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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


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2013 - 2014 DSHS Flu Report Week 46

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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

During week 46 in Texas

Summary
Statewide influenza-like illness (ILI) activity continues to increase and is now above baseline levels. Influenza activity is increasing steadily. All Texas Regions have now reported laboratory confirmed influenza.

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)

Increased

Regional

Local

--

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

▲2

7-Moderate

5-Low

--

Percentage of specimens positive for influenza

▲4.19%

8.65%

4.46%

1

Percentage of visits due to ILI (ILINet)

 0.66%

5.85%

5.19%

3

Number of regions reporting increased flu/ILI activity

▲1

4

3

5

Number of regions reporting decreased flu/ILI activity

No Change

0

0

5

Number of variant/novel influenza infections

No Change

0

0

5

Number of ILI/influenza outbreaks

▲4

4

0

5

Number of pediatric influenza deaths

No New Cases

0

0

5

†Data displayed were reported in last week’s flu report. Data may change as more reports are 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 45

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

Number of labs reporting flu tests

16

Number of specimens tested

994

Number of positive specimens (%)

86 (8.65%)

Percentage of total tests that were antigen detection tests

43.66%

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

Influenza A

83 (96.5%)

      Subtyping performed

43 (51.8%)

              A (H1N1)

40 (93.0%)

              A (H3N2)

3 (7.0%)

      Subtyping not performed

40 (48.2%)

Influenza B

3 (3.5%)

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

5

431

19

4.41%

HMPV

4

421

2

0.48%

Parainfluenza virus

5

431

35

8.12%

Rhinovirus

3

405

136

33.58%

RSV

12

311

45

14.47%

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


Antigenic Characterization
Since September 29, 2013, CDC has reported antigenic characterization results from two influenza A (H1N1) 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) [2]
    Two viruses were related to A/California/07/2009. This virus strain was included in the 2013-2014 influenza vaccine for the Northern Hemisphere

Antiviral Resistance
No antiviral resistance testing data are available at this time.

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

 

Week 46

Table 4: Texas ILINet Reporting and Patient Visit Summary for the Current Week

Number of providers reporting

103

Number of providers reporting patient visits

103

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

88 (85%)

Percentage of all visits due to ILI

5.85%

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 5: Percentage of Visits for Influenza-like Illness Reported by Texas ILINet Participants (as of 11/21/2013 1:00 PM)
201340 121 244 423 278 129 129 1203 32128 3.74%
201341 126 308 452 294 126 116 1296 33982 3.81%
201342 122 302 427 321 136 99 1285 30444 4.22%
201343 123 303 478 324 110 111 1326 34055 3.89%
201344 120 327 414 285 149 135 1310 32904 3.98%
201345 112 258 448 290 141 103 1240 24774 5.01%
201346 103 286 553 450 164 138 1591 27209 5.85%


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 seven Health Service Regions (HSRs) during week 46. HSRs 1, 9/10, and 11 reported the same level of flu activity compared to week 45. HSRs 2/3, 4/5N, 6/5S, and 8 reported an increased level of flu activity compared to week 45.

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

Institutional Outbreaks and School Closures

Four institutional outbreaks were reported during week 46. In the first outbreak, several respiratory and gastrointestinal illnesses were reported in residents of a long-term care facility in HSR 7. The first illness onsets began during week 42 (week ending October 19, 2013). The facility worked with the local health department to investigate the illnesses and implement control measures. One resident tested positive for parainfluenza virus 1, but two other residents were negative for common viral respiratory pathogens including influenza.

The second outbreak was reported during week 46 but began during week 43 (week ending October 26, 2013). Six hospital employees who worked in non-patient care areas were positive for influenza B by rapid flu test. The facility worked with the health department on investigations and control measures. The third outbreak occurred in a hospital in HSR 6/5S and was reported during week 46. Six patients tested positive for influenza A by rapid flu test.

The fourth outbreak began during week 46 in an assisted living facility in HSR 4/5N. Several facility residents reported symptoms of influenza-like illness, and six of these tested positive for influenza A (H1N1) by PCR test. The facility worked with the health department to offer antiviral prophylaxis to residents and to vaccinate staff and residents.

Influenza-Associated Pediatric Mortality
No influenza-associated pediatric deaths were reported during week 46. No 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 6: 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

Total

0

0

0

0

0

0

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

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Last updated October 07, 2014