Summary Key Points FluView Activity Update

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Summary Key Points FluView Activity Update

CDC Influenza Division Key PointsMarch 29, 2013In this document: Summary Key Points FluView Activity Update Influenza-Related Pediatric Deaths CDC Antiviral Treatment Recommendations Message to Health Care Providers: Ordering Flu Vaccine for 2013-2014Summary Key PointsInfluenza activity continues to decline across the United States with influenza-likeillnessfalling below baseline for the first time since December. (See Flu ActivityUpdate.)However, influenza may continue to spread at low levels and cause illness for severalweeks in parts of the country.Today CDC posted a Flu Spotlight, “Flu Season Draws to a Close.”CDC routinely recommends vaccination as long as influenza viruses are circulating,but since it takes two weeks for vaccine to become protective and flu activity iswinding down, the window for vaccination this season is closing.However, ongoing vaccination is still recommended in institutional outbreak settings,for children needing to complete the second dose in their two-dose regime, and forpeople preparing to travel to the Southern Hemisphere, which is beginning to enterits traditional flu season.Because of the ongoing influenza activity, however, CDC continues to urge people athigh risk from flu complications, including people 65 and older, to seek treatmentquickly if they develop flu symptoms including cough, fever, sore throat, and bodyaches.Antiviral treatment can avert serious outcomes and should begin as quickly aspossible in high risk persons, including people 65 and older, young children,pregnant women, and people with certain underlying conditions like asthma, heartdisease, diabetes and neurological disorders. (See section on CDC’s AntiviralTreatment Recommendations.)The 2013-2014 influenza vaccine can be ordered at this time from manufacturersand distributors. (See section Message to Health Care Providers: Ordering FluVaccine for 2013-2014.)FluView Activity UpdateAccording to the latest FluView report, influenza activity continues to decline acrosskey flu indicators, including influenza-like-illness (ILI), which dropped belowbaseline. Influenza viruses are still circulating, with influenza B viruses nowpredominating; however, the season has peaked and activity is winding down.1


CDC Influenza Division Key PointsMarch 29, 2013 Below is a summary of the key indicators for the week of March 17-23, 2013.For the week of March 17-23, the proportion of people seeing their health careprovider for influenza-like illness (ILI) decreased this week from last and is nowbelow the national baseline.No states reported high ILI activity. One state reported moderate ILI activity for theweek of March 17-23. The remaining 49 states and New York City reported low orminimal ILI activity. ILI activity data indicate the amount of flu-like illness that isoccurring in each jurisdiction.Six states reported widespread geographic influenza activity for the week of March17-23; a decrease from the seven states in the previous week. Eight states andPuerto Rico reported regional influenza activity. Geographic spread data show howmany areas within a state or territory are seeing flu activity.The number of newly reported flu-associated hospitalizations continues to decrease.Since October 1, 2012, 11,639 laboratory-confirmed influenza-associatedhospitalizations have been reported; an increase of 332 hospitalizations from theprevious week. This translates to a cumulative rate of 41.8 influenza-associatedhospitalizations per 100,000 people in the United States.oHospitalization data are collected from 15 states and represent approximately9% of the total U.S. population. The number of hospitalizations reported doesnot reflect the actual total number of influenza-associated hospitalizations inthe United States.The proportion of deaths attributed to pneumonia and influenza (P&I) based on the122 Cities Mortality Reporting System held at 7.5% this week, and remains slightlyabove the epidemic threshold.Five influenza-associated pediatric deaths were reported during the week of March17-23, 2013. One death was associated with an influenza A (H3) virus and twodeaths were associated with influenza A viruses for which the subtype was notdetermined. The remaining two deaths were associated with influenza B viruses. Thisbrings the total number of influenza-associated pediatric deaths reported to CDC for2012-2013 to 110. Additional information regarding pediatric deaths is availablethrough FluView Interactive.Nationally, the percentage of respiratory specimens testing positive for influenza inthe United States during the week of March 17-23, 2013 remains above 10%, butdecreased for the twelfth consecutive week. Influenza B viruses accounted for 74%of all reported influenza positive specimens this week as the number of influenza AH3N2 viruses detected has declined.Influenza A (H3N2), 2009 influenza A (H1N1), and influenza B viruses have all beenidentified in the U.S. this season. During the week of March 17-23, 186 of the 702influenza-positive tests reported to CDC were influenza A and 516 were influenza Bviruses. Of the 72 influenza A viruses that were subtyped, 84.7% were H3 virusesand 15.3% were 2009 H1N1 viruses.2


CDC Influenza Division Key PointsMarch 29, 2013Since October 1, 2012, CDC has antigenically characterized 1,870 influenza viruses,including 176 2009 influenza A (H1N1) viruses, 1,085 influenza A (H3N2) viruses and609 influenza B viruses.oooOf the 176 2009 influenza A (H1N1) characterized, 173 (98.3%) werecharacterized as A/California/7/2009-like. This is the influenza A (H1N1)component of the Northern Hemisphere vaccine for the 2012-2013 season.Of the 1,085 influenza A (H3N2) viruses, 1,081 (99.6%) were characterizedas A/Victoria/361/2011-like. This is the influenza A (H3N2) component of theNorthern Hemisphere influenza vaccine for the 2012-2013 season.Of the 609 influenza B viruses characterized, 70% belonged to theB/Yamagata lineage of viruses, and were characterized asB/Wisconsin/1/2010-like, the influenza B component for the 2012-2013Northern Hemisphere influenza vaccine. The remaining 30% of the testedinfluenza B viruses belonged to the B/Victoria lineage of viruses. Since October 1, 2012, CDC has tested 427 2009 influenza A (H1N1), 1,692influenza A (H3N2), and 649 influenza B virus samples for resistance toneuraminidase inhibitors. While the vast majority of the tested virus samples(>99%) showed susceptibility to the antiviral drugs oseltamivir and zanamivir, two2009 H1N1 viruses (reported during week 3 and week 6) and two influenza A (H3N2)viruses (reported during weeks 10 and 11) showed resistance to oseltamivir. Highlevels of resistance to the adamantanes (amantadine and rimantadine) persistamong 2009 influenza A (H1N1) and A (H3N2) viruses. Adamantanes are noteffective against influenza B viruses.FluView is available – and past issues are archived – on the CDC website.Note: Delays in reporting may mean that data changes over time. The most up to datedata for all weeks during the 2012-2013 season can be found on the current FluViewwebpage at www.cdc.gov/flu/weekly.Influenza‐Related Pediatric Deaths Five pediatric deaths were reported during the week of March 17-23, 2013.A total of 110 influenza-associated pediatric deaths have been reported during the2012-2013 season from Chicago [1], New York City [4] and 36 states (AL [1], AR[3], AZ [2], CA [3], CO [5], FL [8], HI [1], IA [1], IL [1], IN [4], KS [2], KY [1], LA[1], MA [3], MD [2], ME [1], MI [5], MN [4], MS [1], NE [1], NH [3], NJ [6], NM [2],NV [1], NY [7], OH [4], OK [1], PA [1], SC [4], SD [2], TN [2], TX [15], UT [3], VA[1], WA [1], and WI [2]).A pediatric death is a death in a person younger than 18 who died from an illnessrelated to infection with an influenza virus.A preliminary review of the available 2012-2013 pediatric death reports indicatesthat:3


CDC Influenza Division Key PointsMarch 29, 2013ooo60% of deaths occurred in children who were at high risk of developingserious flu-related complications. However, 40% had no recognized chronichealth problems.About 90% of flu-related deaths were in unvaccinated children.The proportions of pediatric deaths that occurred in unvaccinated children andamong children at high risk from flu complications are largely consistent withwhat has been seen in the past.Since 2004, when pediatric deaths associated with influenza infection became anationally notifiable condition, the number of deaths reported to CDC each year hasranged from 34 (2011-2012 season) to 122 deaths (2010-2011 season). During the 2009 H1N1 pandemic — April 15, 2009 to October 2, 2010 — 348pediatric deaths were reported to CDC.These deaths are a somber reminder of the danger flu poses to children.The single best way to protect against seasonal flu and its potential severeconsequences is to have children receive a seasonal flu vaccine each year.Vaccination is especially important for children younger than 5 years of age andchildren of any age with an underlying medical condition like asthma, a neurologicalor neurodevelopmental disease, or immune suppression. These children are at higherrisk of serious complications if they get the flu.Information about the pediatric deaths, including basic demographics, underlyingconditions and time and place of death, is collected through the Influenza-AssociatedPediatric Mortality Surveillance System. Information for the 2012-2013 season isnow available through the Influenza Associated Pediatric Mortality application ofFluView Interactive at http://www.cdc.gov/flu/weekly/fluviewinteractive.htm.Yearly vaccination also is especially important for people in contact with high riskchildren in order to protect the child (or children) from the flu.Even previously healthy children can become seriously ill if they get the flu. Thelatest laboratory-confirmed influenza hospitalization data reported in this week’sFluView indicate that approximately 44% of children hospitalized with the flu had noidentified underlying medical conditions.Flu-related deaths in children younger than 18 years old should be reported throughthe Influenza-Associated Pediatric Mortality Surveillance System. The number of fluassociateddeaths among children reported during the 2012-2013 flu season will beupdated each week and can be found at www.cdc.gov/flu/weekly/#S3.CDC Antiviral Treatment RecommendationsClinical benefit is greatest when antiviral treatment is administered early. Whenindicated, antiviral treatment should be started as soon as possible after illnessonset, ideally within 48 hours of symptom onset. However, antiviral treatment might4


CDC Influenza Division Key PointsMarch 29, 2013still be beneficial in patients with severe, complicated or progressive illness and inhospitalized patients when started after 48 hours of illness onset, as indicated byobservational studies.Antiviral treatment is recommended as early as possible for any patient withconfirmed or suspected influenza whoooois hospitalized;has severe, complicated, or progressive illness; oris at higher risk for influenza complications.Treatment of persons with suspected influenza should not wait for laboratoryconfirmation of influenza. While influenza vaccination is the first and best way toprevent influenza, a history of influenza vaccination does not rule out the possibilityof influenza virus infection in an ill patient with clinical signs and symptomscompatible with influenza.Antiviral treatment also can be considered for any previously healthy, symptomaticoutpatient not at high risk with confirmed or suspected influenza on the basis ofclinical judgment, if treatment can be initiated within 48 hours of illness onset.More information is available athttp://www.cdc.gov/flu/professionals/antivirals/index.htm.Message to Health Care Providers: Ordering Flu Vaccine for 2013‐2014The 2013-2014 influenza vaccine can be ordered at this time from manufacturersand distributors.As the 2012-2013 flu season has shown, it is important to pre-book vaccine as soonas it is available.Most of the flu vaccine offered for the 2013-2014 season will be trivalent (threecomponent).Some quadrivalent (four-component) vaccine will be available as well according tomanufacturers; however, supplies are expected to be limited.All nasal spray vaccine is expected to be quadrivalent, however, this makes up only asmall portion of total vaccine availability.oOrdering flu vaccine should not be delayed if quadrivalent flu vaccine is notavailable.Trivalent vaccine offers important protection from flu.5

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