Weekly US Influenza Surveillance Report: Key Updates for Week 46, ending November 16, 2024

Resumen

Virus

Enfermedad

Todos los datos son preliminares y pueden variar a medida que se reciban más informes.

Las flechas direccionales indican los cambios entre la semana actual y la semana previa. Hay información adicional sobre las flechas en la parte inferior de esta página.

A description of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component is available on the surveillance methods page.¹

Hay más información sobre la temporada de influenza actual y la temporada anterior para cada componente de vigilancia disponible en  FluView Interactive.

U.S. virologic surveillance

Nationally and in HHS regions 6, 8, 9, and 10, the percentage of respiratory specimens testing positive for influenza virus in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. In regions 3, 4, and 5, percent positivity has trended upward during the past few weeks. Influenza A(H1N1)pdm09 and A(H3N2) viruses are co-circulating; however, the distribution of circulating viruses varies by region. Para obtener datos a nivel estatal y regional y la distribución de grupos de edad, visite FluView Interactive. Los virus que se sabe que están asociados a la vacunación reciente con la vacuna de virus vivo atenuado (LAIV) o hallados después de pruebas más exhaustivas como virus de vacunas no están incluidos, o no son virus de la influenza en circulación.

Laboratorios clínicos

A continuación se resumen los resultados de las pruebas realizadas por los laboratorios clínicos a nivel nacional. Los datos de laboratorios clínicos (el porcentaje de muestras positivas para virus de la influenza) se utilizan para monitorear si la actividad de la influenza está aumentando o disminuyendo.

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Laboratorios de Salud Pública

A continuación se resumen los resultados de las pruebas realizadas por laboratorios de salud pública a nivel nacional. Los datos de los laboratorios de salud pública se utilizan para monitorear la proporción de virus de influenza en circulación que pertenecen a cada subtipo/linaje de influenza.

_{*These data reflect specimens tested, and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). The data do not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 virus testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 virus than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the "¿Cómo los CDC están monitoreando los datos de la influenza entre las personas para comprender mejor la situación actual de la influenza aviar A (H5N1)?"}

^†_{When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a "variant" influenza virus. La mayoría de las infecciones en seres humanos por variantes del virus de la influenza ocurren después de una exposición a cerdos, pero puede haber contagio entre personas. Es importante destacar que en la mayoría de los casos, las variantes del virus de la influenza no han demostrado tener la capacidad de propagarse fácilmente y de manera continua de persona a persona.}

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_{*En este gráfico se muestra la cantidad de muestras analizadas y la cantidad que se determinó que fueron positivas para los virus de la influenza en el laboratorio de salud pública (las muestras analizadas no son lo mismo que los casos). No refleja muestras analizadas únicamente en los CDC y podría incluir más de una muestra analizada por persona. Se incluyen las muestras analizadas como parte de la vigilancia de rutina de la influenza, así como las analizadas como parte de pruebas específicas para personas expuestas a la influenza A(H5).}

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Infecciones por el nuevo virus de influenza A 

Six confirmed human infections with influenza A(H5) viruses were reported to CDC this week. Hasta la fecha, no se ha identificado transmisión entre personas del virus de la influenza A(H5) en Estados Unidos.

Five confirmed cases were reported by the California Department of Public Health. Four of these cases occurred in workers at commercial dairy cattle farms in areas where highly pathogenic avian influenza (HPAI) A(H5N1) viruses had been detected in cows, and one case occurred in a child with no known contact with influenza A(H5N1) virus-infected animals. The investigation into the source of infection for this case is ongoing, but there is currently no evidence of human-to-human transmission. There have now been 29 total confirmed human cases and one probable human case in California.

One confirmed case was reported by the Oregon Health Authority. This case was in a worker who performed depopulation activities at a commercial poultry facility where HPAI A (H5N1) viruses had been detected in birds. This is the first human case identified in Oregon.

Five of the six individuals reported this week are more than 18 years old and one was less than 18 years old. All six individuals had mild symptoms. Specimens from all six individuals were tested at state or public health laboratories using the CDC influenza A (H5) assay before being sent to CDC for further testing. Specimens from all six confirmed cases were positive for influenza A(H5) virus using diagnostic RT-PCR or genetic sequencing at CDC. Additional analysis including genetic sequencing is underway.

In response to these detections, additional case investigations and surveillance activities are being conducted by public health officials in California and Oregon.

The CSTE position statement, which includes updated case definitions for confirmed, probable, and suspect cases is available at http://www.cste.org/resource/resmgr/position_statements_files_2023/24-ID-09_Novel_Influenza_A.pdf

An up-to-date human case summary during the 2024 outbreak by state and exposure source is available at www.cdc.gov/bird-flu/situation-summary/index.html

Information about avian influenza is available at https://www.cdc.gov/flu/avianflu/index.htm.

Interim recommendations for Prevention, Monitoring, and Public Health Investigations are available at https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html.

The latest case reports on avian influenza outbreaks in wild birds, commercial poultry, backyard or hobbyist flocks, and mammals in the United States are available from the USDA at https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/animal-disease-information/avian/avian-influenza/2022-hpai.

Caracterización de virus de la influenza 

Los CDC hacen la caracterización genética y antigénica de los virus que circulan en los Estados Unidos enviados por laboratorios de salud pública estatales y locales, de conformidad con las normas de Right Size Roadmap. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing the current influenza vaccines. Los datos también se utilizan para monitorear los cambios en la evolución que se producen constantemente en los virus de la influenza que circulan en seres humanos. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the polymerase acidic protein (PA) endonuclease inhibitor baloxavir. The HA clade and subclades were assigned using Nextclade (https://clades.nextstrain.org).

Los CDC han caracterizado genéticamente 863 virus de la influenza de muestras obtenidas desde el 19 de mayo del 2024.

CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, and B/Victoria viruses) or neutralization-based HINT (virus H3N2) usando antisuero producido por hurones infectados por los virus de referencia que representaban los virus de referencia de las vacunas de cultivo celular o recombinantes recomendados para el hemisferio norte en el 2024-2025. Las diferencias antigénicas en los virus se determinan al comparar la capacidad de los anticuerpos generados contra los virus de referencia de la vacuna de reconocer los virus en circulación generados en cultivo celular. Los antisueros de hurones son útiles porque los anticuerpos que se generan contra un virus en particular por lo general pueden reconocer pequeños cambios en las proteínas de la superficie de otros virus. En pruebas de HI, los virus con propiedades antigénicas similares tienen diferencias en la titulación de anticuerpos de menos o igual a 4 veces con respecto al virus de referencia (candidato para la vacuna). Con la HINT, los virus con propiedades antigénicas similares tienen diferencias de titulación de neutralización de anticuerpos menor o igual a 8 veces. Viruses selected for antigenic characterization are a subset of the recent genetically characterized viruses and are chosen based on the genetic changes in their surface proteins and may not be proportional to the number of such viruses circulating in the United States.

Virus de la influenza A

• A(H1N1)pdm09: 97 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 94 (96,9 %) were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
• A(H3N2): 203 A(H3N2) viruses were antigenically characterized by HI or HINT, and 149 (73,4 %) were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Massachusetts/18/2022-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.

Virus de la influenza B

• B/Victoria: 28 influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
• B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.

Evaluación de la susceptibilidad del virus a los medicamentos antivirales

Los CDC evalúan la susceptibilidad de los virus de la influenza a los medicamentos antivirales, incluidos los inhibidores de la neuraminidasa (oseltamivir, zanamivir y peramivir) y el inhibidor de la endonucleasa de la subunidad PA (baloxavir), mediante el análisis de secuencias de última generación que se complementa con ensayos de laboratorio. Puede encontrar información sobre los métodos de análisis de susceptibilidad a los antivirales en Vigilancia de la influenza en los EE. UU.: propósito y métodos.

Viruses collected in the U.S. since May 19, 2024, were tested for antiviral susceptibility as follows:

Two A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution conferring highly reduced inhibition by oseltamivir and peramivir. One A(H1N1)pdm09 virus had NA-I223V and NA-S247N amino acid substitutions and showed reduced inhibition by oseltamivir.

Altos niveles de resistencia a los adamantanos (amantadina y rimantadina) persisten entre los virus de influenza A (H1N1)pdm09 e influenza A (H3N2) (los adamantanos no son efectivos contra los virus de influenza B). Por consiguiente, no se recomienda el uso de estos antivirales para el tratamiento y la prevención de las infecciones por el virus de la influenza A y no se presentan datos de análisis de resistencia a la adamantina.

Outpatient and Emergency Department Illness Surveillance

Outpatient respiratory illness visits

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with any pathogen that can present with similar symptoms, including influenza virus, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity.

Nationally, during Week 46, 2,7 % of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This week's percentage increased (change of > 0.1 percentage points) compared to Week 45 and has been trending upward for the past four weeks but remains below baseline. Region 4 is at its baseline while the remaining nine HHS regions are below their respective baselines. The percentage of visits for ILI increased this week compared to last week in regions 4, 6, 9, and 10 , and has been trending upward in regions 2 and 8. ILI activity remained stable (change of ≤ 0.1 percentage points) in all other regions (1, 3, 5, and 7) in Week 46 compared to Week 45. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infections to ILI varies by location.

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Outpatient respiratory illness visits by age group

Aproximadamente un 70 % de los participantes de ILINet informan tanto la cantidad de pacientes que consultaron por enfermedades respiratorias como la cantidad total de pacientes de una semana, clasificadas por grupo de edad. Based on these data, the percentage of visits for respiratory illness increased (change of > 0.1 percentage point) in the 0-4 years, 5-24 years, and 25-49 years age groups and remained stable (change of ≤ 0.1 percentage point) in the 50-64 years and 65+ years age groups in Week 46 compared to Week 45.

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Outpatient respiratory illness activity map

Los datos recopilados en ILINet se usan para medir la actividad de ILI* por estado/jurisdicción y áreas estadísticas básicas (CBSA).

National Syndromic Surveillance System (NSSP)

The overall percentage of emergency department (ED) visits with a discharge diagnosis of influenza reported in NSSP was 0,5 % during Week 46 and has been trending up slightly over the past few weeks. In Region 9, the percentage of ED visits increased in Week 46 compared to the previous week and in regions 4 and 6 it has been trending upward over the past few weeks. In the remaining seven HHS regions, the percentage of ED visits for influenza remained stable (change of ≤ 0.1 percentage point) compared to the previous week. This percentage increased among the 0-4 years and 5-17 years age groups and remained stable (change of ≤ 0.1 percentage point) among the 18-64 years and 65+ age groups.

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Vigilancia de hospitalización

FluSurv-Net

La Red de Vigilancia de Hospitalizaciones por Influenza (FluSurv-NET) lleva adelante tareas de vigilancia basadas en la población para detectar hospitalizaciones relacionadas con la influenza, y confirmadas por laboratorio, en determinados condados en 14 estados y representa aproximadamente el 9 % de la población estadounidense. Los datos de hospitalizaciones en FluSurv-NET son preliminares. A medida que se reciben datos todas las semanas, se actualizan las cantidades y tasas de casos anteriores.

Entre el 1 de octubre del 2024 y el 16 de noviembre del 2024, los sitios de FluSurv-NET reportaron 365 casos en total de hospitalizaciones asociadas a la influenza confirmada por laboratorios. La tasa de hospitalizaciones observada en la semana 46 fue de 0.3 por cada 100 000 habitantes. The cumulative hospitalization rate observed in Week 46 was 1.2 per 100 000 population.

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_{**En esta imagen, las tasas semanales para todas las temporadas anteriores a la 2024-2025 reflejan tasas de final de temporada. Para la temporada 2024-2025, las tasas de hospitalizaciones recientes están sujetas a demoras en la notificación y se muestran con una línea discontinua para la temporada actual. A medida que se reciben datos de hospitalizaciones todas las semanas, se actualizan las cantidades y tasas de casos anteriores.}

National healthcare safety network (NHSN) hospitalization surveillance

Effective November 1, 2024, all acute care and critical access hospitals are required to report the number of patients admitted with laboratory-confirmed influenza to NHSN. These data will be updated weekly in FluView and on FluView Interactive once sufficient data has been collected. Public datasets, including data reported on a voluntary basis prior to November 1, 2024, can be found here: https://data.cdc.gov/Public-Health-Surveillance/Weekly-United-States-Hospitalization-Metrics-by-Ju/aemt-mg7g/about_data.

Vigilancia de mortalidad

Vigilancia de mortalidad del Centro Nacional de Estadísticas de Salud (NCHS, en inglés)

Based on NCHS mortality surveillance data available on November 21, 2024, 0,03 % of the deaths that occurred during the week ending November 16, 2024 (Week 46), were due to influenza. This percentage remained stable (≤ 0.1 percentage point change) compared to Week 45. Los datos presentados son preliminares y pueden cambiar a medida que se reciba y se procese más información.

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Mortalidad infantil asociada a la influenza

Durante la semana 46 se notificó la muerte de un paciente pediátrico asociada a la influenza, ocurrida en la temporada 2024-2025. The death was associated with an influenza A(H3) virus and occurred during Week 45 (the week ending November 9, 2024). This is the second seasonal influenza-associated pediatric death occurring during the 2024-2025 season that has been reported to CDC.

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Información de vigilancia adicional sobre la influenza a nivel nacional e internacional

Estado de los indicadores por sistema

Additional surveillance information