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USA: 2014-15 FluView: Influenza Season Weekly Summary, Wks 40+

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  • #16
    2014-2015 Influenza Season Week 3 ending January 24, 2015

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

    During week 3 (January 18-24, 2015), influenza activity remained elevated in the United States.
    • Viral Surveillance: Of 23,339 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 3, 4,651 (19.9%) were positive for influenza.
    • Novel Influenza A Virus: One human infection with a novel influenza A virus was reported.
    • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
    • Influenza-associated Pediatric Deaths: Five influenza-associated pediatric deaths were reported.
    • Influenza-associated Hospitalizations: A cumulative rate for the season of 40.5 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 4.4%, above the national baseline of 2.0%. All 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and 29 states experienced high ILI activity; New York City and seven states experienced moderate ILI activity; six states experienced low ILI activity; eight states experienced minimal ILI activity; and the District of Columbia had insufficient data.
    • Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 44 states was reported as widespread; the U.S. Virgin Islands and five states reported regional activity; and the District of Columbia, Guam, and one state reported local activity.
    Nation Elevated 51 of 54 19.9% 130 31,711 40,211 3,989 61
    Region 1 Elevated 6 of 6 25.0% 5 1,377 1,361 69 0
    Region 2 Elevated 4 of 4 24.1% 40 2,151 3,425 141 2
    Region 3 Elevated 5 of 6 26.0% 5 4,378 3,777 239 4
    Region 4 Elevated 8 of 8 14.3% 6 2,991 10,668 1,448 13
    Region 5 Elevated 6 of 6 15.6% 9 6,862 7,248 404 16
    Region 6 Elevated 5 of 5 21.3% 27 3,364 6,418 968 13
    Region 7 Elevated 4 of 4 17.5% 8 1,527 2,053 166 6
    Region 8 Elevated 6 of 6 23.1% 18 3,708 3,122 202 3
    Region 9 Elevated 4 of 5 27.4% 8 2,057 1,609 205 4
    Region 10 Elevated 3 of 4 26.6% 4 3,296 530 147 0
    *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 athttp://gis.cdc.gov/grasp/fluview/flu...dashboard.html.
    23,339
    366,891
    4,651 (19.9%)
    76,042 (20.7%)
    4,343 (93.4%)
    72,053 (94.8%)
    2 (0.05%)
    130 (0.2%)
    1,698 (39.1%)
    31,711 (44.0%)
    2,643 (60.9%)
    40,211 (55.8%)
    308 (6.6%)
    3,989 (5.2%)

    View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation Novel Influenza A Virus:

    One human infection with a novel influenza A virus was reported by the state of Minnesota. The person was infected with an influenza A (H1N1) variant (H1N1v) virus, and has fully recovered from their illness. No ongoing human-to-human transmission has been identified and the case patient reported contact with swine in the week prior to illness onset.
    Early identification and investigation of human infections with novel influenza A viruses are critical in order to evaluate the extent of the outbreak and possible human-to-human transmission. Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with swine can be found at http://www.cdc.gov/flu/swineflu/index.htm.
    Influenza Virus Characterization*:

    CDC has characterized 602 influenza viruses [21 A(H1N1)pdm09, 478 A(H3N2), and 103 influenza B viruses] collected by U.S. laboratories since October 1, 2014.
    Influenza A Virus [499]
    • A (H1N1)pdm09 [21]: All 21 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
    • A (H3N2) [478]: 159 (33.3%) of the 478 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. 319 (66.7%) of the 478 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable, from the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.
    Influenza B Virus [103]
    Sixty-nine (67.0%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 34 (33.0%) influenza B viruses tested belong to B/Victoria/02/87 lineage.
    • Yamagata Lineage [69]: All 69 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines.
    • Victoria Lineage [34]: Thirty (88.2%) of the 34 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Four (11.8%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.
    *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.

    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.
    948
    0 (0.0)
    948
    0 (0.0)
    740
    0 (0.0)
    139
    0 (0.0)
    139
    0 (0.0)
    139
    0 (0.0)
    16
    1 (6.3)
    13
    0 (0.0)
    16
    1 (6.3)
    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 3, 9.1% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.1% for week 3.

    View Full Screen | View PowerPoint Presentation 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:

    Five influenza-associated pediatric deaths were reported to CDC during week 3. Four deaths were associated with an influenza A (H3) virus and occurred during weeks 53, 1, 2, and 3 (weeks ending January 3, January 10, January 17, and January 24, 2015, respectively). One death was associated with an influenza A virus for which no subtyping was performed and occurred during week 1.
    A total of 61 influenza-associated deaths have been reported during the 2014-2015 season from New York City [1] and 24 states (Arizona [1], Colorado [2], Florida [2], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Michigan [1], Minnesota [4], Missouri [1], North Carolina [2], Nevada [3], New York [1], Ohio [5], Oklahoma [4], Pennsylvania [1], South Carolina [1], South Dakota [1], Tennessee [4], Texas [7], Virginia [3], and Wisconsin [5]).

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

    View Interactive Application | View Full Screen | View PowerPoint Presentation


    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 January 24, 2015, 11,077 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 40.5 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (198.4 per 100,000 population), followed by children aged 0-4 years (38.2 per 100,000 population). Among all hospitalizations, 10,690 (96.6%) were associated with influenza A, 290 (2.6%) with influenza B, 29 (0.3%) with influenza A and B co-infection, and 62 (0.5%) had no virus type information. Among those with influenza A subtype information, 3,016 (99.7%) were A(H3N2) virus and nine (0.3%) were A(H1N1)pdm09.
    Clinical findings are preliminary and based on 1,729 (15.6%) cases with complete medical chart abstraction. The majority (93.7%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, metabolic disorders, and obesity. There were 230 hospitalized children with complete medical chart abstraction, 94 (40.9%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, obesity, neurologic disorders and immune suppression. Among the 173 hospitalized women of childbearing age (15-44 years), 47 were pregnant.
    Additional FluSurv-NET data can be found at: http://gis.cdc.gov/GRASP/Fluview/FluHospRates.html andhttp://gis.cdc.gov/grasp/fluview/FluHospChars.html.

    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. Incidence rates are calculated using the National Center for Health Statistics? (NCHS) population estimates for the counties included in the surveillance catchment area.
    View Interactive Application | View Full Screen | View PowerPoint Presentation
    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 diseasesinclude 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.
    View Interactive Application | View Full Screen | View PowerPoint Presentation



    Outpatient Illness Surveillance:

    Nationwide during week 3, 4.4% 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/flu...dashboard.html.

    View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation On a regional level, the percentage of outpatient visits for ILI ranged from 2.5% to 7.7% during week 3. All 10 regions 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 3, the following ILI activity levels were experienced:
    • Puerto Rico and 29 states (Alabama, Arkansas, California, Colorado, Connecticut, Idaho, Kansas, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wyoming) experienced high ILI activity.
    • New York City and seven states (Arizona, Delaware, Hawaii, Maine, North Dakota, South Carolina, and South Dakota) experienced moderate ILI activity.
    • Six states (Alaska, Georgia, Maryland, Michigan, Montana, and New Hampshire) experienced low ILI activity.
    • Eight states (Florida, Illinois, Indiana, Iowa, Kentucky, Ohio, Oregon, and Wisconsin) experienced minimal ILI activity.
    • Data were insufficient to calculate an ILI activity level from the District of Columbia.
    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 3, the following influenza activity was reported:
    • Widespread influenza activity was reported by Puerto Rico and 44 states (Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, 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, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming).
    • Regional influenza activity was reported by the U.S. Virgin Islands and five states (Alabama, Georgia, Hawaii, Minnesota, and Tennessee).
    • Local activity was reported by the District of Columbia, Guam, and one state (Alaska).







    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, visithttp://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.

    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 theGlobal 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 athttp://ecdc.europa.eu/en/publication..._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 athttps://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.

    Learn more about the weekly influenza surveillance report (FluView) prepared by the Influenza Division.


    Comment


    • #17
      2014-2015 Influenza Season Week 4 ending January 31, 2015

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

      During week 4 (January 25-31, 2015), influenza activity decreased, but remained elevated in the United States.
      • Viral Surveillance: Of 22,122 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 4, 3,869 (17.5%) were positive for influenza.
      • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
      • Influenza-associated Pediatric Deaths: Eight influenza-associated pediatric deaths were reported.
      • Influenza-associated Hospitalizations: A cumulative rate for the season of 43.5 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 4.1%, above the national baseline of 2.0%. All 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and 26 states experienced high ILI activity; New York City and eight states experienced moderate ILI activity; six states experienced low ILI activity; 10 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
      • Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 40 states was reported as widespread; Guam, the U.S. Virgin Islands, and nine states reported regional activity; and the District of Columbia and one state reported local activity.

      Nation Elevated 52 of 54 17.5% 137 34,589 43,270 4,511 69
      Region 1 Elevated 6 of 6 28.2% 5 1,789 1,812 96 1
      Region 2 Elevated 4 of 4 26.9% 43 2,626 3,922 167 3
      Region 3 Elevated 5 of 6 24.1% 5 4,696 4,086 264 4
      Region 4 Elevated 8 of 8 12.4% 6 3,128 10,959 1,518 13
      Region 5 Elevated 6 of 6 12.2% 11 7,128 7,391 451 16
      Region 6 Elevated 5 of 5 22.9% 27 3,768 7,076 1,141 17
      Region 7 Elevated 4 of 4 16.1% 8 1,580 2,180 194 7
      Region 8 Elevated 6 of 6 18.0% 19 3,905 3,207 276 3
      Region 9 Elevated 5 of 5 27.2% 8 2,386 2,050 230 5
      Region 10 Elevated 3 of 4 24.1% 5 3,583 587 174 0
      *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/flu...dashboard.html.
      22,122 396,596
      3,869 (17.5%) 82,508 (20.8%)
      3,535 (91.4%) 77,997 (94.5%)
      5 (0.1%) 137 (0.2%)
      1,345 (38.0%) 34,589 (44.3%)
      2,185 (61.8%) 43,270 (55.5%)
      334 (8.6%) 4,511 (5.5%)

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


      Influenza Virus Characterization*:

      CDC has characterized 734 influenza viruses [21 A(H1N1)pdm09, 569 A(H3N2), and 144 influenza B viruses] collected by U.S. laboratories since October 1, 2014.
      Influenza A Virus [590]
      • A (H1N1)pdm09 [21]: All 21 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
      • A (H3N2) [569]: 178 (31.3%) of the 569 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. 391 (68.7%) of the 569 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.

      Influenza B Virus [144]
      Ninety-nine (68.7%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 45 (31.3%) influenza B viruses tested belong to B/Victoria/02/87 lineage.
      • Yamagata Lineage [99]: Ninety-two (92.9%) of the 99 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Seven (7.1%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012.
      • Victoria Lineage [45]: Forty-one (91.1%) of the 45 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Four (8.9%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

      *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.

      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.
      1,035 0 (0.0) 1,035 0 (0.0) 807 0 (0.0)
      150 0 (0.0) 150 0 (0.0) 150 0 (0.0)
      25 1 (4.0) 22 0 (0.0) 25 1 (4.0)
      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 4, 8.5% 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 4.

      View Full Screen | View PowerPoint Presentation
      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:

      Eight influenza-associated pediatric deaths were reported to CDC during week 4. Four deaths were associated with an influenza A (H3) virus and occurred during weeks 1, 2, and 4 (weeks ending January 10, January 17, and January 31, 2015, respectively). Four deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 50, 51, 52, and 4 (weeks ending December 13, December 20, December 27, 2014 and January 31, 2015).
      A total of 69 influenza-associated pediatric deaths have been reported during the 2014-2015 season from New York City [1] and 27 states (Arizona [2], Colorado [2], Florida [2], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Massachusetts [1], Michigan [1], Minnesota [4], Missouri [1], Nebraska [1], New Jersey [1], North Carolina [2], Nevada [3], New York [1], Ohio [5], Oklahoma [6], Pennsylvania [1], South Carolina [1], South Dakota [1], Tennessee [4], Texas [9], Virginia [3], and Wisconsin [5]).

      Additional data can be found at: http://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html.
      View Interactive Application | View Full Screen | View PowerPoint Presentation


      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 January 31, 2015, 11,897 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 43.5 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (213.8 per 100,000 population), followed by children aged 0-4 years (40.2 per 100,000 population). Among all hospitalizations, 11,449 (96.2%) were associated with influenza A, 355 (3.0%) with influenza B, 40 (0.3%) with influenza A and B co-infection, and 53 (0.4%) had no virus type information. Among those with influenza A subtype information, 3,423 (99.7%) were A(H3N2) virus and 10 (0.3%) were A(H1N1)pdm09.
      Clinical findings are preliminary and based on 2,080 (17.5%) cases with complete medical chart abstraction. The majority (93.5%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, metabolic disorders, and obesity. There were 272 hospitalized children with complete medical chart abstraction, 107 (39.3%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, neurologic disorders, and immune suppression. Among the 182 hospitalized women of childbearing age (15-44 years), 51 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.
      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. Incidence rates are calculated using the National Center for Health Statistics? (NCHS) population estimates for the counties included in the surveillance catchment area.
      View Interactive Application | View Full Screen | View PowerPoint Presentation
      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.
      View Interactive Application | View Full Screen | View PowerPoint Presentation



      Outpatient Illness Surveillance:

      Nationwide during week 4, 4.1% 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/flu...dashboard.html.

      View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation
      On a regional level, the percentage of outpatient visits for ILI ranged from 2.1% to 6.7% during week 4. All 10 regions 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 4, the following ILI activity levels were experienced:
      • Puerto Rico and 26 states (Arizona, Arkansas, California, Colorado, Connecticut, Hawaii, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington, and West Virginia) experienced high ILI activity.
      • New York City and eight states (Alabama, Delaware, Massachusetts, Minnesota, New Mexico, North Dakota, Utah, and Wyoming) experienced moderate ILI activity.
      • Six states (Georgia, Kentucky, Maryland, Montana, South Carolina, and South Dakota) experienced low ILI activity.
      • Ten states (Alaska, Florida, Illinois, Indiana, Iowa, Michigan, New Hampshire, Ohio, Oregon, and Wisconsin) experienced minimal ILI activity.
      • Data were insufficient to calculate an ILI activity level from the District of Columbia.

      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 4, the following influenza activity was reported:
      • Widespread influenza activity was reported by Puerto Rico and 40 states (Arizona, Arkansas, California, Connecticut, Delaware, Florida, Idaho, 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, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming).
      • Regional influenza activity was reported by Guam, the U.S. Virgin Islands, and nine states (Alabama, Colorado, Georgia, Hawaii, Illinois, Minnesota, South Dakota, Tennessee, and Texas).
      • Local activity was reported by the District of Columbia and one state (Alaska).






      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.

      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.
      --------------------------------------------------------------------------------
      Full report also available as PDF




      Comment


      • #18
        2014-2015 Influenza Season Week 5 ending February 7, 2015

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

        During week 5 (February 1-7, 2015), influenza activity decreased, but remained elevated in the United States.
        • Viral Surveillance: Of 21,340 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 5, 3,174 (14.9%) were positive for influenza.
        • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
        • Influenza-associated Pediatric Deaths: Eleven influenza-associated pediatric deaths were reported.
        • Influenza-associated Hospitalizations: A cumulative rate for the season of 44.1 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 3.8%, above the national baseline of 2.0%. All 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and 15 states experienced high ILI activity; New York City and 15 states experienced moderate ILI activity; eight states experienced low ILI activity; 12 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
        • Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 32 states was reported as widespread; Guam, the U.S. Virgin Islands, and 16 states reported regional activity; and the District of Columbia and two states reported local activity.

        Nation Elevated 51 of 54 14.9% 143 36,771 45,534 5,091 80
        Region 1 Elevated 6 of 6 27.4% 5 2,041 2,125 116 1
        Region 2 Elevated 4 of 4 26.7% 44 3,051 4,310 205 4
        Region 3 Elevated 5 of 6 21.9% 6 4,879 4,340 300 6
        Region 4 Elevated 8 of 8 11.5% 6 3,307 11,392 1,637 15
        Region 5 Elevated 5 of 6 10.1% 11 7,341 7,489 518 18
        Region 6 Elevated 5 of 5 20.2% 27 3,926 7,327 1,281 17
        Region 7 Elevated 4 of 4 12.8% 8 1,645 2,251 226 7
        Region 8 Elevated 6 of 6 15.1% 19 4,073 3,287 357 4
        Region 9 Elevated 5 of 5 24.2% 11 2,735 2,374 266 8
        Region 10 Elevated 3 of 4 19.3% 5 3,773 639 185 0
        *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/flu...dashboard.html.
        21,340 425,649
        3,174 (14.9%) 87,540 (20.6%)
        2,768 (87.2%) 82,449 (94.2%)
        6 (0.2%) 143 (0.2%)
        1,058 (38.2%) 36,771 (44.6%)
        1,704 (61.6%) 45,534 (55.2%)
        406 (12.8%) 5,091 (5.8%)

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


        Influenza Virus Characterization*:

        CDC has characterized 809 influenza viruses [21 A(H1N1)pdm09, 634 A(H3N2), and 154 influenza B viruses] collected by U.S. laboratories since October 1, 2014.
        Influenza A Virus [655]
        • A (H1N1)pdm09 [21]: All 21 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
        • A (H3N2) [634]: 199 (31.4%) of the 634 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. 435 (68.6%) of the 634 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.

        Influenza B Virus [154]
        107 (69.5%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 47 (30.5%) influenza B viruses tested belong to B/Victoria/02/87 lineage.
        • Yamagata Lineage [107]: 100 (93.4%) of the 107 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Seven (6.6%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012.
        • Victoria Lineage [47]: 43 (91.5%) of the 47 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Four (8.5%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

        *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.

        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.
        29 1 (3.4) 25 0 (0.0) 29 1 (3.4)
        1,213 0 (0.0) 1,213 0 (0.0) 891 0 (0.0)
        163 0 (0.0) 163 0 (0.0) 163 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 5, 8.1% 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 5.

        View Full Screen | View PowerPoint Presentation
        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:

        Eleven influenza-associated pediatric deaths were reported to CDC during week 5. Four deaths were associated with an influenza A (H3) virus and occurred during weeks 52, 3 and 4 (weeks ending December 27, 2014, January 24 and January 31, 2015). Five deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 53, 1, 2, and 3 (weeks ending January 3, January 10, January 17, and January 24, 2015). One death was associated with an influenza B virus and occurred during week 4. One death was associated with an influenza A and influenza B virus co-infection and occurred during week 5 (week ending February 7, 2015).
        A total of 80 influenza-associated pediatric deaths have been reported during the 2014-2015 season from New York City [1] and 28 states (Arizona [2], Colorado [3], Florida [2], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Maryland [1], Massachusetts [1], Michigan [1], Minnesota [5], Missouri [1], Nebraska [1], New Jersey [1], North Carolina [2], Nevada [6], New York [2], Ohio [5], Oklahoma [6], Pennsylvania [1], South Carolina [2], South Dakota [1], Tennessee [5], Texas [9], Virginia [4], and Wisconsin [6]).

        Additional data can be found at: http://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html.
        View Interactive Application | View Full Screen | View PowerPoint Presentation


        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 February 7, 2015, 12,065 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 44.1 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (217.3 per 100,000 population), followed by children aged 0-4 years (40.4 per 100,000 population). Among all hospitalizations, 11,585 (96.1%) were associated with influenza A, 377 (3.1%) with influenza B, 40 (0.3%) with influenza A and B co-infection, and 54 (0.4%) had no virus type information. Among those with influenza A subtype information, 3,517 (99.7%) were A(H3N2) virus and 10 (0.3%) were A(H1N1)pdm09.
        Clinical findings are preliminary and based on 2,086 (17.3%) cases with complete medical chart abstraction. The majority (93.4%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, metabolic disorders, and obesity. There were 273 hospitalized children with complete medical chart abstraction, 108 (39.6%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, neurologic disorders, and immune suppression. Among the 182 hospitalized women of childbearing age (15-44 years), 51 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.
        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. Incidence rates are calculated using the National Center for Health Statistics? (NCHS) population estimates for the counties included in the surveillance catchment area.
        View Interactive Application | View Full Screen | View PowerPoint Presentation
        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.
        View Interactive Application | View Full Screen | View PowerPoint Presentation



        Outpatient Illness Surveillance:

        Nationwide during week 5, 3.8% 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/flu...dashboard.html.

        View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation
        On a regional level, the percentage of outpatient visits for ILI ranged from 1.9% to 6.4% during week 5. All 10 regions 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 5, the following ILI activity levels were experienced:
        • Puerto Rico and 15 states (Arkansas, Colorado, Connecticut, Kansas, Louisiana, Mississippi, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, and West Virginia) experienced high ILI activity.
        • New York City and 15 states (Alabama, Arizona, California, Hawaii, Idaho, Massachusetts, Missouri, Nebraska, Nevada, New Mexico, Utah, Vermont, Virginia, Washington, and Wyoming) experienced moderate ILI activity.
        • Eight states (Delaware, Georgia, Maine, Minnesota, New Hampshire, North Dakota, South Carolina, and South Dakota) experienced low ILI activity.
        • Twelve states (Alaska, Florida, Illinois, Indiana, Iowa, Kentucky, Maryland, Michigan, Montana, Ohio, Oregon, and Wisconsin) experienced minimal ILI activity.
        • Data were insufficient to calculate an ILI activity level from the District of Columbia.

        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 5, the following influenza activity was reported:
        • Widespread influenza activity was reported by Puerto Rico and 32 states (Arizona, Arkansas, California, Connecticut, Delaware, Florida, Idaho, Indiana, Iowa, Maine, Maryland, Massachusetts, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, Washington, Wisconsin, and Wyoming).
        • Regional influenza activity was reported by Guam, the U.S. Virgin Islands, and 16 states (Alabama, Colorado, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Michigan, Missouri, Nevada, South Dakota, Tennessee, Texas, Utah, and West Virginia).
        • Local activity was reported by the District of Columbia and two states (Alaska and Minnesota).






        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.

        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.
        --------------------------------------------------------------------------------
        Full report also available as PDF

        Learn more about the weekly influenza surveillance report (FluView) prepared by the Influenza Division.






        Comment


        • #19
          2014-2015 Influenza Season Week 6 ending February 14, 2015

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

          During week 6 (February 8-14, 2015), influenza activity decreased, but remained elevated in the United States.
          • Viral Surveillance: Of 18,370 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 6, 2,381 (13.0%) were positive for influenza.
          • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
          • Influenza-associated Pediatric Deaths: Six influenza-associated pediatric deaths were reported.
          • Influenza-associated Hospitalizations: A cumulative rate for the season of 48.6 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 3.2%, above the national baseline of 2.0%. All 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and 12 states experienced high ILI activity; five states experienced moderate ILI activity; New York City and 12 states experienced low ILI activity; 21 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
          • Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 30 states was reported as widespread; Guam, the U.S. Virgin Islands, and 15 states reported regional activity; and the District of Columbia and five states reported local activity.
          Nation Elevated 48 of 54 13.0% 152 38,301 47,213 5,794 86
          Region 1 Elevated 6 of 6 24.6% 7 2,258 2,357 144 1
          Region 2 Elevated 4 of 4 23.5% 46 3,243 4,628 249 5
          Region 3 Elevated 5 of 6 17.7% 6 4,938 4,478 318 7
          Region 4 Elevated 7 of 8 10.5% 8 3,372 11,642 1,771 16
          Region 5 Elevated 5 of 6 8.8% 12 7,501 7,576 517 19
          Region 6 Elevated 5 of 5 17.0% 27 4,140 7,585 1,538 18
          Region 7 Elevated 4 of 4 11.2% 8 1,698 2,279 261 7
          Region 8 Elevated 5 of 6 12.7% 20 4,182 3,348 462 5
          Region 9 Elevated 4 of 5 24.0% 12 3,111 2,655 335 8
          Region 10 Elevated 3 of 4 16.1% 6 3,858 665 199 0
          *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 athttp://gis.cdc.gov/grasp/fluview/flu...dashboard.html.
          18,370
          449,355
          2,381 (13.0%)
          91,461 (20.4%)
          1,833 (77.0%)
          85,667 (93.7%)
          6 (0.3%)
          152 (0.2%)
          512 (27.9%)
          38,301 (44.7%)
          1,315 (71.7%)
          47,213 (55.1%)
          548 (23.0%)
          5,794 (6.3%)

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


          Influenza Virus Characterization*:

          CDC has characterized 871 influenza viruses [21 A(H1N1)pdm09, 696 A(H3N2), and 154 influenza B viruses] collected by U.S. laboratories since October 1, 2014.
          Influenza A Virus [717]
          • A (H1N1)pdm09 [21]: All 21 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
          • A (H3N2) [696]: 214 (30.7%) of the 696 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. 482 (69.3%) of the 696 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.
          Influenza B Virus [154]
          107 (69.5%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 47 (30.5%) influenza B viruses tested belong to B/Victoria/02/87 lineage.
          • Yamagata Lineage [107]: 100 (93.5%) of the 107 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Seven (6.5%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012.
          • Victoria Lineage [47]: 43 (91.5%) of the 47 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Four (8.5%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.
          *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.

          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.
          30
          1 (3.3)
          26
          0 (0.0)
          30
          1 (3.3)
          1,418
          0 (0.0)
          1,418
          0 (0.0)
          1,025
          0 (0.0)
          194
          0 (0.0)
          194
          0 (0.0)
          194
          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 6, 8.4% 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 6.

          View Full Screen | View PowerPoint Presentation 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:

          Six influenza-associated pediatric deaths were reported to CDC during week 6. Four deaths were associated with an influenza A (H3) virus and occurred during weeks 51, 3, and 4 (the weeks ending December 20, 2014, January 24 and January 31, 2015, respectively). Two deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 4 and 5 (the weeks ending January 31 and February 7, 2015, respectively).
          A total of 86 influenza-associated pediatric deaths have been reported during the 2014-2015 season from New York City [2] and 29 states (Arizona [2], Colorado [3], Florida [3], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Maryland [1], Massachusetts [1], Michigan [1], Minnesota [5], Missouri [1], Nebraska [1], New Jersey [1], North Carolina [2], Nevada [6], New York [2], Ohio [6], Oklahoma [6], Pennsylvania [2], South Carolina [2], South Dakota [1], Tennessee [5], Texas [10], Utah [1], Virginia [4], and Wisconsin [6]).

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

          View Interactive Application | View Full Screen | View PowerPoint Presentation


          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 February 14, 2015, 13,320 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 48.6 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (242.2 per 100,000 population), followed by children aged 0-4 years (43.4 per 100,000 population). Among all hospitalizations, 12,706 (95.5%) were associated with influenza A, 499 (3.7%) with influenza B, 44 (0.3%) with influenza A and B co-infection, and 59 (0.4%) had no virus type information. Among those with influenza A subtype information, 3,789 (99.7%) were A(H3N2) virus and 10 (0.3%) were A(H1N1)pdm09.
          Clinical findings are preliminary and based on 2,763 (20.7%) cases with complete medical chart abstraction. The majority (93.6%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, metabolic disorders, and obesity. There were 374 hospitalized children with complete medical chart abstraction, 151 (40.4%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, neurologic disorders, and immune suppression. Among the 236 hospitalized women of childbearing age (15-44 years), 64 were pregnant.
          Additional FluSurv-NET data can be found at: http://gis.cdc.gov/GRASP/Fluview/FluHospRates.html andhttp://gis.cdc.gov/grasp/fluview/FluHospChars.html.

          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. Incidence rates are calculated using the National Center for Health Statistics? (NCHS) population estimates for the counties included in the surveillance catchment area.
          View Interactive Application | View Full Screen | View PowerPoint Presentation
          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 diseasesinclude 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.
          View Interactive Application | View Full Screen | View PowerPoint Presentation



          Outpatient Illness Surveillance:

          Nationwide during week 6, 3.2% 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 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/flu...dashboard.html.

          View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation On a regional level, the percentage of outpatient visits for ILI ranged from 1.8% to 5.9% during week 6. All 10 regions 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 6, the following ILI activity levels were experienced:
          • Puerto Rico and 12 states (Arkansas, Connecticut, Hawaii, Idaho, Kansas, Mississippi, Nevada, New York, North Carolina, Oklahoma, Texas, and West Virginia) experienced high ILI activity.
          • Five states (California, Colorado, Louisiana, New Mexico, and Rhode Island) experienced moderate ILI activity.
          • New York City and 12 states (Alabama, Arizona, Massachusetts, Minnesota, Missouri, New Jersey, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, and Virginia) experienced low ILI activity.
          • Twenty-one states (Alaska, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Michigan, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oregon, Vermont, Washington, Wisconsin, and Wyoming) experienced minimal ILI activity.
          • Data were insufficient to calculate an ILI activity level from the District of Columbia.
          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 6, the following influenza activity was reported:
          • Widespread influenza activity was reported by Puerto Rico and 30 states (Arizona, Arkansas, California, Connecticut, Delaware, Idaho, Indiana, Iowa, Maine, Maryland, Massachusetts, Mississippi, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, Washington, Wisconsin, and Wyoming).
          • Regional influenza activity was reported by Guam, the U.S. Virgin Islands, and 15 states (Florida, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Michigan, Missouri, Nebraska, South Dakota, Tennessee, Texas, Utah, and West Virginia).
          • Local activity was reported by the District of Columbia and five states (Alabama, Alaska, Colorado, Minnesota, and Nevada).







          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, visithttp://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.

          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 theGlobal 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 athttp://ecdc.europa.eu/en/publication..._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 athttps://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.
          --------------------------------------------------------------------------------
          Full report also available as PDF


          Learn more about the weekly influenza surveillance report (FluView) prepared by the Influenza Division.






          Comment


          • #20
            Weekly U.S. Influenza Surveillance Report



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            Full report also available as PDF





            2014-2015 Influenza Season Week 7 ending February 21, 2015

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

            During week 7 (February 15-21, 2015), influenza activity continued to decrease, but remained elevated in the United States.
            • Viral Surveillance: Of 18,505 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 7, 2,236 (12.1%) were positive for influenza.
            • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
            • Influenza-associated Pediatric Deaths: Six influenza-associated pediatric deaths were reported.
            • Influenza-associated Hospitalizations: A cumulative rate for the season of 51.7 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 3.0%, above the national baseline of 2.0%. All 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and 11 states experienced high ILI activity; three states experienced moderate ILI activity; 16 states experienced low ILI activity; New York City and 20 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
            • Geographic Spread of Influenza: The geographic spread of influenza in Guam and 20 states was reported as widespread; Puerto Rico, the U.S. Virgin Islands, and 25 states reported regional activity; and the District of Columbia and five states reported local activity.
            Nation Elevated 48 of 54 12.1% 165 43,123 48,548 6,843 92
            Region 1 Elevated 6 of 6 21.0% 7 2,402 2,498 172 1
            Region 2 Elevated 4 of 4 19.9% 49 3,419 4,831 302 5
            Region 3 Elevated 5 of 6 15.0% 6 5,709 4,606 372 8
            Region 4 Elevated 8 of 8 10.4% 8 3,510 11,863 1,973 16
            Region 5 Elevated 4 of 6 8.0% 12 7,740 7,746 607 19
            Region 6 Elevated 5 of 5 15.4% 28 4,257 7,674 1,723 20
            Region 7 Elevated 4 of 4 9.4% 8 1,711 2,342 345 7
            Region 8 Elevated 4 of 6 12.6% 22 4,359 3,385 615 6
            Region 9 Elevated 5 of 5 23.8% 18 5,998 2,925 514 9
            Region 10 Elevated 3 of 4 12.4% 7 4,018 678 220 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 athttp://gis.cdc.gov/grasp/fluview/flu...dashboard.html.
            18,505
            486,004
            2,236 (12.1%)
            98,680 (20.3%)
            1,545 (69.1%)
            91,837 (93.1%)
            7 (0.5%)
            165 (0.2%)
            623 (40.3%)
            43,123 (47.0%)
            915 (59.2%)
            48,548 (52.9%)
            691 (30.9%)
            6,843 (6.9%)

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


            Influenza Virus Characterization*:

            CDC has characterized 933 influenza viruses [27 A(H1N1)pdm09, 752 A(H3N2), and 154 influenza B viruses] collected by U.S. laboratories since October 1, 2014.
            Influenza A Virus [779]
            • A (H1N1)pdm09 [27]: All 27 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
            • A (H3N2) [752]: 228 (30.3%) of the 752 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. 524 (69.7%) of the 752 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.
            Influenza B Virus [154]
            107 (69.5%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 47 (30.5%) influenza B viruses tested belong to B/Victoria/02/87 lineage.
            • Yamagata Lineage [107]: 100 (93.5%) of the 107 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Seven (6.5%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012.
            • Victoria Lineage [47]: 43 (91.5%) of the 47 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Four (8.5%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.
            *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.

            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.
            32
            1 (3.1)
            28
            0 (0.0)
            32
            1 (3.1)
            1,762
            0 (0.0)
            1,762
            0 (0.0)
            1,128
            0 (0.0)
            217
            0 (0.0)
            217
            0 (0.0)
            217
            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 7, 7.4% 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 7.

            View Full Screen | View PowerPoint Presentation 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:

            Six influenza-associated pediatric deaths were reported to CDC during week 7. Three deaths were associated with an influenza A (H3) virus and occurred during weeks 51, 4, and 5 (the weeks ending December 20, 2014, January 31, and February 7, 2015, respectively). Two deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 5 and 6 (the weeks ending February 7 and February 14, 2015, respectively). One death was associated with an influenza B virus and occurred during week 53 (the week ending January 3, 2015).
            A total of 92 influenza-associated pediatric deaths have been reported during the 2014-2015 season from New York City [2] and 31 states (Arizona [2], California [1], Colorado [3], Florida [3], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Maryland [1], Massachusetts [1], Michigan [1], Minnesota [5], Missouri [1], Nebraska [1], New Jersey [1], North Carolina [2], Nevada [6], New York [2], Ohio [6], Oklahoma [6], Pennsylvania [3], South Carolina [2], South Dakota [1], Tennessee [5], Texas [12], Utah [2], Virginia [4], Washington [1], and Wisconsin [6]).

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

            View Interactive Application | View Full Screen | View PowerPoint Presentation


            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 February 21, 2015, 14,162 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 51.7 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (258.0 per 100,000 population), followed by children aged 0-4 years (45.7 per 100,000 population). Among all hospitalizations, 13,416 (94.8%) were associated with influenza A, 625 (4.4%) with influenza B, 46 (0.3%) with influenza A and B co-infection, and 67 (0.5%) had no virus type information. Among those with influenza A subtype information, 4,000 (99.7%) were A(H3N2) virus and 10 (0.2%) were A(H1N1)pdm09.
            Clinical findings are preliminary and based on 3,118 (22.0%) cases with complete medical chart abstraction. The majority (92.9%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, metabolic disorders, and obesity. There were 432 hospitalized children with complete medical chart abstraction, 169 (39.1%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, neurologic disorders, and immune suppression. Among the 253 hospitalized women of childbearing age (15-44 years), 67 were pregnant.
            Additional FluSurv-NET data can be found at: http://gis.cdc.gov/GRASP/Fluview/FluHospRates.html andhttp://gis.cdc.gov/grasp/fluview/FluHospChars.html.

            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. Incidence rates are calculated using the National Center for Health Statistics? (NCHS) population estimates for the counties included in the surveillance catchment area.
            View Interactive Application | View Full Screen | View PowerPoint Presentation
            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 diseasesinclude 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.
            View Interactive Application | View Full Screen | View PowerPoint Presentation



            Outpatient Illness Surveillance:

            Nationwide during week 7, 3.0% 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/flu...dashboard.html.

            View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation On a regional level, the percentage of outpatient visits for ILI ranged from 1.2% to 5.4% during week 7. All 10 regions 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 7, the following ILI activity levels were experienced:
            • Puerto Rico and 11 states (Arkansas, Connecticut, Kansas, Louisiana, Mississippi, New Jersey, New York, North Carolina, Oklahoma, Texas, and West Virginia) experienced high ILI activity.
            • Three states (Colorado, Idaho, and Nevada) experienced moderate ILI activity.
            • Sixteen states (Alabama, California, Georgia, Hawaii, Massachusetts, Minnesota, Missouri, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, and Wyoming) experienced low ILI activity.
            • New York City and 20 states (Alaska, Arizona, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Michigan, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Ohio, Oregon, Washington, and Wisconsin) experienced minimal ILI activity.
            • Data were insufficient to calculate an ILI activity level from the District of Columbia.
            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 7, the following influenza activity was reported:
            • Widespread influenza activity was reported by Guam and 20 states (Alabama, California, Connecticut, Delaware, Idaho, Indiana, Iowa, Maine, Maryland, Massachusetts, Mississippi, Montana, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Rhode Island, Vermont, and Virginia).
            • Regional influenza activity was reported by Puerto Rico, the U.S. Virgin Islands, and 25 states (Arizona, Arkansas, Florida, Georgia, Hawaii, Kansas, Kentucky, Louisiana, Michigan, Missouri, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming).
            • Local activity was reported by the District of Columbia and five states (Alaska, Colorado, Illinois, Minnesota, and South Dakota).







            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, visithttp://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.

            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 theGlobal 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 athttp://ecdc.europa.eu/en/publication..._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 athttps://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.
            --------------------------------------------------------------------------------
            Full report also available as PDF


            Learn more about the weekly influenza surveillance report (FluView) prepared by the Influenza Division.








            Comment


            • #21

              2014-2015 Influenza Season Week 8 ending February 28, 2015

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

              During week 8 (February 22-28, 2015), influenza activity continued to decrease, but remained elevated in the United States.
              • Viral Surveillance: Of 16,821 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 8, 1,834 (10.9%) were positive for influenza.
              • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was at the epidemic threshold.
              • Influenza-associated Pediatric Deaths: Six influenza-associated pediatric deaths were reported, including one influenza-associated pediatric death that occurred during the 2013-2014 season.
              • Influenza-associated Hospitalizations: A cumulative rate for the season of 53.5 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 2.5%, above the national baseline of 2.0%. Seven regions reported ILI at or above region-specific baseline levels. Puerto Rico and six states experienced high ILI activity; four states experienced moderate ILI activity; 10 states experienced low ILI activity; New York City and 30 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
              • Geographic Spread of Influenza: The geographic spread of influenza in Guam and 12 states was reported as widespread; Puerto Rico, the U.S. Virgin Islands, and 30 states reported regional activity; the District of Columbia and six states reported local activity; and two states reported sporadic activity.
              Nation Elevated 45 of 54 10.9% 179 44,943 49,354 7,797 97
              Region 1 Elevated 6 of 6 19.0% 7 2,591 2,605 222 1
              Region 2 Elevated 4 of 4 17.1% 53 3,737 4,962 360 6
              Region 3 Normal 3 of 6 12.1% 6 5,977 4,676 426 8
              Region 4 Elevated 8 of 8 10.0% 9 3,577 12,140 2,189 18
              Region 5 Normal 5 of 6 8.2% 12 7,898 7,787 764 19
              Region 6 Elevated 5 of 5 14.5% 28 4,411 7,713 1,857 20
              Region 7 Elevated 4 of 4 9.7% 8 1,735 2,359 394 7
              Region 8 Elevated 4 of 6 10.9% 26 4,428 3,409 743 6
              Region 9 Normal 4 of 5 19.4% 22 6,505 3,021 601 11
              Region 10 Elevated 2 of 4 8.6% 8 4,084 682 240 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/flu...dashboard.html.
              16,821 509,958
              1,834 (10.9%) 102,274 (20.1%)
              1,128 (61.5%) 94,477 (92.4%)
              11 (1.0%) 179 (0.2%)
              524 (46.5%) 44,943 (47.6%)
              593 (52.6%) 49,354 (52.2%)
              706 (38.5%) 7,797 (7.6%)

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


              Influenza Virus Characterization*:

              CDC has characterized 1,033 influenza viruses [27 A(H1N1)pdm09, 814 A(H3N2), and 192 influenza B viruses] collected by U.S. laboratories since October 1, 2014.
              Influenza A Virus [841]
              • A (H1N1)pdm09 [27]: All 27 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
              • A (H3N2) [814]: 229 (28.1%) of the 814 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. 585 (71.9%) of the 814 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.
              Influenza B Virus [192]
              145 (75.5%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 47 (24.5%) influenza B viruses tested belong to B/Victoria/02/87 lineage.
              • Yamagata Lineage [145]: 138 (95.2%) of the 145 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Seven (4.8%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012.
              • Victoria Lineage [47]: 43 (91.5%) of the 47 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Four (8.5%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.
              *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.

              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.
              32 1 (3.1) 28 0 (0.0) 32 1 (3.1)
              1,944 0 (0.0) 1,944 0 (0.0) 1,222 0 (0.0)
              237 0 (0.0) 237 0 (0.0) 237 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 athttp://www.cdc.gov/flu/antivirals/index.htm.


              Pneumonia and Influenza (P&I) Mortality Surveillance:

              During week 8, 7.2% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was at the epidemic threshold of 7.2% for week 8.

              View Full Screen | View PowerPoint Presentation 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:

              Six influenza-associated pediatric deaths were reported to CDC during week 8. Five deaths were associated with an influenza A (H3) virus and occurred during weeks 52, 3, 5, 6, and 7 (the weeks ending December 27, 2014, January 24, February 7, February 14, and February 21, 2015, respectively).
              One death was associated with an influenza A (H1N1)pdm09 virus and occurred during the 2013-14 season and brings the total number of reported pediatric deaths occurring during that season to 110.
              A total of 97 influenza-associated pediatric deaths have been reported during the 2014-2015 season from New York City [2] and 31 states (Arizona [2], California [2], Colorado [3], Florida [3], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Maryland [1], Massachusetts [1], Michigan [1], Minnesota [5], Missouri [1], Nebraska [1], New Jersey [1], North Carolina [2], Nevada [7], New York [3], Ohio [6], Oklahoma [6], Pennsylvania [3], South Carolina [3], South Dakota [1], Tennessee [6], Texas [12], Utah [2], Virginia [4], Washington [1], and Wisconsin [6]).

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

              View Interactive Application | View Full Screen | View PowerPoint Presentation


              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 February 28, 2015, 14,644 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 53.5 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (266.1 per 100,000 population), followed by children aged 0-4 years (47.8 per 100,000 population). Among all hospitalizations, 13,778 (94.2%) were associated with influenza A, 739 (5.0%) with influenza B, 54 (0.4%) with influenza A and B co-infection, and 61 (0.4%) had no virus type information. Among those with influenza A subtype information, 4,245 (99.7%) were A(H3N2) and 12 (0.3%) were A(H1N1)pdm09.
              Clinical findings are preliminary and based on 3,439 (23.5%) cases with complete medical chart abstraction. The majority (93.1%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, metabolic disorders, and obesity. There were 489 hospitalized children with complete medical chart abstraction, 194 (39.7%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, neurologic disorders, obesity, and immune suppression. Among the 278 hospitalized women of childbearing age (15-44 years), 81 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.

              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.
              View Interactive Application | View Full Screen | View PowerPoint Presentation
              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.
              View Interactive Application | View Full Screen | View PowerPoint Presentation



              Outpatient Illness Surveillance:

              Nationwide during week 8, 2.5% 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/flu...dashboard.html.

              View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation On a regional level, the percentage of outpatient visits for ILI ranged from 1.1% to 4.7% during week 8. Seven regions (Regions 1, 2, 4, 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 8, the following ILI activity levels were experienced:
              • Puerto Rico and six states (Connecticut, Kansas, Mississippi, New Jersey, North Carolina, and Oklahoma) experienced high ILI activity.
              • Four states (Arkansas, Idaho, Louisiana, and Texas) experienced moderate ILI activity.
              • Ten states (Alabama, Arizona, Colorado, Georgia, Hawaii, Missouri, New Mexico, South Carolina, South Dakota, and Wyoming) experienced low ILI activity.
              • New York City and 30 states (Alaska, California, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin) experienced minimal ILI activity.
              • Data were insufficient to calculate an ILI activity level from the District of Columbia.
              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 8, the following influenza activity was reported:
              • Widespread influenza activity was reported by Guam and 12 states (California, Connecticut, Indiana, Maine, Maryland, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, Oklahoma, and Vermont).
              • Regional influenza activity was reported by Puerto Rico, the U.S. Virgin Islands, and 30 states (Alabama, Arizona, Arkansas, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Michigan, Missouri, Montana, Nebraska, New Mexico, North Carolina, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and Wyoming).
              • Local activity was reported by the District of Columbia and six states (Colorado, Delaware, Minnesota, Nevada, South Dakota, and West Virginia).
              • Sporadic activity was reported by two states (Alaska and Oregon).






              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.

              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/publication..._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.

              Comment


              • #22

                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.
                • Viral Surveillance: Of 14,634 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 9, 1,670 (11.4%) were positive for influenza.
                • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
                • Influenza-associated Pediatric Deaths: Seven influenza-associated pediatric deaths were reported.
                • Influenza-associated Hospitalizations: A cumulative rate for the season of 55.7 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 2.4%, above the national baseline of 2.0%. Eight regions reported ILI at or above region-specific baseline levels. Puerto Rico and six states experienced high ILI activity; one state experienced moderate ILI activity; 13 states experienced low ILI activity; New York City and 30 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
                • Geographic Spread of Influenza: The geographic spread of influenza in nine states was reported as widespread; Guam, Puerto Rico, the U.S. Virgin Islands, and 29 states reported regional activity; 11 states reported local activity; and the District of Columbia and one state reported sporadic activity.
                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/flu...dashboard.html.
                14,634 530,071
                1,670 (11.4%) 105,269 (19.9%)
                800 (47.9%) 96,255 (91.4%)
                4 (0.5%) 185 (0.2%)
                376 (47.0%) 46,169 (48.0%)
                420 (52.5%) 49,900 (51.8%)
                870 (52.1%) 9,014 (8.6%)

                View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation 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]
                • A (H1N1)pdm09 [27]: All 27 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
                • A (H3N2) [902]: 238 (26.4%) of the 902 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. 664 (73.6%) of the 902 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.
                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.
                • Yamagata Lineage [157]: 150 (95.5%) of the 157 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Seven (4.5%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012.
                • Victoria Lineage [64]:60 (93.8%) of the 64 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Four (6.2%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.
                *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.
                34 1 (2.9) 30 0 (0.0) 34 1 (2.9)
                2,053 0 (0.0) 2,053 0 (0.0) 1,294 0 (0.0)
                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 athttp://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.

                View Full Screen | View PowerPoint Presentation 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.

                View Interactive Application | View Full Screen | View PowerPoint Presentation


                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.

                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.
                View Interactive Application | View Full Screen | View PowerPoint Presentation
                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.
                View Interactive Application | View Full Screen | View PowerPoint Presentation



                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/flu...dashboard.html.

                View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation 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:
                • Puerto Rico and six states (Arkansas, Connecticut, Kansas, Mississippi, Oklahoma, and Texas) experienced high ILI activity.
                • One state (Alabama) experienced moderate ILI activity.
                • Thirteen states (Colorado, Georgia, Hawaii, Idaho, Louisiana, Maine, Missouri, New Jersey, New York, Utah, Vermont, West Virginia, and Wyoming) experienced low ILI activity.
                • New York City and 30 states (Alaska, Arizona, California, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, Washington, and Wisconsin) experienced minimal ILI activity.
                • Data were insufficient to calculate an ILI activity level from the District of Columbia.
                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:
                • Widespread influenza activity was reported by nine states (Connecticut, Indiana, Maine, Massachusetts, New Hampshire, New Jersey, New York, Oklahoma, and Vermont).
                • Regional influenza activity was reported by Guam, Puerto Rico, the U.S. Virgin Islands, and 29 states (Alabama, Arizona, Arkansas, California, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Mexico, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, and Wyoming).
                • Local activity was reported by 11 states (Colorado, Delaware, Kentucky, Maryland, Minnesota, Nevada, Oregon, Rhode Island, South Dakota, West Virginia, and Wisconsin).
                • Sporadic activity was reported by the District of Columbia and one state (Alaska).






                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.

                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/publication..._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.

                Comment


                • #23

                  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.
                  • Viral Surveillance: Of 14,634 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 9, 1,670 (11.4%) were positive for influenza.
                  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
                  • Influenza-associated Pediatric Deaths: Seven influenza-associated pediatric deaths were reported.
                  • Influenza-associated Hospitalizations: A cumulative rate for the season of 55.7 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 2.4%, above the national baseline of 2.0%. Eight regions reported ILI at or above region-specific baseline levels. Puerto Rico and six states experienced high ILI activity; one state experienced moderate ILI activity; 13 states experienced low ILI activity; New York City and 30 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
                  • Geographic Spread of Influenza: The geographic spread of influenza in nine states was reported as widespread; Guam, Puerto Rico, the U.S. Virgin Islands, and 29 states reported regional activity; 11 states reported local activity; and the District of Columbia and one state reported sporadic activity.
                  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/flu...dashboard.html.
                  14,634 530,071
                  1,670 (11.4%) 105,269 (19.9%)
                  800 (47.9%) 96,255 (91.4%)
                  4 (0.5%) 185 (0.2%)
                  376 (47.0%) 46,169 (48.0%)
                  420 (52.5%) 49,900 (51.8%)
                  870 (52.1%) 9,014 (8.6%)

                  View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation 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]
                  • A (H1N1)pdm09 [27]: All 27 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
                  • A (H3N2) [902]: 238 (26.4%) of the 902 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. 664 (73.6%) of the 902 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.
                  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.
                  • Yamagata Lineage [157]: 150 (95.5%) of the 157 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Seven (4.5%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012.
                  • Victoria Lineage [64]:60 (93.8%) of the 64 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Four (6.2%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.
                  *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.
                  34 1 (2.9) 30 0 (0.0) 34 1 (2.9)
                  2,053 0 (0.0) 2,053 0 (0.0) 1,294 0 (0.0)
                  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 athttp://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.

                  View Full Screen | View PowerPoint Presentation 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.

                  View Interactive Application | View Full Screen | View PowerPoint Presentation


                  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.

                  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.
                  View Interactive Application | View Full Screen | View PowerPoint Presentation
                  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.
                  View Interactive Application | View Full Screen | View PowerPoint Presentation



                  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/flu...dashboard.html.

                  View National and Regional Level Graphs and Data | View Chart Data | View Full Screen | View PowerPoint Presentation 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:
                  • Puerto Rico and six states (Arkansas, Connecticut, Kansas, Mississippi, Oklahoma, and Texas) experienced high ILI activity.
                  • One state (Alabama) experienced moderate ILI activity.
                  • Thirteen states (Colorado, Georgia, Hawaii, Idaho, Louisiana, Maine, Missouri, New Jersey, New York, Utah, Vermont, West Virginia, and Wyoming) experienced low ILI activity.
                  • New York City and 30 states (Alaska, Arizona, California, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, Washington, and Wisconsin) experienced minimal ILI activity.
                  • Data were insufficient to calculate an ILI activity level from the District of Columbia.
                  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:
                  • Widespread influenza activity was reported by nine states (Connecticut, Indiana, Maine, Massachusetts, New Hampshire, New Jersey, New York, Oklahoma, and Vermont).
                  • Regional influenza activity was reported by Guam, Puerto Rico, the U.S. Virgin Islands, and 29 states (Alabama, Arizona, Arkansas, California, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Mexico, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, and Wyoming).
                  • Local activity was reported by 11 states (Colorado, Delaware, Kentucky, Maryland, Minnesota, Nevada, Oregon, Rhode Island, South Dakota, West Virginia, and Wisconsin).
                  • Sporadic activity was reported by the District of Columbia and one state (Alaska).






                  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.

                  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/publication..._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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