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Weekly Report: Influenza Summary Update
Week ending February 12, 2005-Week 6
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The following information may be quoted:
Synopsis:
During week 6 (February 6-12, 2005)*, influenza activity continued to increase in the United States. Nine hundred twelve (25.3%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza viruses. The proportion of patient visits to sentinel providers for influenza-like illness (ILI) has been above the national baseline for 5 consecutive weeks. The proportion of deaths attributed to pneumonia and influenza is below the epidemic threshold. There have been six influenza-associated pediatric deaths reported to CDC this season. Twenty-nine states reported widespread influenza activity, 19 states and New York City reported regional influenza activity, and 2 states and the District of Columbia reported local activity.
Laboratory Surveillance*:
During week 6, WHO and NREVSS laboratories in the United States reported testing 3,610 specimens for influenza viruses, of which 912 (25.3%) were positive. Of these, 180 were influenza A (H3N2) viruses, 603 were influenza A viruses that were not subtyped, and 129 were influenza B viruses.Since October 3, WHO and NREVSS laboratories in the United States have tested a total of 73,412 specimens for influenza viruses and 9,361 (12.8%) were positive. Among the 9,361 influenza viruses, 7,953 (85.0%) were influenza A viruses and 1,408 (15.0%) were influenza B viruses. Two thousand five hundred thirty (31.8%) of the 7,953 influenza A viruses have been subtyped; 2,522 (99.7%) were influenza A (H3N2) and 8 (0.3%) were influenza A (H1N1) viruses. The percentage of specimens testing positive during the last 3 weeks has ranged from 9.6% in the Pacific region to 38.0% in the East North Central region**. The percentage of total isolates that are influenza type A virus is the highest in the New England (96%) and Mid-Atlantic (96%) regions. Influenza A viruses represent a smaller proportion of positive results in the other seven regions, ranging from 87% in the East South Central and East North Central regions to 63% in the Pacific region.
Antigenic Characterization:
CDC has antigenically characterized 313 influenza viruses collected by U.S. laboratories since October 1, 2004: 2 influenza A (H1) viruses, 228 influenza A (H3N2) viruses, and 83 influenza B viruses. The hemagglutinin proteins of the influenza A (H1) viruses were similar antigenically to the hemagglutinin of the vaccine strain A/New Caledonia/20/99. One hundred twenty-five (55%) of the 228 influenza A(H3N2) isolates were characterized as antigenically similar to A/Wyoming/3/2003, which is the A/Fujian/411/2002-like (H3N2) component of the 2004-05 influenza vaccine. One hundred three (45%) influenza A(H3N2) isolates had reduced titers to A/Wyoming/3/2003 and are most closely related to a recent reference strain, A/California/7/2004 (H3N2). Sixty-one of the influenza B viruses isolated this season belong to the B/Yamagata lineage and were characterized as B/Shanghai/361/2002-like, which is the influenza B component recommended for the 2004-05 influenza vaccine, and 5 showed somewhat reduced titers to ferret antisera produced against B/Shanghai/361/2002. Seventeen influenza B viruses belong to the B/Victoria lineage.
Influenza B viruses currently circulating can be divided into two antigenically and genetically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. B/Yamagata lineage viruses circulated widely between 1990 and 2001, during which time B/Victoria-like viruses were not identified outside of Asia. However, between March 2001 and October 2003, B/Victoria-like viruses predominated in many countries, including the United States, and the vaccine strains were changed accordingly. While both Victoria lineage and Yamagata lineage viruses have been reported worldwide during the past year, Yamagata lineage viruses have once again become predominant.
Pneumonia and Influenza (P&I) Mortality Surveillance*:
During week 6, 8.0% of all deaths reported by the vital statistics offices of 122 U.S. cities were attributed to pneumonia or influenza. This percentage is below the epidemic threshold of 8.2% for week 6.
Influenza-Associated Pediatric Mortality*:
During week 6, there were no pediatric deaths reported to CDC. Six pediatric deaths have been reported to CDC from 6 states (California, Maine, Massachusetts, Mississippi, Ohio, and Vermont) this season.
Influenza-Associated Pediatric Hospitalizations:
Laboratory-confirmed influenza-associated pediatric hospitalizations are monitored in two population-based surveillance networks?/sup>: the Emerging Infections Program (EIP) and the New Vaccine Surveillance Network (NVSN). During October 3, 2004朏ebruary 5, 2005, the preliminary influenza-associated hospitalization rate for children 0? years old reported by the NVSN and EIP was 2.0 and 0.81 per 10,000, respectively. The EIP also monitors hospitalizations in children 5-17 years and the preliminary influenza-associated hospitalization rate for this age group was 0.11 per 10,000. The overall hospitalization rate reported by the EIP for children aged 0-17 years was 0.35 per 10,000. In years 2000?004, the end-of-season hospitalization rate for the NVSN ranged from 3.7(2002-2003) to 12 (2003-2004) per 10,000 children. The 2003-04 end of season hospitalization rate for the EIP was 7.8 per 10,000 children 0-4 years and 0.8 per 10,000 for children 5-17 years. The difference in rates between the NVSN and EIP may be due to different case-finding methods and the different populations monitored. For a summary of the methods used in each system, please refer to the surveillance methods in the Flu Activity section of the CDC Influenza website.
Influenza-like Illness Surveillance*:
During week 6, 5.4%唵 of patient visits to U.S. sentinel providers were due to ILI. This percentage has been above the national baseline of 2.5% for 5 consecutive weeks. The percentage of visits for ILI ranged from 2.4% in the New England region to 9.4% in the West South Central region. Due to wide variability in regional level data, it is not appropriate to apply the national baseline to regional level data.
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Influenza Activity as Assessed by State and Territorial Epidemiologists*:
During week 6, 29 states (Colorado, Connecticut, Delaware, Georgia, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin) reported widespread activity. Nineteen states (Alaska, Arizona, Arkansas, California, Florida, Hawaii, Idaho, Illinois, Indiana, Maine, Montana, Nevada, New Hampshire, Oklahoma, Oregon, South Carolina, South Dakota, West Virginia, and Wyoming) and New York City reported regional influenza activity. Alabama, Ohio, and the District of Columbia reported local activity.
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Report prepared: February 17, 2005
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