadic cases of oseltamivir-resistant 2009 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 serious 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 18, 6.8% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 7.0% for week 18.

Pneumonia And Influenza Mortality
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Influenza-Associated Pediatric Mortality

No influenza-associated pediatric deaths were reported to CDC during week 18.

A total of 91 influenza-associated pediatric deaths have been reported during the 2013-2014 season from Chicago [1], New York City [4] and 30 states (AR [4]; AZ [1]; CA [8]; FL [4]; GA [1]; IA [1]; IL [1]; KS [2]; KY [1]; LA [6]; MA [2]; MD [1]; ME [1]; MI [2]; MS [1]; NC [6]; NE [1]; NJ [2]; NV [1]; NY[1]; OK [2]; OR [1]; PA [3]; SC [2]; TN [4]; TX [18]; UT [2]; VA [3]; WI [2]; and WV [2]).

Additional data can be found at http://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html.


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Influenza-Associated Hospitalizations

The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in children younger than 18 years of age (since the 2003-2004 influenza season) and adults (since the 2005-2006 influenza season).

The FluSurv-NET covers more than 70 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 2009-2010 season to enhance surveillance during the 2009 H1N1 pandemic. IHSP sites included IA, ID, MI, OK and SD during the 2009-2010 season; ID, MI, OH, OK, RI, and UT during the 2010-2011 season; MI, OH, RI, and UT during the 2011-2012 season; IA, MI, OH, RI, and UT during the 2012-2013 season; and MI, OH, and UT during the 2013-2014 season.

Data gathered are used to estimate age-specific hospitalization rates on a weekly basis, and describe characteristics of persons hospitalized with severe influenza illness. The rates provided are likely to be an underestimate as 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, 2013 and April 30, 2014, 9,587 laboratory-confirmed influenza-associated hospitalizations were reported. This is a rate of 35.4 per 100,000 population. The highest rate of hospitalization is among adults aged ≥65 years, although those aged 18-64 years account for approximately 60% of reported hospitalized cases. Among all hospitalizations, 8,483 (88.5%) were associated with influenza A, 1,010 (10.5%) with influenza B, 45 (0.5%) with influenza A and B co-infection, and 49 (0.5%) had no virus type information. Among those with influenza A subtype information, 221 (5.2%) were H3 and 4,044 (94.8%) were 2009 H1N1.

Clinical findings are preliminary and based on approximately 64% of cases with complete medical chart abstraction. The most commonly reported underlying medical conditions among adults were obesity, metabolic disorders, cardiovascular disease, and chronic lung disease (excluding asthma). Approximately 11% of hospitalized adults had no identified underlying medical conditions. The most commonly reported underlying medical conditions in children were asthma, neurologic disorders, chronic lung disease (excluding asthma), and cardiovascular disease. Approximately 43% of hospitalized children had no identified underlying medical conditions. Among 820 hospitalized women of childbearing age (15-44 years), 186 (23%) were pregnant.

Additional FluSurv-NET data can be found at:http://gis.cdc.gov/GRASP/Fluview/FluHospRates.html and http://gis.cdc.gov/grasp/fluview/FluHospChars.html.

The current season’s influenza-associated hospitalization data includes patients admitted from October 1, 2013 through April 30, 2014. While cases admitted after April 30, 2014 will not be included, data on cases admitted through April 30, 2014 will continue to be updated as additional information is received.


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Outpatient Illness Surveillance

Nationwide during week 18, 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 2.0%. (ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat.)

national levels of ILI and ARI
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On a regional level, the percentage of outpatient visits for ILI ranged from 0.6% to 2.1% during week 18. All regions reported a proportion of outpatient visits for ILI below their region-specific baseline level.

Region specific data is available at http://gis.cdc.gov/grasp/fluview/fluportaldashboard.html.


ILINet 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 weeks with little or no influenza virus circulation. Activity levels range from minimal, which would correspond to ILI activity from outpatient clinics being below, or only slightly above, the average, to high, which would correspond to ILI activity from outpatient clinics being much higher than average.

During week 18, the following ILI activity levels were experienced:

  • One state experienced low ILI activity (Minnesota).
  • Forty-nine states and New York City experienced minimal ILI activity (Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming).
  • Data were insufficient to calculate an ILI activity level for the District of Columbia.

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*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 is 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 severity of influenza activity.

During week 18, the following influenza activity was reported:

  • Widespread influenza activity was reported by Guam and four states (Connecticut, Massachusetts, New York, and Rhode Island).
  • Regional influenza activity was reported by two states (Maine and New Jersey).
  • Local influenza activity was reported by eight states (Arizona, Colorado, Maryland, New Hampshire, Ohio, Texas, Vermont, and Virginia).
  • Sporadic influenza activity was reported by Puerto Rico, the District of Columbia and 32 states (Alabama, Alaska, Arkansas, California, Delaware, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Utah, Washington, West Virginia, Wisconsin, and Wyoming).
  • The U.S. Virgin Islands and Four states (Georgia, Kansas, Mississippi, and Tennessee) reported no influenza activity.

U. S. Map for Weekly Influenza Activity

Flu Activity data in XML Format | View Full Screen



Additional National and International Influenza Surveillance Information


FluView Interactive: FluView includes enhanced web-based interactive applications that can provide dynamic visuals of the influenza data collected and analyzed by CDC. These FluView Interactive applications allow people to create customized, visual interpretations of influenza data, as well as make comparisons across flu seasons, regions, age groups and a variety of other demographics. To access these tools visit http://www.cdc.gov/flu/weekly/fluviewinteractive.htm.

U.S. State and local influenza surveillance: Click on a jurisdiction below to access the latest local influenza information.

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

New York City

Virgin Islands



Google Flu Trends: Google Flu Trends uses aggregated Google search data in a model created in collaboration with CDC to estimate influenza activity in the United States. For more information and activity estimates from the U.S. and worldwide, see http://www.google.org/flutrends/

World Health Organization: Additional influenza surveillance information from participating WHO member nations is available through FluNet and the Global Epidemiology Reports.

WHO Collaborating Centers for Influenza located in Australia, China, Japan, and the United Kingdom.

Europe: for the most recent influenza surveillance information from Europe, please see WHO/Europe at http://www.euroflu.org/index.php and visit the European Centre for Disease Prevention and Control at http://ecdc.europa.eu/en/publications/surveillance_reports/influenza/Pages/weekly_influenza_surveillance_overview.aspx

Public Health Agency of Canada: The most up-to-date influenza information from Canada is available at http://www.phac-aspc.gc.ca/fluwatch/

Health Protection Agency (United Kingdom): The most up-to-date influenza information from the United Kingdom is available at http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SeasonalInfluenza/



Any links provided to non-Federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization web pages found at these links.

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A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/overview.htm

 
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