• FluTrackers.com Inc. does not provide medical advice. Information on this web site is collected from various internet resources, and the FluTrackers board of directors makes no warranty to the safety, efficacy, correctness or completeness of the information posted on this site by any author or poster. The information collated here is for instructional and/or discussion purposes only and is NOT intended to diagnose or treat any disease, illness, or other medical condition. Every individual reader or poster should seek advice from their personal physician/healthcare practitioner before considering or using any interventions that are discussed on this website. By continuing to access this website you agree to consult your personal physican before using any interventions posted on this website, and you agree to hold harmless FluTrackers.com Inc., the board of directors, the members, and all authors and posters for any effects from use of any medication, supplement, vitamin or other substance, device, intervention, etc. mentioned in posts on this website, or other internet venues referenced in posts on this website.
  • We are not asking for any donations. Do not donate to any entity who says they are raising funds for us.

US FluView - Weekly Surveillance Flu report 2023/2024 season - for trend analysis

Lance

MPH, CSP & CIT Retired, CHMM Emeritus
For previous year please see:

US FluView - Weekly Surveillance Flu report 2022/2023 season - for trend analysis




Weekly U.S. Influenza Surveillance Report


Print

Updated October 13, 2023
fluview-banner2.jpg

Key Updates for Week 40, ending October 7, 2023

Seasonal influenza activity remains low nationally. Viruses


Clinical Lab 1.1%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization are summarized in this report. Illness


Outpatient Respiratory Illness 2.2%

(Trend )


of visits to a health care provider this week were for respiratory illness
(below baseline).


Outpatient Respiratory Illness: Activity Map
This week 1 jurisdiction experienced moderate activity and 0 jurisdictions experienced high or very activity.

FluSurv-NET 0.1 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 1,127

(Trend )


patients admitted to hospitals with influenza
this week.


NCHS Mortality 0.05%

(Trend )


of deaths attributed influenza this week.

Pediatric Deaths 1


death that occurred during the 2022-2023 season was reported this week.

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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains low nationally.
  • Nationally, outpatient respiratory illness is below baseline[SUP]1[/SUP], and all 10 HHS regions are below their respective baselines.
  • The number of flu hospital admissions remains low.
  • During week 40, 50 (86.2%) of the 58 viruses reported by public health laboratories were influenza A and 8 (13.8%) were influenza B. Of the 33 influenza A viruses subtyped during week 40; 30 were influenza A(H1N1) and 3 were A(H3N2).
  • One influenza-associated pediatric death that occurred during the 2022-2023 season was reported this week.
  • CDC recommends that everyone ages 6 months and older get an annual flu vaccine, ideally by the end of October.[SUP]2[/SUP]
  • There are also prescription flu antiviral drugs that can be used to treat flu illness; those need to be started as early as possible.[SUP]3[/SUP]
  • Influenza virus is one of several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, influenza, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of specimens testing positive for influenza in clinical laboratories remained stable (change of <0.5 percentage points) compared to the previous week. In Regions 4 and 9, this percentage increased compared to the previous week. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent live attenuated influenza vaccine (LAIV) receipt or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested47,29653,556
No. of positive specimens (%)530 (1.1%)492 (0.9%)
Positive specimens by type
Influenza A320 (60.4%)315 (64.0%)
Influenza B210 (39.6%)177 (36.0%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,2463,011
No. of positive specimens58152
Positive specimens by type/subtype
Influenza A50 (86.2%)126 (82.9%)
Subtyping Performed33 (66.0%)116 (92.1%)
(H1N1)pdm0930 (90.9%)108 (93.1%)
H3N23 (9.1%)8 (6.9%)
H3N2v0 (0%)0 (0%)
Subtyping not performed17 (34.0%)10 (7.9%)
Influenza B8 (13.8%)26 (17.1%)
Lineage testing performed2 (25.0%)18 (69.2%)
Yamagata lineage0 (0%)0 (0%)
Victoria lineage2 (100%)18 (100%)
Lineage not performed6 (75.0%)8 (30.8%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of viruses submitted from U.S. state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 435 influenza viruses collected since May 1, 2023.
A/H1214
6B.1A.5a214 (100%)2a80 (37.4%)
2a.1134 (62.6%)
A/H324
3C.2a1b.2a24 (100%)2a.3a2 (8.3%)
2a.3a.121 (87.5%)
2b1 (4.2%)
B/Victoria197
V1A197 (100%)3a.2197 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Sixty-eight A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Fourteen A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Forty-five influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Antiviral susceptibility data will be reported later this season when a sufficient number of viruses has been tested. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with any pathogen that can present with similar symptoms, including influenza virus, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during week 40, 2.2% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has remained stable (change of ≤ 0.1 percentage points) compared to week 39 and is below the national baseline of 2.9%. All 10 HHS regions are below their respective baselines. Region 9 increased, Region 2 decreased, and all other regions remained stable compared to week 39. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet increased for two age groups (0-4 years, 5-24 years) and remained stable (change of ≤ 0.1 percentage point) for three age groups (25-49 years, 50-64 years, and 65+ years) in week 40 compared to week 39.

national levels of ILI and ARI by age group
View Chart Data | View Full Screen Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 40
(Week ending
Oct. 7, 2023)
Week 39
(Week ending
Sept. 30, 2023)
Week 40
(Week ending
Oct. 7, 2023)
Week 39
(Week ending
Sept. 7, 2023)
Very High0002
High03314
Moderate12926
Low665780
Minimal4744610554
Insufficient Data10250253


*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 37 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and October 7, 2023. The weekly hospitalization rate observed in week 40 was 0.1 per 100,000 population.

When examining rates by age, the hospitalization rate per 100,000 population among adults aged 18 years and older was 0.1, and among children aged 0-17 years, the hospitalization rate per 100,000 population was also 0.1.

FluSurvNet Cumulative Rates

View Full Screen
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the number of patients admitted with laboratory-confirmed influenza. During week 40, 1,127 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza slightly increased compared to week 39 (increase of >5%). Regions 1, 4, 5, 7, and 10 slightly increased and all other regions remained stable or decreased.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on October 12, 2023, 0.05% of the deaths that occurred during the week ending October 7, 2023 (week 40), were due to influenza. This percentage remained stable (≤ 0.1 percentage point change) compared to week 39. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.
Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


No influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

One influenza-associated pediatric death occurring during the 2022-2023 season was reported to CDC during week 40. The death was associated with an influenza A(H3) virus and occurred during week 52 (the week ending December 31, 2022). A total of 178 influenza-associated pediatric deaths that occurred during the 2022-2023 season have been reported to CDC.
Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.3 percentage points of the percent of deaths due to PIC compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

https://www.cdc.gov/flu/weekly/index.htm
 
Last edited by a moderator:
Weekly U.S. Influenza Surveillance Report


Print
Updated October 20, 2023
fluview-banner2.jpg

Key Updates for Week 41, ending October 14, 2023

Seasonal influenza activity remains low nationally although small increases were reported in some parts of the country. Viruses


Clinical Lab 1.3%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization are summarized in this report. Illness


Outpatient Respiratory Illness 2.3%

(Trend )


of visits to a health care provider this week were for respiratory illness
(below baseline).


Outpatient Respiratory Illness: Activity Map
This week 0 jurisdictions experienced moderate activity and 2 jurisdictions experienced high activity.

FluSurv-NET 0.3 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 1,228

(Trend )


patients admitted to hospitals with influenza
this week.


NCHS Mortality 0.05%

(Trend )


of deaths attributed influenza this week.

Pediatric Deaths 1


death that occurred during the 2022-2023 season was reported this week.

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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains low nationally, but there are slight increases in some parts of the country.
  • Nationally, outpatient respiratory illness is below baseline[SUP]1[/SUP], and all 10 HHS regions are below their respective baselines.
  • The number of flu hospital admissions remains low.
  • During week 41, of the 159 viruses reported by public health laboratories, 124 (78.0%) were influenza A, and 35 (22.0%) were influenza B. Of the 99 influenza A viruses subtyped during week 41,93 (93.9%) were influenza A(H1N1), and 6 (6.1%) were A(H3N2).
  • One influenza-associated pediatric death that occurred during the 2022-2023 season was reported this week.
  • CDC recommends that everyone ages 6 months and older get an annual flu vaccine, ideally by the end of October.[SUP]2[/SUP]
  • There are also prescription flu antiviral drugs that can be used to treat flu illness; those need to be started as early as possible.[SUP]3[/SUP]
  • Influenza virus is one of several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, influenza, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of specimens testing positive for influenza in clinical laboratories remained stable (change of <0.5 percentage points) compared to the previous week. In Region 8, this week’s percentage increased compared to the previous week, and in all other regions this week’s percentage remained stable. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent live attenuated influenza vaccine (LAIV) receipt or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested49,312108,688
No. of positive specimens (%)661 (1.3%)1,294 (1.2%)
Positive specimens by type
Influenza A457 (69.1%)853 (65.9%)
Influenza B204 (30.9%)441 (34.1%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,3745,105
No. of positive specimens159343
Positive specimens by type/subtype
Influenza A124 (78.0%)268 (78.1%)
Subtyping Performed99 (79.8%)233 (86.9%)
(H1N1)pdm0993 (93.9%)214 (91.8%)
H3N26 (6.1%)19 (8.2%)
H3N2v0 (0%)0 (0%)
Subtyping not performed25 (20.2%)35 (13.1%)
Influenza B35 (22.0%)75 (21.9%)
Lineage testing performed26 (74.3%)56 (74.7%)
Yamagata lineage0 (0%)0 (0%)
Victoria lineage26 (100%)56 (100%)
Lineage not performed9 (25.7%)19 (25.3%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of viruses submitted from U.S. state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 477 influenza viruses collected since May 1, 2023.
A/H1234
6B.1A.5a234 (100%)2a83 (35.5%)
2a.1151 (64.5%)
A/H335
3C.2a1b.2a35 (100%)2a.3a4 (11.4%)
2a.3a.130 (85.7%)
2b1 (2.9%)
B/Victoria208
V1A208 (100%)3a.2208 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Sixty-eight A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Fourteen A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines
Influenza B Viruses
  • B/Victoria: Forty-five influenza B/Victoria-lineage viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Antiviral susceptibility data will be reported later this season, when a sufficient number of viruses has been tested. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with any pathogen that can present with similar symptoms, including influenza virus, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during week 41, 2.3% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has remained stable (change of ≤ 0.1 percentage points) compared to week 40 and is below the national baseline of 2.9%. All 10 HHS regions are below their respective baselines. Region 8 increased, Region 2 decreased, and all other regions remained stable compared to week 40. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet increased for the 0-4 years and 25-49 years age groups and remained stable (change of ≤ 0.1 percentage point) for all other age groups (4-24 years, 50-64 years, and 65+ years) in week 41 compared to week 40.

national levels of ILI and ARI by age group
View Chart Data | View Full Screen Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 41
(Week ending
Oct. 14, 2023)
Week 40
(Week ending
Oct. 7, 2023)
Week 41
(Week ending
Oct. 14, 2023)
Week 40
(Week ending
Oct. 7, 2023)
Very High0001
High2173
Moderate021411
Low465857
Minimal4946615632
Insufficient Data00235225




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in selected counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 103 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and October 14, 2023. The weekly hospitalization rate observed in week 41 was 0.2 per 100,000 population. The overall cumulative hospitalization rate was 0.3 per 100,000 population.

When examining rates by age, the cumulative hospitalization rate per 100,000 population among adults aged 18 years and older was 0.4, while among children aged 0-17 years, the cumulative hospitalization rate per 100,000 population was 0.2.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the number of patients admitted with laboratory-confirmed influenza. During week 41, 1,228 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza slightly increased compared to week 40 (change of >5%). Regions 5, 6, 8, and 9 slightly increased and all other regions remained stable or decreased.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on October 19, 2023, 0.05% of the deaths that occurred during the week ending October 14, 2023 (week 41), were due to influenza. This percentage remained stable (≤ 0.1 percentage point change) compared to week 40. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


No influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

One influenza-associated pediatric death occurring during the 2022-2023 season was reported to CDC during week 41. The death was associated with an influenza A (H1N1)pdm09 virus and occurred during week 39 (the week ending September 30, 2023). A total of 179 influenza-associated pediatric deaths that occurred during the 2022-2023 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.3 percentage points of the percent of deaths due to PIC compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated November 3, 2023
fluview-banner2.jpg

Key Updates for Week 43, ending October 28, 2023

Seasonal influenza activity remains low nationally but continues to slightly increase in most parts of the country. Viruses


Clinical Lab 1.9%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization are summarized in this report. Illness


Outpatient Respiratory Illness 2.7%

(Trend )


of visits to a health care provider this week were for respiratory illness
(below baseline).


Outpatient Respiratory Illness: Activity Map
This week 6 jurisdictions experienced moderate activity and 2 jurisdictions experienced high activity.

FluSurv-NET 0.8 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 1,607

(Trend )


patients admitted to hospitals with influenza
this week.


NCHS Mortality 0.06%

(Trend )


of deaths attributed influenza this week.

Pediatric Deaths 3


deaths were reported (2 occurred in 2022-23 season and 1 occurred in 2023-24 season)

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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains low nationally but continues to slightly increase in most parts of the country.
  • Outpatient respiratory illness is below baseline[SUP]1 [/SUP]nationally and in nine HHS regions. Region 4 (the Southeast of the country) is above its outpatient respiratory illness baseline.
  • The number of weekly flu hospital admissions remains low but is increasing.
  • During week 43, of the 189 viruses reported by public health laboratories, 145 (76.7%) were influenza A, and 44 (23.3%) were influenza B. Of the 98 influenza A viruses subtyped during week 43, 84 (85.7%) were influenza A(H1N1), and 14 (14.3%) were A(H3N2).
  • The first influenza-associated pediatric death occurring during the 2023-24 season was reported this week.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine.[SUP]2[/SUP]
  • There also are prescription flu antiviral drugs that can be used to treat flu illness; those should be started as early as possible.[SUP]3[/SUP]
  • Influenza viruses are among several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, influenza, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories remained stable (change of <0.5 percentage points) compared to the previous week but is trending upwards. In Regions 1, 3, 6, 8, and 9 the percentage this week increased compared to the previous week, and in all other regions it remained stable. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested50,459233,932
No. of positive specimens (%)964 (1.9%)3,373 (1.4%)
Positive specimens by type
Influenza A676 (70.1%)2,275 (67.4%)
Influenza B288 (29.9%)1,098 (32.6%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,21310,656
No. of positive specimens189901
Positive specimens by type/subtype
Influenza A145 (76.7%)697 (77.4%)
Subtyping Performed98 (67.6%)597 (85.7%)
(H1N1)pdm0984 (85.7%)548 (91.8%)
H3N214 (14.3%)49 (8.2%)
H3N2v0 (0%)0 (0%)
Subtyping not performed47 (32.4%)100 (14.3%)
Influenza B44 (23.3%)204 (22.6%)
Lineage testing performed29 (65.9%)159 (77.9%)
Yamagata lineage0 (0%)0 (0%)
Victoria lineage29 (100%)159 (100%)
Lineage not performed15 (34.1%)45 (22.1%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of viruses submitted by U.S. state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to influenza antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 559 influenza viruses collected since May 1, 2023.
A/H1293
6B.1A.5a293(100%)2a90 (30.7%)
2a.1203 (69.3%)
A/H341
3C.2a1b.2a41 (100%)2a.3a4 (9.8%)
2a.3a.136 (87.8%)
2b1 (2.4%)
B/Victoria225
V1A225 (100%)3a.2225 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Seventy-six A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Twenty-two A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Sixty influenza B/Victoria-lineage viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Antiviral susceptibility data will be reported later this season, when a sufficient number of viruses has been tested. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during week 43, 2.7% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has increased (change of > 0.1 percentage points) compared to week 42 but remains below the national baseline of 2.9%. ILI activity is trending upward in 8 of the 10 HHS Regions (Regions 2-9) and is above baseline in Region 4 (the Southeast). Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet is trending upward in all age groups.

national levels of ILI and ARI by age group
View Chart Data | View Full Screen Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 43
(Week ending
Oct. 28, 2023)
Week 42
(Week ending
Oct. 21, 2023)
Week 43
(Week ending
Oct. 28, 2023)
Week 42
(Week ending
Oct. 21, 2023)
Very High0010
High21199
Moderate633325
Low8128078
Minimal3939569593
Insufficient Data00227224




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in selected counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 238 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and October 28, 2023. The weekly hospitalization rate observed during week 43 was 0.2 per 100,000 population. The overall cumulative hospitalization rate was 0.8 per 100,000 population.

When examining rates by age, the cumulative hospitalization rate per 100,000 population among adults 18 years and older was 0.8, while among children 0-17 years, the cumulative hospitalization rate per 100,000 population was 0.6.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the number of patients admitted with laboratory-confirmed influenza. During week 43, 1,607 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for the week slightly increased compared to week 42 (change of >5%) nationally and in Regions 1, 2, 9, and 10. All other regions remained stable or decreased.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on November 2, 2023, 0.06% of the deaths that occurred during the week ending October 28, 2023 (week 43), were due to influenza. This percentage remained stable (≤ 0.1 percentage point change) compared to week 42. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Three influenza-associated pediatric deaths were reported to CDC during week 43.

One death occurred during week 40 (the week ending October 7, 2023) that was associated with an influenza A virus for which no subtyping was performed. This is the first influenza-associated pediatric death occurring during the 2023-2024 season that has been reported to CDC.

Two deaths occurring during the 2022-2023 season were also reported, which brings the total number of pediatric deaths for last season to 181. One death was associated with an influenza A virus for which no subtyping was performed and occurred during week 7 (the week ending February 18, 2023). The other death was associated with an influenza B virus with no lineage determined and occurred during week 38 (the week ending September 23, 2023).

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated November 3, 2023
fluview-banner2.jpg

Key Updates for Week 43, ending October 28, 2023

Seasonal influenza activity remains low nationally but continues to slightly increase in most parts of the country. Viruses


Clinical Lab 1.9%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization are summarized in this report. Illness


Outpatient Respiratory Illness 2.7%

(Trend )


of visits to a health care provider this week were for respiratory illness
(below baseline).


Outpatient Respiratory Illness: Activity Map
This week 6 jurisdictions experienced moderate activity and 2 jurisdictions experienced high activity.

FluSurv-NET 0.8 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 1,607

(Trend )


patients admitted to hospitals with influenza
this week.


NCHS Mortality 0.06%

(Trend )


of deaths attributed influenza this week.

Pediatric Deaths 3


deaths were reported (2 occurred in 2022-23 season and 1 occurred in 2023-24 season)

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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains low nationally but continues to slightly increase in most parts of the country.
  • Outpatient respiratory illness is below baseline[SUP]1 [/SUP]nationally and in nine HHS regions. Region 4 (the Southeast of the country) is above its outpatient respiratory illness baseline.
  • The number of weekly flu hospital admissions remains low but is increasing.
  • During week 43, of the 189 viruses reported by public health laboratories, 145 (76.7%) were influenza A, and 44 (23.3%) were influenza B. Of the 98 influenza A viruses subtyped during week 43, 84 (85.7%) were influenza A(H1N1), and 14 (14.3%) were A(H3N2).
  • The first influenza-associated pediatric death occurring during the 2023-24 season was reported this week.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine.[SUP]2[/SUP]
  • There also are prescription flu antiviral drugs that can be used to treat flu illness; those should be started as early as possible.[SUP]3[/SUP]
  • Influenza viruses are among several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, influenza, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories remained stable (change of <0.5 percentage points) compared to the previous week but is trending upwards. In Regions 1, 3, 6, 8, and 9 the percentage this week increased compared to the previous week, and in all other regions it remained stable. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested50,459233,932
No. of positive specimens (%)964 (1.9%)3,373 (1.4%)
Positive specimens by type
Influenza A676 (70.1%)2,275 (67.4%)
Influenza B288 (29.9%)1,098 (32.6%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,21310,656
No. of positive specimens189901
Positive specimens by type/subtype
Influenza A145 (76.7%)697 (77.4%)
Subtyping Performed98 (67.6%)597 (85.7%)
(H1N1)pdm0984 (85.7%)548 (91.8%)
H3N214 (14.3%)49 (8.2%)
H3N2v0 (0%)0 (0%)
Subtyping not performed47 (32.4%)100 (14.3%)
Influenza B44 (23.3%)204 (22.6%)
Lineage testing performed29 (65.9%)159 (77.9%)
Yamagata lineage0 (0%)0 (0%)
Victoria lineage29 (100%)159 (100%)
Lineage not performed15 (34.1%)45 (22.1%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of viruses submitted by U.S. state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to influenza antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 559 influenza viruses collected since May 1, 2023.
A/H1293
6B.1A.5a293(100%)2a90 (30.7%)
2a.1203 (69.3%)
A/H341
3C.2a1b.2a41 (100%)2a.3a4 (9.8%)
2a.3a.136 (87.8%)
2b1 (2.4%)
B/Victoria225
V1A225 (100%)3a.2225 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Seventy-six A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Twenty-two A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Sixty influenza B/Victoria-lineage viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Antiviral susceptibility data will be reported later this season, when a sufficient number of viruses has been tested. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during week 43, 2.7% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has increased (change of > 0.1 percentage points) compared to week 42 but remains below the national baseline of 2.9%. ILI activity is trending upward in 8 of the 10 HHS Regions (Regions 2-9) and is above baseline in Region 4 (the Southeast). Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet is trending upward in all age groups.

national levels of ILI and ARI by age group
View Chart Data | View Full Screen Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 43
(Week ending
Oct. 28, 2023)
Week 42
(Week ending
Oct. 21, 2023)
Week 43
(Week ending
Oct. 28, 2023)
Week 42
(Week ending
Oct. 21, 2023)
Very High0010
High21199
Moderate633325
Low8128078
Minimal3939569593
Insufficient Data00227224




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in selected counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 238 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and October 28, 2023. The weekly hospitalization rate observed during week 43 was 0.2 per 100,000 population. The overall cumulative hospitalization rate was 0.8 per 100,000 population.

When examining rates by age, the cumulative hospitalization rate per 100,000 population among adults 18 years and older was 0.8, while among children 0-17 years, the cumulative hospitalization rate per 100,000 population was 0.6.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the number of patients admitted with laboratory-confirmed influenza. During week 43, 1,607 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for the week slightly increased compared to week 42 (change of >5%) nationally and in Regions 1, 2, 9, and 10. All other regions remained stable or decreased.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on November 2, 2023, 0.06% of the deaths that occurred during the week ending October 28, 2023 (week 43), were due to influenza. This percentage remained stable (≤ 0.1 percentage point change) compared to week 42. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Three influenza-associated pediatric deaths were reported to CDC during week 43.

One death occurred during week 40 (the week ending October 7, 2023) that was associated with an influenza A virus for which no subtyping was performed. This is the first influenza-associated pediatric death occurring during the 2023-2024 season that has been reported to CDC.

Two deaths occurring during the 2022-2023 season were also reported, which brings the total number of pediatric deaths for last season to 181. One death was associated with an influenza A virus for which no subtyping was performed and occurred during week 7 (the week ending February 18, 2023). The other death was associated with an influenza B virus with no lineage determined and occurred during week 38 (the week ending September 23, 2023).

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated November 17, 2023
fluview-banner2.jpg

Key Updates for Week 45, ending November 11, 2023

Seasonal influenza activity continues to increase in most parts of the country, most notably in the South Central, Southeast, and West Coast regions. Viruses


Clinical Lab 4.0%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization are summarized in this report. Illness


Outpatient Respiratory Illness 3.5%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 8 jurisdictions experienced moderate activity and 9 jurisdictions experienced high or very high activity.

FluSurv-NET 1.7 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 2,721

(Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.10%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 0


influenza-associated deaths reported this week.

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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity continues to increase in most parts of the country, most notably in the South Central, Southeast, and West Coast regions.
  • Outpatient respiratory illness is above baseline[SUP]1 [/SUP]nationally for the second week and is at or above baseline in five of 10 HHS Regions. Region 3 (Mid-Atlantic) is at its region-specific outpatient respiratory illness baseline and Regions 2, 4, 6, and 9 (New York/New Jersey/Puerto Rico/Virgin Islands, Southeast, South Central, and West Coast) are above their region-specific baselines.
  • The number of weekly flu hospital admissions continues to increase.
  • During week 45, of the 310 viruses reported by public health laboratories, 235 (75.8%) were influenza A and 75 (24.2%) were influenza B. Of the 133 influenza A viruses subtyped during week 45, 116 (87.2%) were influenza A(H1N1) and 17 (12.8%) were A(H3N2).
  • CDC estimates that there have been at least 780,000 illnesses, 8,000 hospitalizations, and 490 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine.[SUP]2[/SUP]
  • There also are prescription flu antiviral drugs that can be used to treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Influenza viruses are among several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, influenza, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally and in HHS Regions 1, 2, 4, 5, 6, 7, 8, 9 and 10, the percentage of respiratory specimens testing positive for influenza in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. In Region 3 the percentage remained stable compared to the previous week but is trending upwards. The regions with the highest percent positivity were Regions 8 (7.4%), 4 (7.0%), 6 (6.5%) and 9 (5.3%). For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested74,217396,399
No. of positive specimens (%)3,002 (4.0%)8,508 (2.2%)
Positive specimens by type
Influenza A2,144 (71.4%)5,912 (69.5%)
Influenza B858 (28.6%)2,596 (30.5%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,13616,551
No. of positive specimens3101,909
Positive specimens by type/subtype
Influenza A235 (75.8%)1,501 (78.6%)
Subtyping Performed133 (56.6%)1,166 (77.7%)
(H1N1)pdm09116 (87.2%)1,053 (90.3%)
H3N217 (12.8%)113 (9.7%)
H3N2v0 (0%)0 (0%)
Subtyping not performed102 (43.4%)335 (22.3%)
Influenza B75 (24.2%)408 (21.4%)
Lineage testing performed52 (69.3%)340 (83.3%)
Yamagata lineage0 (0%)0 (0%)
Victoria lineage52 (100%)340 (100%)
Lineage not performed23 (30.7%)68 (16.7%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of viruses submitted by U.S. state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to influenza antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 567 influenza viruses collected since May 1, 2023.
A/H1297
6B.1A.5a297 (100%)2a90 (30.3%)
2a.1207 (69.7%)
A/H341
3C.2a1b.2a41 (100%)2a.3a4 (9.8%)
2a.3a.136 (87.8%)
2b1 (2.4%)
B/Victoria229
V1A229 (100%)3a.2229 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: One hundred and nine A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Twenty-three A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Seventy-three influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Antiviral susceptibility data will be reported later this season, when a sufficient number of viruses has been tested. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during week 45, 3.5% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has increased (change of > 0.1 percentage points) compared to week 44 and is above the national baseline of 2.9%. ILI activity is trending upward in 9 of the 10 HHS Regions (Regions 1, 2, 3, 4, 5, 6, 7, 8, and 9). Five regions are at or above their region-specific baselines (Regions 2, 3, 4, 6, and 9) this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet has increased (change of > 0.1 percentage points) in all age groups in week 45 compared to week 44.

national levels of ILI and ARI by age group
View Chart Data | View Full Screen Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 45
(Week ending
Nov. 11, 2023)
Week 44
(Week ending
Nov. 4, 2023)
Week 45
(Week ending
Nov. 11, 2023)
Week 44
(Week ending
Nov. 4, 2023)
Very High1091
High844131
Moderate866237
Low1010125104
Minimal2735453532
Insufficient Data10239224




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in selected counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 527 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and November 11, 2023; 425 (80.6%) were associated with influenza A virus, 93 (17.6%) with influenza B virus, 4 (0.8%) with influenza A virus and influenza B virus co-infection, and 5 (0.9%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 76 (83.5%) were A(H1N1)pdm09 virus and 14 (15.4%) were A(H3N2).

The weekly hospitalization rate observed during week 45 was 0.5 per 100,000 population. The overall cumulative hospitalization rate was 1.7 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative in-season hospitalization rate observed during week 45, after the 2022-2023 season (8.1). Cumulative in-season hospitalization rates observed during week 45 from 2010-2011 through 2021-2022 ranged from 0.1 to 0.9.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults 65 years and older (4.3), followed by children 0-4 years (2.4) and adults 50-64 years (2.1). When examining unadjusted rates by race and ethnicity, the highest hospitalization rate per 100,000 population was among non-Hispanic Black persons (2.7), followed by Hispanic persons (1.9), non-Hispanic American Indian or Alaska Native persons (1.6), non-Hispanic Asian persons (1.4), and non-Hispanic White persons (1.3).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During week 45, 2,721 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for week 45 increased compared to week 44 (change of >5%) nationally and in 9 of the 10 HHS Regions (2, 3, 4, 5, 6, 7, 8, 9, and 10). In Region 1, the number of hospitalizations remained stable in week 45 compared to week 44.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on November 16, 2023, 0.10% of the deaths that occurred during the week ending November 11, 2023 (week 45), were due to influenza. This percentage remained stable (≤ 0.1 percentage point change) compared to week 44. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


No influenza-associated pediatric deaths were reported to CDC during week 45.

One influenza-associated pediatric death occurring during the 2023-2024 season has been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated December 1, 2023
fluview-banner2.jpg

Key Updates for Week 47, ending November 25, 2023

Seasonal influenza activity continues to increase in most parts of the country, most notably in the South Central, Southeast, Mountain, and West Coast regions. Viruses


Clinical Lab 6.2%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 3.9%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 10 jurisdictions experienced moderate activity and 13 jurisdictions experienced high or very high activity.

FluSurv-NET 3.7 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 4,268

(Trend )


patients admitted to hospitals with influenza this week.



NCHS Mortality 0.1%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 5


influenza-associated deaths reported this week for a
total of 8 so far this season


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity continues to increase in most parts of the country, most notably in the South Central, Southeast, Mountain, and West Coast regions.
  • Outpatient respiratory illness is above baseline[SUP]1 [/SUP]nationally for the fourth week and is at or above baseline in eight of 10 HHS Regions. Region 7 (Central) is at its region-specific outpatient respiratory illness baseline and regions 1, 2, 4, 5, 6, 8, and 9 (New England, New York/New Jersey/Puerto Rico/Virgin Islands, Midwest, Southeast, South Central, Mountain, and West Coast) are above their region-specific baselines.
  • The number of weekly flu hospital admissions continues to increase.
  • In week 47, 5 pediatric deaths associated with influenza were reported. This brings the 2023-2024 season total to 8 pediatric deaths.
  • During week 47, of the 379 viruses reported by public health laboratories, 311 (82.1%) were influenza A and 68 (17.9%) were influenza B. Of the 202 influenza A viruses subtyped during week 47, 166 (82.2%) were influenza A(H1N1) and 32 (17.8%) were A(H3N2).
  • CDC estimates that there have been at least 1.8 million illnesses, 17,000 hospitalizations, and 1,100 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine, as there are still vaccines available.[SUP]2 [/SUP]Now is still a good time to get a vaccine, if you haven’t already.
  • There also are prescription flu antiviral drugs that can be used to treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Influenza viruses are among several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, influenza, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally and in HHS Regions 1, 2, 3, 4, 8, 9, and 10, the percentage of respiratory specimens testing positive for influenza in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. In all other regions the percentage remained stable compared to the previous week but is trending upwards. The regions with the highest percent positivity were regions 8 (13.2%), 4 (10.3%), 6 (7.7%), and 9 (7.2%). Influenza A(H1N1)pdm09 is the predominant virus circulating in all regions, however a larger proportion (38%) of the viruses detected by public health labs have been influenza B in regions 4 and 6 compared to other regions (9-19%). For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested69,884581,944
No. of positive specimens (%)4,336 (6.2%)17,814 (3.1%)
Positive specimens by type
Influenza A3,257 (75.1%)12,873 (72.3%)
Influenza B1,079 (24.9%)4,941 (27.7%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested1,79822,823
No. of positive specimens3793,561
Positive specimens by type/subtype
Influenza A311 (82.1%)2,845 (79.9%)
Subtyping Performed202 (65.0%)2,250 (79.1%)
(H1N1)pdm09166 (82.2%)1,969 (87.5%)
H3N236 (17.8%)281 (12.5%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed109 (35.0%)595 (20.9%)
Influenza B68 (17.9%)716 (20.1%)
Lineage testing performed47 (69.1%)561 (78.4%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage47 (100%)561 (100%)
Lineage not performed21 (30.9%)155 (21.6%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of viruses submitted by U.S. state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to influenza antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 818 influenza viruses collected since May 1, 2023.
A/H1441
6B.1A.5a441 (100%)2a141 (32.0%)
2a.1300 (68.0%)
A/H381
3C.2a1b.2a81 (100%)2a.1b1 (1.2%)
2a.3a4 (4.9%)
2a.3a.175 (92.6%)
2b1 (1.2%)
B/Victoria296
V1A296 (100%)3a.2296 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A(H1N1)pdm09: One hundred and thirty-four A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A(H3N2): Twenty-three A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Eighty influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023 were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested2651564168
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested2651564168
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested2651564168
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested2621534168
Decreased Susceptibility0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during Week 47, 3.9% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has increased compared to week 47 and is above the national baseline of 2.9% for the fourth consecutive week. ILI activity increased in 7 of the 10 HHS Regions (regions 1, 5, 6, 7, 8, 9, and 10) during week 47 compared to week 48 and, while stable compared to last week, is trending upward in Region 4. Percent of visits for ILI decreased in Region 3, but that may be attributed to low reporting during week 47. Eight regions are at or above their region-specific baselines (regions 1, 2, 4, 5, 6, 7, 8, and 9) this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet has increased (change of > 0.1 percentage points) in two age groups (5-24 years and 50-64 years) in Week 47 compared to week 46 and is trending upward in all other age groups (0-4 years, 25-49 years, 65+ years).

national levels of ILI and ARI by age group
View Chart Data | View Full Screen Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 47
(Week ending
Nov. 25, 2023)
Week 46
(Week ending
Nov. 18, 2023)
Week 47
(Week ending
Nov. 25, 2023)
Week 46
(Week ending
Nov. 18, 2023)
Very High221012
High11105659
Moderate1098271
Low119156128
Minimal1925385433
Insufficient Data20240226




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 1,131 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and November 25, 2023; 923 (81.6%) were associated with influenza A virus, 162 (14.3%) with influenza B virus, 4 (0.4%) with influenza A virus and influenza B virus co-infection, and 42 (3.7%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 185 (83.3%) were A(H1N1)pdm09 and 36 (16.2%) were A(H3N2).

The weekly hospitalization rate observed in week 47 was 0.9 per 100,000 population. The overall cumulative hospitalization rate was 3.7 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative in-season hospitalization rate observed in week 47, following the 2022-2023 season (16.6). Cumulative in-season hospitalization rates observed in week 46 from 2010-2011 through 2021-2022 ranged from 0.1 to 2.0.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (8.9), followed by adults aged 50-64 years (4.9), and children aged 0-4 years (4.0). When examining unadjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (6.4), followed by non-Hispanic American Indian or Alaska Native persons (4.4), Hispanic persons (3.7), non-Hispanic Asian persons (2.7), and non-Hispanic White persons (2.6).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 47, 4,268 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 47 increased compared to Week 46 (change of >5%) nationally and in 9 of the 10 HHS Regions (1- 9). In Region 10, the number of hospitalizations slightly decreased compared to week 46.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on November 30, 2023, 0.1% of the deaths that occurred during the week ending November 25, 2023 (week 47), were due to influenza. This percentage remained stable (≤ 0.1 percentage point change) compared to Week 46, but is trending upwards slightly since early October. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Five influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during week 47. The deaths occurred during weeks 43, 45, and 46 of 2023 (weeks ending October 28, November 11, and November 25, respectively). Two deaths were associated with influenza A(H1N1) viruses and three deaths were associated with influenza B viruses with no lineage determined.

A total of 8 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated December 8, 2023
fluview-banner2.jpg

Key Updates for Week 48, ending December 2, 2023

Seasonal influenza activity continues to increase in most parts of the country, with the southeast and south-central areas of the country reporting the highest levels of activity. Viruses


Clinical Lab 6.8%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.0%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 9 jurisdictions experienced moderate activity and 16 jurisdictions experienced high or very high activity.

FluSurv-NET 5.5 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 5,753

(Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.2%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 4


influenza-associated deaths were reported
this week for a season total of 12.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal flu activity continues to increase in most parts of the country, with the southeast and south-central areas of the country reporting the highest levels of activity.
  • Outpatient respiratory illness is above baseline[SUP]1 [/SUP]nationally for the fifth week and is at or above baseline in all 10 HHS Regions. Region 10 (Pacific Northwest) is at its region-specific outpatient respiratory illness baseline, and regions 1-9 are above their region-specific baselines.
  • The number of weekly flu hospital admissions continues to increase.
  • Four influenza-associated pediatric deaths were reported during Week 48, bringing the 2023-2024 season total to 12 pediatric deaths.
  • During Week 48, of the 547 viruses reported by public health laboratories, 437 (79.9%) were influenza A and 110 (20.1%) were influenza B. Of the 294 influenza A viruses subtyped during week 48, 218 (74.1%) were influenza A(H1N1) and 76 (25.9%) were A(H3N2).
  • CDC estimates that there have been at least 2.6 million illnesses, 26,000 hospitalizations, and 1,600 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine, as there are still vaccines available.[SUP]2 [/SUP]Now is still a good time to get vaccinated if you haven’t already.
  • There also are prescription flu antiviral drugs that can be used to treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally and in HHS Regions 2, 3, 4, 5, 7, and 9, the percentage of respiratory specimens testing positive for influenza in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. Regions 1 and 10 continue trending upward while region 6 and 8 remained stable compared to the previous week. The regions with the highest percent positivity were regions 8 (13.1%), 4 (10.9%), 6 (8.9%), and 9 (8.6%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. A larger combined proportion (37%) of the viruses detected by public health labs have been influenza B in regions 4 and 6 compared to other regions (7-20%). For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested93,944690,802
No. of positive specimens (%)6,415 (6.8%)25,243 (3.7%)
Positive specimens by type
Influenza A5,152 (80.3%)18,772 (74.4%)
Influenza B1,263 (19.7%)6,471 (25.6%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,82827,138
No. of positive specimens5474,778
Positive specimens by type/subtype
Influenza A437 (79.9%)3,843 (80.4%)
Subtyping Performed294 (67.3%)3,107 (80.8%)
(H1N1)pdm09218 (74.1%)2,656 (85.5%)
H3N276 (25.9%)451 (14.5%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed143 (32.7%)736 (19.2%)
Influenza B110 (20.1%)935 (19.6%)
Lineage testing performed84 (76.4%)764 (81.7%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage84 (100%)764 (100%)
Lineage not performed26 (23.6%)171 (18.3%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of viruses submitted by U.S. state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to influenza antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 1,005 influenza viruses collected since May 1, 2023.
A/H1541
6B.1A.5a541 (100%)2a170 (31.4%)
2a.1371 (68.6%)
A/H3113
3C.2a1b.2a113 (100%)2a.1b1 (0.9%)
2a.3a5 (4.4%)
2a.3a.1106 (93.8%)
2b1 (0.9%)
B/Victoria351
V1A351 (100%)3a.2351 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: One hundred and thirty-four A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Fifty-one A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Eighty influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.


Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023 were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested42123367121
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested42123367121
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested42123367121
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested41623067119
Decreased Susceptibility0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during Week 48, 4.0% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has remained stable compared to Week 47 and is above the national baseline of 2.9% for the fifth consecutive week. ILI activity increased in regions 1, 3, 5, and 9, decreased slightly in Region 6, and remained stable but trending upward in all other regions (regions 2, 4, 7, 8, and 10) during Week 48 compared to Week 47. All regions are at or above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet has increased (change of > 0.1 percentage points) in the 25-49 years, 50-64 years, and 65+ years age groups, decreased in the 5-24 years age group, and remained stable in the 0-4 years age group in Week 48 compared to Week 47.

national levels of ILI and ARI by age group
View Chart Data | View Full Screen Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 48
(Week ending
Dec. 2, 2023)
Week 47
(Week ending
Nov. 25, 2023)
Week 48
(Week ending
Dec. 2, 2023)
Week 47
(Week ending
Nov. 25, 2023)
Very High22710
High14138658
Moderate998289
Low1212149156
Minimal1819346392
Insufficient Data00259224




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 1,696 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and December 2, 2023; 1,452 (85.6%) were associated with influenza A virus, 229 (13.5%) with influenza B virus, 4 (0.2%) with influenza A virus and influenza B virus co-infection, and 11 (0.6%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 273 (83.7%) were A(H1N1)pdm09 and 52 (16.0%) were A(H3N2).

The weekly hospitalization rate observed in Week 48 was 1.4 per 100,000 population. The overall cumulative hospitalization rate for the season was 5.5 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative in-season hospitalization rate observed in Week 48, following the 2022-2023 season (26.0). Cumulative in-season hospitalization rates observed in Week 48 from 2010-2011 through 2021-2022 ranged from 0.2 to 2.7.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (13.6), followed by adults aged 50-64 years (7.1) and children aged 0-4 years (5.9). When examining unadjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (9.9), followed by non-Hispanic American Indian or Alaska Native persons (5.5), Hispanic persons (5.2), non-Hispanic Asian/Pacific Islander persons (4.2), and non-Hispanic White persons (3.9).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 48, 5,753 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 48 increased compared to Week 47 (change of >5%) nationally and in all 10 HHS Regions (1- 10).

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on December 7, 2023, 0.2% of the deaths that occurred during the week ending December 2, 2023 (Week 48), were due to influenza. This percentage remained stable (< 0.1 percentage point change) compared to Week 47 but is trending upward. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Four influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 48. The deaths occurred during weeks 45, 46 and 47 of 2023 (the weeks ending November 11, November 18, and November 25, respectively). Three deaths were associated with influenza A(H1N1) viruses and one death was associated with an influenza B virus with no lineage determined.

A total of 12 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated December 15, 2023
fluview-banner2.jpg

Key Updates for Week 49, ending December 9, 2023

Seasonal influenza activity is elevated in most parts of the country, with the southeast, south-central, and west coast areas of the country reporting the highest levels of activity. Viruses


Clinical Lab 10.2%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.4%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 9 jurisdictions experienced moderate activity and 18 jurisdictions experienced high or very high activity.

FluSurv-NET 8.0 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 7,090

(Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.2%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 2


influenza-associated deaths were reported
this week for a season total of 14.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity is elevated in most parts of the country, with the southeast, south-central, and west coast areas of the country reporting the highest levels of activity.
  • Outpatient respiratory illness is above baseline[SUP]1 [/SUP]nationally for the sixth consecutive week and is above baseline in all 10 HHS Regions.
  • The number of weekly flu hospital admissions continues to increase.
  • Two influenza-associated pediatric deaths were reported during Week 49, bringing the 2023-2024 season total to 14 pediatric deaths.
  • During Week 49, of the 971 viruses reported by public health laboratories, 806 (83%) were influenza A and 165 (17%) were influenza B. Of the 500 influenza A viruses subtyped during week 49, 374 (74.8%) were influenza A(H1N1) and 126 (25.2%) were A(H3N2).
  • CDC estimates that there have been at least 3.7 million illnesses, 38,000 hospitalizations, and 2,300 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine, as there are still vaccines available.[SUP]2 [/SUP]Now is still a good time to get vaccinated if you haven’t already.
  • There also are prescription flu antiviral drugs that can be used to treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally and in all HHS Regions, the percentage of respiratory specimens testing positive for influenza in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. The regions with the highest percent positivity were regions 8 (15.3%), 6 (13.0%), 4 (11.7%), and 9 (11.6%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, a larger combined proportion (34%) of the viruses detected by public health labs have been influenza B in regions 4 and 6 compared to other regions (5-20%). For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested90,439810,104
No. of positive specimens (%)9,212 (10.2%)36,366 (4.5%)
Positive specimens by type
Influenza A7,570 (82.2%)27,751 (76.3%)
Influenza B1,642 (17.8%)8,615 (23.7%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested3,06032,227
No. of positive specimens9716,596
Positive specimens by type/subtype
Influenza A806 (83.0%)5,345 (81.0%)
Subtyping Performed500 (62.0%)4,209 (78.7%)
(H1N1)pdm09374 (74.8%)3,519 (83.6%)
H3N2126 (25.2%)690 (16.4%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed306 (38.0%)1,136 (21.3%)
Influenza B165 (17.0%)1,251 (19.0%)
Lineage testing performed95 (57.6%)1,000 (79.9%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage95 (100%)1,000 (100%)
Lineage not performed70 (42.4%)251 (20.1%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 484 influenza viruses collected since October 1, 2023.
A/H1274
6B.1A.5a274 (100%)2a95 (34.7%)
2a.1179 (65.3%)
A/H377
3C.2a1b.2a77 (100%)2a.1b1 (1.3%)
2a.3a1 (1.3%)
2a.3a.174 (96.1%)
2b1 (1.3%)
B/Victoria133
V1A133 (100%)3a.2133 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Nineteen A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Twenty-four A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Three influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.


Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested49427878138
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested49427878138
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested49427878138
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested48927678135
Decreased Susceptibility0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during Week 49, 4.4% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has increased compared to Week 48 and is above the national baseline of 2.9% for the sixth consecutive week. During week 49 compared to week 48, ILI activity increased in regions 1-4 and 6-10 and remained stable but trending upward in region 5. All regions are above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet has increased (change of > 0.1 percentage points) in the 0-4 years, 5-24 years, and 50-64 years age groups, and remained stable, but trending upward in the 25-49 years and 65+ years age groups in Week 49 compared to Week 48.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 49
(Week ending
Dec. 9, 2023)
Week 48
(Week ending
Dec. 2, 2023)
Week 49
(Week ending
Dec. 9, 2023)
Week 48
(Week ending
Dec. 2, 2023)
Very High52157
High131310791
Moderate91111087
Low1511160158
Minimal1218310362
Insufficient Data10227224




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 2,449 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and December 9, 2023; 2,115 (86.4%) were associated with influenza A virus, 313 (12.8%) with influenza B virus, 5 (0.2%) with influenza A virus and influenza B virus co-infection, and 16 (0.7%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 369 (81.5%) were A(H1N1)pdm09 and 84 (18.5%) were A(H3N2).

The weekly hospitalization rate observed in Week 49 was 1.8 per 100,000 population. The overall cumulative hospitalization rate was 8.0 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative in-season hospitalization rate observed in Week 49, following the 2022-2023 season (32.7). Cumulative in-season hospitalization rates observed in Week 49 from 2010-2011 through 2021-2022 ranged from 0.2 to 3.9.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (20.3), followed by adults aged 50-64 years (10.0) and children aged 0-4 years (8.2). When examining unadjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (14.6), followed by non-Hispanic American Indian or Alaska Native persons (8.8), Hispanic persons (7.1), non-Hispanic Asian/Pacific Islander persons (5.9), and non-Hispanic White persons (5.7).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 49, 7,090 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 49 increased compared to Week 48 (change of >5%) nationally and in all 10 HHS Regions (1- 10).

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on December 14, 2023, 0.2% of the deaths that occurred during the week ending December 9, 2023 (Week 49), were due to influenza. This percentage remained stable (< 0.1 percentage point change) compared to Week 48 but has been trending upward for several weeks. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Two influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 49. One death was associated with an influenza B virus with no lineage determined and occurred during Week 46 (the week ending November 18, 2023). The other death was associated with an influenza A(H3) virus and occurred during Week 49 (the week ending December 9, 2023).

A total of 14 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated December 22, 2023
fluview-banner2.jpg

Key Updates for Week 50, ending December 16, 2023

Seasonal influenza activity is elevated and continues to increase in most parts of the country. Viruses


Clinical Lab 12.8%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1).

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 5.1%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 11 jurisdictions experienced moderate activity and 25 jurisdictions experienced high or very high activity.

FluSurv-NET 11.3 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 9,825

(Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.3%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 0


influenza-associated deaths were reported
this week. A total of 14 influenza-associated deaths have been reported.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity is elevated and continues to increase in most parts of the country.
  • Outpatient respiratory illness is above baseline[SUP]1 [/SUP]nationally for the seventh consecutive week and is above baseline in all 10 HHS Regions.
  • The number of weekly flu hospital admissions continues to increase.
  • During Week 50, of the 1,050 viruses reported by public health laboratories, 860 (81.9%) were influenza A and 190 (18.1%) were influenza B. Of the 481 influenza A viruses subtyped during week 50, 376 (78.2%) were influenza A(H1N1) and 105 (21.8%) were A(H3N2).
  • CDC estimates that there have been at least 5.3 million illnesses, 54,000 hospitalizations, and 3,200 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine, as there are still vaccines available.[SUP]2 [/SUP]Now is still a good time to get vaccinated if you haven’t already.
  • There also are prescription flu antiviral drugs that can be used to treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses that contribute to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally and in all HHS Regions, the percentage of respiratory specimens testing positive for influenza in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. The regions with the highest percent positivity were regions 8 (23.6%), 6 (17.5%), 4 (15.5%), and 9 (14.3%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested105,774949,819
No. of positive specimens (%)13,576 (12.8%)52,825 (5.6%)
Positive specimens by type
Influenza A11,243 (82.8%)41,302 (78.2%)
Influenza B2,333 (17.2%)11,523 (21.8%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,97436,500
No. of positive specimens1,0508,385
Positive specimens by type/subtype
Influenza A860 (81.9%)6,809 (81.2%)
Subtyping Performed481 (55.9%)5,405 (79.4%)
(H1N1)pdm09376 (78.2%)4,481 (82.9%)
H3N2105 (21.8%)924 (17.1%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed379 (44.1%)1,404 (20.6%)
Influenza B190 (18.1%)1,576 (18.8%)
Lineage testing performed97 (51.1%)1,240 (78.7%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage97 (100%)1,240 (100%)
Lineage not performed93 (48.9%)336 (21.3%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 580 influenza viruses collected since October 1, 2023.
A/H1321
6B.1A.5a321 (100%)2a103 (32.1%)
2a.1218 (67.9%)
A/H3105
3C.2a1b.2a105 (100%)2a.1b1 (1.0%)
2a.3a1 (1.0%)
2a.3a.1102 (97.1%)
2b1 (1.0%)
B/Victoria154
V1A154 (100%)3a.2154 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Nineteen A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Forty-nine A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Nineteen influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested583321105157
Reduced Inhibition1 (0.2%)1 (0.3%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested583321105157
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested583321105157
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested52830487137
Decreased Susceptibility0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-S247N and NA-I223V amino acid substitutions and showed reduced inhibition by oseltamivir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during Week 50, 5.1% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has increased compared to Week 49 and is above the national baseline of 2.9% for the seventh consecutive week. During Week 50 compared to week 49, ILI activity increased in all regions. All regions are above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet has increased (change of > 0.1 percentage points) in all age groups in Week 50 compared to Week 49.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 50
(Week ending
Dec. 16, 2023)
Week 49
(Week ending
Dec. 9, 2023)
Week 50
(Week ending
Dec. 16, 2023)
Week 49
(Week ending
Dec. 9, 2023)
Very High1054015
High1514135106
Moderate119107112
Low915162160
Minimal1012253310
Insufficient Data00232226




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 3,455 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023 and December 16, 2023; 3,000 (86.8%) were associated with influenza A virus, 415 (12.0%) with influenza B virus, 9 (0.3%) with influenza A virus and influenza B virus co-infection, and 31 (0.9%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 513 (79.4%) were A(H1N1)pdm09 and 133 (20.6%) were A(H3N2).

The weekly hospitalization rate observed in week 50 was 2.5 per 100,000 population. The overall cumulative hospitalization rate was 11.3 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative in-season hospitalization rate observed in week 50, following the 2022-2023 season (39.9). Cumulative in-season hospitalization rates observed in week 50 from 2010-2011 through 2021-2022 ranged from 0.3 to 6.2.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (28.1), followed by adults aged 50-64 years (13.9) and children aged 0-4 years (12.4). When examining unadjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (20.2), followed by non-Hispanic American Indian or Alaska Native persons (13.2), Hispanic persons (9.8), non-Hispanic White persons (7.7), and non-Hispanic Asian/Pacific Islander persons (7.2).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 50, 9,825 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 50 increased compared to Week 49 (change of >5%) nationally and in 9 of the 10 HHS Regions (1-6 and 8-10) and in Region 7, the number of hospitalizations remained stable.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on December 21, 2023, 0.3% of the deaths that occurred during the week ending December 16, 2023 (Week 50), were due to influenza. This percentage remained stable (< 0.1 percentage point change) compared to Week 49 but has been trending upward for several weeks. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


No influenza-associated pediatric deaths were reported to CDC during week 50.

A total of 14 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated December 29, 2023
fluview-banner2.jpg

Key Updates for Week 51, ending December 23, 2023

Seasonal influenza activity is elevated and continues to increase in most parts of the country. Viruses


Clinical Lab 16.1%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 6.1%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 6 jurisdictions experienced moderate activity and 33 jurisdictions experienced high or very high activity.

FluSurv-NET 15.4 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 14,732

(Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.5%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 7


influenza-associated deaths were reported
(1 occurred during 2022-2023 season and 6 occurred during 2023-2024 season)


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity is elevated and continues to increase in most parts of the country.
  • Outpatient respiratory illness is above baseline[SUP]1 [/SUP]nationally for the eighth consecutive week and is above baseline in all 10 HHS Regions.
  • The number of weekly flu hospital admissions continues to increase.
  • During Week 51, of the 875 viruses reported by public health laboratories, 748 (85.5%) were influenza A and 127 (14.5%) were influenza B. Of the 391 influenza A viruses subtyped during Week 51, 309 (79.0%) were influenza A(H1N1) and 82 (21.0%) were A(H3N2).
  • Six influenza-associated pediatric deaths occurring during the 2023-2024 influenza season were reported during Week 51, bringing the 2023-2024 season total to 20 pediatric deaths.
  • CDC estimates that there have been at least 7.1 million illnesses, 73,000 hospitalizations, and 4,500 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2 [/SUP]Vaccination now can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally the percentage of respiratory specimens testing positive for influenza in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. The regions with the highest percent positivity were regions 8 (25.4%), 6 (25.0%), 4 (20.7%), and 3 (20.2%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested79,3531,060,095
No. of positive specimens (%)12,775 (16.1%)67,851 (6.4%)
Positive specimens by type
Influenza A10,401 (81.4%)53,548 (78.9%)
Influenza B2,374 (18.6%)14,303 (21.1%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,79540,596
No. of positive specimens87510,143
Positive specimens by type/subtype
Influenza A748 (85.5%)8,270 (81.5%)
Subtyping Performed391 (52.3%)6,444 (77.9%)
(H1N1)pdm09309 (79.0%)5,309 (82.4%)
H3N282 (21.0%)1,135 (17.6%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed357 (47.7%)1,826 (22.1%)
Influenza B127 (14.5%)1,873 (18.5%)
Lineage testing performed60 (47.2%)1,470 (78.5%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage60 (100%)1,470 (100%)
Lineage not performed67 (52.8%)403 (21.5%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 687 influenza viruses collected since October 1, 2023.
A/H1361
6B.1A.5a361 (100%)2a110 (30.5%)
2a.1251 (69.5%)
A/H3121
3C.2a1b.2a121 (100%)2a.1b1 (0.8%)
2a.3a1 (0.8%)
2a.3a.1118 (97.5%)
2b1 (0.8%)
B/Victoria205
V1A205 (100%)3a.2205 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Fifty A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Forty-nine A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Nineteen influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested694362121211
Reduced Inhibition1 (0.1%)1 (0.3%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested694362121211
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested694362121211
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested687360120207
Decreased Susceptibility0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-S247N and NA-I223V amino acid substitutions and showed reduced inhibition by oseltamivir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during Week 51, 6.1% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has increased compared to Week 50 and has remained above the national baseline of 2.9% since Week 44. All regions are above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet has increased (change of > 0.1 percentage points) in all age groups in Week 51 compared to Week 50.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 51
(Week ending
Dec. 23, 2023)
Week 50
(Week ending
Dec. 16, 2023)
Week 51
(Week ending
Dec. 23, 2023)
Week 50
(Week ending
Dec. 16, 2023)
Very High14107541
High1914163135
Moderate61289107
Low58145159
Minimal911205258
Insufficient Data20252229




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 4,697 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and December 23, 2023; 4,105 (87.4%) were associated with influenza A virus, 529 (11.3%) with influenza B virus, 12 (0.3%) with influenza A virus and influenza B virus co-infection, and 51 (1.1%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 706 (79.8%) were A(H1N1)pdm09 and 179 (20.2%) were A(H3N2).

The weekly hospitalization rate observed during Week 51 was 2.8 per 100,000 population. The overall cumulative hospitalization rate was 15.4 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative in-season hospitalization rate observed during Week 51, following the 2022-2023 season (44.3). Cumulative in-season hospitalization rates observed during Week 51 from 2010-2011 through 2021-2022 ranged from 0.3 to 9.7.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (38.8), followed by adults aged 50-64 years (18.9) and children aged 0-4 years (16.6). When examining unadjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (29.0), followed by non-Hispanic American Indian or Alaska Native persons (17.6), Hispanic persons (12.8), non-Hispanic White persons (11.2), and non-Hispanic Asian/Pacific Islander persons (9.9).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 51, 14,732 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 51 increased compared to Week 50 (change of >5%) nationally and in all the 10 HHS Regions.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on December 28, 2023, 0.5% of the deaths that occurred during the week ending December 23, 2023 (Week 51), were due to influenza. This percentage increased (≥ 0.1 percentage point change) compared to Week 50. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Seven influenza-associated pediatric deaths were reported to CDC during week 51.

Six deaths occurred during Weeks 49, 50, and 51 (the weeks ending December 9, December 16, and December 23 of 2023, respectively). Four of the deaths were associated with influenza A viruses. Two of the influenza A viruses had subtyping performed; both were A(H1N1) viruses. Two deaths were associated with influenza B viruses with no lineage determined.

One death occurring during the 2022-2023 season was also reported, which brings the total number of pediatric deaths for last season to 183. The death was associated with an influenza B virus with no lineage determined and occurred during Week 33 (the week ending August 19, 2023).

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated January 5, 2024
fluview-banner2.jpg

Key Updates for Week 52, ending December 30, 2023

Seasonal influenza activity is elevated and continues to increase in most parts of the country. Viruses


Clinical Lab 17.5%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 6.9%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 6 jurisdictions experienced moderate activity and 39 jurisdictions experienced high or very high activity.

FluSurv-NET 22.3 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 20,066

(Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.9%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 7


influenza-associated deaths were reported
this week for a total of 27 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity is elevated and continues to increase in most parts of the country.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS Regions.
  • The number of weekly flu hospital admissions continues to increase.
  • During Week 52, of the 651 viruses reported by public health laboratories, 581 (89.2%) were influenza A and 70 (10.8%) were influenza B. Of the 342 influenza A viruses subtyped during Week 52, 300 (87.7%) were influenza A(H1N1) and 42 (12.3%) were A(H3N2).
  • Seven influenza-associated pediatric deaths were reported during Week 52, bringing the 2023-2024 season total to 27 pediatric deaths.
  • CDC estimates that there have been at least 10 million illnesses, 110,000 hospitalizations, and 6,500 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2 [/SUP]Vaccination now can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally the percentage of respiratory specimens testing positive for influenza in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. The regions with the highest percent positivity were regions 8 (29.2%), 4 (21.8%), 6 (21.4%), and 3 (21.2%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested102,2941,186,063
No. of positive specimens (%)17,925 (17.5%)88,881 (7.5%)
Positive specimens by type
Influenza A14,732 (82.2%)70,485 (79.3%)
Influenza B3,193 (17.8%)18,396 (20.7%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,30044,620
No. of positive specimens65111,639
Positive specimens by type/subtype
Influenza A581 (89.2%)9,552 (82.1%)
Subtyping Performed342 (58.9%)7,622 (79.8%)
(H1N1)pdm09300 (87.7%)6,254 (82.1%)
H3N242 (12.3%)1,368 (17.9%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed239 (41.1%)1,930 (20.2%)
Influenza B70 (10.8%)2,087 (17.9%)
Lineage testing performed43 (61.4%)1,692 (81.1%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage43 (100%)1,692 (100%)
Lineage not performed27 (38.6%)395 (18.9%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 776 influenza viruses collected since October 1, 2023.
A/H1394
6B.1A.5a394 (100%)2a118 (29.9%)
2a.1276 (70.1%)
A/H3149
3C.2a1b.2a149 (100%)2a.1b1 (0.7%)
2a.3a1 (0.7%)
2a.3a.1146 (98.0%)
2b1 (0.7%)
B/Victoria233
V1A233 (100%)3a.2233 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Fifty A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Sixty-eight A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Nineteen influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested780394147239
Reduced Inhibition1 (0.1%)1 (0.3%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested780394147239
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested780394147239
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested762389145228
Decreased Susceptibility0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-S247N and NA-I223V amino acid substitutions and showed reduced inhibition by oseltamivir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during Week 52, 6.9% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has increased compared to Week 51 and has remained above the national baseline of 2.9% since Week 44. All regions are above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet has increased (change of > 0.1 percentage points) in the 0-4 years, 25-49 years, 50-64 years, and 65+ years age groups, and decreased slightly in the 5-24 years age group in Week 52 compared to Week 51.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 52
(Week ending
Dec. 30, 2023)
Week 51
(Week ending
Dec. 23, 2023)
Week 52
(Week ending
Dec. 30, 2023)
Week 51
(Week ending
Dec. 23, 2023)
Very High22169477
High1718171168
Moderate6714398
Low66126148
Minimal28149208
Insufficient Data20246230




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 6,829 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and December 30, 2023; 6,034 (88.4%) were associated with influenza A virus, 728 (10.7%) with influenza B virus, 15 (0.2%) with influenza A virus and influenza B virus co-infection, and 52 (0.8%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 951 (78.7%) were A(H1N1)pdm09 and 258 (21.3%) were A(H3N2).

The weekly hospitalization rate observed in Week 52 was 3.9 per 100,000 population. The overall cumulative hospitalization rate was 22.3 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative in-season hospitalization rate observed in Week 52, following the 2022-2023 season (48.6). Cumulative in-season hospitalization rates observed in Week 52 from 2010-2011 through 2021-2022 ranged from 0.3 to 13.8.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (58.2), followed by adults aged 50-64 years (27.6) and children aged 0-4 years (23.7). When examining unadjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (40.0), followed by non-Hispanic American Indian or Alaska Native persons (22.5), Hispanic persons (17.0), non-Hispanic White persons (16.2), and non-Hispanic Asian/Pacific Islander persons (13.0).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 52, 20,066 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 52 increased compared to Week 51 (change of >5%) nationally and in 9 of the 10 HHS regions (1-8 and 10). The number of hospital admissions remained stable this week compared to last in Region 9.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on January 5, 2023, 0.9% of the deaths that occurred during the week ending December 30, 2023 (Week 52), were due to influenza. This percentage increased (≥ 0.1 percentage point change) compared to Week 51. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Seven influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 52. The deaths occurred during Weeks 50, 51, and 52 of 2023 (the weeks ending December 16, December 23, and December 30, respectively). Five deaths were associated with influenza A viruses. Three of the influenza A viruses had subtyping performed; all three were A(H1N1) viruses. Two deaths were associated with influenza B viruses with no lineage determined.

A total of 27 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated January 12, 2024
fluview-banner2.jpg

Key Updates for Week 1, ending January 6, 2024

Seasonal influenza activity remains elevated in most parts of the country. Viruses


Clinical Lab 14.0%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 5.7%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 7 jurisdictions experienced moderate activity and 37 jurisdictions experienced high or very high activity.

FluSurv-NET 31.7 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 18,526

(Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 1.3%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 13


influenza-associated deaths were reported
this week for a total of 40 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated in most parts of the country.
  • After several weeks of increases in key flu indicators a single week of decrease has been noted. CDC will continue to monitor for a second period of increased influenza activity that often occurs after the winter holidays.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS Regions.
  • The number of weekly flu hospital admissions decreased slightly.
  • During Week 1, of the 1,036 viruses reported by public health laboratories, 830 (80.1%) were influenza A and 206 (19.9%) were influenza B. Of the 511 influenza A viruses subtyped during Week 1, 407 (79.6%) were influenza A(H1N1) and 104 (20.4%) were A(H3N2).
  • Thirteen influenza-associated pediatric deaths were reported during Week 1, bringing the 2023-2024 season total to 40 pediatric deaths.
  • CDC estimates that there have been at least 14 million illnesses, 150,000 hospitalizations, and 9,400 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2 [/SUP]Vaccination now can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories decreased (change of ≥0.5 percentage points) compared to the previous week. The regions with the highest percent positivity were regions 6 (22.7%), 8 (22.4%), 3 (18.8%), and 4 (15.0%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested107,3341,412,848
No. of positive specimens (%)15,018 (14.0%)123,398 (8.7%)
Positive specimens by type
Influenza A11,942 (79.5%)98,983 (80.2%)
Influenza B3,076 (20.5%)24,415 (19.8%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested3,02850,191
No. of positive specimens1,03614,255
Positive specimens by type/subtype
Influenza A830 (80.1%)11,743 (82.4%)
Subtyping Performed511 (61.6%)9,392 (80.0%)
(H1N1)pdm09407 (79.6%)7,638 (81.3%)
H3N2104 (20.4%)1,754 (18.7%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed319 (38.4%)2,351 (20.0%)
Influenza B206 (19.9%)2,512 (17.6%)
Lineage testing performed138 (67.0%)2,028 (80.7%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage138 (100%)2,028 (100%)
Lineage not performed68 (33.0%)484 (19.3%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 904 influenza viruses collected since October 1, 2023.
A/H1455
6B.1A.5a455 (100%)2a133 (29.2%)
2a.1322 (70.8%)
A/H3202
3C.2a1b.2a202 (100%)2a.1b1 (0.5%)
2a.3a1 (0.5%)
2a.3a.1199 (98.5%)
2b1 (0.5%)
B/Victoria247
V1A247 (100%)3a.2247 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell- or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Eighty-three A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Sixty-eight A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Forty-three influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested893422209262
Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested893422209262
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested893422209262
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested869417200252
Decreased Susceptibility0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-S247N and NA-I223V amino acid substitutions and showed reduced inhibition by oseltamivir. Another A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended, and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during Week 1, 5.7% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has decreased compared to Week 52 and is above the national baseline of 2.9%. All regions have decreased compared to Week 52 and remain above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet decreased (change of > 0.1 percentage points) in all age groups during Week 1 compared to Week 52.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 1
(Week ending
Jan. 6, 2023)
Week 52
(Week ending
Dec. 30, 2023)
Week 1
(Week ending
Jan. 6, 2023)
Week 52
(Week ending
Dec. 30, 2023)
Very High14225193
High2319167177
Moderate78121140
Low84158132
Minimal32198151
Insufficient Data00234236




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 9,676 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and January 6, 2024; 8,555 (88.4%) were associated with influenza A virus, 1,019 (10.5%) with influenza B virus, 19 (0.2%) with influenza A virus and influenza B virus co-infection, and 83 (0.9%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 1,296 (78.4%) were A(H1N1)pdm09 and 358 (21.6%) were A(H3N2).

The weekly hospitalization rate observed in Week 1 was 4.5 per 100,000 population. The weekly hospitalization rate observed during Week 52 is the fourth highest peak weekly rate observed during all seasons going back to 2010-2011, following the 2014-2015, 2017-2018, and 2022-2023 seasons. The overall cumulative hospitalization rate was 31.7 per 100,000 population. This cumulative hospitalization rate is the third highest cumulative hospitalization rate when compared against previous end-of-season rates for Week 1, while it is the second highest cumulative in-season hospitalization rate observed in Week 1, following the 2022-2023 season (54.4). Cumulative in-season hospitalization rates observed in Week 1 from 2010-2011 through 2021-2022 ranged from 0.4 to 30.0.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (85.3), followed by adults aged 50-64 years (39.2) and children aged 0-4 years (32.4). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (60.2), followed by non-Hispanic American Indian or Alaska Native persons (32.4), Hispanic persons (30.5), non-Hispanic White persons (21.9), and non-Hispanic Asian/Pacific Islander persons (18.8).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 1, 18,526 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 1 decreased compared to Week 52 (change of >5%) nationally and in 7 of the 10 HHS regions (2-5 and 7-9). The number of hospital admissions increased in Region 1 and remained stable this week compared to last in regions 6 and 10.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on January 11, 2024, 1.3% of the deaths that occurred during the week ending January 6, 2024 (Week 1), were due to influenza. This percentage increased (≥ 0.1 percentage point change) compared to Week 52. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Thirteen influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 1. The deaths occurred between Week 49 of 2023 (the week ending December 9, 2023) and Week 1 of 2024 (the week ending January 6, 2024). Six deaths were associated with influenza A viruses. Two of the influenza A viruses had subtyping performed; one was an A(H1N1) virus and one was an A(H3N2) virus. Seven deaths were associated with influenza B viruses. Three of the influenza B viruses had lineage determined and all were B/Victoria viruses.

A total of 40 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated January 19, 2024
fluview-banner2.jpg

Key Updates for Week 2, ending January 13, 2024

Seasonal influenza activity remains elevated in most parts of the country. Viruses


Clinical Lab 13.7%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.7%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 14 jurisdictions experienced moderate activity and 25 jurisdictions experienced high or very high activity.

FluSurv-NET 37.3 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 14,874 (Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 1.2%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 7


influenza-associated deaths were reported
this week for a total of 47 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated in most parts of the country.
  • After several weeks of increases in key flu indicators through the end of 2023, two weeks of decreasing or stable trends nationally have been noted. CDC will continue to monitor for a second period of increased influenza activity that often occurs after the winter holidays.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS regions.
  • The number of weekly flu hospital admissions has decreased slightly for two consecutive weeks.
  • During Week 2, of the 727 viruses reported by public health laboratories, 591 (81.3%) were influenza A and 136 (18.7%) were influenza B. Of the 264 influenza A viruses subtyped during Week 2, 193 (73.1%) were influenza A(H1N1) and 71 (26.9%) were A(H3N2).
  • Seven influenza-associated pediatric deaths were reported during Week 2, bringing the 2023-2024 season total to 47 pediatric deaths.
  • CDC estimates that there have been at least 16 million illnesses, 180,000 hospitalizations, and 11,000 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2 [/SUP]Vaccination now can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories remained stable (change of ≥0.5 percentage points) compared to the previous week. The regions with the highest percent positivity were regions 6 (23.4%), 8 (22.6%), 4 (14.8%), and 7 (14.8%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested94,8151,511,701
No. of positive specimens (%)13,006 (13.7%)139,669 (9.2%)
Positive specimens by type
Influenza A10,330 (79.4%)112,121 (80.3%)
Influenza B2,676 (20.6%)27,548 (19.7%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,77954,318
No. of positive specimens72715,826
Positive specimens by type/subtype
Influenza A591 (81.3%)13,054 (82.5%)
Subtyping Performed264 (44.7%)10,362 (79.4%)
(H1N1)pdm09193 (73.1%)8,373 (80.8%)
H3N271 (26.9%)1,989 (19.2%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed327 (55.3%)2,692 (20.6%)
Influenza B136 (18.7%)2,772 (17.5%)
Lineage testing performed60 (44.1%)2,222 (80.2%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage60 (100%)2,222 (100%)
Lineage not performed76 (55.9%)550 (19.8%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 1,069 influenza viruses collected since October 1, 2023.
A/H1522
6B.1A.5a522 (100%)2a153 (29.3%)
2a.1369 (70.7%)
A/H3256
3C.2a1b.2a256 (100%)2a.1b1 (0.4%)
2a.3a1 (0.4%)
2a.3a.1253 (98.8%)
2b1 (0.5%)
B/Victoria291
V1A291 (100%)3a.2291 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: Eighty-three A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Ninety-one A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Sixty-one influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested1075522257296
Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested1075522257296
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested1075522257296
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested1063513254296
Decreased Susceptibility0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-S247N and NA-I223V amino acid substitutions and showed reduced inhibition by oseltamivir. Another A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide during Week 2, 4.7% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has decreased compared to Week 1 and is above the national baseline of 2.9%. All regions have decreased compared to Week 1 and remain above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet decreased (change of > 0.1 percentage points) in all age groups during Week 2 compared to Week 1.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 2
(Week ending
Jan. 13, 2024)
Week 1
(Week ending
Jan. 6, 2024)
Week 2
(Week ending
Jan. 13, 2024)
Week 1
(Week ending
Jan. 13, 2024)
Very High8142152
High1723126167
Moderate146101121
Low109190160
Minimal63252202
Insufficient Data00239227




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 11,414 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and January 13, 2024; 10,101 (88.5%) were associated with influenza A virus, 1,196 (10.5%) with influenza B virus, 25 (0.2%) with influenza A virus and influenza B virus co-infection, and 92 (0.8%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 1,591 (77.6%) were A(H1N1)pdm09 and 458 (22.4%) were A(H3N2).

The weekly hospitalization rate observed in Week 2 was 3.2 per 100,000 population. The weekly hospitalization rate observed during Week 2 is the fourth highest peak weekly rate observed during all seasons going back to 2010-2011 following the 2014-2015, 2017-2018, and 2022-2023 seasons. The overall cumulative hospitalization rate was 37.3 per 100,000 population. This cumulative hospitalization rate is the fourth highest cumulative hospitalization rate when compared against previous end-of-season rates for Week 2, while it is the second highest cumulative in-season hospitalization rate observed in Week 2, following the 2022-2023 season (56.7). Cumulative in-season hospitalization rates observed in Week 2 from 2010-2011 through 2021-2022 ranged from 0.5 to 36.3.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (99.8), followed by adults aged 50-64 years (46.8) and children aged 0-4 years (39.2). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (73.0), followed by non-Hispanic American Indian or Alaska Native persons (36.5), Hispanic persons (34.7), non-Hispanic White persons (26.2), and non-Hispanic Asian/Pacific Islander persons (22.1).

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 2, 14,874 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 2 decreased compared to Week 1 (change of >5%) nationally and in all 10 HHS regions.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on January 18, 2024, 1.2% of the deaths that occurred during the week ending January 13, 2024 (Week 2), were due to influenza. This percentage decreased (≥ 0.1 percentage point change) compared to Week 1. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Seven influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 2. The deaths occurred between Week 48 of 2023 (the week ending December 2, 2023) and Week 1 of 2024 (the week ending January 6, 2024). Two deaths were associated with influenza A viruses for which no subtyping was performed and five deaths were associated with influenza B viruses with no lineage determined.

A total of 47 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated January 26, 2024
fluview-banner2.jpg

Key Updates for Week 3, ending January 20, 2024

Seasonal influenza activity remains elevated in most parts of the country. Viruses


Clinical Lab 14.2%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.3%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 12 jurisdictions experienced moderate activity and 22 jurisdictions experienced high or very high activity.

FluSurv-NET 43.3 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 12,382 (Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 1.1%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 10


influenza-associated deaths were reported
this week for a total of 57 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated in most parts of the country.
  • Key flu indicators have decreased or remained stable nationally for three weeks. CDC will continue to monitor for a second period of increased influenza activity that often occurs after the winter holidays.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS regions.
  • The number of weekly flu hospital admissions has decreased for three consecutive weeks.
  • During Week 3, of the 699 viruses reported by public health laboratories, 581 (83.1%) were influenza A and 118 (16.9%) were influenza B. Of the 370 influenza A viruses subtyped during Week 3, 264 (71.4%) were influenza A(H1N1) and 106 (28.6%) were A(H3N2).
  • Ten influenza-associated pediatric deaths were reported during Week 3, bringing the 2023-2024 season total to 57 pediatric deaths.
  • CDC estimates that there have been at least 18 million illnesses, 210,000 hospitalizations, and 13,000 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2[/SUP] Vaccination now can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories remained stable (change of <0.5 percentage points) compared to the previous week, but trends varied by region. Regions 1, 3, 5, 6, 9, and 10 reported an increase in percent positivity while regions 2, 4, 7, and 8 reported a decrease. The regions with the highest percent positivity were regions 6 (25.1%), 8 (20.0%), 5 (15.7%), and 3 (14.5%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested85,6641,649,919
No. of positive specimens (%)12,194 (14.2%)156,919 (9.5%)
Positive specimens by type
Influenza A9,509 (78.0%)125,365 (79.9%)
Influenza B2,685 (22.0%)31,554 (20.1%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,23858,291
No. of positive specimens69917,481
Positive specimens by type/subtype
Influenza A581 (83.1%)14,442 (82.6%)
Subtyping Performed370 (63.7%)11,623 (80.5%)
(H1N1)pdm09264 (71.4%)9,314 (80.1%)
H3N2106 (28.6%)2,309 (19.9%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed211 (36.3%)2,819 (19.5%)
Influenza B118 (16.9%)3,039 (17.4%)
Lineage testing performed70 (59.3%)2,450 (80.6%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage70 (100%)2,450 (100%)
Lineage not performed48 (40.7%)589 (19.4%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 1,144 influenza viruses collected since October 1, 2023.
A/H1540
6B.1A.5a540 (100%)2a158 (29.3%)
2a.1382 (70.7%)
A/H3279
3C.2a1b.2a279 (100%)2a.1b1 (0.4%)
2a.3a1 (0.4%)
2a.3a.1276 (98.9%)
2b1 (0.4%)
B/Victoria325
V1A325 (100%)3a.2325 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: 107 A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Ninety-one A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Sixty-one influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested1139539280320
Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested1139539280320
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested1139539280320
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested1126529277320
Decreased Susceptibility1 (0.1%)0 (0.0%)1 (0.4%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir. One (H1N1)pdm09 virus had NA-S247N and NA-I223V amino acid substitutions and showed reduced inhibition by oseltamivir. One A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to baloxavir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide, during Week 3, 4.3% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This is a decrease compared to Week 2, but remains above the national baseline of 2.9%. All regions, with the exception of Region 6, have decreased compared to Week 2; Region 6 has remained stable. All regions remain above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet decreased (change of > 0.1 percentage points) in all age groups during Week 3 compared to Week 2.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 3
(Week ending
Jan. 20, 2024)
Week 2
(Week ending
Jan. 13, 2024)
Week 3
(Week ending
Jan. 20, 2024)
Week 2
(Week ending
Jan. 13, 2024)
Very High581522
High171783125
Moderate1214110101
Low1311197189
Minimal85277259
Insufficient Data00247233




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 13,224 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and January 20, 2024. The weekly hospitalization rate observed in Week 3 was 2.9 per 100,000 population. The weekly hospitalization rate observed during Week 52 is the fourth highest weekly rate peak observed during all seasons going back to 2010-2011 following the 2014-2015, 2017-2018, and 2022-2023 seasons. The overall cumulative hospitalization rate was 43.3 per 100,000 population. This cumulative hospitalization rate is the fourth highest cumulative hospitalization rate when compared against previous end-of-season rates for Week 3, while it is the second highest cumulative in-season hospitalization rate observed in Week 3, following the 2022-2023 season (58.1). Cumulative in-season hospitalization rates observed in Week 3 from 2010-2011 through 2021-2022 ranged from 0.5 to 41.9.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (115.9), followed by adults aged 50-64 years (54.0) and children aged 0-4 years (46.5). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (83.6), followed by Hispanic persons (39.5), non-Hispanic American Indian or Alaska Native persons (39.0), non-Hispanic White persons (30.1), and non-Hispanic Asian/Pacific Islander persons (25.6).

Among 13,224 hospitalizations, 11,691 (88.4%) were associated with influenza A virus, 1,416 (10.7%) with influenza B virus, 29 (0.2%) with influenza A virus and influenza B virus co-infection, and 88 (0.7%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 1,882 (77.8%) were A(H1N1)pdm09 and 536 (22.2%) were A(H3N2). Based on preliminary data, of the 765 laboratory-confirmed influenza-associated hospitalizations with more complete data, 3.8% (95% CI: 2.2%-5.5%) also tested positive for SARS-CoV-2.

Among 590 hospitalized adults with information on underlying medical conditions, 94.5% had at least one reported underlying medical condition, the most commonly reported were hypertension, cardiovascular disease, metabolic disorder, and obesity. Among 734 hospitalized women of childbearing age (15-49 years) with information on pregnancy status, 22.2% were pregnant. Among 301 hospitalized children with information on underlying medical conditions, 68.7% had at least one reported underlying medical condition; the most commonly reported was asthma, followed by neurologic disease and obesity.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 3, 12,382 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 3 decreased compared to Week 2 (change of >5%) nationally and in all 10 HHS regions.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on January 25, 2024, 1.1% of the deaths that occurred during the week ending January 20, 2024 (Week 3), were due to influenza. This percentage decreased (≥ 0.1 percentage point change) compared to Week 2. The data presented are preliminary and may change as more data are received and processed.

The percentages of deaths due to pneumonia and influenza (P&I) and due to pneumonia, influenza, or COVID-19 (PIC) will no longer be displayed in FluView but are available in FluView Interactive.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Ten influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 3. The deaths occurred between Week 51 of 2023 (the week ending December 23, 2023) and Week 2 of 2024 (the week ending January 13, 2024). Six deaths were associated with influenza A viruses. Three of the influenza A viruses had subtyping performed and all were A(H1N1) viruses. Three deaths were associated with influenza B viruses with no lineage determined. One death was associated with a co-infection with influenza A(H1N1) and influenza B/Victoria viruses.

A total of 57 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated February 2, 2024
fluview-banner2.jpg

Key Updates for Week 4, ending January 27, 2024

Seasonal influenza activity remains elevated nationally with increases in some parts of the country. Viruses


Clinical Lab 16.2%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.3%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 13 jurisdictions experienced moderate activity and 20 jurisdictions experienced high or very high activity.

FluSurv-NET 47.8 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 12,186 (Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.9%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 8


influenza-associated deaths were reported
this week for a total of 65 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated nationally with increases in some parts of the country.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS regions.
  • The number of weekly flu hospital admissions remains stable compared to last week.
  • During Week 4, of the 937 viruses reported by public health laboratories, 739 (78.9%) were influenza A and 198 (21.1%) were influenza B. Of the 412 influenza A viruses subtyped during Week 4, 249 (60.4%) were influenza A(H1N1) and 163 (39.6%) were A(H3N2).
  • Eight influenza-associated pediatric deaths were reported during Week 4, bringing the 2023-2024 season total to 65 pediatric deaths.
  • CDC estimates that there have been at least 20 million illnesses, 230,000 hospitalizations, and 14,000 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2[/SUP] Vaccination now can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories increased (change of >0.5 percentage points) compared to the previous week, but trends varied by region. Regions 1, 4, 5, 6, 7, and 10 reported an increase in percent positivity, region 2 remained stable and regions 3, 8, and 9 reported a decrease. The regions with the highest percent positivity were regions 6 (30.2%), 8 (19.0%), and 5 (18.0%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested93,0111,741,820
No. of positive specimens (%)15,032 (16.2%)174,738 (10.0%)
Positive specimens by type
Influenza A10,989 (73.1%)138,492 (79.3%)
Influenza B4,043 (26.9%)36,236 (20.7%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,89963,718
No. of positive specimens93719,426
Positive specimens by type/subtype
Influenza A739 (78.9%)16,059 (82.7%)
Subtyping Performed412 (55.8%)12,874 (80.2%)
(H1N1)pdm09249 (60.4%)10,197 (79.2%)
H3N2163 (39.6%)2,677 (20.8%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed327 (44.2%)3,185 (19.8%)
Influenza B198 (21.1%)3,367 (17.3%)
Lineage testing performed119 (60.1%)2,704 (80.3%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage119 (100%)2,704 (100%)
Lineage not performed79 (39.9%)663 (19.7%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 1,144 influenza viruses collected since October 1, 2023.
A/H1540
6B.1A.5a540 (100%)2a158 (29.3%)
2a.1382 (70.7%)
A/H3279
3C.2a1b.2a279 (100%)2a.1b1 (0.4%)
2a.3a1 (0.4%)
2a.3a.1276 (98.9%)
2b1 (0.4%)
B/Victoria325
V1A325 (100%)3a.2325 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: 107 A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): Ninety-one A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Sixty-one influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested1140539280321
Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested1140539280321
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.2%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested1140539280321
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested1126529277320
Decreased Susceptibility1 (0.1%)0 (0.0%)1 (0.4%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir. One (H1N1)pdm09 virus had NA-S247N and NA-I223V amino acid substitutions and showed reduced inhibition by oseltamivir. One A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to baloxavir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide, during Week 4, 4.3% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has remained stable (change of ≤ 0.1 percentage points) compared to Week 3 and is above the national baseline of 2.9% for the thirteenth consecutive week. The percentage of visits for ILI increased in Region 6, decreased in regions 2, 4, 9 and 10, and remained stable in regions 1, 3, 5, 7, and 8 compared to Week 3. All regions remain above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet increased in the 5-24 years age group (change of > 0.1 percentage points), decreased in the 0-4 years, 50-64 years, and 65+ years age groups, and remained stable in the 25-49 years age group during Week 4 compared to Week 3.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 4
(Week ending
Jan. 27, 2024)
Week 3
(Week ending
Jan. 20, 2024)
Week 4
(Week ending
Jan. 27, 2024)
Week 3
(Week ending
Jan. 20, 2024)
Very High451715
High16169286
Moderate1313113111
Low813179196
Minimal148306284
Insufficient Data00222237




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 14,596 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and January 27, 2024. The weekly hospitalization rate observed in Week 4 was 3.0 per 100,000 population. The weekly hospitalization rate observed during Week 52 is the third highest peak weekly rate observed during all seasons going back to 2010-2011 following the 2014-2015 and 2017-2018 seasons. The overall cumulative hospitalization rate was 47.8 per 100,000 population. This cumulative hospitalization rate is the fourth highest cumulative hospitalization rate when compared against previous end-of-season rates for Week 4, while it is the second highest cumulative in-season hospitalization rate observed in Week 4, following the 2022-2023 season (58.6). Cumulative in-season hospitalization rates observed in Week 4 from 2010-2011 through 2021-2022 ranged from 0.5 to 43.5.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (128.6), followed by adults aged 50-64 years (59.5) and children aged 0-4 years (50.9). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (93.3), followed by Hispanic persons (45.5), non-Hispanic American Indian or Alaska Native persons (62.7), non-Hispanic White persons (34.3), and non-Hispanic Asian/Pacific Islander persons (27.6).

Among 14,596 hospitalizations, 12,882 (88.3%) were associated with influenza A virus, 1,577 (10.8%) with influenza B virus, 27 (0.2%) with influenza A virus and influenza B virus co-infection, and 110 (0.8%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 2,121 (76.7%) were A(H1N1)pdm09 and 643 (23.3%) were A(H3N2). Based on preliminary data, of the 782 laboratory-confirmed influenza-associated hospitalizations with more complete data, 4.0% (95% CI: 2.3%-5.7%) also tested positive for SARS-CoV-2.

Among 609 hospitalized adults with information on underlying medical conditions, 94.4% had at least one reported underlying medical condition, the most commonly reported were hypertension, cardiovascular disease, metabolic disorder, and obesity. Among 827 hospitalized women of childbearing age (15-49 years) with information on pregnancy status, 18.8% were pregnant. Among 354 hospitalized children with information on underlying medical conditions, 70.4% had at least one reported underlying medical condition; the most commonly reported was asthma, followed by obesity and neurologic disease.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 4, 12,186 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for week 4 remained stable compared to Week 3 (change of <5%) nationally. The number of hospitalizations increased in regions 6 and 8, remained stable in regions 1, 2, 4, 5, and 7, and decreased in regions 3, 9, and 10 this week compared to Week 3.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on February 1, 2024, 0.9% of the deaths that occurred during the week ending January 27, 2024 (Week 4), were due to influenza. This percentage decreased (≥ 0.1 percentage point change) compared to Week 3. The data presented are preliminary and may change as more data are received and processed.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Eight influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 4. The deaths occurred between Week 1 (the week ending January 6, 2024) and Week 4 (the week ending January 27, 2024). Four deaths were associated with influenza A viruses. One of the influenza A viruses had subtyping performed and it was an A(H1N1) virus. Four deaths were associated with influenza B viruses with no lineage determined.

A total of 65 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated February 9, 2024
fluview-banner2.jpg

Key Updates for Week 5, ending February 3, 2024

Seasonal influenza activity remains elevated nationally with increases in some parts of the country. Viruses


Clinical Lab 15.8%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.4%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 11 jurisdictions experienced moderate activity and 25 jurisdictions experienced high or very high activity.

FluSurv-NET 51.5 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 11,073 (Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.8%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 8


influenza-associated deaths were reported
this week for a total of 74 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated nationally with increases in some parts of the country, particularly regions 5 and 7.
  • Nationally, percent positivity for influenza overall remained stable. However, percent positivity for influenza A decreased slightly and percent positivity for influenza B increased slightly, driven primarily by activity in regions 5 and 7.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS regions.
  • The number of weekly flu hospital admissions decreased slightly compared to last week.
  • During Week 5, of the 819 viruses reported by public health laboratories, 623 (76.1%) were influenza A and 196 (23.9%) were influenza B. Of the 400 influenza A viruses subtyped during Week 5, 270 (67.5%) were influenza A(H1N1) and 130 (32.5%) were A(H3N2).
  • Eight influenza-associated pediatric deaths were reported during Week 5, bringing the 2023-2024 season total to 74 pediatric deaths.
  • CDC estimates that there have been at least 22 million illnesses, 250,000 hospitalizations, and 15,000 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2[/SUP] Vaccination can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories remained stable (change of <0.5 percentage points) compared to the previous week, but trends varied by region. Regions 3, 5, and 7 reported an increase in percent positivity, Region 1 remained stable and regions 2, 4, 6, 8, 9, and 10 reported a decrease. The regions with the highest percent positivity were regions 6 (29.5%), 7 (20.7%), 8 (18.4%), and 5 (18.1%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region, particularly in regions 5 and 7 where influenza B activity has been increasing. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested96,3791,868,917
No. of positive specimens (%)15,192 (15.8%)191,459 (10.2%)
Positive specimens by type
Influenza A10,453 (68.8%)150,153 (78.4%)
Influenza B4,739 (31.2%)41,296 (21.6%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,79068,366
No. of positive specimens81921,004
Positive specimens by type/subtype
Influenza A623 (76.1%)17,303 (82.4%)
Subtyping Performed400 (64.2%)13,955 (80.7%)
(H1N1)pdm09270 (67.5%)10,972 (78.6%)
H3N2130 (32.5%)2,983 (21.4%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed223 (35.8%)3,348 (19.3%)
Influenza B196 (23.9%)3,701 (17.6%)
Lineage testing performed99 (50.5%)2,949 (79.7%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage99 (100%)2,949 (100%)
Lineage not performed97 (49.5%)752 (20.3%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 1,725 influenza viruses collected since October 1, 2023.
A/H1815
6B.1A.5a815 (100%)2a225 (27.6%)
2a.1590 (72.4%)
A/H3458
3C.2a1b.2a458 (100%)2a.1b1 (0.2%)
2a.3a1 (0.2%)
2a.3a.1455 (99.3%)
2b1 (0.2%)
B/Victoria452
V1A452 (100%)3a.2452 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: 107 A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): 110 A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Sixty-one influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested1723816460447
Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested1723816460447
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested1723816460447
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested1682793450439
Decreased Susceptibility1 (0.1%)0 (0.0%)1 (0.2%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir. One (H1N1)pdm09 virus had NA-S247N and NA-I223V amino acid substitutions and showed reduced inhibition by oseltamivir. One A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to baloxavir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide, during Week 5, 4.4% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has remained stable (change of ≤ 0.1 percentage points) compared to Week 4 and has remained above the national baseline of 2.9% since Week 44. The percentage of visits for ILI increased in regions 2, 5, 6, 7, and 10, decreased in regions 4 and 9, and remained stable in regions 1, 3, and 8 in Week 5 compared to Week 4. All regions remain above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet increased in the 5-24 years age group (change of > 0.1 percentage points), decreased in the 25-49 years and 50-64 years age groups, and remained stable in the 0-4 and 65+ years age groups during Week 5 compared to Week 4.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 5
(Week ending
Feb. 3, 2024)
Week 4
(Week ending
Jan. 27, 2024)
Week 5
(Week ending
Feb. 3, 2024)
Week 4
(Week ending
Jan. 27, 2024)
Very High651417
High19149793
Moderate1113123112
Low109181182
Minimal814279306
Insufficient Data10235219




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 15,743 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and February 03, 2024. The weekly hospitalization rate observed in Week 5 was 2.7 per 100,000 population. The weekly hospitalization rate observed during Week 52 is the third highest peak weekly rate observed during all seasons going back to 2010-2011 following the 2014-2015 and 2017-2018 seasons. The overall cumulative hospitalization rate was 51.5 per 100,000 population. This cumulative hospitalization rate is the third highest cumulative hospitalization rate when compared against previous end-of-season rates for Week 5, following the 2017-2018 season (59.9) and 2022-2023 season (59.2). Cumulative in-season hospitalization rates observed in Week 5 from 2010-2011 through 2021-2022 ranged from 0.6 to 44.1.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (138.7), followed by adults aged 50-64 years (63.5) and children aged 0-4 years (54.0). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (95.7), followed by Hispanic persons (48.9), non-Hispanic American Indian or Alaska Native persons (68.5), non-Hispanic White persons (34.6), and non-Hispanic Asian/Pacific Islander persons (29.1).

Among 15,743 hospitalizations, 13,854 (88.0%) were associated with influenza A virus, 1,747 (11.1%) with influenza B virus, 29 (0.2%) with influenza A virus and influenza B virus co-infection, and 113 (0.7%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 2,279 (75.8%) were A(H1N1) pdm09 and 727 (24.2%) were A(H3N2). Based on preliminary data, of the 785 laboratory-confirmed influenza-associated hospitalizations with more complete data admitted through November 2023, 4.0% (95% CI: 2.3%-5.7%) also tested positive for SARS-CoV-2.

Among 613 hospitalized adults with information on underlying medical conditions, 94.4% had at least one reported underlying medical condition, the most commonly reported were hypertension, cardiovascular disease, metabolic disorder, and obesity. Among 910 hospitalized women of childbearing age (15-49 years) with information on pregnancy status, 18.2% were pregnant. Among 409 hospitalized children with information on underlying medical conditions, 70.4% had at least one reported underlying medical condition; the most commonly reported was asthma, followed by obesity and neurologic disease.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 5, 11,073 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 5 decreased compared to Week 4 (change of >5%) nationally. The number of hospitalizations increased in regions 1, 5, and 7, remained stable in Region 6, and decreased in regions 2, 3, 4, 8, 9, and 10 this week compared to Week 4.

national levels of influenza hospitalizations
View Chart Data | View Full Screen
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on February 8, 2024, 0.8% of the deaths that occurred during the week ending February 3, 2024 (Week 5), were due to influenza. This percentage decreased (≥ 0.1 percentage point change) compared to Week 4. The data presented are preliminary and may change as more data are received and processed.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Eight influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 5. The deaths occurred between Week 51 of 2023 (the week ending December 23, 2023) and Week 5 of 2024 (the week ending February 3, 2024). Seven deaths were associated with influenza A viruses. Four of the influenza A viruses had subtyping performed; three were A(H1N1) viruses and one was an A(H3) virus. One death was associated with influenza B virus with no lineage determined.

A total of 74 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated February 16, 2024
fluview-banner2.jpg

Key Updates for Week 6, ending February 10, 2024

Seasonal influenza activity remains elevated nationally with increases in some parts of the country. Viruses


Clinical Lab 15.7%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.5%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 10 jurisdictions experienced moderate activity and 27 jurisdictions experienced high or very high activity.

FluSurv-NET 54.9 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 10,787 (Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.7%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 8


influenza-associated deaths were reported
this week for a total of 82 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated nationally with increases in some parts of the country, particularly regions 3, 5, and 7.
  • Nationally, percent positivity for influenza remained stable overall. However, percent positivity for influenza A decreased slightly and percent positivity for influenza B increased slightly, driven primarily by activity in regions 3, 5, and 7.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS regions.
  • The number of weekly flu hospital admissions remained stable compared to last week.
  • During Week 6, of the 766 viruses reported by public health laboratories, 589 (76.9%) were influenza A and 177 (23.1%) were influenza B. Of the 371 influenza A viruses subtyped during Week 6, 219 (59.0%) were influenza A(H1N1) and 152 (41.0%) were A(H3N2).
  • Eight influenza-associated pediatric deaths were reported during Week 6, bringing the 2023-2024 season total to 82 pediatric deaths.
  • CDC estimates that there have been at least 24 million illnesses, 260,000 hospitalizations, and 16,000 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2[/SUP] Vaccination can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories remained stable (change of <0.5 percentage points) compared to the previous week, but trends varied by region. Regions 1, 2, 3, 5, and 7 reported an increase in percent positivity, regions 4 and 8 remained stable, and regions 6, 9, and 10 reported a decrease. The regions with the highest percent positivity were regions 7 (24.4%), 6 (21.6%), 8 (19.9%), and 5 (18.2%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region, particularly in regions 3, 5 and 7 where influenza B activity has been increasing. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested98,5531,993,007
No. of positive specimens (%)15,474 (15.7%)214,718 (10.8%)
Positive specimens by type
Influenza A9,563 (61.8%)164,859 (76.8%)
Influenza B5,911 (38.2%)49,849 (23.2%)
6

INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,54972,061
No. of positive specimens76622,529
Positive specimens by type/subtype
Influenza A589 (76.9%)18,483 (82.0%)
Subtyping Performed371 (63.0%)15,029 (81.3%)
(H1N1)pdm09219 (59.0%)11,678 (77.7%)
H3N2152 (41.0%)3,351 (22.3%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed218 (37.0%)3,454 (18.7%)
Influenza B177 (23.1%)4,046 (18.0%)
Lineage testing performed114 (64.4%)3,260 (80.6%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage114 (100%)3,260 (100%)
Lineage not performed63 (35.6%)786 (19.4%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 1,890 influenza viruses collected since October 1, 2023.
A/H1874
6B.1A.5a874 (100%)2a233 (26.7%)
2a.1641 (73.3%)
A/H3518
3C.2a1b.2a518 (100%)2a.1b1 (0.2%)
2a.3a1 (0.2%)
2a.3a.1515 (99.4%)
2b1 (0.2%)
B/Victoria498
V1A498 (100%)3a.2498 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: 128 A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): 127 A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Sixty-one influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested1887872518497
Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested1887872518497
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested1887872518497
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested1840847508485
Decreased Susceptibility1 (0.1%)0 (0.0%)1 (0.2%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir. One (H1N1)pdm09 virus had NA-I223V and NA-S247N amino acid substitutions and showed reduced inhibition by oseltamivir.

One A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to baloxavir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide, during Week 6, 4.5% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has remained stable (change of ≤ 0.1 percentage points) compared to Week 5 and has remained above the national baseline of 2.9% since Week 44. The percentage of visits for ILI increased in regions 3, 5, and 7, decreased in regions 6, 9, and 10, and remained stable in regions 1, 2, 4, and 8 in Week 6 compared to Week 5. All regions remain above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet increased in the 0-4 years and 5-24 years age groups (change of > 0.1 percentage points) and remained stable in the 25-49 years, 50-64 years, and 65+ years age groups during Week 6 compared to Week 5.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 6
(Week ending
Feb. 10, 2024)
Week 5
(Week ending
Feb. 3, 2024)
Week 6
(Week ending
Feb. 10, 2024)
Week 5
(Week ending
Feb. 3, 2024)
Very High961414
High1819114103
Moderate1010122119
Low1012200184
Minimal87252288
Insufficient Data01227221




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 16,791 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and February 10, 2024. The weekly hospitalization rate observed in Week 6 was 2.6 per 100,000 population. The weekly hospitalization rate observed during Week 52 is the third highest peak weekly rate observed during all seasons going back to 2010-2011, following the 2014-2015 and 2017-2018 seasons. The overall cumulative hospitalization rate was 54.9 per 100,000 population. This is the third highest cumulative in-season hospitalization rate observed in Week 6, following the 2017-2018 season (67.9) and 2022-2023 season (59.5). Cumulative in-season hospitalization rates observed in Week 6 from 2010-2011 through 2021-2022 ranged from 0.6 to 48.7.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (147.8), followed by adults aged 50-64 years (67.2) and children aged 0-4 years (58.3). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (105.9), followed by non-Hispanic American Indian or Alaska Native persons (76.9), Hispanic persons (52.7), non-Hispanic White persons (40.1), and non-Hispanic Asian/Pacific Islander persons (30.3).

Among 16,791 hospitalizations, 14,749 (87.8%) were associated with influenza A virus, 1,914 (11.4%) with influenza B virus, 30 (0.2%) with influenza A virus and influenza B virus co-infection, and 98 (0.6%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 2,472 (75.5%) were A(H1N1) pdm09 and 804 (24.5%) were A(H3N2). Based on preliminary data, of the 1,018 laboratory-confirmed influenza-associated hospitalizations with more complete data admitted through December 2023, 4.0% (95% CI: 1.2%-6.8%) also tested positive for SARS-CoV-2.

Among 729 hospitalized adults with information on underlying medical conditions, 91.6% had at least one reported underlying medical condition; the most commonly reported were hypertension, cardiovascular disease, obesity, and metabolic disorder. Among 170 hospitalized children with information on underlying medical conditions, 68.1% had at least one reported underlying medical condition; the most commonly reported was asthma, followed by obesity and neurologic disease.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 6, 10,787 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 6 remained stable compared to Week 5 (change of <5%) nationally. The number of hospitalizations increased in regions 5 and 7, remained stable in regions 1, 2, 3, and 4, and decreased in regions 6, 8, 9, and 10 this week compared to Week 5.

Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on February 15, 2024, 0.7% of the deaths that occurred during the week ending February 10, 2024 (Week 6), were due to influenza. This percentage decreased (≥ 0.1 percentage point change) compared to Week 5. The data presented are preliminary and may change as more data are received and processed.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Eight influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 6. Three deaths occurred during Week 4 (the week ending January 27, 2024) and five deaths occurred in Week 5 (the week ending February 3, 2024). Three deaths were associated with influenza A viruses. Two of the influenza A viruses had subtyping performed; they were A(H1N1) and A(H3) viruses. Five deaths were associated with influenza B viruses with no lineage determined.

A total of 82 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated February 23, 2024
fluview-banner2.jpg

Key Updates for Week 7, ending February 17, 2024

Seasonal influenza activity remains elevated nationally with increases in some parts of the country. Viruses


Clinical Lab 14.8%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.5%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 11 jurisdictions experienced moderate activity and 27 jurisdictions experienced high or very high activity.

FluSurv-NET 58.2 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 10,480 (Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.8%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 9


influenza-associated deaths were reported
this week for a total of 91 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated nationally with increases in some parts of the country, particularly regions 1, 2, 3, 5, and 7.
  • Nationally, percent positivity for influenza decreased slightly overall with percent positivity for influenza A decreasing and percent positivity for influenza B remaining stable. However, trends in percent positivity varied by region with increases reported in regions 2, 3, and 7.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS regions.
  • The number of weekly flu hospital admissions remained stable compared to last week but have been showing a decreasing trend since Week 1.
  • During Week 6, of the 668 viruses reported by public health laboratories, 479 (71.7%) were influenza A and 189 (28.3%) were influenza B. Of the 298 influenza A viruses subtyped during Week 6, 153 (51.3%) were influenza A(H1N1) and 145 (48.7%) were A(H3N2).
  • Nine influenza-associated pediatric deaths were reported during Week 7, bringing the 2023-2024 season total to 91 pediatric deaths.
  • CDC estimates that there have been at least 25 million illnesses, 280,000 hospitalizations, and 17,000 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2[/SUP] Vaccination can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories decreased (change of <0.5 percentage points) compared to the previous week, but trends varied by region. Regions 2, 3, and 7 reported an increase, regions 4, 5, and 8 reported a decrease and regions 1, 9, and 10 remained stable during Week 7 compared to Week 6. The regions with the highest percent positivity were regions 7 (27.6%), 6 (19.6%), 5 (18.6%), and 3 (18.0%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region, particularly in regions 3, 5, and 7, where influenza B activity has been increasing. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested89,9392,118,431
No. of positive specimens (%)13,304 (14.8%)231,053 (10.9%)
Positive specimens by type
Influenza A8,072 (60.7%)174,793 (75.7%)
Influenza B5,232 (39.3%)56,250 (24.3%)
6

INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,63976,039
No. of positive specimens66824,008
Positive specimens by type/subtype
Influenza A479 (71.7%)19,549 (81.4%)
Subtyping Performed298 (62.2%)15,907 (81.4%)
(H1N1)pdm09153 (51.3%)12,186 (76.6%)
H3N2145 (48.7%)3,721 (23.4%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed181 (37.8%)3,642 (18.6%)
Influenza B189 (28.3%)4,459 (18.6%)
Lineage testing performed118 (62.4%)3,589 (80.5%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage118 (100%)3,589 (100%)
Lineage not performed71 (37.6%)870 (19.5%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 2,114 influenza viruses collected since October 1, 2023.
A/H1962
6B.1A.5a962 (100%)2a253 (26.3%)
2a.1709 (73.7%)
A/H3598
3C.2a1b.2a598 (100%)2a.1b1 (0.2%)
2a.3a1 (0.2%)
2a.3a.1595 (99.4%)
2b1 (0.2%)
B/Victoria554
V1A554 (100%)3a.2554 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: 128 A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): 127 A(H3N2) viruses were antigenically characterized by HI or HINT, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: Seventy-six influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested2,081944582555
Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested2,081944582555
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.1%)1 (0.1%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested2,081944582555
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested2,029919570540
Decreased Susceptibility1 (0.1%)0 (0.0%)1 (0.2%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir. One (H1N1)pdm09 virus had NA-I223V and NA-S247N amino acid substitutions and showed reduced inhibition by oseltamivir.

One A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to baloxavir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide, during Week 7, 4.5% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has remained stable (change of ≤ 0.1 percentage points) compared to Week 6. The percentage of visits for ILI remained stable in regions 1, 2, 3, and 10, increased in regions 5, 7, and 9, and decreased in regions 4, 6, and 8 in Week 7 compared to Week 6. All regions remain above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet increased (change of > 0.1 percentage points) in the 25-49 years, 50-64 years, and 65+ years age groups, decreased in the 0-4 years age group, and remained stable in the 5-24 years age group during Week 7 compared to Week 6.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 7
(Week ending
Feb. 17, 2024)
Week 6
(Week ending
Feb. 10, 2024)
Week 7
(Week ending
Feb. 17, 2024)
Week 6
(Week ending
Feb. 10, 2024)
Very High791514
High201899112
Moderate119121128
Low811227199
Minimal88239253
Insufficient Data10228223




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 17,799 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and February 17, 2024. The weekly hospitalization rate observed in Week 7 was 2.5 per 100,000 population. The weekly hospitalization rate observed during Week 52 is the third highest peak weekly rate observed during all seasons going back to 2010-2011 following the 2014-2015 and 2017-2018 seasons. The overall cumulative hospitalization rate was 58.2 per 100,000 population. This cumulative hospitalization rate is the third highest cumulative hospitalization rate when compared against previous end-of-season rates for Week 7. It is also the third highest cumulative in-season hospitalization rate observed in Week 7, following the 2017-2018 season (74.5) and 2022-2023 season (59.7). Cumulative in-season hospitalization rates observed in Week 7 from 2010-2011 through 2021-2022 ranged from 0.6 to 47.4.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (156.5), followed by adults aged 50-64 years (70.9) and children aged 0-4 years (61.5). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (112.7), followed by non-Hispanic American Indian or Alaska Native persons (80.9), Hispanic persons (55.3), non-Hispanic White persons (43.2), and non-Hispanic Asian/Pacific Islander persons (31.7).

Among 17,799 hospitalizations, 15,564 (87.4%) were associated with influenza A virus, 2,114 (11.9%) with influenza B virus, 33 (0.2%) with influenza A virus and influenza B virus co-infection, and 88 (0.5%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 2,662 (74.4%) were A(H1N1) pdm09 and 916 (25.6%) were A(H3N2). Based on preliminary data, of the 934 laboratory-confirmed influenza-associated hospitalizations with more complete data admitted through December 2023, 5.0% (95% CI: 2.1%-7.8%) also tested positive for SARS-CoV-2.

Among 703 hospitalized adults with information on underlying medical conditions, 92.6% had at least one reported underlying medical condition, the most commonly reported were hypertension, cardiovascular disease, obesity, and metabolic disorder. Among 162 hospitalized children with information on underlying medical conditions, 68% had at least one reported underlying medical condition; the most commonly reported was asthma, followed by obesity and neurologic disease.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 7, 10,480 patients with laboratory-confirmed influenza were admitted to a hospital. The number of patients admitted to a hospital with laboratory-confirmed influenza for Week 7 remained stable (change of <5%) compared to Week 6 nationally. The number of hospitalizations increased in regions 1, 2, and 3, remained stable in region 5, and decreased in regions 4, 6, 7, 8, 9, and 10 this week compared to Week 6.

Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on February 22, 2024, 0.8% of the deaths that occurred during the week ending February 17, 2024 (Week 7), were due to influenza. This percentage increased (≥ 0.1 percentage point change) compared to Week 6. The data presented are preliminary and may change as more data are received and processed.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Nine influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 7. The deaths occurred during Week 46 of 2023 (the week ending November 18, 2023) and between Weeks 4 and 6 of 2024 (the weeks ending January 27, 2024, and February 10, 2024). Five deaths were associated with influenza A(H1N1) viruses and four deaths were associated with influenza B viruses. One of the influenza B viruses had lineage determined and it was a B/Victoria virus.

A total of 91 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated March 1, 2024
fluview-banner2.jpg

Key Updates for Week 8, ending February 24, 2024

Seasonal influenza activity remains elevated nationally with increases in some parts of the country. Viruses


Clinical Lab 14.2%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza B/Victoria.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.4%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 12 jurisdictions experienced moderate activity and 27 jurisdictions experienced high or very high activity.

FluSurv-NET 61.5 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 10,148 (Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.7%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 2


influenza-associated deaths were reported
this week for a total of 93 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated nationally with increases in some parts of the country.
  • Nationally, percent positivity for influenza decreased slightly overall with percent positivity for influenza A decreasing and percent positivity for influenza B remaining stable. Trends in percent positivity for influenza A and B varied by region.
  • Outpatient respiratory illness has been above baseline[SUP]1 [/SUP]nationally since November and is above baseline in all 10 HHS regions.
  • The number of weekly flu hospital admissions remained stable compared to last week.
  • During Week 8, of the 773 viruses reported by public health laboratories, 508 (65.7%) were influenza A and 265 (34.3%) were influenza B. Of the 338 influenza A viruses subtyped during Week 8, 186 (55.0%) were influenza A(H1N1) and 152 (45.0%) were A(H3N2).
  • Two influenza-associated pediatric deaths were reported during Week 8, bringing the 2023-2024 season total to 93 pediatric deaths.
  • CDC estimates that there have been at least 26 million illnesses, 290,000 hospitalizations, and 18,000 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2[/SUP] Vaccination can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories decreased (change of ≤0.5 percentage points) compared to the previous week, but trends varied by region. Region 7 reported an increase, regions 1, 3, 5, 6, 8 and 9 reported a decrease, and regions 2, 4, and 10 remained stable during Week 8 compared to Week 7. The regions with the highest percent positivity were regions 7 (28.4%), 5 (19.4%), and 6 (18.3). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested87,2992,214,809
No. of positive specimens (%)12,376 (14.2%)249,106 (11.2%)
Positive specimens by type
Influenza A7,298 (59.0%)185,263 (74.4%)
Influenza B5,078 (41.0%)63,833 (25.6%)
6

INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,53280,259
No. of positive specimens77325,806
Positive specimens by type/subtype
Influenza A508 (65.7%)20,783 (80.5%)
Subtyping Performed338 (66.5%)16,978 (81.7%)
(H1N1)pdm09186 (55.0%)12,790 (75.3%)
H3N2152 (45.0%)4,188 (24.7%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed170 (33.5%)3,805 (18.3%)
Influenza B265 (34.3%)5,023 (19.5%)
Lineage testing performed187 (70.6%)4,108 (81.8%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage187 (100%)4,108 (100%)
Lineage not performed78 (29.4%)915 (18.2%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 2,226 influenza viruses collected since October 1, 2023.
A/H1997
6B.1A.5a997 (100%)2a254 (25.5%)
2a.1743 (74.5%)
A/H3639
3C.2a1b.2a639 (100%)2a.1b1 (0.2%)
2a.3a1 (0.2%)
2a.3a.1636 (99.5%)
2b1 (0.2%)
B/Victoria590
V1A590 (100%)3a.2590 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: 172 A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): 161 A(H3N2) viruses were antigenically characterized by HI or HINT, and 159 (99%) were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: One hundred influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.
Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested2,229998640591
Reduced Inhibition1 (0.4%)1 (0.1%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.4%)1 (0.1%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested2,229998640591
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.4%)1 (0.1%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested2,229998640591
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested2,162970623569
Decreased Susceptibility1 (0.5%)0 (0.0%)1 (0.2%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir. One (H1N1)pdm09 virus had NA-I223V and NA-S247N amino acid substitutions and showed reduced inhibition by oseltamivir.

One A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to baloxavir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide, during Week 8, 4.4% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has remained stable (change of ≤ 0.1 percentage points) compared to Week 7. The percentage of visits for ILI remained stable in regions 1, 2, 3, and 4, increased in regions 5, 7, and 9, and decreased in regions 6, 8, and 10 in Week 8 compared to Week 7. All regions remain above their region-specific baselines this week. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet remained stable for all age groups during Week 8 compared to Week 7.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 8
(Week ending
Feb. 24, 2024)
Week 7
(Week ending
Feb. 17, 2024)
Week 8
(Week ending
Feb. 24, 2024)
Week 7
(Week ending
Feb. 17, 2024)
Very High571614
High2220109108
Moderate1211116123
Low710210227
Minimal87250235
Insufficient Data10228222




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 18,790 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and February 24, 2024. The weekly hospitalization rate observed in Week 8 was 2.6 per 100,000 population. The weekly hospitalization rate observed during Week 52 is the third highest peak weekly rate observed during all seasons going back to 2010-2011 following the 2014-2015 and 2017-2018 seasons. The overall cumulative hospitalization rate was 61.5 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative hospitalization rate when compared against previous end-of-season rates for Week 8, and it is the second highest cumulative in-season hospitalization rate observed in Week 8, following the 2017-2018 season (81.7). Cumulative in-season hospitalization rates observed in Week 8 from 2010-2011 through 2021-2022 ranged from 0.7 to 59.9.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (166.1), followed by adults aged 50-64 years (74.8) and children aged 0-4 years (63.6). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (119.1), followed by non-Hispanic American Indian or Alaska Native persons (86.5), Hispanic persons (58.8), non-Hispanic White persons (46.2), and non-Hispanic Asian/Pacific Islander persons (33.5).

Among 18,790 hospitalizations, 16,351 (87.0%) were associated with influenza A virus, 2,307 (12.3%) with influenza B virus, 35 (0.2%) with influenza A virus and influenza B virus co-infection, and 97 (0.5%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 2,763 (74.3%) were A(H1N1) pdm09 and 954 (25.7%) were A(H3N2).

Among 2,052 hospitalized adults with information on underlying medical conditions, 95.6% had at least one reported underlying medical condition; the most commonly reported were hypertension, cardiovascular disease, obesity, and metabolic disease. Among 1,079 hospitalized women of childbearing age (15-49 years) with information on pregnancy status, 23.8% were pregnant. Among 571 hospitalized children with information on underlying medical conditions, 69.3% had at least one reported underlying medical condition; the most commonly reported was asthma, followed by obesity and neurologic disease.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 8, 10,148 patients with laboratory-confirmed influenza were admitted to a hospital. Nationally, the number of patients admitted to a hospital with laboratory-confirmed influenza for Week 8 remained stable (change of <5%) compared to Week 7. The number of hospitalizations increased in regions 5, 7, and 10, remained stable in regions 1 and 3, and decreased in regions 2, 4, 6, 8, and 9 this week compared to Week 7.

Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on February 29, 2024, 0.7% of the deaths that occurred during the week ending February 24, 2024 (Week 8), were due to influenza. This percentage remained stable (< 0.1 percentage point change) compared to Week 7. The data presented are preliminary and may change as more data are received and processed.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Two influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 8. One death occurred during Week 6 (the week ending February 10, 2024) and one occurred during Week 7 (the week ending February 17, 2024). Both deaths were associated with an influenza B virus with no lineage determined.

A total of 93 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

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.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly U.S. Influenza Surveillance Report


Print
Updated March 8, 2024
fluview-banner2.jpg

Key Updates for Week 9, ending March 2, 2024

Seasonal influenza activity remains elevated nationally with increases in some parts of the country. Viruses


Clinical Lab 13.9%

(Trend )


positive for influenza
this week


Public Health Lab
The most frequently reported influenza viruses this week were influenza A(H1N1)pdm09.

Virus Characterization
Genetic and antigenic characterization and antiviral susceptibility are summarized in this report. Illness


Outpatient Respiratory Illness 4.1%

(Trend )


of visits to a health care provider this week were for respiratory illness
(above baseline).


Outpatient Respiratory Illness: Activity Map
This week 18 jurisdictions experienced moderate activity and 20 jurisdictions experienced high or very high activity.

FluSurv-NET 64.8 per 100,000


cumulative hospitalization rate.

NHSN Hospitalizations 10,060 (Trend )


patients admitted to hospitals with influenza this week.

NCHS Mortality 0.7%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 10


influenza-associated deaths were reported
this week for a total of 103 deaths this season.


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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

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

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points
  • Seasonal influenza activity remains elevated nationally with increases in some parts of the country.
  • Nationally, percent positivity for influenza remained stable compared to last week. Trends in percent positivity for influenza A and B varied by region.
  • Nationally, outpatient respiratory illness declined slightly but remains above baseline.[SUP]1 [/SUP]Regions 8 and 10 are below their respective baselines during Week 9 for the first time since early and mid-November, respectively, while the remaining HHS regions remain above their respective baselines.
  • The number of weekly flu hospital admissions remained stable compared to last week. After five weeks of sharp decline between late December and early February, the number of weekly flu hospital admissions has been trending downward slightly since mid-February.
  • During Week 9, of the 615 viruses reported by public health laboratories, 437 (71.1%) were influenza A and 178 (28.9%) were influenza B. Of the 286 influenza A viruses subtyped during Week 9, 164 (57.3%) were influenza A(H1N1) and 122 (42.7%) were A(H3N2).
  • Ten influenza-associated pediatric deaths were reported during Week 9, bringing the 2023-2024 season total to 103 pediatric deaths.
  • CDC estimates that there have been at least 28 million illnesses, 310,000 hospitalizations, and 20,000 deaths from flu so far this season.
  • CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading.[SUP]2[/SUP] Vaccination can still provide benefit this season.
  • There also are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.[SUP]3[/SUP]
  • Flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.
U.S. Virologic Surveillance


Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories remained stable (change of <0.5 percentage points) compared to the previous week, but trends varied by region. Region 5 reported an increase; regions 1, 2, 4, 6, and 8 reported a decrease; and regions 3, 7, 9, and 10 remained stable during Week 9 compared to Week 8. The regions with the highest percent positivity were regions 7 (27.9%), 5 (19.8%), and 3 (17.4%). Since Week 40, influenza A(H1N1)pdm09 has been the predominant virus circulating in all regions. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) or found upon further testing to be a vaccine virus are not included, as they are not circulating influenza viruses. Clinical Laboratories


The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.
No. of specimens tested81,2372,346,992
No. of positive specimens (%)11,294 (13.9%)265,084 (11.3%)
Positive specimens by type
Influenza A6,428 (56.9%)194,842 (73.5%)
Influenza B4,866 (43.1%)70,232 (26.5%)
6

INFLUENZA Virus Isolated
View Chart Data | View Full Screen Public Health Laboratories


The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.
No. of specimens tested2,54183,981
No. of positive specimens61527,069
Positive specimens by type/subtype
Influenza A437 (71.1%)21,684 (80.1%)
Subtyping Performed286 (65.4%)17,762 (81.9%)
(H1N1)pdm09164 (57.3%)13,221 (74.4%)
H3N2122 (42.7%)4,541 (25.6%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed151 (34.6%)3,922 (18.1%)
Influenza B178 (28.9%)5,385 (19.9%)
Lineage testing performed138 (77.5%)4,441 (82.5%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage138 (100%)4,441 (100%)
Lineage not performed40 (22.5%)944 (17.5%)
INFLUENZA Virus Isolated
View Chart Data | View Full Screen
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Influenza Virus Characterization


CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 2,227 influenza viruses collected since October 1, 2023.
A/H1998
6B.1A.5a998 (100%)2a254 (25.5%)
2a.1744 (74.5%)
A/H3639
3C.2a1b.2a639 (100%)2a.1b1 (0.2%)
2a.3a1 (0.2%)
2a.3a.1636 (99.5%)
2b1 (0.2%)
B/Victoria590
V1A590 (100%)3a.2590 (100%)
B/Yamagata0
Y30Y30 (0%)
CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses
  • A (H1N1)pdm09: 172 A(H1N1)pdm09 viruses were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): 161 A(H3N2) viruses were antigenically characterized by HI or HINT, and 159 (99%) were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.
Influenza B Viruses
  • B/Victoria: One hundred influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.


2024-2025 Influenza Season – U.S. Influenza Vaccine Composition:

The World Health Organization (WHO) has recommended the Northern Hemisphere 2024-2025 influenza vaccine composition, and the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) subsequently made the influenza vaccine composition recommendation for the United States. Both agencies recommend that influenza vaccines contain the following:

Egg-based vaccines
    • an A/Victoria/4897/2022 (H1N1)pdm09-like virus;
    • an A/Thailand/8/2022 (H3N2)-like virus; and
    • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
Cell- or recombinant-based vaccines
    • an A/Wisconsin/67/2022 (H1N1)pdm09-like virus;
    • an A/Massachusetts/18/2022 (H3N2)-like virus; and
    • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
The Committee recommended that all 2024-2025 U.S. flu vaccines be three-component (trivalent) vaccines and include an influenza A(H1N1), an A(H3N2) and a B/Victoria-lineage vaccine virus. Because influenza B/Yamagata viruses, which are included in current four-component (quadrivalent) influenza vaccines, are no longer actively circulating, their inclusion in flu vaccines is no longer warranted. Further information on vaccine composition for the 2024-2025 influenza season can be found on the CDC Spotlight.



Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods | CDC.

Viruses collected in the U.S. since October 01, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested2,230998640592
Reduced Inhibition1 (0.4%)1 (0.1%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.4%)1 (0.1%)0 (0.0%)0 (0.0%)
PeramivirViruses Tested2,230998640592
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition1 (0.4%)1 (0.1%)0 (0.0%)0 (0.0%)
ZanamivirViruses Tested2,230998640592
Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
Highly Reduced Inhibition0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested2,167974623570
Decreased Susceptibility1 (0.5%)0 (0.0%)1 (0.2%)0 (0.0%)
One A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed highly reduced inhibition by oseltamivir and peramivir. One (H1N1)pdm09 virus had NA-I223V and NA-S247N amino acid substitutions and showed reduced inhibition by oseltamivir.

One A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to baloxavir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented. Outpatient Respiratory Illness Surveillance


The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website. Outpatient Respiratory Illness Visits


Nationwide, during Week 9, 4.1% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This has decreased (change of > 0.1 percentage points) compared to Week 8. The percentage of visits for ILI remained stable in regions 2, 3, 5, and 7, and decreased in regions 1, 4, 6, 8, 9, and 10 in Week 9 compared to Week 8. Regions 8 and 10 are below their region-specific baselines in Week 9 for the first time since early and mid-November respectively, while all other regions remain above their region-specific baselines. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Outpatient Respiratory Illness Visits by Age Group


About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet decreased in the 0-4 years, 5-24 years, and 25-49 years age groups and remained stable in the 50-64 years and 65+ years age groups during Week 9 compared to Week 8.

Outpatient Respiratory Illness Activity Map


Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).
Week 9
(Week ending
Mar. 2, 2024)
Week 8
(Week ending
Feb. 24, 2024)
Week 9
(Week ending
Mar. 2, 2024)
Week 8
(Week ending
Feb. 24, 2024)
Very High551616
High152192109
Moderate181399120
Low97201209
Minimal88296251
Insufficient Data01225224




*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.
Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map Hospitalization Surveillance

FluSurv-NET


The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 19,819 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and March 2, 2024. The weekly hospitalization rate observed in Week 9 was 2.6 per 100,000 population. The weekly hospitalization rate observed during Week 52 is the third highest peak weekly rate observed during all seasons going back to 2010-2011, following the 2014-2015 and 2017-2018 seasons. The overall cumulative hospitalization rate was 64.8 per 100,000 population. This cumulative hospitalization rate is the second highest cumulative hospitalization rate when compared against previous end-of-season rates for Week 9, and it is the second highest cumulative in-season hospitalization rate observed in Week 9, following the 2017-2018 season (86.3). Cumulative in-season hospitalization rates observed in Week 9 from 2010-2011 through 2022-2023 ranged from 0.7 to 60.0.

When examining rates by age, the highest cumulative hospitalization rate per 100,000 population was among adults aged 65 years and older (175.8), followed by adults aged 50-64 years (78.5) and children aged 0-4 years (67.6). When examining age-adjusted rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic Black persons (124.1), followed by non-Hispanic American Indian or Alaska Native persons (90.1), Hispanic persons (61.2), non-Hispanic White persons (49.3), and non-Hispanic Asian/Pacific Islander persons (34.9).

Among 19,819 hospitalizations, 17,163 (86.6%) were associated with influenza A virus, 2,504 (12.6%) with influenza B virus, 39 (0.2%) with influenza A virus and influenza B virus co-infection, and 112 (0.6%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 2,901 (73.1%) were A(H1N1) pdm09 and 1,066 (26.9%) were A(H3N2).

Among 2,168 hospitalized adults with information on underlying medical conditions, 95.6% had at least one reported underlying medical condition, the most commonly reported were hypertension, cardiovascular disease, obesity, and metabolic disease. Among 1,140 hospitalized women of childbearing age (15-49 years) with information on pregnancy status, 23.3% were pregnant. Among 633 hospitalized children with information on underlying medical conditions, 69.3% had at least one reported underlying medical condition; the most commonly reported was asthma, followed by obesity and neurologic disease.

FluSurvNet Cumulative Rates

View Full Screen

In this figure, cumulative rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospitals admissions are subject to reporting delays. As hospitalization data are reviewed each week, prior case counts and rates are updated accordingly.

FluSurvNet Weekly Rate

View Full Screen

In this figure, weekly rates for all seasons prior to the 2023-24 season reflect end-of-season rates. For the 2023-24 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.
Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics | RESP-NET Interactive National Healthcare Safety Network (NHSN) Hospitalization Surveillance


Hospitals report to NHSN the weekly number of patients admitted with laboratory-confirmed influenza. During Week 9, 10,060 patients with laboratory-confirmed influenza were admitted to a hospital. Nationally, the number of patients admitted to a hospital with laboratory-confirmed influenza for Week 9 remained stable (change of <5%) compared to Week 8, and after five weeks of sharp decline between late December and early February, the number of weekly flu hospital admissions has been trending downward slightly since mid-February. The number of hospitalizations increased in regions 1 and 3, remained stable in regions 4, 5, and 7, and decreased in regions 2, 6, 8, 9, and 10 this week compared to Week 8.

Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


Based on NCHS mortality surveillance data available on March 7, 2024, 0.7% of the deaths that occurred during the week ending March 2, 2024 (Week 9), were due to influenza. This percentage remained stable (< 0.1 percentage point change) compared to Week 8. The data presented are preliminary and may change as more data are received and processed.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Influenza-Associated Pediatric Mortality


Ten influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 9. The deaths occurred during Week 51 of 2023 (the week ending December 23, 2023) and between weeks 3 and 9 of 2024 (the weeks ending January 20, 2024, and March 2, 2024). Six deaths were associated with influenza A viruses. Two of the influenza A viruses had subtyping performed; they were A(H1N1) and A(H3) viruses. Four deaths were associated with influenza B viruses, one of which was determined be a B/Victoria lineage-virus.

A total of 103 influenza-associated pediatric deaths occurring during the 2023-2024 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive Trend Indicators


Increasing:
IncreasingArrow.png

Decreasing:
DecreasingArrow.png

Stable:
StableArrow.png
Indicators Status by System


Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week. Reference Footnotes


[SUP]1[/SUP]U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.

[SUP]2[/SUP]Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1

[SUP]3[/SUP]Influenza Antiviral Medications: Summary for Clinicians (2023 Sept). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
https://www.cdc.gov/flu/weekly/index.htm
 
Back
Top