DISPATCHESin Central America and 12 (92%, 95% CI 78%–107%)of 13 subsequent seasons in North America (Table 1; onlineTechnical Appendix, http://wwwnc.cdc.gov/EID/article/21/7/14-0788-Techapp1.xlxs). Similarly, A(H3N2)virus strains in South America predominated in all 11 (92%,95% CI 76%–107%) of 12 subsequent seasons in CentralAmerica and 10 (71%, 95% CI 48%–95%) of 14 subsequentseasons in North America. Predominant influenza B virusstrains in South America only predominated in 8 (67%, 95%CI 40%–93%) of 12 subsequent seasons in Central Americaand 8 (57%, 95% CI 31%–83%) of 14 subsequent seasonsin North America. Virus strains in South America during 1season typically did not predominate in subsequent seasonsin South America (54%, 95% CI 38%–70%).The predominant A(H1N1) virus strains in NorthAmerica predominated in 7 (78%, 95% CI 51%–105%) of 9subsequent seasons in Central America and 10 (83%, 95%CI 62%–104%) of 12 subsequent seasons in South America.A(H3N2) virus strains in North America predominatedin 8 (67%, 95% CI 40%–93%) of 12 subsequent seasonsin Central America and 10 (77%, 95% CI 54%–100%) of13 subsequent seasons in South America. Influenza B virusstrains in North America predominated in 9 (75%, 95% CI51%–100%) of 12 subsequent seasons in Central Americaand 7 (54%, 95% CI 27%–81%) of 13 subsequent seasonsin South America. Virus strains that predominated in NorthAmerica during 1 season were less likely to predominatein the subsequent season in North America (62%, 95% CI46%–77%).At least 1 component of the Southern Hemisphere vaccinecomposition recommendations matched a predominantantigenic characterization in South America in 13 (93%,95% CI 79%–106% of 14 influenza seasons that occurredduring 2001–2014, and at least 1 component of the NorthernHemisphere vaccine composition recommendationsmatched a predominant antigenic characterization in NorthAmerica in all 14 influenza seasons that occurred during2001–2014. Of 33 predominant antigenic virus strainsidentified in Central America during 2002–2014, 21 (64%,95% CI 47%–80%) matched the Southern Hemisphere recommendationsand 24 (73%, 95% CI 58%–88%) matchedthe Northern Hemisphere recommendations (Table 2).ConclusionsOur findings suggest that virus strains identified duringinfluenza epidemics in South America typically becamepredominant in subsequent epidemics in Central and NorthAmerica. Almost as frequently, virus strains identifiedduring epidemics in North America became predominantin the subsequent Central and South America epidemics.Although strain selection for 1 hemisphere’s vaccine formulationtypically occurs before influenza activity is widespreadin the opposite hemisphere, health officials have anopportunity to anticipate which influenza virus strains maypredominate by observing activity in other subregions. Forexample, influenza A(H1N1)pdm09 virus predominated inBrazil during 2013 (8) and became predominant in NorthAmerica during 2013–2014. Health officials identifyinginfluenza B virus strains in 1 hemisphere would have correctlypredicted the predominant influenza B virus strainsin the opposite hemisphere only half of the time unless theyhad also examined other co-circulating influenza B virusTable 1. Most commonly identified antigenic characterizations of influenza strains in the Americas during 2001–2014*†Influenza A(H1N1) virus Influenza A(H3N2) virus Influenza B virusYear South Central North South Central North South Central North2001 A NA A A NA A A NA B‡2002 A NA A A NA A B B B2003 A NA A A B B‡ B NA C‡2004 NA NA A B B C‡ C C C2005 A NA A C C C D‡ E‡ D2006 A A A D‡ D D E D/E D2007 A A B‡ E‡ E E F‡ F F2008 C‡ C C E E E F F G‡2009 D‡ D D E E F‡ F G G2010 D D D F F F G G G2011 D D D F F F G G G2012 D D D F F F H‡ G H2013 D D D G‡ G H‡ G I‡ I2014 D D D H H H I I I*Data from Canada, Mexico, and the United States were aggregated to represent North America; data from Belize, Costa Rica, El Salvador, Guatemala,Honduras, Nicaragua, and Panama to represent Central America; and data from Argentina, Brazil, Chile, Paraguay, and Uruguay to represent SouthAmerica.†For influenza A(H1N1) virus, A, A/New Caledonia/20/99(H1N1); B, A/Solomon Islands/03/2006(H1N1); C, A/Brisbane/59/2007(H1N1); D,A/California/07/2009-(H1N1)pdm09. For influenza A(H3N2) virus, A, A/Panama/2007/99(H3N2); B, A/Fujian/411/2002(H3); C,A/California/07/2004(H3N2); D, A/Wisconsin/67/2005(H3N2); E, A/Brisbane/10/2007(H3N2); F, A/Perth/16/2009(H3N2); G, A/Victoria/361/2011(H3N2);H, A/Texas/50/2012(H3N2). For influenza B virus, A, B/Sichuan/379/99(YAM); B, B/Shandong/7/97(VIC); C, B/Shanghai/361/2002(YAM); D,B/Malaysia/2505/2005(VIC); E, B/Florida/07/2004(YAM); F, B/Florida/04/2006(YAM); G, B/Brisbane/60/2008(VIC); H, B/Wisconsin/01/2010(YAM) I,B/Massachusetts/02/2012(YAM). NA, not applicable.‡Newly identified strain (8 in South America, 2 in Central America, and 7 in North America).1210 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015
Influenza Virus Strains in the AmericasTable 2. Most commonly identified antigenic characterizations of influenza strains in Central America compared with composition ofSouthern and Northern hemisphere vaccines, 2002–2014*MatchedSouth America vaccine southern North America vaccinecompositionvaccinecompositionMatchednorthernvaccinePredominant strains in CentralAmerica2002A/New Caledonia/20/99(H1N1)-like NA A/New Caledonia/20/99(H1N1)-like NAA/Moscow/10/99(H3N2)-like NA A/Moscow/10/99(H3N2)-like NAB/Shandong/7/97(VIC) B/Sichuan/379/99-like – B/Hong Kong/330/2001-like –2003A/Fujian/411/2002(H3)-like A/New Caledonia/20/99(H1N1)-like NA A/New Caledonia/20/99(H1N1)-like NAA/Moscow/10/99(H3N2)-like – A/Moscow/10/99(H3N2)-like –B/Hong Kong/330/2001-like NA B/Hong Kong/330/2001-like NA2004A/New Caledonia/20/99(H1N1)-like NA A/New Caledonia/20/99(H1N1)-like NAA/Fujian/411/2002(H3)-like A/Fujian/411/2002(H3N2)-like + A/Fujian/411/2002(H3N2)-like +B/Shanghai/361/2002(YAM) B/Hong Kong/330/2001-like – B/Shanghai/361/2002-like +2005A/New Caledonia/20/99(H1N1)-like NA A/New Caledonia/20/99(H1N1)-like NAA/California/07/2004(H3N2)-like A/Wellington/1/2004(H3N2)-like – A/California/7/2004(H3N2)-like +B/Florida/07/2004(YAM) B/Shanghai/361/2002-like – B/Shanghai/361/2002-like –2006A/New Caledonia/20/99(H1N1)-like A/New Caledonia/20/99(H1N1)-like + A/New Caledonia/20/99(H1N1)-like +A/Wisconsin/67/2005 (H3N2)-like A/California/7/2004(H3N2)-like – A/Wisconsin/67/2005 (H3N2)-like +B/Malaysia/2505/2005(VIC) B/Malaysia/2506/2004-like + B/Malaysia/2506/2004-like +2007A/New Caledonia/20/99(H1N1)-like A/New Caledonia/20/99(H1N1)-like + A/Solomon Is/3/2006 (H1N1)-like –A/Brisbane/10/2007 (H3N2)-like A/Wisconsin/67/2005(H3N2)-like – A/Wisconsin/67/2005 (H3N2)-like –B/Florida/04/2006(YAM) B/Malaysia/2506/2004-like – B/Malaysia/2506/2004-like –2008A/Brisbane/59/2007(H1N1)-like A/Solomon Is/3/2006(H1N1)-like – A/Brisbane/59/2007 (H1N1)-like +A/Brisbane/10/2007(H3N2)-like A/Brisbane/10/2007(H3N2)-like + A/Brisbane/10/2007 (H3N2)-like +B/Florida/4/2006(YAM) B/Florida/4/2006-like + B/Florida/4/2006-like +2009A/California/7/2009(H1N1)-like A/Brisbane/59/2007(H1N1)-like – A/Brisbane/59/2007 (H1N1)-like –A/Brisbane/10/2007(H3N2)-like A/Brisbane/10/2007(H3N2)-like + A/Brisbane/10/2007 (H3N2)-like +B/Brisbane/60/2008(VIC) B/Florida/4/2006-like – B/Brisbane/60/2008-like +2010A/California/7/2009(H1N1)-like A/California/7/2009(H1N1)-like + A/California/7/2009 (H1N1)-like +A/Perth/16/2009(H3N2)-like A/Perth/16/2009(H3N2)-like + A/Perth/16/2009 (H3N2)-like +B/Brisbane/60/2008(VIC) B/Brisbane/60/2008-like + B/Brisbane/60/2008-like +2011A/California/7/2009(H1N1)-like A/California/7/2009(H1N1)-like + A/California/7/2009 (H1N1)-like +A/Perth/16/2009(H3N2)-like A/Perth/16/2009(H3N2)-like + A/Perth/16/2009 (H3N2)-like +B/Brisbane/60/2008(VIC) B/Brisbane/60/2008-like + B/Brisbane/60/2008-like +2012A/California/7/2009(H1N1)-likeA/California/7/2009(H1N1)pdm09- + A/California/7/2009(H1N1)pdm09- +likelikeA/Perth/16/2009(H3N2)-like A/Perth/16/2009(H3N2)-like + A/Victoria/361/2011(H3N2)-like –B/Brisbane/60/2008-like(VIC) B/Brisbane/60/2008-like + B/Wisconsin/1/2010-like –2013A/California/7/2009(H1N1)-likeA/California/7/2009(H1N1)pdm09- + A/California/7/2009(H1N1)pdm09- +likelikeA/Victoria/361/2011(H3N2)-like A/Victoria/361/2011(H3N2)-like + A/Victoria/361/2011 +B/Massachusetts/02/2012(YAM) B/Wisconsin/1/2010-like – B/Massachusetts/02/2012-like +2014A/California/07/2009(H1N1)pdm09-likeA/California/7/2009 (H1N1)pdm09- + A/California/7/2009(H1N1)pdm09- +likelikeA/Texas/50/2012(H3N2)-like GP A/Texas/50/2012 (H3N2)-like + A/Texas/50/2012(H3N2)-like +B/Massachusetts/02/2012(YAM) B/Massachusetts/2/2012-like + B/Massachusetts/2/2012-like +Total percentage matching strains 64% 73%*Values are proportions of occurrences when predominant strains are represented in each vaccine formulation. +, match; –, no match; NA, influenza typenot among predominant circulating strains; Solomon Is, Solomon Islands.strains. Nevertheless, such findings underscore the importanceof year-round surveillance, viral characterization,data sharing, and annual influenza vaccination.Our analyses are based on a convenience sample ofrespiratory specimens obtained from heterogeneous surveillancesystems using different diagnostic assays (e.g.,Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015 1211
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July 2015SynopsisOn the CoverMarian
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1240 Gastroenteritis OutbreaksCause
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SYNOPSISDisseminated Infections wit
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LETTERSInfluenza A(H5N6)Virus Reass
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BOOKS AND MEDIAin the port cities o
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ABOUT THE COVERNorth was not intere
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Earning CME CreditTo obtain credit,
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Emerging Infectious Diseases is a p