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    Infectious Disease Control Unit
    Mail Code: 1960
    PO BOX 149347 - Austin, TX 78714-9347
    1100 West 49th Street, Suite T801
    Austin, TX 78714

    Phone: 512 776 7676
    Fax: (512) 776-7616


    E-mail

Surveillance

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image1 Influenza
(Flu)
ICD-9 487; ICD-10 J10,11
Related Topics: Protecting Yourself During the Cold and Flu Season, Avian Flu, Vaccine Preventable Diseases, Asthma and SARS

2008 - 2009 Texas Influenza Surveillance Information

Influenza Surveillance Report for MMWR Week 31

The influenza (flu) activity level for Texas for the week ending August 8, 2009 was “local.” For definitions of flu activity levels please see http://www.cdc.gov/flu/weekly/fluactivity.htm. During week 31, 120 (11.8%) specimens tested by NREVSS laboratories in Texas were positive for influenza. The percentage of visits for influenza-like illness as reported by ILINet providers in Texas was below the regional baseline.

Reports from Health Service Regions

Reports were received from all Health Service Regions (HSRs) for week 31. HSR 2/3 reported an increased level of flu activity compared to week 30. HSRs 6/5S, 7, 8, 9/10, and 11 reported the same level of flu activity compared to week 30. HSRs 1 and 4/5N reported a decreased level of flu activity compared to week 30. For a map of Health Service Regions please visit the following website: www.dshs.state.tx.us/regions/state.shtm

Laboratory Results

During week 31, 13 hospital laboratories and public health agencies across Texas reported conducting a total of 1,020 influenza tests (antigen, culture, and PCR) to the National Respiratory and Enteric Virus Surveillance System (NREVSSwindow_ext) sponsored by the Centers for Disease Control and Prevention (CDC). Of the 669 antigen detection tests that were performed, 109 were positive for influenza A/not subtyped. The positive results were reported from Bexar, Brazos, Collin, Dallas, Ellis, Harris, Lubbock, Nueces, and Tarrant counties.

A total of 22 reports of PCR- or culture-confirmed seasonal or unsubtyped influenza were received from public health laboratories, Scott & White Memorial Hospital in Temple, Texas Children's Hospital in Houston, and other sources for the following counties during week 31 (August 2-August 8):

Influenza A/H1 (seasonal) Influenza A/H3 Influenza A/not subtyped Influenza B
(none) Bexar County Bell County (5) (none)
    Bexar County  
    Brazos County (3)  
    Dallas County (2)  
    Harris County (9)  
    Lubbock County (2)  

Positive point-of-care rapid tests for influenza were reported by sentinel providers throughout the state (see county map below).

Novel Influenza A Virus Infections

Case investigations are ongoing, and the number of confirmed cases changes frequently. Please see the DSHS website (http://www.texasflu.org) and the CDC website (http://www.cdc.gov/h1n1flu/) for more information on the current investigation.

Antigenic Characterization

CDC has reported antigenic characterization results from 51 seasonal influenza isolates [20 influenza A/H1, 8 influenza A/H3, and 23 influenza B viruses] and 3 novel influenza A H1N1 viruses received from the DSHS Laboratory since the beginning of the 2008–09 flu season.

Influenza A/H1 [20]

  • All 20 viruses were characterized as A/Brisbane/59/2007, the influenza A/H1 component of the 2008–09 influenza vaccine for the Northern Hemisphere.
Influenza A/H3 [8]
  • All 8 viruses were characterized as A/Brisbane/10/2007, the influenza A/H3 component of the 2008-09 influenza vaccine for the Northern Hemisphere.
Influenza B (B/Victoria/02/87 and B/Yamagata/16/88 lineages) [23]
    Victoria lineage [16]
  • Sixteen of the influenza B viruses were characterized as belonging to the B/Victoria lineage.
    Yamagata lineage [7]
  • Seven viruses were characterized as B/Florida/4/2006, the influenza B component for the 2008-09 influenza vaccine for the Northern Hemisphere.
Novel influenza A/H1 [3]
  • All 3 viruses were characterized as A/California/07/2009-like (H1N1), the reference virus selected by the World Health Organization (WHO) as a candidate for the novel influenza A H1N1 vaccine.

Antiviral Resistance

Since September 28, 2008, 22 seasonal influenza A/H1 isolates, 7 influenza A/H3 isolates, 22 influenza B isolates, and 3 novel influenza A H1N1 isolates from the DSHS laboratory have been tested by CDC for antiviral resistance.
Flu
Types/Subtypes		 Isolates Tested (n) Resistant Viruses,
Number (%)
 Isolates Tested (n) Resistant Viruses,
Number (%)
Oseltamivir Zanamivir Adamantanes
Influenza A/H1 (seasonal) 22 22 (100%) 0 (0) 22 0 (0)
Influenza A/H3 7 0 (0) 0 (0) 7 7 (100%)
Influenza B 22 0 (0) 0 (0) N/A* N/A*
Influenza A/H1 (novel) 3 0 (0) 0 (0) 3 3 (100%)
                                     *Adamantanes are not effective against influenza B viruses.

CDC has issued interim recommendations for use of antiviral medications in the 2008-09 influenza season. Those recommendations are available at: http://www.cdc.gov/flu/professionals/antivirals/index.htm..

Influenza–Associated Pediatric Mortality

One influenza-associated pediatric fatality occurred in a 14-year-old resident of Health Service Region 7 during week 31. At this time it is unknown whether the child had significant underlying medical conditions; however, the child had a methicillin-sensitive Staphylococcus aureus infection during his influenza illness. A specimen obtained from the child was positive for novel influenza A H1N1 by PCR. Texas has reported 14 influenza-associated pediatric fatalities during the 2008-09 influenza season.

School Closures and Institutional Outbreaks

One outbreak of ILI was reported in a Dallas County daycare during week 31. DSHS has issued guidance for cases of ILI and novel influenza A H1N1 in summer camps. This guidance is available at www.dshs.state.tx.us/swineflu/summercamp-flu-guide.shtm.

U.S. Outpatient Influenza-like Illness Surveillance Network

Twenty-nine providers in Texas reported data to the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) (formerly known as the U.S. Influenza Sentinel Provider Surveillance System) on patients with influenza–like illness (ILI) and total patients seen for any reason during week 31. Fourteen (48%) of these providers saw at least one patient with ILI. Of all patient visits during this week, 1.59% were due to ILI. The ILI baseline for HHS Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) of the United States is 4.6% for the 2008-2009 season. The baseline is the mean percentage of patient visits for ILI during non-influenza weeks for the previous three seasons plus two standard deviations.
Percentage of Visits for Influenza–Like Illness Reported by the US Outpatient Influenza–Like Illness Surveillance Network (ILINet) in Texas as of 8/14/2009 3:04:38 PM
Week # Reporting Age 0-4 Age 5-24 Age 25-64 Age over 64 Total ILI Total Patients % ILI
2008-40 78 84 133 127 22 366 20333 1.80
2008-41 78 114 163 124 19 420 20105 2.09
2008-42 79 107 156 90 7 360 19746 1.82
2008-43 80 120 152 106 20 398 19857 2.00
2008-44 82 136 199 104 26 465 20972 2.22
2008-45 79 110 111 122 27 370 20959 1.77
2008-46 74 110 107 103 23 343 19890 1.72
2008-47 76 137 143 122 19 421 19907 2.11
2008-48 80 132 132 125 37 426 17012 2.50
2008-49 78 143 159 153 24 479 20446 2.34
2008-50 76 133 146 108 28 415 19450 2.13
2008-51 70 172 177 175 24 548 17663 3.10
2008-52 77 194 153 154 34 535 13509 3.96
2008-53 78 176 141 165 46 528 15329 3.44
2009-01 79 162 182 188 38 570 18646 3.06
2009-02 78 178 287 235 41 741 20222 3.66
2009-03 79 174 468 341 43 1026 23058 4.45
2009-04 79 260 679 333 47 1319 24350 5.42
2009-05 74 282 884 467 40 1673 24734 6.76
2009-06 80 301 965 392 59 1717 24320 7.06
2009-07 79 317 803 316 57 1493 25821 5.78
2009-08 74 221 552 283 57 1113 24664 4.51
2009-09 77 194 423 245 71 933 22428 4.16
2009-10 81 222 340 228 77 867 44281 1.96
2009-11 77 167 269 178 58 672 19656 3.42
2009-12 72 109 150 179 18 456 20910 2.18
2009-13 74 115 143 163 16 437 18760 2.33
2009-14 81 158 199 234 51 642 20963 3.06
2009-15 78 92 138 156 23 400 21254 1.92
2009-16 87 133 200 163 28 524 22058 2.38
2009-17 77 260 570 348 44 1222 25406 4.81
2009-18 72 200 361 185 31 777 22503 3.45
2009-19 65 125 253 183 24 585 19066 3.07
2009-20 63 122 255 134 7 518 19150 2.70
2009-21 65 115 238 115 31 499 39787 1.25
2009-22 62 109 202 97 23 431 40706 1.06
2009-23 55 79 103 29 9 220 10111 2.18
2009-24 54 67 134 88 5 294 37588 0.78
2009-25 59 72 117 83 15 287 33839 0.85
2009-26 59 68 110 78 13 269 36029 0.75
2009-27 55 71 90 72 15 248 16305 1.52
2009-28 60 44 103 82 15 244 38008 0.64
2009-29 54 64 110 81 14 269 37528 0.72
2009-30 40 17 35 16 5 73 8338 0.88
2009-31 29 26 71 75 9 181 11403 1.59


ILIPercentageChart9

National Influenza Activity Map

The current U.S. flu weekly report may be found at http://www.cdc.gov/flu/weekly/fluactivity.htm.
USMapweekly9

*This map indicates geographic spread and does not measure the severity of influenza activity.

For more information on flu surveillance activities in the State of Texas, please visit our main surveillance page.



flumap080809u

1Influenza activity level corresponds to current MMWR week only and does not reflect previous weeks' activity.
2The majority of influenza cases are not reportable by law to the Texas Department of State Health Services. This map contains data from sentinel sites and does not represent all influenza cases in the state.
3Positive laboratory results are reported according to specimen collection date or date received in the lab if the former is unknown.



Texas Department of State Health Services - Infectious Disease Control Unit
1100 West 49th Street, Suite T801, Mail Code: 1960 PO BOX 149347 - Austin, TX 78714-9347
(512) 458-7676 - Fax: (512) 458-7616 - E-Mail

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Last updated January 10, 2011