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    Infectious Disease Control Unit
    Mail Code: 1960
    PO BOX 149347 - Austin, TX 78714-9347
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2013-2014 DSHS Flu Report Week 01

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INFLUENZA (Flu) - Infectious Disease Control, Texas Department of State Health Services

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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 1 in Texas: 

Summary
Statewide influenza-like illness (ILI) intensity is high. Influenza is widespread in Texas. All Texas Regions have reported laboratory confirmed influenza, and the percentage of specimens positive for influenza is over 10%.

 

 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 Widespread Widespread

--

Statewide ILINet Activity Indicator assigned by CDC (intensity of influenza-like illness) No Change 10-High 10-High --
Percentage of specimens positive for influenza ▲1.82% 34.42% 32.60% 1
Percentage of visits due to ILI (ILINet) ▼1.51% 11.99% 13.50% 3
Number of regions reporting increased flu/ILI activity No Change 6 6 5
Number of regions reporting decreased flu/ILI activity 1 1 0 5
Number of variant/novel influenza infections No Change 0 0 5
Number of ILI/influenza outbreaks 2 2 0 5
Number of pediatric influenza deaths New Cases Reported 3 1 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 1
Table 2: Influenza Testing Performed by Texas Laboratories for the Current Week
                        Number of labs reoprting flu tests         15
                            Number of specimens tested       3643
                        Number of positive specimens (%) 1254 (34.42%)
          Percentage of total tests that were antigen detection tests         66.37%
                         Positive specimens by type/subtype [n (%)]
                                        Influenza A 1243 (99.1%)
                                                Subtyping performed   338 (27.2%)
                                                       A (H1N1)   336 (99.4%)
                                                       A (H3N2)      2 (0.6%)
                                                Subtyping not performed   905 (72.8%)
                                         Influenza B     11 (0.9%)

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.


Figure 1: Number and Percentage of Tests (Antigen, Culture, PCR) Positive for Influenza by Type and Subtype Reported by Texas Laboratories, 2013–2014 Season.
Flu Percentage Subtype

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

771

18

2.33%

HMPV

4

751

11

1.46%

Parainfluenza virus

4

771

10

1.30%

Rhinovirus

3

746

114

15.28%

RSV

9

914

312

34.14%

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


Antigenic Characterization
Since September 29, 2013, CDC has reported antigenic characterization results from 35 influenza A (H1N1) viruses and two influenza A (H3N2) 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) [35]
    Thirty-five 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) [2]
    Two 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.

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

 

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

Oseltamivir

Zanamivir

Virus samples tested (n)

Resistant viruses, number (%)

Virus samples tested (n)

Resistant viruses, number (%)

Influenza A (H1N1)

103

2 (1.94%)

13

0 (0%)

Influenza A (H3N2)

2

0 (0%)

2

0 (0%)

Influenza B

0

--

0

--

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

 

 

Week 01

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

Number of providers reporting

111

Number of providers reporting patient visits

109

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

99 (89.2%)

Percentage of all visits due to ILI

11.99%

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 1/9/2014 11:15 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 127 352 639 486 173 140 1790 34774 5.15%
201347 122 405 760 556 194 112 2027 34707 5.84%
201348 124 326 465 533 162 94 1580 22789 6.93%
201349 117 372 770 794 192 54 2182 29729 7.34%
201350 114 353 928 779 206 65 2331 28571 8.16%
201351 110 554 1468 1464 395 91 3972 31620 12.56%
201352 113 493 954 1266 473 200 3386 25083 13.50%
201401 111 460 764 1325 490 273 3312 27617 11.99%


Figure 2: Percentage of Visits Due to Influenza-like Illness Reported by Texas ILINet Participants, 2013–2014 Season
Ili Data Chart
Figure 3: Percentage of Visits Due to Influenza-like Illness Reported by Texas ILINet Participants, 2010–2014 Seasons
Ili Percentage Graph


Reports from Health Service Regions
Reports were received from all Health Service Regions (HSRs) during week 1. HSR 11 reported a decreased level of flu activity compared to week 52. HSRs 1, 2/3, 6/5S, 7, 8, and 9/10 reported an increased level of flu activity compared to week 52. HSR 4/5N reported the same level of flu activity compared to week 52.

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

Institutional Outbreaks and School Closures

During week 1, HSRs 7 and 8 reported one outbreak each of influenza A (not subtyped) in a nursing home in their region.  

Influenza-Associated Pediatric Mortality

Three influenza-associated pediatric deaths were reported this week. The first death was a 2-year-old resident of HSR 11 who died during week 51 (week ending December 21, 2013). A specimen collected from the child was positive via culture test for influenza A (not subtyped). The child had an underlying medical condition and did not receive an influenza vaccination during the 2013-2014 influenza season.

The second and third reported deaths occurred during week 1. The first of these deaths was in a 9-day-old resident of HSR 7 with no underlying medical conditions. A specimen collected from the child was positive by PCR test for 2009 influenza A (H1N1), respiratory syncytial virus, and parainfluenza virus 3; additionally, the child had a blood culture positive for Streptococcus pneumoniae. The child was too young to receive an influenza vaccination. The second of these deaths was in a 13-year-old resident of HSR 2/3 with an underlying medical condition. A specimen collected from the child was positive for 2009 influenza A (H1N1) by PCR test. The child was not vaccinated for influenza during the current season.

Five 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

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

November

0

0

0

0

0

0


December

2

0

1

0

0

3

2014

January

2

0

0

0

0

2

Total

4

0

1

0

0

5

Statewide Influenza Activity Map
Texas Flu 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 - 201 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

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Last updated October 07, 2014