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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 39

The influenza (flu) activity level for Texas for the week ending October 3, 2009 was “widespread.” For definitions of flu activity levels please see http://www.cdc.gov/flu/weekly/fluactivity.htm. During week 39, 1,037 (29.9%) 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 39.

Reports from Health Service Regions

Reports were received from all Health Service Regions (HSRs) for week 39. HSRs 1, 7, 8, and 11 reported an increased level of flu activity compared to week 38. HSR 2/3, 6/5S and 9/10 reported the same level of flu activity compared to week 38. HSR 4/5N reported a decreased level of flu activity compared to week 38. For a map of Health Service Regions please visit the following website: www.dshs.state.tx.us/regions/state.shtm

Laboratory Results

During week 39, thirteen hospital laboratories and public health agencies across Texas reported conducting a total of 3,469 influenza tests (antigen, culture, and PCR) to the National Respiratory and Enteric Virus Surveillance System (NREVSSwindow_new) sponsored by the Centers for Disease Control and Prevention (CDC). The majority (73%) 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 39
No. of specimens tested 3,469
No. of positive specimens (%) 1,037 (29.9%)
Positive specimens by type/subtype
Influenza A 1,037 (100%)
A (novel H1N1) 340 (32.8%)
A (subtyping not performed) 697 (67.2%)
A (unable to subtype) 0 (0%)
A (H3) 0 (0%)
A (seasonal H1) 0 (0%)
Influenza B 0 (0%)

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 10/3/2009
Health Service Region or County Hospitalizations* Intensive Care Unit (ICU) Admissions* Deaths**
Region 1
Lubbock County 4 4 2
Region 1 Total 4 4 2
Region 2/3
Collin County 2 0 0
Dallas County 50 5 8
Denton County 1 0 0
Ellis County 1 0 0
Fisher County 1 1 0
Kaufman County 2 0 0
Tarrant County 30 5 1
Region 2/3 Total 87 11 9
Region 4/5N
Bowie County 2 1 1
Gregg County 5 1 0
Lamar County 1 1 0
Rusk County 2 1 1
Shelby County 1 0 0
Smith County 7 2 2
Van Zandt County 0 0 1
Region 4/5N Total 18 6 5
Region 6/5S
Brazoria County 0 0 1
Fort Bend County 6 3 2
Harris County 8 3 4
Jefferson County 2 1 0
Region 6/5S Total 16 7 7
Region 7
Bastrop County 0 0 1
Bell County 2 0 1
Burleson County 1 0 0
Caldwell County 1 1 0
Hamilton County 1 0 0
Hays County 2 1 0
McLennan County 5 0 0
Travis County 9 1 2
Williamson County 4 0 0
Region 7 Total 25 3 4
Region 8
Bexar County 17 4 9
Dimmit County 1 0 0
Frio County 1 0 0
Gonzales County 0 0 1
Maverick County 3 0 1
Medina County 1 0 0
Uvalde County 1 0 0
Val Verde County 1 0 1
Victoria County 1 0 1
Wilson County 1 1 0
Zavala County 1 0 0
Region 8 Total 28 5 13
Region 9/10
Andrews County 0 0 1
El Paso County 6 0 7
Hudspeth County 1 0 0
Midland County 2 0 0
Region 9/10 Total 9 0 8
Region 11
Bee County 6 0 0
Brooks County 1 0 0
Cameron County 5 1 3
Hidalgo County 12 7 11
Jim Wells County 2 0 0
Kleberg County 7 0 0
Nueces County 10 2 6
San Patricio County 1 1 0
Webb County 2 2 1
Region 11 Total 46 13 21
Texas Total 233 49 69
*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, and 23 influenza B isolates have been tested by CDC for antiviral resistance. Additionally, novel influenza A (H1N1) isolates from multiple Texas laboratories have been tested by CDC for antiviral resistance. Other laboratories in Texas submit influenza isolates to CDC for testing, but the majority of those results were not available for this report; however, information is available on additional novel influenza A (H1N1) isolates from Texas that were tested at CDC.
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) 110 2 (2%) 0 (0) 42 42 (100%)

*Adamantanes are not effective against influenza B viruses.


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 occurred in week 39. The first death occurred in a 14-year-old resident of HSR 2/3 with no underlying medical conditions. A specimen from the child tested positive by PCR for novel influenza A (H1N1). The second death occurred in a 6-year-old resident of HSR 4/5N with significant underlying medical conditions. The child was positive via PCR testing for novel influenza A (H1N1). The third death occurred in a 9-year-old resident of HSR 4/5N with significant underlying conditions. The child's specimen tested positive for novel influenza A (H1N1) by PCR. The fourth death occurred in an 11-year-old resident of HSR 8 with significant underlying medical conditions. Although the child's specimen tested positive for influenza A by PCR, subtyping was not performed. Texas has reported 26 influenza-associated pediatric fatalities during the 2008-09 influenza season.

School Closures and Institutional Outbreaks

Multiple school closures were reported during week 39. One school in Dallas County closed. School districts in Bowie, Henderson, and Wood counties closed due to increased absenteeism related to flu. Multiple campuses in Walker County closed due to faculty illness and absenteeism. 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

Forty 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 39. Of these 39 providers who saw patients, 32 (82%) saw at least one patient with ILI. Of all patient visits during this week, 8.43% 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 10/08/2009 5:42:58 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 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 51 128 426 99 7 660 20374 3.24
2009-36 50 132 613 177 10 932 20079 4.64
2009-37 50 263 1101 309 17 1690 25056 6.74
2009-38 47 184 598 107 13 902 14102 6.40
2009-39 40 213 1129 446 12 1800 21359 8.43


ILIPercentageChart17

National Influenza Activity Map

The current U.S. flu weekly report may be found at http://www.cdc.gov/flu/weekly/fluactivity.htm.
USMapweekly17

*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.



flumapf

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 -

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Last updated January 10, 2011