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    Infectious Disease Prevention Section
    Mail Code: 1927
    PO BOX 149347 - Austin, TX 78714-9347
    1100 West 49th Street, Suite G401
    Austin, TX 78714

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


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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 38

The influenza (flu) activity level for Texas for the week ending September 26, 2009 was “widespread.” For definitions of flu activity levels please see http://www.cdc.gov/flu/weekly/fluactivity.htm. During week 38, 817 (30.5%) 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 above the regional baseline during week 38.

Reports from Health Service Regions

Reports were received from all Health Service Regions (HSRs) for week 38. HSRs 1, 2/3, 4/5N, 6/5S, 7, 8, and 9/10 reported an increased level of flu activity compared to week 37. HSR 11 reported the same level of flu activity compared to week 37. For a map of Health Service Regions please visit the following website: www.dshs.state.tx.us/regions/state.shtm

Laboratory Results

During week 38, ten hospital laboratories and public health agencies across Texas reported conducting a total of 2,678 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). The majority (68.1%) of influenza tests reported to NREVSS were antigen detection tests; these tests cannot identify the subtype of influenza detected. The results from Texas participants in NREVSS are summarized in the table below.
Testing Information Week 38
No. of specimens tested 2,678
No. of positive specimens (%) 817 (30.5%)
Positive specimens by type/subtype
Influenza A 816 (99.9%)
A (novel H1N1) 253 (31.0%)
A (subtyping not performed) 563 (69.0%)
A (unable to subtype) 0 (0%)
A (H3) 0 (0%)
A (seasonal H1) 0 (0%)
Influenza B 1 (0.1%)

Additional influenza test results (rapid tests, culture, PCR) were reported from providers and public health departments throughout the state (see county map below).

Novel Influenza A Virus Infections

Please see the Texas Department of State Health Services (DSHS) novel influenza website (http://www.texasflu.org) and the CDC website (http://www.cdc.gov/h1n1flu/) for more information. Data collection for confirmed novel influenza A (H1N1) hospitalizations, intensive care unit (ICU) admissions, and deaths began in Texas on September 20, 2009. The table below summarizes the current data.

Cumulative Surveillance Case Summary for Novel Influenza A (H1N1)
by Health Service Region and County as of 9/26/2009
Health Service Region or County Hospitalizations* Intensive Care Unit (ICU) Admissions* Deaths**
Region 1      
Lubbock County 1 1 2
Region 1 Total 1 1 2
Region 2/3      
Collin County 2 0 0
Dallas County 0 0 4
Denton County 1 0 0
Fisher County 1 1 0
Tarrant County 0 0 1
Region 2/3 Total 4 1 5
Region 4/5N      
Bowie County 2 1 1
Gregg County 2 0 0
Rusk County 2 1 1
Smith County 2 1 2
Van Zandt County 0 0 1
Region 4/5N Total 8 3 5
Region 6/5S      
Fort Bend County 2 2 2
Harris County 6 1 3
Region 6/5S Total 8 3 5
Region 7      
Bell County 0 0 1
Burleson County 1 0 0
Hamilton County 1 0 0
Hays County 1 0 0
Travis County 2 0 2
Region 7 Total 5 0 3
Region 8      
Bexar County 0 0 4
Maverick County 3 0 1
Victoria County 0 0 1
Wilson County 1 1 0
Region 8 Total 4 1 6
Region 9/10      
Andrews County 0 0 1
El Paso County 2 0 7
Region 9/10 Total 2 0 8
Region 11      
Bee County 5 0 0
Cameron County 1 0 3
Hidalgo County 0 0 10
Jim Wells County 1 0 0
Kleberg County 4 0 0
Nueces County 5 0 4
Webb County 2 2 1
Region 11 Total 18 2 18
Texas Total 50 11 52
*Reporting for hospitalizations and ICU admissions began on 9/20/2009. ICU admissions are included in the hospitalization totals.
**Reporting for deaths began 4/15/2009 and includes a child from Mexico.

Antigenic Characterization

CDC has reported antigenic characterization results from 51 seasonal influenza isolates [20 influenza A (H1N1), 8 influenza A (H3N2), and 23 influenza B viruses] and 8 novel influenza A (H1N1) viruses received from the DSHS Laboratory since the beginning of the 2008–09 flu season. Other laboratories in Texas submit influenza isolates to CDC for testing, but those results were not available for this report.

Influenza A (H1N1) seasonal [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 (H3N2) [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 (H1N1) [8]
  • All 8 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 (H1N1) isolates, 8 influenza A (H3N2) isolates, 23 influenza B isolates, and 5 novel influenza A (H1N1) isolates from the DSHS laboratory have been tested by CDC for antiviral resistance. Other laboratories in Texas submit influenza isolates to CDC for testing, but those results were not available for this report; therefore, the total number of novel influenza A (H1N1) isolates that have been tested from Texas by CDC is not known at this time.
Flu
Types/Subtypes 		Isolates Tested (n) Resistant Viruses,
Number (%)
 Isolates Tested (n) Resistant Viruses,
Number (%)
Oseltamivir Zanamivir Adamantanes
Influenza A (H1N1) (seasonal) 22 22 (100) 0 (0) 22 0 (0)
Influenza A (H3N2) 8 0 (0) 0 (0) 7 7 (100)
Influenza B 23 0 (0) 0 (0) N/A* N/A*
Influenza A (H1N1) (novel)** Not available 2 (--) 0 (0) Not available -- (100)

*Adamantanes are not effective against influenza B viruses.

**Antiviral resistance testing is performed on a subset of Texas isolates at the CDC lab. The total number of novel influenza A (H1N1) isolates from Texas that have been tested for antiviral resistance is not available. Of all of the novel influenza A (H1N1) isolates from Texas that have been tested for antiviral resistance, only 2 have shown resistance to oseltamivir. No novel influenza A (H1N1) isolates have shown resistance to zanamivir. All novel influenza A (H1N1) isolates have shown resistance to the adamantanes.

CDC has issued interim recommendations for use of antiviral medications in the 2009-10 influenza season. Those recommendations are available at: http://www.cdc.gov/h1n1flu/recommendations.htm.

Influenza–Associated Pediatric Mortality

Four new influenza-associated pediatric deaths are included in this report. The first death occurred during week 37 in a 3-year-old resident of HSR 6/5S with significant underlying medical conditions. A specimen from the child was positive by rapid test for influenza A (not subtyped). The second death occurred in week 37 in a 14-year-old resident of HSR 8 with no underlying medical conditions; however, a sputum specimen collected from the child was positive for methicillin-resistant Staphylococcus aureus (MRSA). The child had a positive PCR test for novel influenza A (H1N1). The third death occurred during week 38 in a 16-year-old resident of HSR 2/3 with significant underlying medical conditions. A specimen from the child tested positive for novel influenza A (H1N1) by PCR. The fourth death occurred in week 38 in an 8-month-old resident of HSR 8 with a significant underlying medical condition. The child's specimen was positive by PCR for novel influenza A (H1N1). Texas has reported 22 influenza-associated pediatric fatalities during the 2008-09 influenza season.

School Closures and Institutional Outbreaks

During week 38, several outbreaks of ILI and/or influenza were reported in the state. An outbreak of ILI and novel influenza A (H1N1) was reported at a daycare in Denton County. One Collin County school with increased ILI closed during week 38. A school district in Hopkins County reopened in week 38 after being closed in week 37 and early week 38 due to influenza A (confirmed by rapid test). A school in Presidio County reported high absenteeism due to ILI. A Travis County nursing home reported a cluster of ILI among residents of the facility. DSHS has issued guidance for cases of ILI and novel influenza A (H1N1) in summer camps, schools, and congregate facilities. Please see http://www.texasflu.org for more information.

U.S. Outpatient Influenza-like Illness Surveillance Network

Thirty-eight 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 38. Of these 38 providers, 29 (76%) saw at least one patient with ILI. Of all patient visits during this week, 5.52% 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 10/02/2009 10:41:58 AM
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 80 221 325 212 77 835 22635 3.69
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 64 115 221 111 31 478 17728 2.70
2009-22 61 108 188 88 14 398 18573 2.14
2009-23 55 79 103 29 9 220 10111 2.18
2009-24 53 65 119 79 4 267 16773 1.59
2009-25 59 72 114 79 15 280 16624 1.68
2009-26 59 68 105 75 13 261 15326 1.70
2009-27 58 72 90 72 15 249 16643 1.50
2009-28 61 44 101 78 15 238 17296 1.38
2009-29 59 67 101 73 14 255 16844 1.51
2009-30 55 25 41 23 11 100 9965 1.00
2009-31 59 56 92 95 9 252 17727 1.42
2009-32 57 56 109 81 9 255 17856 1.43
2009-33 54 46 111 124 13 294 19431 1.51
2009-34 53 74 267 99 4 444 19483 2.28
2009-35 50 120 418 89 6 633 20174 3.14
2009-36 48 120 598 157 10 885 19752 4.48
2009-37 46 228 1058 287 16 1589 23769 6.69
2009-38 38 46 488 58 13 605 10962 5.52


ILIPercentageChart16

National Influenza Activity Map

The current U.S. flu weekly report may be found at http://www.cdc.gov/flu/weekly/fluactivity.htm.
USMapweekly16

*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.



flumap092609d

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