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

2014-2015 Influenza Season Week 9 ending March 7, 2015


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

Synopsis:

During week 9 (March 1-7, 2015), influenza activity continued to decrease, but remained elevated in the United States.

National and Regional Summary of Select Surveillance Components

HHS Surveillance Regions* Data for Current Week Data Cumulative Since September 28, 2014 (Week 40)
Out-patient ILI† Number of jurisdictions reporting regional or widespread activity§ % Respiratory specimens positive for flu‡ A(H1N1)pdm09 A (H3) A(Subtyping not performed) B Pediatric Deaths
Nation Elevated 41 of 54 11.4% 158 46,169 49,169 9,014 104
Region 1 Elevated 5 of 6 16.3% 7 2,653 2,672 251 1
Region 2 Elevated 4 of 4 14.8% 55 3,853 5,051 423 6
Region 3 Normal 2 of 6 11.2% 8 6,034 4,725 471 10
Region 4 Elevated 7 of 8 10.2% 9 3,609 12,266 2,482 19
Region 5 Elevated 4 of 6 9.0% 12 7,981 7,832 935 20
Region 6 Elevated 5 of 5 12.6% 28 4,488 7,793 2,074 20
Region 7 Elevated 4 of 4 10.2% 8 1,743 2,399 516 7
Region 8 Elevated 4 of 6 11.4% 26 4,523 3,396 929 7
Region 9 Normal 4 of 5 17.3% 23 7,163 3,082 669 13
Region 10 Elevated 2 of 4 7.5% 9 4,122 684 264 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
§ Includes all 50 states, the District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands
‡ National data are for current week; regional data are for the most recent three weeks


U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states, Puerto Rico, and the District of Columbia 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 and totals for the influenza season to date are summarized in the table below. Region specific data are available at http://gis.cdc.gov/grasp/fluview/fluportaldashboard.html.

 

Week 9

Data Cumulative
since September 28, 2014
(Week 40)

No. of specimens tested

14,634

530,071

No. of positive specimens (%)

1,670 (11.4%)

105,269 (19.9%)

Positive specimens by type/subtype

   

  Influenza A

800 (47.9%)

96,255 (91.4%)

            A(H1N1)pdm09

4 (0.5%)

185 (0.2%)

            H3

376 (47.0%)

46,169 (48.0%)

            Subytping not performed

420 (52.5%)

49,900 (51.8%)

  Influenza B

870 (52.1%)

9,014 (8.6%)

INFLUENZA Virus Isolated
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Since the start of the season, influenza A (H3N2) viruses have predominated nationally, however in recent weeks the proportion of influenza B viruses has been increasing. During week 9, 52% of all influenza positive specimens reported were influenza B viruses, and influenza B viruses predominated in five regions (Regions 4, 5, 6, 7, and 8).



Influenza Virus Characterization*:

CDC has characterized 1,150 influenza viruses [27 A(H1N1)pdm09, 902 A(H3N2), and 221 influenza B viruses] collected by U.S. laboratories since October 1, 2014.

Influenza A Virus [929]

Influenza B Virus [221]

157 (71.0%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 64 (29.0%) influenza B viruses tested belong to B/Victoria/02/87 lineage.

*CDC routinely uses hemagglutination inhibition (HI) assays to antigenically characterize influenza viruses year-round to compare how similar currently circulating influenza viruses are to those included in the influenza vaccine, and to monitor for changes in circulating influenza viruses. However, a portion of recent influenza A(H3N2) viruses do not grow to sufficient hemagglutination titers for antigenic characterization by HI. For many of these viruses, CDC is also performing genetic characterization to infer antigenic properties.


Composition of the 2015-2016 Influenza Vaccine:

The World Health Organization (WHO) has recommended vaccine viruses for the 2015-2016 Northern Hemisphere vaccines, and the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) has made recommendations for the composition of the 2015-2016 influenza vaccines to be used in the United States. Both agencies recommend that trivalent vaccines contain an A/California/7/2009-like ((H1N1)pdm09) virus, an A/Switzerland/9715293/2013-like (H3N2) virus, and a B/Phuket/3073/2013-like (B/Yamagata lineage) virus. It is recommended that quadrivalent vaccines, which have two influenza B viruses, contain the viruses recommended for the trivalent vaccines, as well as a B/Brisbane/60/2008-like (B/Victoria lineage) virus. This represents a change in the influenza A (H3) and influenza B (Yamagata lineage) components. These vaccine recommendations were based on several factors, including global influenza virologic and epidemiologic surveillance, genetic characterization, antigenic characterization, antiviral resistance, influenza vaccine effectiveness, and the availability of potential vaccine virus candidates.


Antiviral Resistance:

Testing of influenza A(H1N1)pdm09, A(H3N2), and influenza B virus isolates for resistance to neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) is performed at CDC using a functional assay. Additional A(H1N1)pdm09 and 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 A(H1N1)pdm09 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, 2014

 

Oseltamivir

Zanamivir

Peramivir

 

Virus Samples tested (n)

Resistant Viruses, Number (%)

Virus Samples tested (n)

Resistant Viruses, Number (%)

Virus Samples tested (n)

Resistant Viruses, Number (%)

Influenza A (H1N1)pdm09

34

1 (2.9)

30

0 (0.0)

34

1 (2.9)

Influenza A (H3N2)

2,053

0 (0.0)

2,053

0 (0.0)

1,294

0 (0.0)

Influenza B

269

0 (0.0)

269

0 (0.0)

269

0 (0.0)


In the United States, the vast majority of recently circulating influenza viruses have been susceptible to the neuraminidase inhibitor antiviral medications, oseltamivir, zanamivir, and peramivir; rare sporadic instances of oseltamivir-resistant A(H1N1)pdm09 and A(H3N2) viruses have been detected worldwide. Antiviral treatment with oseltamivir, zanamivir, or peramivir 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 high 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 9, 7.6% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.2% for week 9.

Pneumonia And Influenza Mortality
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For the 2014-2015 influenza season, CDC/Influenza Division and the National Center for Health Statistics (NCHS) are collaborating on a pilot project to use NCHS mortality surveillance data for the rapid assessment of pneumonia and influenza (P&I) mortality. To view the data, please click here.



Influenza-Associated Pediatric Mortality:

Seven influenza-associated pediatric deaths were reported to CDC during week 9. One death was associated with an influenza A (H3) virus and occurred during week 8 (the week ending February 28, 2015). Two deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 5 and 8 (the weeks ending February 7 and February 28, 2015, respectively). Four deaths were associated with an influenza B virus and occurred during week 8.

A total of 104 influenza-associated pediatric deaths have been reported during the 2014-2015 season from New York City [2] and 32 states (Arizona [3], California [2], Colorado [4], Florida [3], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Maryland [1], Massachusetts [1], Michigan [1], Minnesota [6], Missouri [1], Nebraska [1], New Jersey [1], North Carolina [2], Nevada [8], New York [3], Ohio [6], Oklahoma [6], Pennsylvania [3], South Carolina [3], South Dakota [1], Tennessee [7], Texas [12], Utah [2], Virginia [5], Washington [1], Wisconsin [6], and West Virginia [1]).

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, and 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 and 2014-2015 seasons.

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, 2014 and March 7, 2015, 15,249 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 55.7 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (277.9 per 100,000 population), followed by children aged 0-4 years (49.5 per 100,000 population). Among all hospitalizations, 14,226 (93.3%) were associated with influenza A, 890 (5.8%) with influenza B, 60 (0.4%) with influenza A and B co-infection, and 73 (0.5%) had no virus type information. Among those with influenza A subtype information, 4,473 (99.7%) were A(H3N2) virus and 12 (0.3%) were A(H1N1)pdm09.

Clinical findings are preliminary and based on 3,843 (25.2%) cases with complete medical chart abstraction. The majority (93.2%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, metabolic disorders, and obesity. There were 516 hospitalized children with complete medical chart abstraction, 205 (39.7%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, neurologic disorders, and obesity. Among the 307 hospitalized women of childbearing age (15-44 years), 88 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.


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Data from the Influenza Hospitalization Surveillance Network (FluSurv-NET), a population-based surveillance for influenza related hospitalizations in children and adults in 13 U.S. states. Cumulative incidence rates are calculated using the National Center for Health Statistics’ (NCHS) population estimates for the counties included in the surveillance catchment area.

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FluSurv-NET data are preliminary and displayed as they become available. Therefore, figures are based on varying denominators as some variables represent information that may require more time to be collected. Data are refreshed and updated weekly. Asthma includes a medical diagnosis of asthma or reactive airway disease; Cardiovascular diseases include conditions such as coronary heart disease, cardiac valve disorders, congestive heart failure, and pulmonary hypertension; does not include isolated hypertension; Chronic lung diseases include conditions such as chronic obstructive pulmonary disease, bronchiolitis obliterans, chronic aspiration pneumonia, and interstitial lung disease; Immune suppression includes conditions such as immunoglobulin deficiency, leukemia, lymphoma, HIV/AIDS, and individuals taking immunosuppressive medications; Metabolic disorders include conditions such as diabetes mellitus; Neurologic diseases include conditions such as seizure disorders, cerebral palsy, and cognitive dysfunction; Neuromuscular diseases include conditions such as multiple sclerosis and muscular dystrophy; Obesity was assigned if indicated in patient's medical chart or if body mass index (BMI) >30 kg/m2; Pregnancy percentage calculated using number of female cases aged between 15 and 44 years of age as the denominator; Renal diseases include conditions such as acute or chronic renal failure, nephrotic syndrome, glomerulonephritis, and impaired creatinine clearance; No known condition indicates that the case did not have any known high risk medical condition indicated in medical chart at the time of hospitalization.

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Outpatient Illness Surveillance:

Nationwide during week 9, 2.4% 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 above 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.)

Additional data are available at http://gis.cdc.gov/grasp/fluview/fluportaldashboard.html.

national levels of ILI and ARI
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On a regional level, the percentage of outpatient visits for ILI ranged from 1.1% to 4.6% during week 9. Eight regions (Regions 1, 2, 4, 5, 6, 7, 8, and 10) reported a proportion of outpatient visits for ILI at or above 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 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 9, the following ILI activity levels were experienced:

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Click on map to launch interactive tool

*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 disproportionally 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 9, the following influenza activity was reported:

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 United States 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, the United Kingdom, and the United States (CDC in Atlanta, Georgia).

Europe: for the most recent influenza surveillance information from Europe, please see WHO/Europe at http://www.flunewseurope.org/ 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/

Public Health England: The most up-to-date influenza information from the United Kingdom is available at https://www.gov.uk/government/statistics/weekly-national-flu-reports



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.

In addition to the eight data components of CDC influenza surveillance for the 2014-2015 influenza season, the use of National Center for Health Statistics (NCHS) pneumonia and influenza mortality surveillance data for the rapid assessment of influenza-associated mortality will be piloted. An overview of influenza surveillance, including a description of the NCHS mortality surveillance data, is available here.

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