According to this week’s FluView report from the Centers for Disease Control and Prevention (CDC), flu activity continues to decline and is below national baseline levels. However three of 10 U.S. regions continue to experience flu-like illness above their regional baselines, including the northeast of the country. Influenza B viruses now account for 87% of all influenza viruses reported.
For the week ending April 11, the proportion of people seeing their health care provider for influenza-like illness (ILI) was 1.8%, which is below the national baseline of 2.0%. ILI was above or at baseline for 20 weeks this season. For the past 13 seasons ILI has remained at or above the national baseline for between one and 19 weeks each season.
No states experienced high ILI activity or moderate ILI activity this week. Puerto Rico and six states (Connecticut, Hawaii, Illinois, Oklahoma, Texas, and Vermont) experienced low ILI activity. New York City and 44 states experienced minimal ILI activity and the District of Columbia did not have sufficient data to calculate an activity level. ILI activity data indicate the amount of flu-like illness that is occurring in each state.
Widespread influenza activity was reported by three states (Connecticut, Massachusetts, and New York); a decrease from four states during the previous week. Guam and 14 states reported regional geographic influenza activity. Local flu activity was reported by the District of Columbia and 19 states. Sporadic flu activity was reported by the U.S. Virgin Islands, Puerto Rico and 14 states. Geographic spread data show how many areas within a state or territory are seeing flu activity.
A total of 17,065 laboratory-confirmed influenza-associated hospitalizations have been reported through the Influenza Hospitalization Surveillance Network (FluSurv-NET) since October 1, 2014. This translates to a cumulative overall rate of 62.4 hospitalizations per 100,000 population. This is higher than the cumulative overall hospitalization rate during 2012-2013, which was 43.9 per 100,000 people. The hospitalization rate in people 65 years and older is 308.0 per 100,000, which is the highest hospitalization rate recorded since data collection on laboratory-confirmed influenza-associated hospitalization in adults began during the 2005-2006 season. This is the highest rate of any age group. Last week, the hospitalization rate in people 65 years and older was 301.8 per 100,000. Previously, the highest recorded hospitalization rate was 183.2 per 100,000, which was the cumulative hospitalization rate for people 65 years and older for the 2012-2013 season. (The 2012-2013 season was the last H3N2-predominant season.) The hospitalization rate for children 0-4 years is 54.4 per 100,000 population. During the 2012-2013 season, the hospitalization rate for that age group during the same week was 65.4 hospitalizations per 100,000 population and was 67.0 per 100,000 cumulatively that season. Hospitalization data are collected from 13 states and represent approximately 9% of the total U.S. population. The number of hospitalizations reported does not reflect the actual total number of influenza-associated hospitalizations in the United States.
The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Mortality Reporting System decreased again this week to 6.1%. This is below the epidemic threshold of 7.0%. P & I was above the epidemic threshold for 12 consecutive weeks this season. Last week, P&I associated deaths was 6.5%. The highest P&I this season was 9.3% and occurred during week 2. During 2012-2013, P&I peaked at 9.9%. This is comparable to recorded percentages for past severe seasons, including the 2003-2004 season when P&I reached 10.4%.
No influenza-associated pediatric deaths were reported to CDC during the week ending April 11. A total of 125 influenza-associated pediatric deaths have been reported for the 2014-2015 season at this time.
Nationally, the percentage of respiratory specimens testing positive for influenza viruses in the United States during the week ending April 11 slightly decreased from 10.7% to 9.6%. For the most recent three weeks, the regional percentage of respiratory specimens testing positive for influenza viruses ranged from 5.8% to 17.7%.
Influenza A (H3N2) viruses have predominated overall during the 2014-2015 flu season, accounting for more than 99% of all subtyped influenza A viruses. However influenza B viruses have accounted for the largest proportion of circulating viruses since early March. During week 14, 87% of all influenza positive specimens reported were influenza B viruses, and influenza B viruses predominated in all 10 regions. It is not uncommon for there to be a second wave of flu activity toward the end of the flu season with another seasonal influenza virus. Influenza A (H1N1) pdm09 viruses have been detected rarely this season.
CDC has antigenically or genetically characterized 1,600 influenza viruses, including 39 influenza A (H1N1)pdm09, 1,102 influenza A (H3N2) viruses and 459 influenza B viruses, collected in the United States since October 1, 2014. All 39 influenza A (H1N1)pdm09 viruses tested were characterized as A/California/7/2009-like. This is the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere quadrivalent and trivalent influenza vaccine. 243 (22.1%) of the 1,102 influenza A (H3N2) viruses tested have been characterized as A/Texas/50/2012-like. This is the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere quadrivalent and trivalent influenza vaccine. The remaining 859 (77.9%) influenza A (H3N2) viruses tested were different from A/Texas/50/2012. The majority of these 859 influenza A (H3N2) viruses were antigenically similar to A/Switzerland/9715293/2013, the influenza A (H3N2) component of the 2015 Southern Hemisphere influenza vaccine and 2015-2016 Northern Hemisphere influenza vaccine. 321 (96.7%) of the 332 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Eleven (3.3%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012. 122 (96.1%) of the 127 other influenza B viruses belonged to the B/Victoria lineage of viruses, and were characterized as B/Brisbane/60/2008-like. This is the recommended influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Five (3.9%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.
Since October 1, 2014, CDC has tested 47 influenza A (H1N1)pdm09, 2,709 influenza A (H3N2), and 512 influenza B viruses for resistance to neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir). While the vast majority of the viruses that have been tested are sensitive to oseltamivir, zanamivir, and peramivir, so far this season, one influenza A (H1N1)pdm09 virus showed resistance to oseltamivir and peramivir. (Because H1N1 viruses have been so rare this season, one virus accounts for 2.1% of the H1N1 viruses analyzed for antiviral resistance this season.) Previously, the neuraminidase inhibitors oseltamivir and zanamivir were the only recommended influenza antiviral drugs. On December 19, 2014, the Food and Drug Administration approved Rapivab (peramivir) to treat influenza infection in adults. As in recent past seasons, high levels of resistance to the adamantanes (amantadine and rimantadine) continue to persist among influenza A (H1N1)pdm09 and influenza A (H3N2) viruses. Adamantanes are not effective against influenza B viruses.