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2013-2014 DSHS Flu Report Week 24

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INFLUENZA(2)

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 2013 - 2014 Texas Influenza Surveillance Information Activity Report

Current Flu Activity Report in PDF Format

Please note: The 2013-2014 influenza season began on September 29, 2013. For reports from the 2012-2013 season, please see http://www.dshs.state.tx.us/idcu/disease/influenza/surveillance/2013/.  

During week 24 in Texas

Summary
According to Texas influenza laboratory data and influenza-like illness (ILI) indicators there is low influenza activity occurring around the state. In addition, ILI activity increased compared to last week, but remained below the 2013-2014 state ILINet baseline of 4.35%.

Texas Surveillance Component

Change from Previous Week

Current Week

Previous Week

Page of Report

Table 1: Summary of Texas Influenza (Flu) and Influenza-like Illness (ILI) Activity for the Current Week

Statewide influenza activity level reported to CDC (geographic spread of influenza)

No Change

Sporadic

Sporadic

--

Statewide ILINet Activity Indicator assigned by CDC (intensity of influenza-like illness)

N/A

Not Reported

Not Reported

--

Percentage of specimens positive for influenza

▲0.73%

4.64%

3.91%

1

Percentage of visits due to ILI (ILINet)

 0.18%

4.05%

3.87%

3

Number of regions reporting increased flu/ILI activity

No Change 

1

1

5

Number of regions reporting decreased flu/ILI activity

▲1

3

2

5

Number of variant/novel influenza infections

No Change

0

0

5

Number of ILI/influenza outbreaks

Increased

1

0

5

Number of pediatric influenza deaths

No New Cases Reported

0

0

5

Data displayed have been updated since last week’s flu report with any new reports received.

Laboratory Results
Influenza
Hospital laboratories across Texas voluntarily report influenza tests (antigen, culture, and PCR) to the National Respiratory and Enteric Virus Surveillance System (NREVSS). Providers throughout Texas also submit specimens for influenza testing (PCR) to Texas public health laboratories, including the Texas Department of State Health Services (DSHS) state laboratory in Austin and the nine additional Texas Laboratory Response Network (LRN) laboratories. The results reported by Texas NREVSS participants and public health laboratories for the current week are summarized in the table below. Additional influenza test results (rapid tests, culture, PCR) and ILI activity were reported from providers and public health departments throughout the state (see county map at the end of this report).

 

Week 24

Table 2: Influenza Testing Performed by Texas Laboratories for the Current Week

Number of labs reporting flu tests

12

Number of specimens tested

517

Number of positive specimens (%)

24 (4.64%)

Percentage of total tests that were antigen detection tests

29.59%

Positive specimens by type/subtype [n (%)]

Influenza A

18 (75.00%)

      Subtyping performed

9 (50.0%)

              A (H1N1)

0 (0.0%)

              A (H3N2)

9 (100.0%)

      Subtyping not performed

9 (50.0%)

Influenza B

6 (25.00%)

†Laboratory data in 2013-2014 season reports may not be comparable to reports from previous seasons because of the inclusion of DSHS and LRN laboratory data for the current season.

week 24 figure 1

Other Respiratory Viruses
The NREVSS system collects information on a variety of respiratory viruses in addition to influenza including parainfluenza virus, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus (HMPV), and respiratory adenovirus. The results for the current week are summarized below.

Virus

Number of Laboratories Testing

Tests Performed

Positive Tests

Percentage of Tests Positive

Table 3: Non-Influenza Respiratory Virus Testing
Performed by Texas NREVSS Laboratories for the Current Week

Adenovirus (respiratory)

4

395

11

2.78%

HMPV

5

326

8

2.45%

Parainfluenza virus

5

505

24

4.75%

Rhinovirus

3

293

69

23.55%

RSV

8

378

2

2.12%

Some non-NREVSS reporters also contribute to the RSV data.


Antigenic Characterization
Since September 29, 2013, CDC has reported antigenic characterization results from 85 influenza A (H1N1) viruses, 25 influenza A (H3N2) viruses, and 39 influenza B viruses received from the Texas Department of State Health Services (DSHS) Laboratory. The DSHS Laboratory sends a representative sample of influenza viruses to the CDC throughout the flu season.

  • Influenza A (H1N1) [85]
    Eighty-five (100%) viruses were related to A/California/07/2009. This virus strain was included in the 2013-2014 influenza vaccine for the Northern Hemisphere
  • Influenza A (H3N2) [25]
    Twenty-five (100%) viruses were related to A/Texas/50/2012, an A (H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011. This virus strain was included in the 2013-2014 influenza vaccine for the Northern Hemisphere.
  • Influenza B [39]
    • Yamagata lineage [14]: Fourteen (36%) influenza B/Yamagata-lineage viruses have been characterized from Texas. B/ Massachusetts/2/2012-like is included as an influenza B component of the 2013-2014 Northern Hemisphere trivalent and quadrivalent influenza vaccines.
    • Victoria lineage [25]: Twenty-five (64%) influenza B/Victoria-lineage viruses have been characterized from Texas  B/Brisbane/60/2008-like, which is included as an influenza B component of the 2013-2014 Northern Hemisphere quadrivalent influenza vaccine.

Antiviral Resistance
Table 4 displays the number of influenza viruses from Texas that have been tested for antiviral resistance since October 1, 2013. Three 2009 influenza A (H1N1) viruses have tested positive for the mutation that confers resistance to oseltamivir.

Oseltamivir

Zanamivir

Table 4: Cumulative Antiviral Resistance Results from Texas Influenza Viruses, 2013-2014 Season†

Virus samples tested (n)

Resistant viruses, number (%)

Virus samples tested (n)

Resistant viruses, number (%)

Influenza A (H1N1)

354

3 (0.85%)

75

0 (0%)

Influenza A (H3N2)

15

0 (0%)

15

0 (0%)

Influenza B

5

0 (0%)

5

0 (0%)

This table includes specimens submitted as part of routine surveillance and not for diagnostic purposes.

U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet)

 

Week 24

Table 5: Texas ILINet Reporting and Patient Visit Summary for the Current Week

Number of providers reporting

90

Number of providers reporting patient visits

89

Number (%) of providers with at least one ILI case

69 (77.5%)

Percentage of all visits due to ILI

4.05

Texas ILINet baseline, 2013–2014

4.35%

Reporting providers include both ILINet and Enhanced ILINet/IISP providers.
The baseline is the mean percentage of patient visits for ILI during non-influenza weeks for the previous three seasons plus two standard deviations. A “non-influenza week” is defined as a week that accounted for less than 2% of the season’s total number of specimens that tested positive for influenza.

  Providers  Number of ILI Cases by Age Group (Years)  Total ILI    

 Week

Reporting 

0-4

5-24

25-49

50-64

65+

(all ages)  

Total Patients  

% ILI  

Table 6: Percentage of Visits for Influenza-like Illness Reported by Texas ILINet Participants (as of 6/19/2014 11:07 AM)
201340 124 244 424 279 129 129 1205 32650 3.69%
201341 129 308 452 295 127 116 1298 34475 3.77%
201342 126 306 434 321 137 100 1298 30976 4.19%
201343 127 305 481 325 110 111 1332 34658 3.84%
201344 127 338 426 285 149 136 1334 33751 3.95%
201345 128 323 516 316 147 104 1406 30801 4.56%
201346 128 352 642 491 174 141 1800 34893 5.16%
201347 124 405 761 558 197 114 2035 34921 5.83%
201348 125 328 465 535 162 95 1585 22865 6.93%
201349 121 372 790 798 198 57 2215 30736 7.21%
201350 120 383 983 812 216 67 2461 29791 8.26%
201351 117 627 1536 1491 401 92 4147 32803 12.64%
201352 123 547 1016 1288 474 200 3525 25638 13.75%
201401 126 532 837 1366 505 281 3521 29199 12.06%
201402 125 517 917 1142 442 299 3317 33700 9.84%
201403 123 405 898 854 274 173 2604 34395 7.57%
201404 120 354 732 694 262 195 2237 30542 7.32%
201405 123 351 719 626 215 160 2071 31005 6.68%
201406 122 341 653 596 206 157 1953 30871 6.33%
201407 121 293 759 550 217 152 1971 32886 5.99%
201408 122 323 735 579 214 148 1999 32555 6.14%
201409 111 316 624 473 122 63 1598 29167 5.48%
201410 117 291 621 544 201 148 1805 30237 5.97%
201411 115 250 421 503 206 140 1520 26028 5.84%
201412 115 255 511 486 203 127 1582 29762 5.32%
201413 114 242 527 475 181 130 1555 29256 5.32%
201414 111 245 518 437 192 125 1517 28638 5.30%
201415 105 228 602 359 85 43 1317 27112 4.86%
201416 111 210 536 405 154 137 1442 27646 5.22%
201417 109 188 201 421 158 131 1399 28859 4.85%
201418 106 199 414 294 116 134 1157 28749 4.02%
201419 105 167 401 354 155 128 1205 27731 4.35%
201420 106 150 422 342 132 114 1160 26544 4.37%
201421 102 196 455 325 135 105 1216 22874 4.69%
201422 100 151 362 289 121 90 1013 22874 4.43%
201423 89 135 355 251 62 12 815 21085 3.87%
201424   90   159 291 273 101 94 918 22686 4.05%


Figure 2: Percentage of Visits Due to Influenza-like Illness Reported by Texas ILINet Participants, 2013–2014 Season
reporting


Figure 3: Percentage of Visits Due to Influenza-like Illness Reported by Texas ILINet Participants, 2010–2014 Seasons

MMWR24

Reports from Health Service Regions

Reports were received from seven Health Service Regions (HSRs) during week 24.
HSR 1 reported an increased level of flu activity compared to week 23. HSRs 4/5N, 6/5S, and 8 reported a decreased level of flu activity compared to week 23. HSRs 2/3, 9/10, and 11 reported the same level of flu activity compared to week 23.

Variant Influenza Viruses
No variant or novel influenza viruses have been detected in Texas in 2013 or 2014.

 

Institutional Outbreaks and School Closures
HSR 7 reported an influenza outbreak at a long-term care facility during week 24.  Four specimens were collected and tested at the DSHS Lab for influenza.  All specimens tested positive for seasonal influenza A H3.

No school closures were reported during week 24. 

Influenza-Associated Pediatric Mortality  
No influenza-associated pediatric deaths were reported during week 24.

Eighteen influenza-associated pediatric deaths have been reported in Texas during the 2013-2014 influenza season. Cases of influenza-associated pediatric mortality (children <18 years of age) are reportable year-round and by law in Texas.

Month of Pediatric Death

Influenza A (H1N1)

Influenza A (H3N2)

Influenza A (Not Subtyped)

Influenza B

Influenza, Not
Typed / Not
Differentiated

Influenza virus co-infection: A (not subtyped) and B

Total, All Influenza Types / Subtypes

Table 7: Influenza-Associated Pediatric Deaths Reported in Texas During the 2013–2014 Season

2013

October

0

0

0

0

0

0

0

November

0

0

0

0

0

0

0


December

3

0

2

0

0

0

5

2014

January

6

0

1

1

0

0

8


February

0

0

1

0

0

1

2


March

0

0

1

2

0

0

3


April

0

0

0

0

0

0

0


May

0

0

0

0

0

0

0


June

0

0

0

0

0

0

0


Total

9

0

5

3

0

1

18

Statewide Influenza Activity Map

Figure 4: Texas Map Displaying the Highest Level of Influenza or ILI Activity Reported by County for the Week Ending June 14, (MMWR Week 24)

Texas Influenza Activity Map

Please note: The majority of influenza cases are not reportable by law in Texas. This map contains data from sentinel sites and only displays influenza and ILI cases that were reported to public health. Positive laboratory results are reported according to specimen collection date, or date received in the laboratory if the former is unknown.

Texas Influenza Surveillance Components and Measures
Activity codes    (see http://www.cdc.gov/flu/weekly/overview.htm)
Statewide influenza activity level
    A code reported weekly by states and territories to CDC indicating the geographic spread of influenza in the state. Levels are no activity, sporadic, local, regional, and widespread.

ILINet Activity Indicator
    A statewide level of influenza-like illness intensity assigned to each state weekly by CDC based on data reported through ILINet.


Morbidity
Novel/variant influenza
    Thorough investigations are performed on all cases of novel/variant influenza. This condition is reportable by law in Texas.

Texas ILINet
    Providers voluntarily report weekly to CDC’s ILINet system on the number of outpatient visits for ILI and total outpatient visits. Providers may submit up to 5 specimens per month for influenza testing. See http://www.dshs.state.tx.us/idcu/disease/influenza/surveillance/ILINet/ for information on how to become an ILINet provider.

Enhanced ILINet/IISP
    Providers report weekly to ILINet and submit specimens on the first 10 patients seen with ILI each week. Specimens are tested for a variety of respiratory viruses.

ILI activity
    Non-ILINet providers report ILI or influenza data weekly to local or regional health departments.

Outbreaks
    Healthcare and childcare facilities report ILI and influenza outbreaks to health departments in Texas. This condition is reportable by law in Texas.


Mortality 
    
Influenza-associated pediatric deaths 
        Deaths that are associated with influenza in children < 18 years of age are reported to health departments in Texas. This condition is reportable by law in Texas. http://www.dshs.state.tx.us/idcu/disease/IAPM/


Laboratory 
        
DSHS Austin laboratory 
            Providers voluntarily submit specimens to the DSHS Austin laboratory for influenza PCR testing throughout the season. 
            Providers sign up for this program through their local health departments. 
        Laboratory Response Network (LRN) laboratories
            Providers voluntarily submit specimens to one of the 9 Texas LRNs for influenza PCR testing throughout the season. 
            Providers sign up for this program through their local health departments. 
        NREVSS 
            Laboratories voluntarily report influenza and other respiratory virus data weekly through the CDC’s online NREVSS reporting system. 
            Laboratories sign up for this program by contacting DSHS. http://www.cdc.gov/surveillance/nrevss/


Recommended Resources
Texas Department of State Health Services 
    
DSHS influenza page: http://www.texasflu.org/  
    
Influenza surveillance data and reports: http://www.dshs.state.tx.us/idcu/disease/influenza/surveillance/
    
Map of Texas Health Service Regions: http://www.dshs.state.tx.us/regions/state.shtm

Centers for Disease Control and Prevention
    
National FluView weekly flu report: http://www.cdc.gov/flu/weekly/
    
Variant and novel influenza viruses: http://www.cdc.gov/flu/avianflu/index.htm; http://www.cdc.gov/flu/swineflu/index.htm
    
Infection Control in Healthcare Facilities: http://www.cdc.gov/flu/professionals/infectioncontrol/
    
Seasonal Flu Information for Schools and Childcare Providers: http://www.cdc.gov/flu/school/index.htm

World Health Organization 
    
Influenza page: http://www.who.int/topics/influenza/en/  
    
Disease Outbreak News: http://www.who.int/csr/don/en/

2013 - 2014 Texas Influenza Surveillance Information --- Flu Reports

For the week ending:10/05/13; 10/12/13; 10/19/13; 10/26/13; 11/2/13; 11/9/13; 11/16/13; 11/23/13; 11/30/13; 12/7/13; 12/14/13; 12/21/13; 12/28/13; 1/4/14; 1/11/14; 1/18/14; 1/25/14; 2/1/14; 2/8/14; 2/15/14; 2/22/14; 3/1/14; 3/8/14; 3/15/14; 3/22/14; 3/29/14; 4/5/14; 4/12/14; 4/19/14; 4/26/14; 5/3/14; 5/10/14; 5/17/14; 5/24/14; 5/31/14; 6/7/146/14/14; 6/21/14; 6/28/14; 7/5/14; 7/12/14; 7/19/14; 7/26/14; 8/2/2014; 8/9/14; 8/16/14; 8/23/14; 8/30/14; 9/6/14; 9/13/14; 9/20/14; 9/27/14

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Last updated October 07, 2014