HK’s Imported H7N9 Case Dies, Seasonal Flu Continues Strong

 

# 9769

 

As the City of Hong Kong struggles with a particularly severe H3N2 flu season, its 3rd imported H7N9 case of the winter (and 13th overall) has reportedly died in a local hospital a week after his case was announced.  Of the two other H7N9 cases imported into Hong Kong this season, one has recovered while the other remains hospitalized in critical condition.

H7N9 bird flu infected man dead

Sing Tao Daily 

Had earlier to the mainland, after his return confirmed cases of H7N9 avian influenza in 61-year-old man, extended to 6:30 am dead. Food and Health Secretary Ko Wing-man, said most H7N9 cases in Hong Kong imported from mainland China appealed to the public when the areas affected by avian influenza to be alert.

Last month, the patient twice to Zhangmutou, and go to the market to buy two chickens have been slaughtered, after returning discomfort, admitted to Queen Mary Hospital intensive care unit, extended to 6:35 this morning, where he died.

(Continue . . . )

Of the 602 H7N9 known cases reported by the World Health Organization as of February 23rd, 227 deaths have been reported, yielding an impressive 37% fatality rate.  

But the real CFR (case fatality rate) is likely far lower, as only the `sickest of the sick’ are likely to be hospitalized, tested, and identified as carrying the virus.  And those people who are sick enough to be hospitalized are also more likely to succumb.

 

If we could factor in the mild or moderate cases that never get counted, but recover on their own, that sky-high CFR would probably drop precipitously. 

 

But even a 10-fold drop in mortality would leave us with a very daunting flu, comparable to the 1918 pandemic.

 

Meanwhile, Hong Kong’s seasonal flu continues unabated, and their Centre for Health Protection has published a YTD report showing its impact.  

 

Thus far, seasonal flu has claimed at least 307 lives in Hong Kong this winter.  To put that in perspective, last year 133 deaths were reported – and this year’s flu season is far from over.

 

Update on severe seasonal influenza cases (As of 1 March, 2015, 12 noon)

MMWR: A 2013-14 Flu Season Review

CDC FluView – A Flu Season dominated by H1N1

 

 

# 8715

 

The flu season just ended was notable for being the first H1N1 dominated flu season in the United States since the 2009 H1N1 pandemic virus first emerged.  Since then, the (now seasonal) H1N109 virus had taken a backseat to the H3N2 virus – that is – until last winter.

H1N1 dominated flu seasons are traditionally not as severe, but are more likely to impact younger adults and children, than do H3N2 seasons.   And that is the pattern we saw last year.

 

A look at the P&I (Pneumonia & Influenza) Mortality charts for the past four years shows that the previous year (2012-13) peaked far higher, and far earlier, than did last year. 

 

FIGURE 4. Percentage of all deaths attributable to pneumonia and influenza (P&I), by surveillance week and year — 122 Cities Mortality Reporting System, United States, 2009–2014*

 

If you go back to the 2011-12 flu season, we barely saw a flu epidemic at all – in what was perhaps the lightest flu season in 30 years.   Such is the variability of our yearly influenza epidemic.

Yesterday the CDC’s MMWR published a detailed review of the past flu season, with an abundance of charts and statistical information.  I’ve excerpted some highlights, but follow the link to read it in its entirety.

 

Influenza Activity — United States, 2013–14 Season and Composition of the 2014–15 Influenza Vaccines

Weekly

June 6, 2014 / 63(22);483-490

Scott Epperson, MPH1, Lenee Blanton, MPH1, Krista Kniss, MPH1, Desiree Mustaquim, MPH1, Craig Steffens, MPH1, Teresa Wallis, MS1, Rosaline Dhara, MPH1, Michelle Leon, MPH1, Alejandro Perez, MPH1, Sandra S. Chaves, MD1, Anwar Abd Elal1, Larisa Gubareva, MD1, Xiyan Xu, MD1, Julie Villanueva, PhD1, Joseph Bresee, MD1, Nancy Cox, PhD1, Lyn Finelli, DrPH1, Lynnette Brammer, MPH1 (Author affiliations at end of text)

During the 2013–14 influenza season in the United States, influenza activity* increased through November and December before peaking in late December. Influenza A (H1N1)pdm09 (pH1N1) viruses predominated overall, but influenza B viruses and, to a lesser extent, influenza A (H3N2) viruses also were reported in the United States. This influenza season was the first since the 2009 pH1N1 pandemic in which pH1N1 viruses predominated and was characterized overall by lower levels of outpatient illness and mortality than influenza A (H3N2)–predominant seasons, but higher rates of hospitalization among adults aged 50–64 years compared with recent years. This report summarizes influenza activity in the United States for the 2013–14 influenza season (September 29, 2013–May 17, 2014†) and reports recommendations for the components of the 2014–15 Northern Hemisphere influenza vaccines.

(Continue . . .. )

 

Another somewhat surprising aspect of last year’s flu season was the near-lack of novel flu detections in the United States. During the previous couple of years we saw several hundred swine variant viruses reported, mostly associated with attendance of state and county fairs where pigs were displayed (see A Variant Swine Flu Review).

One of the things we will be watching for this summer is the possible return of variant swine flu viruses.   Last July, in anticipation of its return,  the CDC Released Updated H3N2v Guidance.

 

But as the MMWR report above states:

 

Novel Influenza A Viruses - During the 2013–14 influenza season, one case of human infection with an H3N2v virus occurred during week 40 (the week ending October 5, 2013) in a child from Iowa with known direct exposure to swine. The child fully recovered, and no additional cases were identified in family members or other close contacts.

 

This year’s flu vaccine will have the same components as last year, but that doesn’t mean if you got a shot last year, you can safely skip this year.  The protection of flu vaccines decreases over time (see BMC Infectious Diseases: Waning Flu Vaccine Protection In the Elderly.) 

 

Since flu shots are generally about 60% protective most years, it makes getting the booster  the smart thing to do every year.

 

Composition of the 2014–15 Influenza Vaccines

The Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee has determined that the 2014–15 influenza vaccines used in the United States have the same antigenic composition as those used in 2013–14. The trivalent vaccines should contain an A/California/7/2009-like (2009 H1N1) virus, an A/Texas/50/2012-like (H3N2) virus, and a B/Massachusetts/2/2012-like (B/Yamagata lineage) virus. The committee also recommended that quadrivalent vaccines contain a B/Brisbane/60/2008-like (B/Victoria lineage) virus (1). These recommendations were based on global influenza virus surveillance data related to epidemiology, antigenic and genetic characteristics, serologic responses to 2013–14 seasonal vaccines, and the availability of candidate vaccine viruses and reagents.

The MMWR report sums up their findings:

 

What is already known on this topic?

CDC collects, compiles, and analyzes data on influenza activity year-round in the United States. Substantial influenza activity generally begins in the fall and continues through the winter and spring months; however, the timing and severity of influenza activity varies by geographic location and season.

What is added by this report?

The 2013–14 influenza season was the first influenza A (H1N1)pdm09–predominant season since the emergence of the virus in 2009, and also had later-season influenza B activity. The highest hospitalization rates were among adults aged ≥65 years, which is consistent with previous influenza seasons; hospitalization rates among those aged 50 to 64 years were significantly higher than in all years since the 2009 pandemic. Nearly all of the influenza virus specimens sent to CDC for antigenic characterization were similar to the components of the 2013–14 Northern Hemisphere influenza vaccine. The Food and Drug Administration has recommended that the 2014–15 influenza vaccines used in the United States have the same antigenic composition as those used in 2013–14.

What are the implications for public health practice?

Influenza surveillance, including for novel influenza viruses, should continue throughout the summer months, and health-care providers should consider influenza as a cause of respiratory illness even outside the typical season. Although influenza viruses typically circulate at low levels during the summer months, timely empiric antiviral treatment is recommended for patients with severe, complicated, or progressive influenza illness and those at higher risk for influenza complications; treatment can be considered for others if it can be started within 48 hours of illness onset.

 

While there is no predicting what kind of flu year lies ahead, influenza has a habit of throwing us curve balls, and its potential impact should never be underestimated.

Texas DSHS Statement On Recent Spike In Flu Activity

CDC FluView Report  Week 50

# 8096

 

Texas, along with several other southern states,are seeing a sharp increase in influenza activity over the past couple of weeks, as illustrated by the map at the top of this post from today’s CDC FluView

 

Today’s summary from the Texas Weekly Influenza Surveillance report states:

 

Statewide influenza-like illness (ILI) activity continues to increase and is above baseline levels. Influenza activity is increasing steadily. All Texas Regions have reported laboratory confirmed influenza, and the percentage of specimens positive for influenza is over 10%. ILI intensity is high, and influenza is widespread in Texas.

.

As the following graphic shows, not only are the vast majority of flu cases Influenza A, the 2009 (H1N1) virus – which has a history of hitting younger patients particularly hard - is the dominant strain being reported in Texas.

 

 

 

Partially as a response to this week’s high profile accounts of severe influenza cases (including fatalities) in and around Montgomery County, Texas (see and the Montgomery County Flu Updates – Dec 19th), and in part due to the statewide increase in influenza, the Texas DSHS  released the following statement this afternoon.  

 

 

Texas Encourages Vigilance in Flu Treatment, Precautions

News Release

Dec. 20, 2013

Though recent increases in flu activity are not unusual, Texas issued flu testing and treatment guidance today to doctors and is continuing to encourage everyone to get vaccinated now to protect themselves.

The level of flu-like illness is classified as “high” in Texas, and medical providers are seeing an increase in flu in multiple parts of the state. Unusually severe cases of flu-like illness are routinely investigated during the flu season by local health departments in coordination with the Texas Department of State Health Services. H1N1 is the most common circulating flu strain so far this season. This year’s flu vaccine includes protection against the most common flu strains, including H1N1.

DSHS advises clinicians to consider antiviral treatment, even if an initial rapid-flu test comes back negative. A negative result does not exclude a diagnosis of flu in a patient with suspected illness. Antiviral treatment is recommended for anyone with confirmed or suspected flu who is hospitalized, has severe or progressive illness or is at a higher risk for complications.

“Given the timing and the season, flu is on the rise and causing severe illness in certain people. This is not unexpected, but it’s a good reminder for people to get vaccinated and stay home if they’re sick,” said Dr. David Lakey, DSHS commissioner. “Flu can be deadly. People who have not been vaccinated should do so now. It’s the best defense we have.”

Flu is a serious disease that kills an average of 23,600 Americans a year, according to estimates from the Centers for Disease Control and Prevention. People over 65, pregnant women, young children and people with chronic health conditions are most at risk for complications, so it’s especially important for them to be vaccinated.

Flu cases and flu-related deaths in adults are not required to be reported to DSHS. Healthcare providers are required to report pediatric flu deaths to their local health department within one business day. There are no confirmed pediatric flu deaths in Texas this season.

DSHS recommends everyone six months old and older get vaccinated. People should talk to their health care provider about the best type of flu vaccine for them. A nasal spray version is available for healthy people ages 2 to 49 who are not pregnant, and a high-dose vaccine is approved for people 65 and older.

Dr. Lakey also urged people to follow standard illness-prevention steps:

• Wash hands frequently with soap and water or alcohol-based hand sanitizer;
• Cover coughs and sneezes;
• Stay home if sick

-30-

 

While Texas, Louisiana, Alabama, and Georgia are reporting the most intense flu activity right now, even states still shown in green, flu activity is on the rise. Just today, news media in Florida reported on the death of a 27 year old woman from H1N1 in Pasco County.

 

With the holidays ahead, and lots of people mingling and traveling, flu is likely to increase substantially around the nation over the next couple of months.   It is not too late to get a flu shot, and of course, one should always practice good flu hygiene regardless of your vaccination status.

An Abbreviated FluView

 

# 7876

Although the government shutdown has ended, and the CDC is back in full force, they’ve got some catch-up to do.  So Friday’s FluView report was brief, and accompanied by the following announcement.

 

Flu activity remains low (at least based on the surveillance data we have at the moment), with no pediatric deaths reported, and just one novel (H3N2v) swine variant infection reported in Iowa.

 

A few excerpts from Friday’s report follow:

 

 

2013-2014 Influenza Season Week 41 ending October 12, 2013

All data are preliminary and may change as more reports are received.

This FluView is in the abbreviated format due to the partial government shut-down from October 1-16, 2013.

Synopsis:

During week 41 (October 6-12, 2013), influenza activity remained low in the United States.

• Viral Surveillance: Of 3,534 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 41, 166 (4.7%) were positive for influenza.
• Novel Influenza A Virus: One human infection with a novel influenza A virus was reported.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
• Influenza-Associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.1%, below the national baseline of 2.0%. All 10 regions reported ILI below region-specific baseline levels. Two states experienced low ILI activity, 48 states and New York City experienced minimal ILI activity and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico was reported as regional; 3 states reported local influenza activity; Guam, the District of Columbia, the U.S. Virgin Islands, and 24 states reported sporadic influenza activity; 22 states reported no influenza activity, and one state did not report.

<SNIP>

Novel Influenza A Virus

One infection with an influenza A (H3N2) variant virus (H3N2v) was reported to CDC by Iowa. Contact between the case patient and swine in the week preceding illness was reported. The patient has fully recovered and no further cases have been identified in contacts of the case patient. This is the first H3N2v infection reported for the 2013-2014 influenza season, which began on September 29, 2013.

(Continue . . . )

 

Meanwhile, north of the border, Canada’s FluWatch reports very little influenza activity as well.

Hong Kong: Summer Flu Surge

 

 

 

 

# 7506

 

Making this summer’s surveillance for MERS-CoV and H7N9 just a little bit tougher, Hong Kong’s CHP has reported a surge in seasonal influenza and RSV (respiratory syncytial virus) over the past couple of weeks.

 

To date, although a number of patients have been tested, no cases of MERS-CoV or H7N9 have been detected in Hong Kong.

 

I suspect that most years a modest summertime rise in influenza activity would not generate this kind of attention, even in Hong Kong. But with concerns over two emerging respiratory viruses, enhanced vigilance is warranted.

 

Today, the CHP sent out letters to doctors reminding them of their reporting requirements (including forms to do so) and issued the following statement:

 

22 July 2013

Local influenza activity closely monitored by DH 

The Centre for Health Protection (CHP) of the Department of Health today (July 22) appealed to members of the public to stay vigilant against seasonal influenza as the latest surveillance data showed that there has been an increase in local influenza activity.

 

The Public Health Laboratory Services Branch of the CHP has reported a further increase in the number of influenza detections recently. The number of influenza virus detections reported increased from 84 in the week ending July 6 to 118 in the week ending July 20. The circulating influenza viruses detected in the week ending July 20 were influenza A (H3N2) (69.5 per cent), influenza A (H1N1) 2009 virus (26.3 per cent) and influenza B (4.2 per cent). The number of influenza-like illness (ILI) outbreaks increased from one in the week ending July 6 to six in the week ending July 20, affecting a total of 28 persons.

 

"In Hong Kong, the seasonal influenza activity usually exhibits two peaks, occurring between January and March and in July and August. We will continue to closely monitor the local situation of influenza activity," a CHP spokesman said.

 

Since 2011, the CHP has collaborated with the Hospital Authority and private hospitals to enhance surveillance concerning patients with influenza infection who required intensive care admission or died during the influenza peak season. This enhanced surveillance will be reactivated on July 26. During the period of enhanced surveillance for cases with influenza-associated intensive care unit (ICU) admission or death from January 18 to May 24, 2013, a total of 70 ICU admissions or death cases (including 29 deaths) with laboratory confirmation were recorded.

 

At the same time, the CHP will continue to closely monitor cases with severe paediatric influenza-associated complications or deaths. Since January 1, 2013, there have been 10 reports of severe paediatric influenza-associated complications. No death cases were recorded among these cases.

 

The CHP has sent letters to doctors, private hospitals and institutions alerting them to the latest local influenza activity.

 

Influenza can cause medical complications, especially among vulnerable people such as the elderly, young children and those with chronic medical conditions. The spokesman stressed that influenza vaccination can reduce complications, hospitalisation and death. As serious influenza infection can occur even in healthy individuals and influenza vaccines are safe and effective, all members of the public (except those with known contraindications) can consult their family doctors to receive seasonal influenza vaccination for personal protection.

 

To prevent influenza, members of the public are reminded to take the following measures:

• Build up good body immunity by having a proper diet, regular exercise and adequate rest, reducing stress and avoiding smoking;
• Maintain good personal and environmental hygiene;
• Wash hands after sneezing, coughing or cleaning the nose;
• Maintain good indoor ventilation; and
• Avoid visiting crowded places with poor ventilation.

Members of the public, particularly young children, elderly people and those with chronic diseases, should wear face masks and consult their doctors promptly if they develop influenza-like symptoms.

Ends/Monday, July 22, 2013

ECDC: Influenza Activity At A Glance

 

 

 

# 6965

 

In addition to producing its comprehensive Weekly influenza surveillance overview (WISO), the ECDC this season has started releasing a weekly influenza infographic that quickly, and elegantly, conveys the highpoints of the latest surveillance data at a glance. 

 

You’ll find the Week 7 infographic below.

 

 

Although only an ocean apart, Europe and North America often report quite different seasonal flu patterns.

 

• While Influenza B has started to gain a greater share in recent weeks, for most of this 2012-13 flu season North America has been struggling against influenza A, and among which H3N2 has been the dominant strain.

 

• In Europe the mix between influenza A & B has been about even - and since week 52/2012 - Europe has reported an increasing proportion of H1N1pdm09 over seasonal H3N2.

 

A more complete surveillance analysis may be read at the link(s) below:

 

Substantial influenza activity in Europe but some signs of decline: ECDC weekly monitoring

22 Feb 2013

ECDC

During week 7, 19 of the 29 countries reporting indicated high/medium-intensity transmission and wide geographic spread of influenza. Eleven countries reported increasing trends, and ten countries reported decreasing trends, compared to thirteen countries reporting increasing trends and six reporting decreasing trends in the previous week (week 6).

 

Virological surveillance shows that the proportion of influenza-positive cases among sentinel specimens continues to be high (52%) but continued to decrease, as first observed in the previous week.

 

Since week 40/2012, an even distribution of influenza virus types has been observed, 50% each for type A and type B viruses. Among influenza A viruses, an increasing proportion of A(H1)pdm09 over A(H3) has been reported since week 52/2012.

On 8 February 2013, ECDC published its annual risk assessment for seasonal influenza 2012-2013 based on data up to week 03/2013.

Resources:

• Weekly influenza surveillance overview, week 7/2013
• Risk assessment: Seasonal influenza 2012/13 in Europe (EU/EEA countries)
• Influenza in Europe at a glance: weekly infographic (.jpg)
• Watch ECDC video on seasonal influenza
• Read weekly influenza surveillance reports
• View influenza surveillance maps
• Learn more about influenza on ECDC website

FluView Week 6: Flu Activity Declines But Impact Remains Heavy

FluView Week 6

 

# 6940

 

The number of flu cases around the country continues to drop, but levels of P&I (Pneumonia & Influenza) Mortality remain high, as do hospitalization rates for those over the age of 65.

H3N2 remains the main player in our flu season (whereas H1N1 and Influenza B are more prominent in Europe), and as we often see with an H3N2 heavy season, the elderly are being hit particularly hard.

Some excerpts from this weeks FluView.

 

2012-2013 Influenza Season Week 6 ending February 9, 2013

All data are preliminary and may change as more reports are received.

Synopsis:

During week 6 (February 3 - 9, 2013), influenza activity remained elevated in the United States, but decreased in most areas.

• Viral Surveillance: Of 7,608 specimens tested and reported by collaborating laboratories, 1,499 (19.7%) were positive for influenza.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• Influenza-Associated Pediatric Deaths: Five pediatric deaths were reported.
• Influenza-Associated Hospitalizations: A cumulative rate for the season of 32.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. Of reported hospitalizations, more than 50% were among adults 65 years and older.

Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.2%. This is above the national baseline of 2.2%. All 10 regions reported ILI above region-specific baseline levels. Eleven states and New York City experienced high ILI activity; 10 states experienced moderate activity; the District of Columbia and 13 states experienced low activity, and 16 states experienced minimal activity.

Geographic Spread of Influenza: Thirty-one states reported widespread influenza activity; Puerto Rico and 14 states reported regional influenza activity; the District of Columbia and 4 states reported local influenza activity; Guam and one state reported sporadic influenza activity, and the U.S. Virgin Islands did not report.

Pneumonia and Influenza (P&I) Mortality Surveillance:

During week 6, 9.1% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.5% for week 6.

 

Along with the slight uptick in P&I mortality chart above, the hospitalization rate for those over 65 also notched up again.

 

 

And lastly, while 5 pediatric flu-related deaths were reported in week 6, all occurred in weeks prior to this latest reporting period.

While the influenza season may be showing signs of receding, the advice from the CDC on flu prevention still remains very much worth following.

 

Take everyday preventive actions to stop the spread of germs.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu–like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
• While sick, limit contact with others as much as possible to keep from infecting them.

ECDC: Influenza Still On The Rise In Europe

ECDC Week 5 Influenza Report

 

 

# 6921

 

While the levels of influenza-like-activity have begun to drop across much of North America, some areas of the Northern Hemisphere have yet to see their seasonal peak.

 

This morning the ECDC released their latest (week 5) influenza surveillance report, that finds that flu activity continues to rise in many parts of the EU.

 

Some excerpts from the week 5 report:

Weekly reporting on influenza surveillance in Europe for the 2012–13 season started in week 40/2012 and active influenza transmission began around week 49/2012, approximately six weeks earlier than in the 2011/2012 season.

• In week 5/2013, 19 countries reported concomitantly high/medium-intensity transmission and wide geographic spread. Twenty-two countries reported increasing trends in influenza activity.
• In week 5/2013, the proportion of influenza-positive sentinel specimens continued to increase, reaching 55%.
• Since week 40/2012, the proportions of influenza A and B viruses have remained similar (51% vs. 49%), but among type A viruses, the percentage of A(H1)pdm09 has continued to increase (64%), compared to 52% in week 2/2012.
• For week 5/2013, of 71 hospitalised laboratory-confirmed influenza cases reported by six countries, 33 (46%) tested positive for influenza A viruses and 38 (54%) for type B viruses.

On 8 February, ECDC published its annual risk assessment for seasonal influenza 2012–2013, based on data up to week 3/2013. The risk assessment is available here.

Influenza activity continued to rise across Europe in week 5/2013. In a few countries, the epidemics seemed to have passed their peaks, although some countries experienced a resurgence of ILI rates.

 

The ECDC is now producing a weekly Infographic that provides a quick review of the flu season in Europe.

 

 

Unlike North America, which this year has seen a flu season dominated by H3N2 Influenza A virus, in Europe the flu this season is nearly equally divided between influenza A & B.

 

And among the influenza A strains identified, 64% have been the 2009 H1N1 strain, and 36% H3N2. This year, In North America, H1N1 has been a relatively minor player.

 

Elsewhere around the world, we are seeing flu on the rise in Hong Kong as well.

FluView Week 5

 

 

# 6917

 

Although flu season continues strong in the some regions of the nation, most states are reporting decreases in influenza activity during the 5th reporting week of 2013.

 

 

Once again hospitalization rates for those over the age of 65, and the 122 City P&I (Pneumonia & Influenza) Mortality Rates remain elevated. Sadly, another 14 pediatric flu-related fatalities were reported in week 5 as well.

 

Overall, however, outpatient visits for influenza-like-illness are on the decline, as the following chart (red line) illustrates.

 

Some excerpts from this week’s FluView follow:

 

 

2012-2013 Influenza Season Week 5 ending February 2, 2013

All data are preliminary and may change as more reports are received.

Synopsis:

During week 5 (January 27 - February 2, 2013), influenza activity remained elevated in the United States, but decreased in most areas.

• Viral Surveillance: Of 10,132 specimens tested and reported by collaborating laboratories, 2,362 (23.3%) were positive for influenza.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• Influenza-Associated Pediatric Deaths: Fourteen pediatric deaths were reported.
• Influenza-Associated Hospitalizations: A cumulative rate for the season of 29.8 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. Of all hospitalizations, more than 50% were among adults 65 years and older.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.6%. This is above the national baseline of 2.2%. All 10 regions reported ILI above region-specific baseline levels. Nineteen states and New York City experienced high ILI activity; 12 states experienced moderate activity; 13 states experienced low activity; 6 states experienced minimal activity; and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: Thirty-eight states reported widespread influenza activity; 9 states reported regional influenza activity; the District of Columbia, Puerto Rico and 2 states reported local influenza activity; one state reported sporadic influenza activity; Guam reported no influenza activity, and the U.S. Virgin Islands did not report.

 

 

While 14 new pediatric deaths were reported this week, most occurred in weeks prior to reporting week five. This brings the total to 59 influenza-associated pediatric deaths reported during the 2012-2013 season.

 

Influenza-Associated Pediatric Mortality:

Fourteen influenza-associated pediatric deaths were reported to CDC during week 5. Three were associated with influenza A (H3) viruses and occurred during weeks 4 and 5 (weeks ending January 26 and February 2, 2013), 4 were associated with an influenza A virus for which the subtype was not determined and occurred during weeks 51, 1, 2, and 4 (weeks ending December 22, 2012, January 5, January 12, and January 26, 2013), and seven were associated with influenza B viruses and occurred during weeks 52, 2, 3, 4, and 5 (weeks ending December 29, 2012, January 12, January 19, January 26, and February 2, 2013).

 

 

Hospitalization rates, particularly for those over 65, remain very high, as the remarkable chart below shows. Well over 50% of all those hospitalized with laboratory confirmed influenza are over the age of 65.

 

 

And finally, while the P&I Mortality rate has dropped to 9%, it still remains higher than any we’ve seen over the past several flu seasons.

 

 

A month ago CDC Director Frieden pointed out the heavy toll this flu season was having on the elderly (see CDC Media Briefing), and stressed the importance of seeking early medical treatment, including the use of Tamiflu (oseltamivir) for high risk patients

While flu may be showing signs of receding, the advice from the CDC on flu prevention still remains very much worth following.

 

 

Take everyday preventive actions to stop the spread of germs.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu–like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
• While sick, limit contact with others as much as possible to keep from infecting them.

 

 

UPDATE:  Just as I posted this, Maggie Fox of NBC NEWS published this report on the number of hospitalizations and deaths during this 2012-2013 flu season, particularly among the elderly.

 

 

Flu season killing record number of older Americans, CDC says

By Maggie Fox Senior Writer

NBC News

This year’s especially grim flu season has been sickening and killing a very high number of people over 65, federal officials report -- even people who consider themselves relatively healthy and not frail.

 

The latest flu statistics show that while the season is leveling off, it’s still a bad one for seniors.

(Continue . . . )

CDC FluView Week 4

 

 

#6902

 

The story of this year’s flu season continues to revolve around the heavy toll the H3N2 virus is talking on the elderly population, but with 8 new pediatric deaths reported for the second week in a row, other age groups are being hit as well.

 

This season is also marked by an unusually early appearance of the flu, and a march of ILI activity across the nation from the south and east to the west.

 

Some excerpts from today’s FluView Report.

 

2012-2013 Influenza Season Week 4 ending January 26, 2013

All data are preliminary and may change as more reports are received.

Synopsis:

During week 4 (January 20-26), influenza activity remained elevated in the United States, but decreased in some areas.

• Viral Surveillance: Of 10,581 specimens tested and reported by collaborating laboratories, 2,701 (25.5%) were positive for influenza.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• Influenza-Associated Pediatric Deaths: Eight pediatric deaths were reported.
• Influenza-Associated Hospitalizations: A cumulative rate for the season of 25.9 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. Of all hospitalizations, more than 50% were among adults 65 years and older.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.2%; this is above the national baseline of 2.2%. All 10 regions reported ILI above region-specific baseline levels. Twenty-four states and New York City experienced high ILI activity; the District of Columbia and 13 states experienced moderate activity; 4 states experienced low activity; and 9 states experienced minimal activity.
• Geographic Spread of Influenza: Forty-two states reported widespread geographic influenza activity; 7 states reported regional activity; the District of Columbia and one state reported local activity; Guam reported sporadic influenza activity, and Puerto Rico and the U.S. Virgin Islands did not report.

 

 

Although the 122 city P&I mortality rate dropped this week to 9.4%, that is still at a level that – until last week – we hadn’t seen in nearly a decade.

 

Pneumonia and Influenza (P&I) Mortality Surveillance:

During week 4, 9.4% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.4% for week 4.

 

Influenza-related hospitalizations continue to be heavily skewed towards those over 65, reaching an 116.1 per 100,000 population, accounting for more than half of all hospitalizations.

 

 

This last chart shows the flu-related pediatric deaths reported to the CDC over the past four years.  The huge spike in 2009-10 due to the emergence of the H1N1 pandemic.

 

 

Pediatric deaths and P&I mortality reports are usually trailing indicators, with reports sometimes delayed by several weeks, so we may well continue to see elevated numbers over the next few FluView reports even as the overall level of flu starts to decline.

 

Two weeks ago, CDC Director Frieden pointed out the heavy toll this flu season is having on the elderly (see CDC Media Briefing), and stressed the importance of seeking early medical treatment, including the use of Tamiflu (oseltamivir) for high risk patients

CDC FluView Week 3

 

 

 

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The FluView report for week three is out, and the news includes eight pediatric deaths and the continued spike in P&I mortality rates (Pneumonia & Influenza) as reported by 122 U.S. Cities, which reached 9.8%.

 

P&I mortality is typically a trailing indicator of the flu season, and so while some regions are seeing decreases in influenza activity, the number of deaths can continue to rise for several weeks.

 

 

Some highlights from this week’s report:

 

2012-2013 Influenza Season Week 3 ending January 19, 2013

All data are preliminary and may change as more reports are received.

Synopsis:

During week 3 (January 13-19), influenza activity remained elevated in the United States, but decreased in some areas.

• Viral Surveillance: Of 11,984 specimens tested and reported by collaborating laboratories, 3,129 (26.1%) were positive for influenza.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• Influenza-Associated Pediatric Deaths: Eight influenza-associated pediatric deaths were reported.
• Influenza-Associated Hospitalizations: A cumulative rate for the season of 22.2 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. Of all hospitalizations, 50% were among adults 65 years and older.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.3%; this is above the national baseline of 2.2%. All 10 regions reported ILI above region-specific baseline levels. Twenty-six states and New York City experienced high ILI activity; 14 states experienced moderate activity; 9 states experienced low activity; 1 state experienced minimal activity, and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: Forty-seven states reported widespread geographic influenza activity; 2 states reported regional activity; the District of Columbia and one state reported local activity; Guam reported sporadic influenza activity, and Puerto Rico and the U.S. Virgin Islands did not report.

 

 

The eight pediatric deaths did not all occur during the reporting week, as the following summary explains.

 

Influenza-Associated Pediatric Mortality:

Eight influenza-associated pediatric deaths were reported to CDC during week 3. Two were associated with influenza A viruses for which the subtype was not determined and occurred during week 1 (week ending January 5, 2013), and six were associated with influenza B viruses and occurred during weeks 43, 46, 50, 52, and 3 (weeks ending October 27, November 17, December 15 and 29, 2012 and January 19, 2013).

 

A total of 37 influenza-associated pediatric deaths have been reported during the 2012-2013 season from New York City [1] and 18 states (Arkansas [1], Colorado [4], Florida [4], Indiana [1], Kansas [1], Maine [1], Massachusetts [1], Michigan [4], Minnesota [1], Nebraska [1], New Jersey [2], New York [3], Ohio [1], South Carolina [1], Tennessee [1], Texas [7], Washington [1], and Wisconsin [1]). Additional data can be found at http://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html.

 

The age group most impacted by this year’s flu season continues to be those over the age of 65, who account for half of all those hospitalized.

 

 

The last time the CDC charted P&I 122 City Mortality Rates this high was in Dec-Jan of the 2003-04 flu season (see chart below) – that like this one – began early and has been categorized as `moderately severe’ by the CDC (cite 2003 - 04 U.S. INFLUENZA SEASON SUMMARY*)

 

2003-04 Flu Season P&I Mortality

As a historical note, the P&I mortality rate reached 11% across 122 cities during the 3rd week of January, 2000.

So while elevated, this week’s P&I mortality rate is not unprecedented.

 

Last week, CDC Director Frieden pointed out the heavy toll this flu season is having on the elderly (see CDC Media Briefing), and stressed the importance of early treatment with Tamiflu (oseltamivir) for high risk patients

UK: HPA Reports Decline In Flu Activity

Current Season in RED – Credit HPA

 

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While the flu season continues in full force across much of North America, in the UK the HPA this week is reporting significant declines in influenza and influenza-like activity.

 

Unlike the H3N2 dominated flu season we’ve seen in the United States and Canada, influenza B appears to be leading the viral charge in the UK.

 

It is possible – as we saw in Hong Kong last year – to see more than one peak in a flu season. With several more `flu prone months’ ahead, one can’t necessarily assume the flu season is over for this year in the UK.

 

 

Weekly update on seasonal infections: 24 January 2013

24 January 2013

Latest figures from the Health Protection Agency (HPA) up to 24 January 2013 show that flu activity has decreased compared to the previous week based on a number of indicators, including GP consultation rates in England and the proportion of calls to NHS direct.

 

The number of laboratory confirmed cases of norovirus have also fallen again over the last week with 233 cases being reported during the first week of January and 168 in week two.

 

The latest figures show that GP consultation rates in England have decreased from 24.8 per 100,000 last week to 13.6 this week. Rates have also decreased in Northern Ireland (53.7 down from 72.4), Scotland (33.8 down from 52.22) and Wales (11.2 down from 26.1).

 

Calls received by NHS Direct for cold and flu remained stable below the threshold of 1.6 per cent and the calls for fever in five to 14 year olds increased slightly but remained below the flu threshold of 11.7 per cent.

 

There have been 4,720 confirmed cases of norovirus so far this season (from the beginning of July 2012 to January 13, 2013). This is 49 per cent higher than the number of cases reported to the same point last year when there were 3,168.

 

(Continue . . . )

 

For the latest national flu report refer to the  HPA National Influenza Report - week 4 (2013) (PDF, 629 KB)  document.

For the latest national flu graphs see the HPA Weekly National Influenza Graphs (PDF, 714 KB) document.

 

Laboratory confirmed influenza in the UK this season has been primarily Influenza B, followed by A/H3N2.

The most recent virological analysis of flu activity from the HPA indicates:

 

90 (12.7%) of the 709 respiratory specimens reported to DataMart (England) tested positive for influenza in week 3 (48 B, 16 A(H3), 20 A subtype not known and 6 A(H1N1)pdm09).

The proportion of samples positive in DataMart (England) increased for rhinovirus and remained stable for RSV, hMPV, adenovirus and parainfluenza.

7 influenza positive detections were recorded through the two English GP-based sentinel schemes in week 3 (5 B, 1 A(H3) and 1 A(H1N1)pdm09), giving a positivity of 44%

 

The UK’s norovirus season continues to run about 50% above last year, due primarily to the introduction of a new GII.4 variant, dubbed Sydney 2012 (see  UNSW: Sydney 2012 Norovirus Rising).

EuroFlu: H1N1 & Influenza B Driving Their Flu Season

 

Credit EuroFlu report Week 2

 

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Dominated by the H3N2 virus, the United States and Canada continue to see a worse than average flu season (see yesterday’s CDC FluView & Canadian FluWatch reports) – while reports from Europe remain a mixed bag, with many countries reporting H1N1pdm09 or Influenza B leading this year’s viral charge.

 

Regions where H3N2 predominates generally see a more severe flu season, which may help explain why Europe hasn’t been hit nearly as hard as has North America.

 

Some excerpts from this week’s EuroFlu Report.

 

Large variation in influenza activity across the WHO European Region

Summary, week 2/2013

Consultation rates for influenza-like illness (ILI) and/or acute respiratory infection (ARI) are now increasing in almost all countries in the Region.

 

However, influenza activity is still largely limited to the western part of the Region, where widespread transmission is being reported by most countries currently.

 

While influenza A(H1N1)pdm09, A(H3N2) and type B viruses are circulating in the Region, the proportion of influenza A(H1N1)pdm09 continues to increase, relative to influenza B and A(H3N2), and accounts for 84% of influenza A viruses subtyped.

 

The number of reported hospitalizations due to severe acute respiratory infection (SARI) is increasing slowly along with a rising proportion of patients testing positive for influenza.

 

Virological surveillance for influenza

The number of specimens testing positive for influenza in the Region continues to rise, mainly due to increasing detections in the western part of the Region. Overall, a total of 3495 specimens tested positive for influenza in week 02/2013, the majority of which, 2532 (72%), were influenza A (Fig. 1).

The proportion of influenza A(H1N1)pdm09 viruses relative to A(H3N2) continues to increase. In week 2, among 1363 influenza A viruses subtyped, 1151 (84%) were A(H1N1)pdm09 while 212 (16%) were A(H3N2)(Fig. 2a).

 

This presents a very different picture from the 2011/2012 influenza season when A(H1N1)pdm09 detections were rare. In the 19 countries testing 20 or more sentinel specimens, influenza positivity ranged from 11% to 68%, with a median of 45% (mean: 44%).

 

Since the beginning of the season (week 40/2012), 12,247 influenza viruses from sentinel and non-sentinel sources have been typed: 8250 (67%) were influenza A and 3997 (33%) influenza B (Fig. 2b). Of the influenza A viruses, 4475 were subtyped: 2945 (66%) as A(H1N1)pdm09and 1530 (34%) as A(H3N2). In addition, since week 40/2012, the lineage has been determined for 497 influenza B viruses: 454 (91%) belonged to the B/Yamagata lineage and 43 (9%) to B/Victoria.

 

In another telling difference between the North American flu season and Europe’s are the age groups being hospitalized for SARI (Severe Acute Respiratory Infection).

 

Here in the United States where H3N2 currently reigns, laboratory confirmed influenza hospitalizations are overwhelmingly for those 65 and older (see CDC FluView chart below).

 

 

Whereas in Europe it is those under the age of 4 making up the majority of hospitalized cases. Once again, a pattern we’d expect to see when H1N1 and influenza B are the most active strains.

 

Hospital surveillance for SARI

Hospitalizations due to SARI have increased slightly over the past few weeks along with an increase in the proportion of respiratory specimens from patients testing positive for influenza (Fig. 7). Overall, the great majority of cases reported have been in the age-group 0–4 years (see Country data and graphs for individual country data).

 

 

While North America is likely about half-way through its flu season, for many parts of Europe flu activity is just starting to ramp up.

 

Influenza is unpredictable, so we’ll have to wait to see whether their contrarian pattern of seeing mostly H1N1 & Influenza B cases continues throughout the rest of their flu season.

CDC FluView Week 2 & CDC Media Briefing

 

 

Credit CDC FluView

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With the caveat that - `As a result of the end of year holidays and elevated influenza activity, some sites may be experiencing longer than normal reporting delays and data in previous weeks are likely to change as additional reports are received’ – the CDC has released their latest FluView Report, and has just completed a media briefing on this year’s flu season.

 

At noon EST today Tom Frieden, M.D., M.P.H., Director, Centers for Disease Control and Prevention and Margaret A. Hamburg, M.D., Commissioner, Food and Drug Administration held a telephone briefing.

 

Dr. Frieden stressed that while the flu season is roughly half-way through, influenza is still on the rise in some western states and he characterized it as shaping up to a `worse-than-average season’.

 

Hospitalizations and deaths, he warned are likely to increase for weeks to come.

 

Dr. Frieden also stressed the importance of early treatment with Tamiflu (oseltamivir) for high risk patients, and reiterated the confidence the CDC has in the beneficial effects of Tamiflu when taken promptly.

 

This year he warned that antivirals are being underused, and that somewhere between 1/3rd and 1/2 of those hospitalized with influenza were not prescribed Tamiflu prior to admission.

 

 

Dr. Frieden also reminded the media that flu vaccine is still available (although some spot shortages exist) – more is in the pipe line - and that it isn’t too late to get vaccinated. While available, you may need to call around to find vaccine in your vicinity.

 

He also urged people who are sick to stay home, and suggested that the elderly might want to limit their exposure to children right now.

 

Dr. Hamburg addressed the spot shortages of pediatric Tamiflu, and assured that pharmacists can easily compound liquid Tamiflu suspension using the capsules.

 

Dr. Hamburg also described some of the newer vaccines coming available, including cell-based vaccines, recombinant FluBlok vaccine, and quadravalent vaccines to come next year.

 

Some of the highlights of this week’s report include:

 

 

2012-2013 Influenza Season Week 2 ending January 12, 2013

During week 2 (January 6-12), influenza activity remained elevated in the United States, but decreased in some areas.

• Viral Surveillance: Of 12,360 specimens tested and reported by collaborating laboratories, 3,638 (29.4%) were positive for influenza.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• Influenza-Associated Pediatric Deaths: Nine influenza-associated pediatric deaths were reported.
• Influenza-Associated Hospitalizations: A cumulative rate for the season of 18.8 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. Among all cases, 49.6% were in adults 65 years and older.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.6%; this is above the national baseline of 2.2%. All 10 regions reported ILI above region-specific baseline levels. Thirty states and New York City experienced high ILI activity; 10 states experienced moderate activity; 7 states experienced low activity; 3 states experienced minimal activity, and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: Forty-eight states reported widespread geographic influenza activity; 2 states reported regional activity; the District of Columbia reported local activity; Guam reported no influenza activity, and Puerto Rico and the U.S. Virgin Islands did not report.

 

Three notable graphics from this week’s report.

 

First the 122 City P&I Mortality rate, which – due to the time patients may be hospitalized, and reporting delays – is usually a trailing indicator of flu activity shows its biggest jump this season.

 

 

And second, pediatric influenza-related deaths which adds 9 to this season’s total, albeit not all occurring during this last reporting week. In non-pandemic years, we often see 70 to 100 pediatric deaths reported, so while always tragic, the number of child deaths to date are running below average.

And finally, the age breakdown among influenza-confirmed hospitalizations shows a recent steep climb for those over the age of 65 indicating this is a particularly rough season for the elderly. 

 

This is the highest rate (82 per 100,000 pop) that we’ve seen in recent years.

 

 

Patients under the age of 4 come in second place, followed by adolescents and young adults. This is the normal pattern we expect to see with an H3N2 seasonal flu.