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

Weekly U.S. Influenza Surveillance Report


Print
Updated August 2, 2024
fluview-banner2.jpg

Key Updates for Week 30, ending July 27, 2024

Seasonal influenza activity remains low nationally. Viruses


Clinical Lab 0.7%

(Trend )


positive for influenza
this week


Public Health Lab
Influenza A(H1N1)pdm09, A(H3N2), and B viruses were all co-circulating this week.

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


Outpatient Respiratory Illness 1.5%

(Trend )


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


Outpatient Respiratory Illness: Map
This week, no jurisdictions experienced moderate, high, or very high activity.

FluSurv-NET 0.1 per 100,000


weekly hospitalization rate.

NCHS Mortality 0.03%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 1


influenza-associated death was reported this week for a total of 188 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 low nationally.
  • CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.
  • There 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]
  • Seasonal 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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. 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 tested28,3803,653,344
No. of positive specimens (%)193 (0.7%)350,276 (9.6%)
Positive specimens by type
Influenza A172 (89.1%)242,008 (69.1%)
Influenza B21 (10.9%)108,257 (30.9%)
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 tested921121,787
No. of positive specimens5938,759
Positive specimens by type/subtype
Influenza A55 (93.2%)29,650 (76.5%)
Subtyping Performed52 (94.5%)25,077 (84.6%)
(H1N1)pdm0920 (38.5%)16,544 (66.0%)
H3N232 (61.5%)8,533 (34.0%)
H3N2v0 (0.0%)0 (0.0%)
Subtyping not performed3 (5.5%)4,573 (15.4%)
Influenza B4 (6.8%)9,109 (23.5%)
Lineage testing performed4 (100.0%)7,927 (87.0%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage4 (100.0%)7,927 (87.0%)
Lineage not performed0 (0.0%)1,182 (13.0%)

Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Novel Influenza A Virus:


No new human infections of influenza A have been reported during Week 30.

During the 2023-2024 influenza season, a total of 13 cases of human infections with influenza A (H5) have been reported in the U.S. Four of these occurred in individuals working with dairy cows and nine in individuals associated with poultry depopulation and disposal. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional cases is ongoing.

Three cases of Influenza A (H1N2v) were also reported during the 2023-2024 season, bringing the total for the season to 16 novel influenza A cases.

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

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

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

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses:

Surveillance Methods | FluView Interactive 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 5,127 influenza viruses collected since October 1, 2023.
A/H11,890
6B.1A.5a1,890 (100%)2a451 (23.9%)
2a.11,439 (76.1%)
A/H31,775
3C.2a1b.2a1,775 (100%)2a.1b1 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,772 (99.8%)
2b1 (0.1%)
B/Victoria1,462
V1A1,462 (100%)3a.21,462 (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: 523 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 522 (99.8%) 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): 604 A(H3N2) viruses were antigenically characterized by HI or HINT, and 574 (95.0%) 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: 400 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 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,0371,8641,7441,429
Reduced Inhibition1 (0.02%)1 (0.1%)0 (0.00%)0 (0.00%)
Highly Reduced Inhibition5 (0.1%)5 (0.3%)0 (0.00%)0 (0.00%)
PeramivirViruses Tested5,0371,8641,7441,429
Reduced Inhibition3 (0.1%)0 (0.00%)0 (0.00%)3 (0.2%)
Highly Reduced Inhibition6 (0.1%)5 (0.3%)0 (0.00%)1 (0.1%)
ZanamivirViruses Tested5,0371,8641,7441,429
Reduced Inhibition1 (0.02%)0 (0.00%)0 (0.00%)1 (0.1%)
Highly Reduced Inhibition0 (0.00%)0 (0.00%)0 (0.00%)0 (0.00%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested4,9601,8201,7231,417
Decreased Susceptibility1 (0.02%)0 (0.00%)1 (0.1%)0 (0.00%)
Four A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and is below the national baseline. All 10 regions are below 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 increased in the 0-4 years age group and remained stable for all other age groups in Week 30 compared to Week 29.

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 30
(Week ending
Jul. 27, 2024)
Week 29
(Week ending
Jul. 20, 2024)
Week 30
(Week ending
Jul. 27, 2024)
Week 29
(Week ending
Jul. 20, 2024)
Very High0000
High0010
Moderate0022
Low0056
Minimal5555661667
Insufficient Data00260254




*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 25,319 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and July 27, 2024. The weekly hospitalization rate observed in Week 30 was 0.1 per 100,000 population. The peak weekly hospitalization rate observed this season was 9.0 per 100,000 population and occurred during Week 52.

Among 25,319 hospitalizations, 21,400 (84.5%) were associated with influenza A virus, 3,735 (14.8%) with influenza B virus, 51 (0.2%) with influenza A virus and influenza B virus co-infection, and 133 (0.5%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4,286 (67.7%) were A(H1N1) pdm09 and 2,047 (32.3%) were A(H3N2).



**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.
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 August 1, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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


One influenza-associated pediatric death occurring during the 2023-2024 season was reported to CDC during Week 30. The death was associated with an influenza A(H3) virus and occurred during Week 11 (the week ending March 16, 2024).

A total of 188 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 August 9, 2024
fluview-banner2.jpg

Key Updates for Week 31, ending August 3, 2024

Seasonal influenza activity remains low nationally. Viruses


Clinical Lab 0.6%

(Trend )


positive for influenza
this week


Public Health Lab
Influenza A(H1N1)pdm09, A(H3N2), and B viruses were all co-circulating this week.

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


Outpatient Respiratory Illness 1.5%

(Trend )


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


Outpatient Respiratory Illness: Map
This week, no jurisdictions experienced moderate, high, or very high activity.

FluSurv-NET 0 per 100,000


weekly hospitalization rate.

NCHS Mortality 0.03%

(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 remains low nationally.
  • One human infection with an influenza A(H3N2) variant virus was reported by the Colorado Department of Public Health and Environment.
  • CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.
  • There 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]
  • Seasonal 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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. 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 tested30,8683,697,927
No. of positive specimens (%)172 (0.6%)350,513 (9.5%)
Positive specimens by type
Influenza A145 (84.3%)242,211 (69.1%)
Influenza B27 (15.7%)108,921 (30.9%)
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 tested882123,131
No. of positive specimens5138,925
Positive specimens by type/subtype
Influenza A50 (98.0%)29,801 (76.6%)
Subtyping performed on specimens46 (93.9%)25,219 (84.6%)
(H1N1)pdm0919 (42.2%)16,603 (65.8%)
H3N226 (57.8%)8,615 (34.2%)
H3N2v1 (2.0%)2 (<0.1%)
H5*0 (0.0%)12* (<0.1%)
Subtyping not performed4 (8.1%)4,582 (15.4%)
Influenza B1 (2.0%)9,112 (23.4%)
Lineage testing performed on specimens1 (100.0%)7,930 (87.0%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage1 (100.0%)7,930 (100.0%)
Lineage testing not performed0 (0.0%)1,182 (13.0%)
* This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the “How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation



This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Novel Influenza A Virus:


A human infection with a novel influenza A virus was reported by the Colorado Department of Public Health and Environment. The patient was infected with an influenza A(H3N2) variant (A(H3N2)v) virus. The patient is < 18 years of age, sought healthcare during the week ending July 13, 2024 (Week 28), and was not hospitalized. An investigation by state public health officials found the patient attended an agricultural event prior to their illness onset. Investigation did not identify illness among close contacts of the patient. The investigation is ongoing.

Three cases of influenza A (H1N2)v were also reported during the 2023-2024 season bringing the total to 4 variant influenza cases this season. No new human infections of avian influenza A(H5N1) virus have been reported during Week 31. A total of 13 cases of human infection with influenza A (H5) were previously reported this season bringing the total to 17 novel influenza cases reported during the 2023-2024 season. An ongoing outbreak of H5N1 continues in domestic dairy cattle and poultry and monitoring for additional cases is ongoing.

When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant” influenza virus. Most human infections with variant influenza viruses occur following exposure to swine, but human-to-human transmission can occur. It is important to note that in most cases, variant influenza viruses have not shown the ability to spread easily and sustainably from person to person.

Early identification and investigation of human infections with novel influenza A viruses are critical so that the risk of infection can be understood, and appropriate public health measures can be taken.

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses:

Surveillance Methods | FluView Interactive 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 5,235 influenza viruses collected since October 1, 2023.
A/H11,924
6B.1A.5a1,924 (100%)2a462 (24.0%)
2a.11,462 (76.0%)
A/H31,835
3C.2a1b.2a1,835 (100%)2a.1b1 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,832 (99.8%)
2b1 (0.1%)
B/Victoria1,476
V1A1,476 (100%)3a.21,476 (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: 523 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 522 (99.8%) 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): 604 A(H3N2) viruses were antigenically characterized by HI or HINT, and 574 (95.0%) 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: 400 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 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,1471,8981,8051,444
Reduced Inhibition1 (0.02%)1 (0.1%)0 (0.00%)0 (0.00%)
Highly Reduced Inhibition5 (0.1%)5 (0.3%)0 (0.00%)0 (0.00%)
PeramivirViruses Tested5,1471,8981,8051,444
Reduced Inhibition3 (0.1%)0 (0.00%)0 (0.00%)3 (0.2%)
Highly Reduced Inhibition6 (0.11%)5 (0.3%)0 (0.00%)1 (0.1%)
ZanamivirViruses Tested5,1471,8981,8051,444
Reduced Inhibition1 (0.02%)0 (0.00%)0 (0.00%)1 (0.07%)
Highly Reduced Inhibition0 (0.00%)0 (0.00%)0 (0.00%)0 (0.00%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,0601,8471,7821,431
Decreased Susceptibility1 (0.02%)0 (0.0%)1 (0.1%)0 (0.0%)
Four A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and is below the national baseline. All 10 regions are below 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 age group and remained stable for all other age groups in Week 31 compared to Week 30.

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 31
(Week ending
Aug. 3, 2024)
Week 30
(Week ending
Jul. 27, 2024)
Week 31
(Week ending
Aug. 3, 2024)
Week 30
(Week ending
Jul. 27, 2024)
Very High0000
High0031
Moderate0012
Low0075
Minimal5555663676
Insufficient Data00255245




*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 25,317 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and August 3, 2024. The weekly hospitalization rate observed in Week 31 was 0.0 per 100,000 population. The peak weekly hospitalization rate observed this season was 9.0 per 100,000 population and occurred during Week 52.

Among 25,317 hospitalizations, 21,409 (84.6%) were associated with influenza A virus, 3,734 (14.7%) with influenza B virus, 53 (0.2%) with influenza A virus and influenza B virus co-infection, and 121 (0.5%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4,312 (67.5%) were A(H1N1) pdm09 and 2,072 (32.5%) were A(H3N2).



**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.
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 August 8, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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


No influenza-associated pediatric deaths were reported to CDC during Week 31.

A total of 188 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 August 16, 2024
fluview-banner2.jpg

Key Updates for Week 32, ending August 10, 2024

Seasonal influenza activity remains low nationally. Viruses


Clinical Lab 0.4%

(Trend )


positive for influenza
this week


Public Health Lab
Influenza A(H1N1)pdm09, A(H3N2), and B viruses were all co-circulating this week.

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


Outpatient Respiratory Illness 1.5%

(Trend )


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


Outpatient Respiratory Illness: Map
This week, no jurisdictions experienced moderate, high, or very high activity.

FluSurv-NET 0.1 per 100,000


weekly hospitalization rate.

NCHS Mortality 0.1%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 5


influenza-associated deaths were reported this week for a total of 193 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 low nationally.
  • One human infection with an influenza A(H3N2) variant virus was reported by the Michigan Department of Health and Human Services.
  • CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.
  • There 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]
  • Seasonal 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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. 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 tested34,6363,750,556
No. of positive specimens (%)147 (0.4%)350,749 (9.4%)
Positive specimens by type
Influenza A128 (87.1%)242,415 (69.1%)
Influenza B19 (12.9%)108,323 (30.9%)
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 tested954124,462
No. of positive specimens6039,084
Positive specimens by type/subtype
Influenza A59 (98.3%)29,967 (76.7%)
Subtyping performed on specimens50 (84.7%)25,353 (84.6%)
(H1N1)pdm0915 (30.0%)16,649 (65.7%)
H3N235 (70.0%)8,691 (34.3%)
H3N2v0 (0.0%)1 (<0.1%)
H5*0 (0.0%)12* (<0.1%)
Subtyping not performed9 (15.3%)4,614 (15.4%)
Influenza B1 (1.7%)9,117 (23.3%)
Lineage testing performed on specimens1 (100.0%)7,936 (87.0%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage1 (100.0%)7,936 (100.0%)
Lineage testing not performed0 (0.0%)1,181 (13.0%)
* This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the “How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation



This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Novel Influenza A Virus:


A human infection with a novel influenza A virus was reported by the Michigan Department of Health and Human Services. The patient was infected with an influenza A(H3N2) variant (A(H3N2)v) virus. The patient is < 18 years of age, sought healthcare during the week ending July 27, 2024 (Week 30), and was admitted to hospital due to a pre-existing condition. The patient is currently recovering. An investigation by state and local public health officials did not find any exposure to swine or attendance at an agricultural event prior to patient’s illness onset. Further investigation did not identify illness among close contacts of the patient.

One other case of influenza A (H3N2)v and three cases of influenza A (H1N2)v were also reported during the 2023-2024 season bringing the total to 5 variant influenza cases this season. No new human infections with highly pathogenic avian influenza A(H5N1) virus were reported during Week 32. A total of 13 cases of human infection with influenza A (H5) have been reported this season, bringing the current total to 18 novel influenza A cases reported during the 2023-2024 season. An ongoing outbreak of H5N1 continues in domestic dairy cattle and poultry, and monitoring for additional cases is ongoing.

When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant” influenza virus. Most human infections with variant influenza viruses occur following exposure to swine, but human-to-human transmission can occur. It is important to note that in most cases, variant influenza viruses have not shown the ability to spread easily and sustainably from person to person.

Early identification and investigation of human infections with novel influenza A viruses are critical so that the risk of infection can be understood, and appropriate public health measures can be taken.

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses:

Surveillance Methods | FluView Interactive 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 5,253 influenza viruses collected since October 1, 2023.
A/H11,932
6B.1A.5a1,932 (100%)2a466 (24.0%)
2a.11,466 (76.0%)
A/H31,843
3C.2a1b.2a1,843 (100%)2a.1b1 (0.05%)
2a.3a1 (0.05%)
2a.3a.11,832 (99.84%)
2b1 (0.05%)
B/Victoria1,478
V1A1,478 (100%)3a.21,478 (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: 561 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 560 (99.8%) 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): 626 A(H3N2) viruses were antigenically characterized by HI or HINT, and 594 (95%) 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: 400 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 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,1631,9061,8121,445
Reduced Inhibition1 (0.02%)1 (0.1%)0 (0.00%)0 (0.00%)
Highly Reduced Inhibition5 (0.1%)5 (0.3%)0 (0.00%)0 (0.00%)
PeramivirViruses Tested5,1631,9061,8121,445
Reduced Inhibition3 (0.1%)0 (0.00%)0 (0.00%)3 (0.2%)
Highly Reduced Inhibition6 (0.1%)5 (0.3%)0 (0.00%)1 (0.1%)
ZanamivirViruses Tested5,1631,9061,8121,445
Reduced Inhibition1 (0.02%)0 (0.00%)0 (0.00%)1 (0.1%)
Highly Reduced Inhibition0 (0.00%)0 (0.00%)0 (0.00%)0 (0.00%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,0691,8461,7901,433
Decreased Susceptibility1 (0.02%)0 (0.0%)1 (0.1%)0 (0.0%)
Four A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and is below the national baseline. All 10 regions are below 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 remained stable for all age groups in Week 32 compared to Week 31.

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 32
(Week ending
Aug. 10, 2024)
Week 31
(Week ending
Aug. 3, 2024)
Week 32
(Week ending
Aug. 10, 2024)
Week 31
(Week ending
Aug. 3, 2024)
Very High0000
High0023
Moderate0021
Low10149
Minimal5355643663
Insufficient Data10268253




*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 25,338 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and August 10, 2024. The weekly hospitalization rate observed in week 32 was 0.1 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during week 52.

Among 25,338 hospitalizations, 21,432 (84.6%) were associated with influenza A virus, 3,738 (14.8%) with influenza B virus, 53 (0.2%) with influenza A virus and influenza B virus co-infection, and 115 (0.5%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4,325 (67.5%) were A(H1N1) pdm09 and 2,082 (32.5%) were A(H3N2).



**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.
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 August 15, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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


Five influenza-associated pediatric deaths occurring during the 2023-2024 season were reported to CDC during Week 32. The deaths occurred between weeks 7 and 10 (the weeks ending February 17, 2024, and March 9, 2024) and during week 15 (the week ending April 13, 2024). All five 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 193 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 August 23, 2024
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Key Updates for Week 33, ending August 17, 2024

Seasonal influenza activity remains low nationally. Viruses


Clinical Lab 0.4%

(Trend )


positive for influenza
this week


Public Health Lab
Influenza A(H1N1)pdm09, A(H3N2), and B viruses were all co-circulating this week.

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


Outpatient Respiratory Illness 1.5%

(Trend )


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


Outpatient Respiratory Illness: Map
This week, no jurisdictions experienced moderate, high, or very high activity.

FluSurv-NET 0.1 per 100,000


weekly hospitalization rate.

NCHS Mortality 0.04%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 1


influenza-associated death was reported this week for a total of 194 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 low nationally.
  • One human infection with an influenza A(H1N1) variant virus was reported by the Ohio Department of Health and one human infection with an influenza A(H1N2) variant virus was reported by the Pennsylvania Department of Health.
  • CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.
  • There 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]1[/SUP]
  • Seasonal 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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. 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 tested37,5903,795,257
No. of positive specimens (%)147 (0.4%)350,952 (9.2%)
Positive specimens by type
Influenza A127 (86.4%)242,610 (69.1%)
Influenza B20 (13.6%)108,331 (30.9%)
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 tested992126,613
No. of positive specimens5339,403
Positive specimens by type/subtype
Influenza A52 (98.1%)30,216 (76.7%)
Subtyping performed on specimens46 (88.5%)25,568 (84.6%)
(H1N1)pdm0919 (41.3%)16,714 (65.4%)
H3N227 (58.7%)8,841 (34.6%)
H3N2v0 (0.0%)1 (<0.1%)
H5*0 (0.0%)12* (<0.1%)
Subtyping not performed6 (11.5%)4,648 (15.4%)
Influenza B1 (1.9%)9,187 (23.3%)
Lineage testing performed on specimens1 (100.0%)8,003 (87.1%)
Yamagata lineage0 (0.0%)0 (0.00%)
Victoria lineage1 (100.0%)8,003 (100.0%)
Lineage testing not performed0 (0.0%)1,184 (12.9%)
* This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the “How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation



This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Novel Influenza A Virus:


Two human infections with novel influenza A viruses were reported to CDC this week. One infection with an influenza A(H1N1) variant (A(H1N1)v) virus was reported by the Ohio Department of Health and one infection with an influenza A(H1N2)v was reported by the Pennsylvania Department of Health. Both patients are >18 years of age, and developed symptoms and sought healthcare during the week ending August 10, 2024 (Week 32). Both patients were briefly hospitalized due to underlying medical conditions and have since recovered. Investigation by Ohio public health officials found the Ohio patient had exposure to swine at an agricultural event prior to the patient’s illness onset. Investigation by Pennsylvania public health officials found the Pennsylvania patient had occupational exposure to swine. No symptoms were reported among close contacts of either case after the cases’ symptom onset, and no human-to-human transmission related to these cases has been identified.

No new human infections with highly pathogenic avian influenza A(H5N1) virus were reported during Week 33. An ongoing outbreak of H5N1 continues in domestic dairy cattle and poultry, and monitoring for additional cases is ongoing.

A total of seven variant influenza cases have been reported during the 2023-2024 season (four A(H1N2)v, two A(H3N2)v, and one A(H1N1)v). Thirteen cases of human infection with influenza A (H5) have been reported this season, for a total of 20 novel influenza A cases reported during the 2023-2024 season.

When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant” influenza virus. Most human infections with variant influenza viruses occur following exposure to swine, but human-to-human transmission can occur. It is important to note that in most cases, variant influenza viruses have not shown the ability to spread easily and sustainably from person to person.

Early identification and investigation of human infections with novel influenza A viruses are critical so that the risk of infection can be understood, and appropriate public health measures can be taken.

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses:

Surveillance Methods | FluView Interactive 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 5,295 influenza viruses collected since October 1, 2023.
A/H11,949
6B.1A.5a1,949 (100%)2a476 (24.4%)
2a.11,473 (75.6%)
A/H31,863
3C.2a1b.2a1,863 (100%)2a.1b1 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,860 (99.8%)
2b1 (0.1%)
B/Victoria1,483
V1A1,483 (100%)3a.21,483 (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: 561 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 560 (99.8%) 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): 647 A(H3N2) viruses were antigenically characterized by HI or HINT, and 613 (94.7%) 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: 427 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 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,2051,9231,8321,450
Reduced Inhibition1 (0.02%)1 (0.1%)0 (0.00%)0 (0.00%)
Highly Reduced Inhibition5 (0.1%)5 (0.3%)0 (0.00%)0 (0.00%)
PeramivirViruses Tested5,2051,9231,8321,450
Reduced Inhibition3 (0.1%)0 (0.00%)0 (0.00%)3 (0.2%)
Highly Reduced Inhibition6 (0.1%)5 (0.3%)0 (0.00%)1 (0.1%)
ZanamivirViruses Tested5,2051,9231,8321,450
Reduced Inhibition1 (0.02%)0 (0.00%)0 (0.00%)1 (0.1%)
Highly Reduced Inhibition0 (0.00%)0 (0.00%)0 (0.00%)0 (0.00%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,1191,8711,8101,438
Decreased Susceptibility1 (0.02%)0 (0.0%)1 (0.1%)0 (0.0%)
Four A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and is below the national baseline. All 10 regions are below 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 increased in the 5-24 years age group and remained stable for all other age groups in Week 33 compared to Week 32.

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 33
(Week ending
Aug. 17, 2024)
Week 32
(Week ending
Aug. 10, 2024)
Week 33
(Week ending
Aug. 17, 2024)
Week 32
(Week ending
Aug. 10, 2024)
Very High0000
High0032
Moderate0032
Low211914
Minimal5353643665
Insufficient Data01261246




*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 25,415 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and August 17, 2024. The weekly hospitalization rate observed in Week 33 was 0.1 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during Week 52.

Among 25,415 hospitalizations, 21,460 (84.4%) were associated with influenza A virus, 3,748 (14.7%) with influenza B virus, 55 (0.2%) with influenza A virus and influenza B virus co-infection, and 152 (0.6%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4,341 (67.5%) were A(H1N1) pdm09 and 2,093 (32.5%) were A(H3N2).



**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.
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 August 22, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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


One influenza-associated pediatric death occurring during the 2023-2024 season was reported to CDC during Week 33. The death was associated with an influenza A virus with no subtyping performed and occurred during Week 14 (the week ending April 6, 2024).

A total of 194 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 August 30, 2024
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Key Updates for Week 34, ending August 24, 2024

Seasonal influenza activity remains low nationally. Viruses


Clinical Lab 0.4%

(Trend )


positive for influenza
this week


Public Health Lab
Influenza A(H1N1)pdm09, A(H3N2), and B viruses were all co-circulating this week.

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


Outpatient Respiratory Illness 1.8%

(Trend )


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


Outpatient Respiratory Illness: Map
This week, no jurisdictions experienced moderate, high, or very high activity.

FluSurv-NET 0 per 100,000


weekly hospitalization rate.

NCHS Mortality 0.06%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 1


influenza-associated death was reported this week for a total of 195 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 low nationally.
  • CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.
  • There 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]1[/SUP]
  • Seasonal 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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. 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 tested41,5033,851,118
No. of positive specimens (%)147 (0.4%)351,189 (9.1%)
Positive specimens by type
Influenza A126 (85.7%)242,816 (69.1%)
Influenza B21 (14.3%)108,362 (30.9%)
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 tested991128,195
No. of positive specimens5539,552
Positive specimens by type/subtype
Influenza A53 (96.4%)30,359 (76.8%)
Subtyping performed on specimens47 (88.7%)25,696 (84.6%)
(H1N1)pdm0929 (61.7%)16,785 (65.3%)
H3N218 (38.3%)8,898 (34.6%)
H3N2v0 (0.0%)1 (<0.1%)
H5*0 (0.0%)12* (<0.1%)
Subtyping not performed6 (11.3%)4,663 (15.4%)
Influenza B2 (3.6%)9,193 (23.3%)
Lineage testing performed on specimens2 (100.0%)8,008 (87.1%)
Yamagata lineage0 (0.0%)0 (0.00%)
Victoria lineage2 (100.0%)8,008 (100.0%)
Lineage testing not performed0 (0.0%)1,185 (12.9%)
* This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the “How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation



This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Novel Influenza A Virus:


No new human infections with novel influenza A viruses were reported during Week 34.

During the 2023-2024 influenza season, a total of 13 cases of human infections with influenza A (H5) have been reported in the U.S. Four of these occurred in individuals working with dairy cows and nine in individuals associated with poultry depopulation and disposal. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional cases is ongoing.

Seven variant influenza cases were also reported during the 2023-2024 season (four A(H1N2)v, two A(H3N2)v, and one A(H1N1)v), for a total of 20 novel influenza A cases reported this season.

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

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

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

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses:

Surveillance Methods | FluView Interactive 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 5,329 influenza viruses collected since October 1, 2023.
A/H11,963
6B.1A.5a1,963 (100%)2a478 (24%)
2a.11,485 (76%)
A/H31,883
3C.2a1b.2a1,883 (100%)2a.1b1 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,880 (99.8%)
2b1 (0.1%)
B/Victoria1,483
V1A1,483 (100%)3a.21,483 (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: 574 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 573 (99.8%) 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): 647 A(H3N2) viruses were antigenically characterized by HI or HINT, and 613 (95%) 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: 436 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 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,2381,9361,8521,450
Reduced Inhibition1 (0.02%)1 (0.05%)0 (0.00%)0 (0.00%)
Highly Reduced Inhibition5 (0.10%)5 (0.3%)0 (0.00%)0 (0.00%)
PeramivirViruses Tested5,2381,9361,8521,450
Reduced Inhibition3 (0.1%)0 (0.00%)0 (0.00%)3 (0.2%)
Highly Reduced Inhibition6 (0.1%)5 (0.3%)0 (0.00%)1 (0.1%)
ZanamivirViruses Tested5,2381,9361,8521,450
Reduced Inhibition1 (0.02%)0 (0.00%)0 (0.00%)1 (0.1%)
Highly Reduced Inhibition0 (0.00%)0 (0.00%)0 (0.00%)0 (0.00%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,1461,8831,8291,434
Decreased Susceptibility1 (0.02%)0 (0.0%)1 (0.01%)0 (0.0%)
Four A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet increased (change of ≥ 0.1 percentage points) compared to the previous week and is below the national baseline. All 10 regions are below 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 increased in the 0-4 years and 5-24 years age groups and remained stable for all other age groups in Week 34 compared to Week 33

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 34
(Week ending
Aug. 24, 2024)
Week 33
(Week ending
Aug. 17, 2024)
Week 34
(Week ending
Aug. 24, 2024)
Week 33
(Week ending
Aug. 17, 2024)
Very High0010
High0023
Moderate0063
Low224619
Minimal5353630659
Insufficient Data00244245




*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 25,405 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and August 24, 2024. The weekly hospitalization rate observed in week 34 was 0.0 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during week 52.

Among 25,405 hospitalizations, 21,484 (84.6%) were associated with influenza A virus, 3,760 (14.8%) with influenza B virus, 56 (0.2%) with influenza A virus and influenza B virus co-infection, and 105 (0.4%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4,401 (67.6%) were A(H1N1) pdm09 and 2,111 (32.4%) were A(H3N2).



**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.
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 August 29, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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


One influenza-associated pediatric death occurring during the 2023-2024 season was reported to CDC during Week 34. The death was associated with an influenza A(H3) virus and occurred during Week 5 (the week ending February 3, 2024).

A total of 195 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 September 6, 2024
fluview-banner2.jpg

Key Updates for Week 35, ending August 31, 2024

Seasonal influenza activity remains low nationally. Viruses


Clinical Lab 0.4%

(Trend )


positive for influenza
this week


Public Health Lab
Influenza A(H1N1)pdm09 and A(H3N2) were co-circulating this week.

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


Outpatient Respiratory Illness 1.9%

(Trend )


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


Outpatient Respiratory Illness: Map
1 Moderate

0 High or Very High

FluSurv-NET 0 per 100,000


weekly hospitalization rate.

NCHS Mortality
No data this week.

Pediatric Deaths 2


influenza-associated deaths were reported this week for a total of 197 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 low nationally.
  • CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.
  • There 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]1[/SUP]
  • Seasonal 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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. 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 tested38,2953,910,204
No. of positive specimens (%)168 (0.4%)351,460 (9.0%)
Positive specimens by type
Influenza A136 (81.0%)243,048 (69.2%)
Influenza B32 (19.0%)108,401 (30.8%)
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 tested795129,638
No. of positive specimens5039,885
Positive specimens by type/subtype
Influenza A49 (98.0%)30,689 (76.9%)
Subtyping performed on specimens46 (93.9%)25,919 (84.5%)
(H1N1)pdm0917 (37.0%)16,875 (65.1%)
H3N229 (63.0%)9,031 (34.8%)
H3N2v0 (0.0%)1 (<0.1%)
H5*0 (0.0%)12* (<0.1%)
Subtyping not performed3 (6.1%)4,770 (15.5%)
Influenza B1 (2.0%)9,196 (23.1%)
Lineage testing performed on specimens1 (100.0%)8,010 (87.1%)
Yamagata lineage0 (0.0%)0 (0.00%)
Victoria lineage1 (100.0%)8,010 (100.0%)
Lineage testing not performed0 (0.0%)1,186 (12.9%)
* This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the “How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation



This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Novel Influenza A Virus:


No new human infections with novel influenza A viruses were reported during Week 35.

During the 2023-2024 influenza season, a total of 13 cases of human infections with influenza A (H5) virus have been reported in the United States. Four of these occurred in individuals working with dairy cows and nine in individuals associated with poultry depopulation and disposal. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional human cases is ongoing.

Seven variant influenza virus cases were also reported during the 2023-2024 season (four A(H1N2)v, two A(H3N2)v, and one A(H1N1)v virus), for a total of 20 novel influenza A virus cases reported this season.

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

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

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

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses:

Surveillance Methods | FluView Interactive 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 5,348 influenza viruses collected since October 1, 2023.
A/H11,971
6B.1A.5a1,971 (100%)2a480 (24.4%)
2a.11,491 (75.6%)
A/H31,894
3C.2a1b.2a1,894 (100%)2a.1b1 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,891 (99.8%)
2b1 (0.1%)
B/Victoria1,483
V1A1,483 (100%)3a.21,483 (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: 574 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 573 (99.8%) 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): 665 A(H3N2) viruses were antigenically characterized by HI or HINT, and 629 (94.6%) 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: 436 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 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,2561,9441,8621,450
Reduced Inhibition1 (0.02%)1 (0.1%)0 (0%)0 (0%)
Highly Reduced Inhibition5 (0.1%)5 (0.3%)0 (0%)0 (0%)
PeramivirViruses Tested5,2561,9441,8621,450
Reduced Inhibition3 (0.1%)0 (0%)0 (0%)3 (0.2%)
Highly Reduced Inhibition6 (0.1%)5 (0.3%)0 (0%)1 (0.1%)
ZanamivirViruses Tested5,2561,9441,8621,450
Reduced Inhibition1 (0.02%)0 (0%)0 (0%)1 (0.1%)
Highly Reduced Inhibition0 (0%)0 (0%)0 (0%)0 (0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,1701,8911,8411,438
Decreased Susceptibility1 (0.02%)0 (0%)1 (0.1%)0 (0%)
Four A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir.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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week but has been trending upward for the past two weeks and remains below the national baseline. All 10 regions are below 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 increased in the 0-4 years and 5-24 years age groups and remained stable for all other age groups in Week 35 compared to Week 34.

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 35
(Week ending
Aug. 31, 2024)
Week 34
(Week ending
Aug. 24, 2024)
Week 35
(Week ending
Aug. 31, 2024)
Week 34
(Week ending
Aug. 24, 2024)
Very High0011
High0042
Moderate1076
Low224247
Minimal5153612634
Insufficient Data10263239




*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 25,390 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and August 31, 2024. The weekly hospitalization rate observed in Week 35 was 0.0 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during Week 52.

Among 25,390 hospitalizations, 21,471 (84.6%) were associated with influenza A virus, 3,763 (14.8%) with influenza B virus, 56 (0.2%) with influenza A virus and influenza B virus co-infection, and 100 (0.4%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4406 (67.6%) were A(H1N1) pdm09 and 2,112 (32.4%) were A(H3N2).



**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.
Additional NHSN Hospitalization Surveillance information:
Surveillance Methods | Additional Data | FluView Interactive Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance


The NCHS mortality surveillance data were not available in time for inclusion in this week’s report.

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 35. One death was associated with an influenza A(H1N1) virus and occurred during Week 7 (the week ending February 17, 2024). The other death was associated with an influenza B virus with no lineage determined and occurred during Week 11 (the week ending March 16, 2024).

A total of 197 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 September 13, 2024
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Key Updates for Week 36, ending September 7, 2024

Seasonal influenza activity remains low nationally. Viruses


Clinical Lab 0.4%

(Trend )


positive for influenza
this week


Public Health Lab
Influenza A(H1N1)pdm09 and A(H3N2) were co-circulating this week.

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


Outpatient Respiratory Illness 1.9%

(Trend )


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


Outpatient Respiratory Illness: Map
1 Moderate

0 High or Very High

FluSurv-NET 0.1 per 100,000


weekly hospitalization rate.

NCHS Mortality 0.06%

(Trend )


of deaths attributed to influenza this week.

Pediatric Deaths 3


influenza-associated deaths were reported; 1 occurred during 2022-2023 season, and 2 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 remains low nationally.
  • One human infection with an influenza A(H5) virus was reported by the Missouri Department of Health and Senior Services.
  • CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.
  • There 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]1[/SUP]
  • Seasonal 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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. 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 tested42,0813,979,467
No. of positive specimens (%)179 (0.4%)351,928 (8.8%)
Positive specimens by type
Influenza A154 (86.0%)243,405 (69.2%)
Influenza B25 (14.0%)108,512 (30.8%)
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 tested926131,076
No. of positive specimens5840,099
Positive specimens by type/subtype
Influenza A57 (98.3%)30,882 (77.0%)
Subtyping performed on specimens50 (87.7%)26,086 (84.5%)
(H1N1)pdm0923 (46.0%)16,968 (65.0%)
H3N227 (54.0%)9,104 (34.9%)
H3N2v0 (0.0%)1 (<0.1%)
H5*0 (0.0%)13* (<0.1%)
Subtyping not performed7 (12.3%)4,796 (15.5%)
Influenza B1 (1.7%)9,217 (23.0%)
Lineage testing performed on specimens1 (100.0%)8,013 (86.9%)
Yamagata lineage0 (0.0%)0 (0.00%)
Victoria lineage1 (100.0%)8,013 (100.0%)
Lineage testing not performed0 (0.0%)1,204 (13.1%)
* This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the “How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation



This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.
Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data Novel Influenza A Virus:


One new human infection with a novel influenza A virus was reported by the Missouri Department of Health and Senior Services. The patient was infected with an influenza A(H5) virus.

The patient is >18 years and has multiple underlying medical conditions. The patient developed symptoms during the week ending August 24, 2024, was hospitalized, and has since recovered. A respiratory specimen collected from the patient tested positive for influenza A at the hospital. The specimen was then forwarded to the Missouri State Public Health Laboratory (MSPHL) with the Department of Health and Senior Services as part of routine influenza surveillance. CDC confirmed the infection was caused by an influenza A (H5) virus. A subsequent investigation by state and local public health officials did not find any known direct or indirect contact with wild birds, domestic poultry, cattle (including no consumption of raw dairy products), or other wildlife prior to the patient’s illness onset. One close contact of the patient was also ill at the same time, was not tested, and has since recovered.

During the 2023-2024 influenza season, a total of 14 cases of human infection with influenza A (H5) virus have been reported in the United States. Four of these occurred in individuals working with dairy cows, nine in individuals associated with poultry depopulation and disposal, and one in an individual with an unknown source of exposure. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional human cases is ongoing.

Seven variant influenza virus cases were also reported during the 2023-2024 season (four A(H1N2)v, two A(H3N2)v, and one A(H1N1)v virus), for a total of 20 novel influenza A virus cases reported this season.

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

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

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

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses:

Surveillance Methods | FluView Interactive 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 5,425 influenza viruses collected since October 1, 2023.
A/H12,004
6B.1A.5a2,004 (100%)2a504 (25%)
2a.11,500 (75%)
A/H31,935
3C.2a1b.2a1,935 (100%)2a.1b1 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,932 (99.8%)
2b1 (0.1%)
B/Victoria1,486
V1A1,486 (100%)3a.21,486 (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: 582 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 581 (99.8%) 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): 665 A(H3N2) viruses were antigenically characterized by HI or HINT, and 629 (95%) 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: 447 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 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,3301,9761,9011,453
Reduced Inhibition1 (0.02%)1 (0.1%)0 (0%)0 (0%)
Highly Reduced Inhibition6 (0.1%)6 (0.3%)0 (0%)0 (0%)
PeramivirViruses Tested5,3301,9761,9011,453
Reduced Inhibition3 (0.1%)0 (0%)0 (0%)3 (0.2%)
Highly Reduced Inhibition7 (0.1%)6 (0.3%)0 (0%)1 (0.1%)
ZanamivirViruses Tested5,3301,9761,9011,453
Reduced Inhibition1 (0.02%)0 (0%)0 (0%)1 (0.1%)
Highly Reduced Inhibition0 (0%)0 (0%)0 (0%)0 (0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,2391,9251,8731,441
Decreased Susceptibility1 (0.02%)0 (0%)1 (0.1%)0 (0%)
Five A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and remains below the national baseline. All 10 regions are below 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 remained stable in all age groups in Week 36 compared to Week 35.

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 36
(Week ending
Sep. 7, 2024)
Week 35
(Week ending
Aug. 31, 2024)
Week 36
(Week ending
Sep. 7, 2024)
Week 35
(Week ending
Aug. 31, 2024)
Very High0001
High0024
Moderate1087
Low033642
Minimal5451618620
Insufficient Data01265255




*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 25,423 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and September 7, 2024. The weekly hospitalization rate observed in week 36 was 0.1 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during week 52.

Among 25,423 hospitalizations, 21,506 (84.6%) were associated with influenza A virus, 3,768 (14.8%) with influenza B virus, 56 (0.2%) with influenza A virus and influenza B virus co-infection, and 93 (0.4%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4431 (67.6%) were A(H1N1) pdm09 and 2,119 (32.3%) were A(H3N2).



**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.
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 September 12, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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


Three influenza-associated pediatric deaths were reported to CDC during Week 36.

Two deaths occurred during the 2023-2024 season, bringing the total pediatric deaths for this season to 199. One of the deaths was associated with an influenza B virus with no lineage determined and occurred during week 13 (the week ending March 30, 2024). The other death was associated with an influenza A(H1N1) virus and occurred during week 33 (the week ending August 17, 2024).

One death occurring during the 2022-2023 season was also reported, which brings the total number of pediatric deaths for last season to 187. The death was associated with an influenza A virus for which subtyping was not performed and occurred during week 27 of 2023 (the week ending July 8, 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.
https://www.cdc.gov/flu/weekly/index.htm
 
Weekly US Influenza Surveillance Report: Key Updates for Week 36, ending September 6, 2024

What to know


Seasonal influenza activity remains low nationally.
Summary

Viruses

Clinical Lab 0.4% (Trend
StableArrow.png
)
positive for influenza
this week Public Health Lab Influenza A(H1N1)pdm09 and
A(H3N2) were co-circulating this week.

Illness

Outpatient Respiratory Illness

1.9% (Trend
StableArrow.png
)
of visits to a health care provider this
week were for respiratory illness
(below baseline).

Activity Map

1 moderate jurisdiction
0 high or very high jurisdictions

FluSurv-NET

0.1 per 100,000
weekly hospitalization rate.

NCHS Mortality

0.06% (Trend
StableArrow.png
)
of deaths attributed to influenza this week.

Pediatric Deaths

3 influenza-associated deaths
were reported this week for a
total of 197 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.1

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.







• One human infection with an influenza A(H5) virus was reported by the Missouri Department of Health and Senior Services.







• CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.







•There 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.1





•Seasonal 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.


COVID-19, flu, and RSV activity

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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive.

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 tested42,0813,979,467
No. of positive specimens (%)179 (0.4%)351,928 (8.8%)
Positive specimens by type
Influenza A154 (86.0%)243,405 (69.2%)
Influenza B25 (14.0%)108,512 (30.8%)
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 tested926131,076
No. of positive specimens5840,099
Positive specimens by type/subtype
Influenza A57 (98.3%)30,882 (77.0%)
Subtyping Performed50 (87.7%)26,086 (84.5%)
(H1N1)pdm0923 (46.0%)16,968 (65.0%)
H3N227 (54.0%)9,104 (34.9%)
H3N2v0 (0.0%)1 (<0.1%)
H5*0 (0.0%)13* (<0.1%)
Subtyping not performed7 (12.3%)4,796 (15.5%)
Influenza B1 (1.7%)9,217 (23.0%)
Lineage testing performed1 (100.0%)8,013 (86.9%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage1 (100.0%)8,013 (100.0%)
Lineage not performed0 (0.0%)1,204 (13.1%)
[SUB]*This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the "How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation"[/SUB]



[SUB]This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.[/SUB]


Additional virologic surveillance information for current and past seasons:‎

Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data


Novel Influenza A Virus


No new human infections of influenza A have been reported during Week 30.

One new human infection with a novel influenza A virus was reported by the Missouri Department of Health and Senior Services. The patient was infected with an influenza A(H5) virus.

The patient is >18 years and has multiple underlying medical conditions. The patient developed symptoms during the week ending August 24, 2024, was hospitalized, and has since recovered. A respiratory specimen collected from the patient tested positive for influenza A at the hospital. The specimen was then forwarded to the Missouri State Public Health Laboratory (MSPHL) with the Department of Health and Senior Services as part of routine influenza surveillance. CDC confirmed the infection was caused by an influenza A (H5) virus. A subsequent investigation by state and local public health officials did not find any known direct or indirect contact with wild birds, domestic poultry, cattle (including no consumption of raw dairy products), or other wildlife prior to the patient's illness onset. One close contact of the patient was also ill at the same time, was not tested, and has since recovered.

During the 2023-2024 influenza season, a total of 14 cases of human infection with influenza A (H5) virus have been reported in the United States. Four of these occurred in individuals working with dairy cows, nine in individuals associated with poultry depopulation and disposal, and one in an individual with an unknown source of exposure. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional human cases is ongoing.

Seven variant influenza virus cases were also reported during the 2023-2024 season (four A(H1N2)v, two A(H3N2)v, and one A(H1N1)v virus), for a total of 20 novel influenza A virus cases reported this season.
Highly Pathogenic Avian Influenza A(H5N1) Virus in Animals: Interim Recommendations for Prevention, Monitoring, and Public Health Investigations
Bird Flu
The latest case reports on avian influenza outbreaks in wild birds, commercial poultry, backyard or hobbyist flocks, and mammals in the United States are available from the USDA
Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at Swine Flu.

Additional information regarding human infections with novel influenza A viruses:‎

Surveillance Methods | FluView Interactive
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 5,348 influenza viruses collected since October 1, 2023.
A/H12,004
6B.1A.5a2,004 (100%)2a504 (25%)
2a.11,500 (75%)
A/H31,775
3C.2a1b.2a1,935 (100%)2a.1b1 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,932 (99.8%)
2b1 (0.1%)
B/Victoria1,462
V1A1,486 (100%)3a.21,486 (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: 582 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 581 (99.8%) 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): 665 A(H3N2) viruses were antigenically characterized by HI or HINT, and 629 (95%) 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: 447 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.

Viruses collected in the U.S. since October 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,3301,9761,9011,453
Reduced Inhibition1 (0.02%)1 (0.1%)0 (0%)0 (0%)
Highly Reduced Inhibition6 (0.1%)6 (0.3%)0 (0%)0 (0%)
PeramivirViruses Tested5,3301,9761,9011,453
Reduced Inhibition3 (0.1%)0 (0%)0 (0%)3 (0.2%)
Highly Reduced Inhibition7 (0.1%)6 (0.3%)0 (0%)1 (0.1%)
ZanamivirViruses Tested5,3301,9761,9011,453
Reduced Inhibition1 (0.02%)0 (0%)0 (0%)1 (0.1%)
Highly Reduced Inhibition0 (0%)0 (0%)0 (0%)0 (0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,2391,9251,8731,441
Decreased Susceptibility1 (0.02%)0 (0%)1 (0.1%)0 (0%)
Five A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and remains below the national baseline. All 10 regions are below 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 remained stable in all age groups in Week 36 compared to Week 35.

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 36
(Week ending
Sep. 7, 2024)
Week 35
(Week ending
Aug. 31, 2024)
Week 36
(Week ending
Sep. 7, 2024)
Week 35
(Week ending
Aug. 31, 2024)
Very High0001
High0024
Moderate1087
Low033642
Minimal5451681620
Insufficient Data01265255

*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 25,423 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and September 7, 2024. The weekly hospitalization rate observed in week 36 was 0.1 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during week 52.

Among 25,423 hospitalizations, 21,506 (84.6%) were associated with influenza A virus, 3,768 (14.8%) with influenza B virus, 56 (0.2%) with influenza A virus and influenza B virus co-infection, and 93 (0.4%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4431 (67.6%) were A(H1N1) pdm09 and 2,119 (32.3%) were A(H3N2).



[SUB]**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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.[/SUB]

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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.

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 September 12, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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


Three influenza-associated pediatric deaths were reported to CDC during Week 36.

Two deaths occurred during the 2023-2024 season, bringing the total pediatric deaths for this season to 199. One of the deaths was associated with an influenza B virus with no lineage determined and occurred during week 13 (the week ending March 30, 2024). The other death was associated with an influenza A(H1N1) virus and occurred during week 33 (the week ending August 17, 2024).

One death occurring during the 2022-2023 season was also reported, which brings the total number of pediatric deaths for last season to 187. The death was associated with an influenza A virus for which subtyping was not performed and occurred during week 27 of 2023 (the week ending July 8, 2023).

Additional pediatric mortality surveillance information for current and past seasons:‎

Surveillance Methods | FluView Interactive

https://www.cdc.gov/fluview/surveillance/2024-week-36.html
 
Weekly US Influenza Surveillance Report: Key Updates for Week 38, ending September 21, 2024


Seasonal influenza activity remains low nationally.
Summary

Viruses

Clinical Lab 0.6% (Trend
StableArrow.png
)
positive for influenza
this week Public Health Lab Influenza A(H1N1)pdm09 and
A(H3N2) were co-circulating this week. Illness

Outpatient Respiratory Illness

1.9% (Trend
StableArrow.png
)
of visits to a health care provider this
week were for respiratory illness
(below baseline). Activity Map

1 moderate jurisdiction

FluSurv-NET

0 per 100,000
weekly hospitalization rate.

NCHS Mortality

0.08% (Trend
StableArrow.png
)
of deaths attributed to influenza this week.

Pediatric Deaths

1 influenza-associated death
was reported this week for a total of 200 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.1

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.

• CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 21,000 deaths from flu so far this season.

• There 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]1[/SUP]

• CDC recommends that everyone ages 6 months and older get an annual flu vaccine, ideally by the end of October.[SUP]2[/SUP]

• Seasonal 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.


COVID-19, flu, and RSV activity

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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive.

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 tested46,9094,101,482
No. of positive specimens (%)267 (0.1%)352,669 (8.6%)
Positive specimens by type
Influenza A232 (86.9%)244,062 (69.2%)
Influenza B35 (13.1%)108,596 (30.8%)


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 tested971134,007
No. of positive specimens8340,419
Positive specimens by type/subtype
Influenza A82 (98.8%)31,163 (77.1%)
Subtyping Performed71 (86.6%)26,365 (84.6%)
(H1N1)pdm0938 (53.5%)17,121 (64.9%)
H3N233 (46.5%)9,228 (35.0%)
H3N2v03 (<0.1%)
H5*013* (<0.1%)
Subtyping not performed11 (13.4%)4,798 (15.4%)
Influenza B1 (1.2%)9,256 (22.9%)
Lineage testing performed1 (100.0%)8,052 (87.0%)
Yamagata lineage00
Victoria lineage1 (100.0%)8,052 (100.0%)
Lineage not performed01,204 (13.0%)
[SUB]*This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the [/SUB][SUB]"How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation"[/SUB]

[SUB]This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.[/SUB]

Additional virologic surveillance information for current and past seasons:‎

Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data

Novel Influenza A Virus

No new human infections with novel influenza A viruses were reported during Week 38.

Fourteen cases of human infection with influenza A (H5) virus have also been reported in the United States during the 2023-2024 season, for a total of 23 novel influenza A virus cases reported this season. Four of these influenza A (H5) virus infections occurred in individuals working with dairy cows, nine in individuals associated with poultry depopulation and disposal, and one in an individual with an unknown source of exposure. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional human cases is ongoing.

Nine variant influenza virus cases have been reported during the 2023-2024 season (four A(H1N2)v, four A(H3N2)v, and one A(H1N1)v virus).

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

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

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

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses:‎

Surveillance Methods | FluView Interactive


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 5,480 influenza viruses collected since October 1, 2023.
A/H12,021
6B.1A.5a2,021 (100.0%)2a515 (25.5%)
2a.11,506 (74.5%)
A/H31,970
3C.2a1b.2a1,970 (100.0%)2a.1b1 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,967 (99.8%)
2b1 (0.1%)
B/Victoria1,489
V1A1,489 (100.0%)3a.21,489 (100.0%)
B/Yamagata0
Y30Y30
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: 593 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 592 (99.8%) 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): 694 A(H3N2) viruses were antigenically characterized by HI or HINT, and 657 (94.7%) 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: 454 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.

Viruses collected in the U.S. since October 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,3851,9941,9361,455
Reduced Inhibition1 (0.02%)1 (0.05%)00
Highly Reduced Inhibition6 (0.1%)6 (0.3%)00
PeramivirViruses Tested5,3851,9941,9361,455
Reduced Inhibition3 (0.1%)003 (0.2%)
Highly Reduced Inhibition7 (0.1%)6 (0.3%)01 (0.1%)
ZanamivirViruses Tested5,3851,9941,9361,455
Reduced Inhibition1 (0.02%)001 (0.1%)
Highly Reduced Inhibition0000
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,2841,9411,9071,436
Decreased Susceptibility1 (0.02%)01 (0.1%)0
Five A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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 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

Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and remains below the national baseline. All 10 regions are below 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 increased in the 0-4 years age group and remained stable in all other age groups in Week 38 compared to Week 37.

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 38
(Week ending
Sep. 21, 2024)
Week 37
(Week ending
Sep. 14, 2024)
Week 38
(Week ending
Sep. 21, 2024)
Week 37
(Week ending
Sep. 14, 2024)
Very High0000
High0013
Moderate1155
Low013741
Minimal5353636623
Insufficient Data10250257


*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 25,423 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and September 21, 2024. The weekly hospitalization rate observed in week 38 was 0.0 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during week 52.

Among 25,423 hospitalizations, 21,520 (84.6%) were associated with influenza A virus, 3,772 (14.8%) with influenza B virus, 55 (0.2%) with influenza A virus and influenza B virus co-infection, and 76 (0.3%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4,485 (67.6%) were A(H1N1) pdm09 and 2,151 (32.4%) were A(H3N2).

[SUB]**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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.[/SUB]

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

Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.

Additional NHSN Hospitalization Surveillance information:‎

Surveillance Methods | Additional Data | FluView Interactive


Mortality surveillance

Based on NCHS mortality surveillance data available on September 26, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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

One influenza-associated pediatric death occurring during the 2023-2024 season was reported to CDC during week 38. The death was associated with an influenza A virus for which subtyping was not performed and occurred during Week 31 (the week ending August 3, 2024).

A total of 200 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
 
Weekly US Influenza Surveillance Report: Key Updates for Week 39, ending September 28, 2024

What to know


Seasonal influenza activity remains low nationally.

Summary

Viruses

Clinical Lab 0.5% (Trend
StableArrow.png
)
positive for influenza
this week Public Health Lab Influenza A(H1N1)pdm09 and
A(H3N2) were co-circulating this week.

Illness

Outpatient Respiratory Illness

1.9% (Trend
StableArrow.png
)
of visits to a health care provider this
week were for respiratory illness
(below baseline).

Activity Map

0 moderate, high, or very high jursidictions

FluSurv-NET

0.1 per 100,000
weekly hospitalization rate.

NCHS Mortality

0.07% (Trend
StableArrow.png
)
of deaths attributed to influenza this week.

Pediatric Deaths

1 influenza-associated death
was reported this week for a total of 201 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.1

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.
• Two human infections with an influenza A(H5) virus were reported by the California Department of Public Health.
• There 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]1[/SUP]
• CDC recommends that everyone ages 6 months and older get an annual flu vaccine, ideally by the end of October.[SUP]2[/SUP]
• Seasonal 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.


COVID-19, flu, and RSV activity


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. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive.

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 tested41,0574,163,943
No. of positive specimens (%)223 (0.5%)352,980 (8.5%)
Positive specimens by type
Influenza A174 (78.0%)244,318 (69.2%)
Influenza B49 (22.0%)108,651 (30.8%)


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 tested880135,556
No. of positive specimens6840,874
Positive specimens by type/subtype
Influenza A65 (95.6%)31,580 (77.3%)
Subtyping Performed54 (83.1%)26,774 (84.8%)
(H1N1)pdm0939 (72.2%)17,284 (64.6%)
H3N215 (27.8%)9,474 (35.4%)
H3N2v0 (0.0%)3 (<0.1%)
H5*0 (0.0%)13 (<0.1%)
Subtyping not performed11 (16.9%)4,806 (15.2%)
Influenza B3 (4.4%)9,294 (22.7%)
Lineage testing performed3 (100.0%)8,089 (87.0%)
Yamagata lineage0 (0.0%)0 (0.0%)
Victoria lineage3 (100.0%)8,089 (100%)
Lineage not performed0 (0.0%)1,205 (13.0%)
[SUB]*This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the [/SUB][SUB]"How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation"[/SUB]


[SUB]This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.[/SUB]


Additional virologic surveillance information for current and past seasons:‎

Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data

Novel Influenza A Virus


Two human infections with an influenza A(H5) virus were reported to CDC this week by the California Department of Public Health. These cases are associated with the ongoing outbreak of HPAI A(H5N1) virus in dairy cows.

Both individuals are aged >18 years and work at commercial dairy cattle farms where highly pathogenic avian influenza (HPAI) A(H5N1) virus had been detected in cows. These individuals work on different farms and there is no known link or contact between them. These individuals had mild symptoms which they reported to the local health department. Specimens were collected from both persons and were initially tested at the local public health laboratory using the Centers for Disease Control and Prevention (CDC) influenza A(H5) assay before being sent to CDC for further testing. Specimens from both individuals were positive for influenza A(H5) virus using diagnostic rRT-PCR at CDC. Additional analysis including genetic sequencing is underway.

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

During the 2023-2024 influenza season, a total of 16 cases of human infections with influenza A(H5) virus have been reported in the United States. Six of these occurred in individuals working with dairy cows, nine in individuals associated with poultry depopulation and disposal, and one in an individual with an unknown source of exposure. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional human cases is ongoing.

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

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

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

Additional information regarding human infections with novel

influenza A viruses:‎


Surveillance Methods | FluView Interactive


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 5,522 influenza viruses collected since October 1, 2023.
A/H12,034
6B.1A.5a2,034 (100%)2a523 (25.7%)
2a.11,511 (74.3%)
A/H31,993
3C.2a1b.2a1,993 (100%)2a.1b2 (0.1%)
2a.3a1 (0.1%)
2a.3a.11,989 (99.8%)
2b1 (0.1%)
B/Victoria1,495
V1A1,495 (100%)3a.21,495 (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: 593 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 592 (99.8%) 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): 711 A(H3N2) viruses were antigenically characterized by HI or HINT, and 674 (94.8%) 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: 454 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.

Viruses collected in the U.S. since October 1, 2023, were tested for antiviral susceptibility as follows:
Neuraminidase InhibitorsOseltamivirViruses Tested5,4282,0071,9601,461
Reduced Inhibition1 (0.02%)1 (0.1%)0 (0%)0 (0%)
Highly Reduced Inhibition6 (0.1%)6 (0.3%)0 (0%)0 (0%)
PeramivirViruses Tested5,4282,0071,9601,461
Reduced Inhibition3 (0.1%)0 (0%)0 (0%)3 (0.2%)
Highly Reduced Inhibition7 (0.1%)6 (0.3%)0 (0%)1 (0.1%)
ZanamivirViruses Tested5,4282,0071,9601,461
Reduced Inhibition1 (0.02%)0 (0%)0 (0%)1 (0.1%)
Highly Reduced Inhibition0 (0%)0 (0%)0 (0%)0 (0%)
PA Cap-Dependent Endonuclease InhibitorBaloxavirViruses Tested5,3241,9511,9311,442
Decreased Susceptibility1 (0.02%)0 (0%)1 (0.05%)0 (0%)
Five A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring 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. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. 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 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


Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and is below the national baseline. All 10 regions are below 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 remained stable in all age groups in Week 39 compared to Week 38.

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 39
(Week ending
Sep. 28, 2024)
Week 38
(Week ending
Sep. 21, 2024)
Week 39
(Week ending
Sep. 28, 2024)
Week 38
(Week ending
Sep. 21, 2024)
Very High0000
High0021
Moderate0126
Low102839
Minimal5354614637
Insufficient Data10283246


*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 25,456 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and September 28, 2024. The weekly hospitalization rate observed in Week 39 was 0.1 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during Week 52.

Among 25,456 hospitalizations, 21,547 (84.6%) were associated with influenza A virus, 3,778 (14.8%) with influenza B virus, 55 (0.2%) with influenza A virus and influenza B virus co-infection, and 76 (0.3%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4,508 (67.5%) were A(H1N1) pdm09 and 2,175 (32.5%) were A(H3N2).


[SUB]**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 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.[/SUB]

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


Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.

Additional NHSN Hospitalization Surveillance information:‎

Surveillance Methods | Additional Data | FluView Interactive


Mortality surveillance


Based on NCHS mortality surveillance data available on October 3, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. 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


One influenza-associated pediatric death occurring during the 2023-2024 season was reported to CDC during Week 39. The death was associated with an influenza A virus for which subtyping was not performed and occurred during Week 42 of 2023 (the week ending October 21, 2023).

A total of 201 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

https://www.cdc.gov/fluview/surveillance/2024-week-39.html
 
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