CDC Influenza Key Points Dec 21 2012

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CDC Influenza Key Points Dec 21 2012

CDC Influenza Division Key PointsDecember 21, 2012In this document:Seasonal Influenza Note from the Director Summary Key Messages Key Influenza Indicators/FluView Summary CDC Reports 2 Influenza-Related Pediatric Deaths Influenza Mobile App Available for DownloadInfluenza Antivirals FDA Approves the Use of Oseltamivir in Persons Aged Weeks and Older Influenza Antiviral Medications: BackgroundNote from the Director"Today’s report confirms that the U.S. flu season is off to an early start,” said CDCDirector Dr. Thomas Frieden. “It’s too early to tell how severe our season mightbe. However, we know that thousands die and hundreds of thousands of peopleare hospitalized with flu each year. Vaccination is the single most important stepwe can take to protect ourselves and our families against infection. It's not too lateto get vaccinated before the flu season peaks.”Summary Key MessagesInfluenza activity in the United States continues to increase according to themost recent FluView report.Current indications are that the U.S. is experiencing an early influenza seasonwith high levels of activity concentrated in the south central and southeasternregions, but other parts of the nation are seeing increases as well.Right now, influenza A H3N2 viruses are predominant. Typically “H3N2 seasons”are more severe, with higher numbers of hospitalizations and deaths, but it’s notpossible to say at this time what influenza viruses will predominate this seasonor how severe the season will be.So far this season, most (89%) of the influenza viruses that have beenantigenically characterized are well-matched to the 2012-2013 influenzavaccine.1


CDC Influenza Division Key PointsDecember 21, 2012People who have not already gotten a flu vaccine this season should do so now.It is not too late to get vaccinated to protect you and your family againstinfluenza.CDC recommends that everyone 6 months of age and older get a seasonal fluvaccine each year. For more information, seehttp://www.cdc.gov/flu/protect/whoshouldvax.htm.Some children 6 months through 8 years of age require 2 doses of influenzavaccine. The second dose should be given at least 28 days after the first dose.Your child’s health care provider can tell you whether two doses arerecommended for your child.It takes about two weeks after vaccination for the body’s immune response tofully respond and for you to be protected.You need this season’s influenza vaccine to protect against the influenza virusesmost likely to circulate and cause illness this season.More than 127 million doses of influenza vaccine had been delivered in theUnited States as of the mid-December, with manufacturers projecting totalproduction of 135 million doses this season.People have several options in terms of where they can get vaccinated and thetype of influenza vaccine to choose.While doctor’s offices and health departments continue to provide influenzavaccinations, vaccine also is available at many pharmacies, work places andother retail and clinic locations.In addition to the traditional seasonal flu shot available for people 6 months andolder, a nasal spray influenza vaccine is available for non-pregnant, healthypeople between 2 and 49 years of age, and a high dose flu shot is available forpeople 65 and older.An intradermal flu shot, which uses a needle 90% smaller than the regular flushot, also is approved for people 18 to 64 years of age.Key Flu Indicators/FluView SummaryAccording to this week’s FluView report, influenza activity continues to increasein the United States across most key indicators.2


CDC Influenza Division Key PointsDecember 21, 2012Current indications are that the U.S. is experiencing an early influenza seasonwith high levels of activity concentrated in the south central and southeasternregions, but other parts of the nation are seeing increases as well.This FluView update corresponds to the week of December 9-15, 2012 of the2012-2013 influenza season.Below is a summary of these key indicators:oooooooThe proportion of visits to doctors for influenza-like illness (ILI) increasedonce again and is above the national baseline for the second week in arow. Twelve states are now reporting high ILI activity (Alabama, Georgia,Illinois, Louisiana, Mississippi, Missouri, North Carolina, South Carolina,Tennessee, Texas, Utah, and Virginia) which is an increase from the eightstates that reported high ILI activity last week.Overall, influenza activity is being reported widely across much of theUnited States. Twenty-nine states reported widespread geographicinfluenza activity for the week of December 9-15, 2012. During the priorweek, only 18 states reported widespread activity.October 1, 2012, 1,013 laboratory-confirmed influenza-associatedhospitalizations have been reported; an increase of 336 hospitalizationsfrom the previous week. This translates to a rate of 3.6 influenzaassociatedhospitalizations per 100,000 people in the United States.The proportion of deaths attributed to pneumonia and influenza (P&I)based on the 122 Cities Mortality Reporting System was below theepidemic threshold.Two influenza-related pediatric deaths were reported during the week ofDecember 9-15. One death was associated with an influenza A virus ofunknown subtype. The second death was associated with an influenzaA(H3) virus. Eight influenza-associated pediatric deaths have beenreported so far during the 2012-2013 season.Nationally, the percentage of respiratory specimens testing positive forinfluenza viruses in the United States during the week of December 9-15decreased slightly to 28.3%. For the three weeks from November 25 toDecember 15, the regional percentage of respiratory specimens testingpositive for influenza viruses ranged from 10.3% to 50.8%.Influenza A (H3N2), 2009 influenza A (H1N1), and influenza B viruseshave all been identified in the U.S. this season. During the week ofDecember 9-15, 2,138 of the 2,709 influenza positive tests reported to3


CDC Influenza Division Key PointsDecember 21, 2012CDC were influenza A and 571 were influenza B viruses. Of the 2,138influenza A viruses identified, approximately 56% were H3 viruses and1% were 2009 H1N1 viruses; 44% were not subtyped.oSince October 1, 2012, CDC has antigenically characterized 351 influenzaviruses, including 10 2009 influenza A (H1N1) viruses, 226 influenza A(H3N2) viruses and 115 influenza B viruses.• All 10 of the 2009 influenza A (H1N1) viruses were characterized asA/California/7/2009-like. This is the influenza A (H1N1) componentof the Northern Hemisphere vaccine for the 2012-2013 season.• Of the 226 influenza A (H3N2) viruses, 224 (99%) werecharacterized as A/Victoria/361/2011-like. This is the influenza A(H3N2) component of the Northern Hemisphere influenza vaccinefor the 2012-2013 season.• Approximately 69% of the 115 influenza B viruses belonged to theB/Yamagata lineage of viruses, and were characterized asB/Wisconsin/1/2010-like, the influenza B component for the 2012-2013 Northern Hemisphere influenza vaccine. The remaining 31%of the tested influenza B viruses belonged to the B/Victoria lineageof viruses.o Since October 1, 2012, CDC has tested 18 2009 influenza A (H1N1), 344influenza A (H3N2), and 135 influenza B virus isolates for resistance toneuraminidase inhibitors this season. The tested viruses showedsusceptibility to the antiviral drugs oseltamivir and zanamivir. High levelsof resistance to the adamantanes (amantadine and rimantadine) persistamong 2009 influenza A (H1N1) and A (H3N2) viruses. Adamantanes arenot effective against influenza B viruses.FluView is available – and past issues are archived – on the CDC website.CDC Reports 2 Influenza‐Related Pediatric DeathsTwo pediatric deaths were reported for the week of December 9-15, bringing thetotal number of flu-associated deaths to 8 for the 2012-2013 season.Because of confidentiality issues, CDC does not discuss or give details onindividual cases.These deaths are a somber reminder of the danger flu poses to children.4


CDC Influenza Division Key PointsDecember 21, 2012The app assists clinicians in their evaluation, diagnosis and treatment ofinfluenza during the flu season, and it makes it possible for clinicians to accessCDC’s latest recommendations and influenza activity updates.The application provides easy access to a wide range of information, including:national flu activity, influenza vaccination recommendations, diagnosis andtreatment of influenza, laboratory testing for influenza, and guidelines oninfluenza antiviral drugs and influenza infection control.Clinicians can personalize their experience within the app with features likehighlighting, notes and bookmarking. It’s also possible to e-mail informationdirectly from the app and share content through social media such as Facebookand Twitter.The arrival of the app is timely given that flu season is off to the earliest start ina decade and physicians are likely to be seeing many influenza patients over thecoming weeks.FDA Approves the Use of Oseltamivir in Persons Aged 2 Weeks and OlderOn December 21, 2012, the U.S. Food and Drug Administration (FDA) approvedthe influenza antiviral medication oseltamivir (trade name Tamiflu®) for thetreatment of influenza in people aged 2 weeks and older. An FDA press releaserelated to this announcement is available athttp://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm333205.htm.Previously, oseltamivir was approved by FDA for treatment of influenza inpersons aged 1 year and older; however, CDC and the Advisory Committee forImmunization Practices (ACIP) have recommended oseltamivir for treatment ofinfluenza in persons of all ages, including those younger than one year old.All children younger than 5 years old are considered at high risk forcomplications from influenza. The highest risk lies with children younger than 2years of age, and especially with infants younger than 6 months of age whoexperience the highest rates of influenza-associated hospitalization and deathrates. On the basis of epidemiologic studies of patients with seasonal influenza or 2009H1N1, antiviral treatment with a neuraminidase inhibitor, such as oseltamivir, isrecommended for all persons with suspected or confirmed influenza who are athigher risk for influenza complications because of age or underlying medicalconditions.6


CDC Influenza Division Key PointsDecember 21, 2012CDC’s recommendation for the use of oseltamivir to treat influenza has notchanged, and CDC continues to recommend oseltamivir for treatment ofinfluenza in persons of all ages.Early antiviral treatment of influenza provides the greatest clinical benefit. Oseltamivir has been in use in the United States since 1999.Influenza Antiviral Medications: BackgroundTwo FDA-approved influenza antiviral medications are recommended for use inthe United States during the 2012-2013 influenza season: oral oseltamivir(Tamiflu®) and inhaled zanamivir (Relenza®).Oseltamivir and zanamivir are known as neuraminidase inhibitors and haveactivity against both influenza A and B viruses.When clinically indicated, influenza antiviral medications should be used to treatthese most vulnerable patients as soon as possible, ideally (but not limited to)within 48 hours of symptom onset. Treatment is still recommended if started>48 hours after illness onset.Antiviral treatment with oseltamivir or zanamivir is recommended as early aspossible for patients with confirmed or suspected influenza who have severe,complicated, or progressive illness; who require hospitalization; or who are atgreater risk for serious influenza-related complications. including young children,pregnant women, and persons with certain chronic medical conditions.Treatment of persons with suspected influenza should not wait for laboratoryconfirmation of influenza.Antiviral treatment can also be considered for any previously healthy, non-highrisk,symptomatic outpatient with confirmed or suspected influenza based uponclinical judgment, if treatment can be initiated within 48 hours of illness onset.Influenza vaccination to prevent influenza and prompt antiviral therapy to treatinfluenza illness are the two most important medical countermeasures againstthe influenza viruses. Their correct application by health care professionals canprovide life-saving benefits to patients.For more information about antiviral medications, visithttp://www.cdc.gov/flu/antivirals/index.htm.7


CDC Influenza Division Key PointsDecember 21, 20128

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