Global & Disaster Medicine

Archive for December, 2019

Weekly U.S. Influenza Surveillance Report: Key Updates for Week 49, ending December 7, 2019

CDC

Viruses

Clinical Lab

11.3% of respiratory specimens tested by clinical laboratories were positive for influenza viruses. This is higher than the previous week.

Public Health Lab

Nationally, B/Victoria viruses are most common followed by A(H1N1)pdm09 and A(H3N2) viruses. The predominant virus varies by region and age group.

Virus Characterization

Genetic and antigenic characterization and antiviral susceptibility of viruses collected in the U.S. this season are now being reported.

Illness

Outpatient Illness: ILINet

3.2% of visits to health care providers were for influenza-like illness (ILI). ILI has been at or above the national baseline of 2.4% for five weeks. All regions were at or above their baselines.

 

The number of jurisdictions experiencing high ILI activity decreased to 12 this week compared to 13 last week. In addition, 12 jurisdictions had moderate activity compared to 15 last week.

 

The number of jurisdictions reporting regional or widespread activity increased to 38 this week from 30 last week.

Severe Disease

Hospitalizations

The overall hospitalization rate for the season is 3.9 per 100,000. This is similar to what has been seen at this time during other recent seasons.

P&I Mortality

5.0% of deaths were attributed to pneumonia and influenza (P&I). This is below the epidemic threshold of 6.5%.

Pediatric Deaths

Four new influenza-associated pediatric deaths occurring during the 2019-2020 season were reported to CDC this week. The total for the season is 10.

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

A description of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component is available on the surveillance methods page.

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points

  • The 2019-2020 season is underway; all regions of the country are seeing elevated levels of flu-like illness.
  • Activity is being caused mostly by influenza B/Victoria viruses, which is unusual for this time of year.  A/H1N1 viruses are the next most common and are increasing in proportion relative to other influenza viruses in some regions.
  • CDC estimates that so far this season there have been at least 2.6 million flu illnesses, 23,000 hospitalizations and 1,300 deaths from flu.
  • It’s not too late to get vaccinated.  Flu vaccination is always the best way to prevent flu and its potentially serious complications.
  • Antiviral medications are an important adjunct to flu vaccine in the control of influenza.  Almost all (>99%) of the influenza viruses tested this season are susceptible to the 4 FDA-approved influenza antiviral medications recommended for use in the U.S. this season.

U.S. Virologic Surveillance

Clinical Laboratories

The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza) are used to monitor whether influenza activity is increasing or decreasing.

Week 49 Data Cumulative since
September 29, 2019
(week 40)
No. of specimens tested 30,510 265,670
No. of positive specimens (%) 3,436 (11.3%) 15,027 (5.7%)
Positive specimens by type
    Influenza A 1,083 (31.5%) 4,577 (30.5%)
    Influenza B 2,353 (68.5%) 10,450 (69.5%)

INFLUENZA Virus Isolated
View Chart Data | View Full Screen

Public Health Laboratories

The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating viruses that belong to each influenza subtype/lineage.

Week 49 Data Cumulative since
September 29, 2019
(week 40)
No. of specimens tested 1,508 15,172
No. of positive specimens 631 4,556
Positive specimens by type/subtype
         Influenza A 283 (44.8%) 1,932 (42.4%)
            (H1N1)pdm09 221 (83.7%) 1,171 (64.7%)
             H3N2 43 (16.3%) 640 (35.3%)
             Subtyping not performed 19 121
        Influenza B 348 (55.2%) 2,624 (57.6%)
            Yamagata lineage 6 (2.5%) 59 (3.0%)
            Victoria lineage 232 (97.5%) 1,904 (97.0%)
            Lineage not performed 110 661

Nationally influenza B/Victoria viruses have been reported more frequently than other influenza viruses this season; followed by A(H1N1)pdm09 and A(H3N2) viruses. The predominant virus varies by region and the proportions of influenza B/Victoria and influenza A(H1N1)pmd09 viruses are increasing in some regions. Regional and state level data about circulating influenza viruses can be found on FluView Interactive. The predominant virus also varies by age group. Nationally, influenza B/Victoria viruses are the most commonly reported influenza viruses among children age 0-4 years (46% of reported viruses) and 5-24 years (59% of reported viruses), while A(H3N2) viruses are the most commonly reported influenza viruses among persons 65 years of age and older (47% of reported viruses). Among adults aged 25-64 years, approximately equal proportions of influenza A(H1N1)pdm09 and B/Victoria viruses (38% and 34%, respectively) have been reported. Additional age data can be found on FluView Interactive.

Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data

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Novel Influenza A Virus:

One additional human infection with a novel influenza A virus was reported by Ohio. This person was infected with an influenza A(H1N2) variant (A(H1N2)v) virus and reported exposure to swine at an agricultural fair during the week preceding illness onset. The patient is a child < 18 years of age, was not hospitalized, and continues to recover from illness.

A total of 14 variant viruses have been reported to CDC during 2018. One of these has been an influenza A(H3N2) variant (A(H3N2)v) virus (Indiana [1]), and 13 have been A(H1N2)v viruses (California [6], Michigan [3], and Ohio [4]).

Early identification and investigation of human infections with novel influenza A viruses are critical so that the risk of infection can be more fully understood and appropriate public health measures can be taken. Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with swine can be found at http://www.cdc.gov/flu/swineflu/index.htm.

Additional information regarding human infections with novel influenza A viruses can be found at http://gis.cdc.gov/grasp/fluview/Novel_Influenza.html.

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Influenza Virus Characterization

CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local health laboratories using Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses used for developing new influenza vaccines and to monitor evolutionary changes that continually occur in circulating influenza. CDC also tests susceptibility of influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC genetically characterized 369 influenza viruses collected in the U.S. from September 29, 2019 to December 7, 2019.

Virus Subtype or Lineage Genetic Characterization
Total No. of Subtype/Lineage Tested          Clade Number (% of subtype/lineage tested)          Subclade Number (% of subtype/lineage tested)
A/H1 81
6B.1A 81 (100%)
A/H3 132
3C.2a 132 (100%) 2a1 132 (100%)
   2a2 0
    2a3 0
2a4 0
3C.3a 0 3a 0
B/Victoria 142
V1A 142 (100%) V1A 0
V1A.1 22 (15.5%)
V1A.3 120 (84.5%)
B/Yamagata 14
Y3 14 (100%)

CDC antigenically characterizes a subset of influenza viruses by hemagglutination inhibition (HI) or neutralization based Focus Reduction assays (FRA). Antigenic drift is evaluated by comparing antigenic properties of cell-propagated reference viruses representing currently recommended vaccine components with those of cell-propagated circulating viruses. CDC antigenically characterized 61 influenza viruses collected in the U.S. from September 29, 2019 to December 7, 2019.

Influenza A Viruses

  • A (H1N1)pdm09: Eighteen A(H1N1)pdm09 viruses were antigenically characterized by HI with ferret antisera, and all were antigenically similar (reacting at titers that were within 4-fold of the homologous virus titer) to cell-propagated A/Brisbane/02/2018-like reference viruses representing the A(H1N1)pdm09 component for the 2019-20 Northern Hemisphere influenza vaccines.
  • A (H3N2): Seventeen A(H3N2) viruses were antigenically characterized by FRA with ferret antisera, and 12 (70.6%) were antigenically similar to cell-propagated A/Kansas/14/2017-like reference viruses representing the A(H3N2) component for the 2019-20 Northern Hemisphere influenza vaccines.

Influenza B Viruses

  • B/Victoria: Sixteen B/Victoria lineage viruses, including viruses from both co-circulating sub-clades, were antigenically characterized by HI with ferret antisera, and 10 (62.5%) were antigenically similar to cell-propagated B/Colorado/06/2017-like reference viruses representing the B/Victoria component for the 2019-20 Northern Hemisphere influenza vaccines.
  • B/Yamagata: Ten B/Yamagata lineage viruses were antigenically characterized by HI with ferret antisera, and all 10 (100%) were antigenically similar to cell-propagated B/Phuket/3073/2013-like reference viruses representing the B/Yamagata component for the 2019-20 Northern Hemisphere influenza vaccines.

CDC assesses susceptibility of influenza viruses to the antiviral medications oseltamivir, zanamivir, peramivir, and baloxavir using next generation sequence analysis supplemented by laboratory assays. Viruses collected in the U.S. since September 29, 2019 were tested for antiviral susceptibility as follows:

Antiviral Medication Total Viruses A/H1 A/H3 B/Victoria B/Yamagata
Neuraminidase Inhibitors
Oseltamivir Viruses Tested 415 81 130 190 14
Reduced Inhibition (0.0%) (0.0%) (0.0%) (0.0%) (0.0%)
Highly Reduced Inhibition 1 (0.2%) 1 (1.2%) (0.0%) (0.0%) (0.0%)
Peramivir Viruses Tested 415 81 130 190 14
Reduced Inhibition (0.0%) (0.0%) (0.0%) (0.0%) (0.0%)
Highly Reduced Inhibition 1 (0.2%) 1 (1.2%) (0.0%) (0.0%) (0.0%)
Zanamivir Viruses Tested 415 81 130 190 14
Reduced Inhibition 1 (0.2%) (0.0%) (0.0%) 1 (0.5%) (0.0%)
Highly Reduced Inhibition (0.0%) (0.0%) (0.0%) (0.0%) (0.0%)
PA Endonuclease Inhibitor
Baloxavir Viruses Tested 336 75 122 126 13
Reduced Susceptibility (0.0%) (0.0%) (0.0%) (0.0%) (0.0%)

<!–Influenza A Viruses

  • A (H1N1)pdm09: Phylogenetic analysis of the HA genes from 63 A(H1N1)pdm09 viruses showed that all belonged to clade 6B.1. Fifty-seven A(H1N1)pdm09 viruses were antigenically characterized, and 57 (100%) were antigenically similar (analyzed using HI with ferret antisera) to A/Michigan/45/2015 (6B.1), a cell-propagated A/Michigan/45/2015-like reference virus representing the A(H1N1)pdm09 component for the 2018-2019 Northern Hemisphere influenza vaccines.
  • A (H3N2): Phylogenetic analysis of the HA genes from 64 A(H3N2) viruses revealed extensive genetic diversity with multiple clades/subclades co-circulating. The HA genes of circulating viruses belonged to clade 3C.2a (n=24), subclade 3C.2a1 (n=35) or clade 3C.3a (n=5). Thirty influenza A(H3N2) viruses were antigenically characterized by FRA with ferret antisera, and 28 (93.3%) A(H3N2) viruses tested were well-inhibited (reacting at titers that were within fourfold of the homologous virus titer) by ferret antisera raised against A/Singapore/INFIMH-16-0019/2016 (3C.2a1), a cell-propagated A/Singapore/INFIMH-16-0019/2016 -like reference virus representing the A(H3N2) component of 2018-2019 Northern Hemisphere influenza vaccines.

    Influenza B Viruses

    • B/Victoria: Phylogenetic analysis of 10 B/Victoria-lineage viruses indicate that all HA genes belonged to genetic clade V1A, however genetic subclades which are antigenically distinct have emerged. The majority of recent B/Victoria-lineage viruses belonged to a subclade of viruses with a 6-nucleotide deletion (encoding amino acids 162 and 163) in the HA (V1A.1, previously abbreviated as V1A-2Del). In addition, a small number of B/Victoria-lineage viruses have a three amino acid deletion (162-164) in the HA protein (abbreviated as V1A-3Del). Nine (90%) B/Victoria lineage viruses were well-inhibited by ferret antisera raised against cell-propagated B/Colorado/06/2017-like (V1A.1) reference virus, representing the B/Victoria lineage component of 2018-2019 Northern Hemisphere influenza vaccines. One (10%) B/Victoria lineage virus reacted poorly (at titers that were 8-fold or greater reduced compared with the homologous virus titer) with ferret antisera raised against cell-propagated B/Colorado/06/2017-like reference virus, and belonged to clade V1A.
    • B/Yamagata: Phylogenetic analysis of 33 influenza B/Yamagata-lineage viruses indicate that the HA genes belonged to clade Y3. A total of 32 influenza B/Yamagata-lineage viruses were antigenically characterized, and all were antigenically similar to cell-propagated B/Phuket/3073/2013 (Y3), the reference vaccine virus representing the influenza B/Yamagata-lineage component of the 2018-2019 Northern Hemisphere quadrivalent vaccines.

    The majority of U.S. viruses submitted for characterization come from state and local public health laboratories. Due to Right Size Roadmap considerations, specimen submission guidance to laboratories is that, if available, 2 influenza A(H1N1)pdm09, 2 influenza A(H3N2), and 2 influenza B viruses be submitted every other week. Therefore, the numbers of each virus type/subtype characterized should be more balanced across subtypes/lineages but will not reflect the actual proportion of circulating viruses. In the figure below, the results of tests performed by public health labs are shown on the left and CDC sequence results (by genetic clade/subclade) are shown on the right.

    Genetic Characterization
    View Chart Data | View Full Screen | View PowerPoint Presentation

      Antiviral Resistance:

      During May 20-October 6, 2018, 156 specimens (61 influenza A(H1N1)pdm09, 51 influenza A(H3N2), and 44 influenza B viruses) collected in the United States were tested for susceptibility to the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir). All tested viruses were sensitive to all three recommended antiviral medications.

       
      Antiviral Medication Total Viruses A/H1 A/H3 B/Victoria B/Yamagata
      Neuraminidase Inhibitors Oseltamivir Viruses Tested 2,547 1,183 969 215 180
      Reduced 2 (0.1%) 2 (0.2%) 0 (0%) 0 (0%) 0 (0%)
      Highly Reduced 4 (0.2%) 4 (0.3%) 0 (0%) 0 (0%) 0 (0%)
      Peramivir Viruses Tested 2,547 1,183 969 215 180
      Reduced 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
      Highly Reduced 4 (0.2%) 4 (0.3%) 0 (0%) 0 (0%) 0 (0%)
      Zanamivir Viruses Tested 2,547 1,183 969 215 180
      Reduced 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
      Highly Reduced 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
      PA Cap-Dependent Endonuclease Inhibitor Baloxavir Marboxil Viruses Tested 2,547 1,162 964 229 187
      Decreased Susceptibility 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

      While all of the recently circulating influenza viruses are susceptible to the neuraminidase inhibitor antiviral medications oseltamivir, zanamivir, and peramivir; rare sporadic instances of oseltamivir-resistant and peramivir-resistant influenza A(H1N1)pdm09 viruses and oseltamivir-resistant influenza A(H3N2) viruses have been detected worldwide. Antiviral treatment as early as possible is recommended for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at high risk for serious influenza-related complications. Additional information on recommendations for treatment and chemoprophylaxis of influenza virus infection with antiviral agents is available at http://www.cdc.gov/flu/antivirals/index.htm.

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      Outpatient Illness Surveillance

      ILINet

      Nationwide during week 49, 3.2% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.4%. The decrease in the percentage of patient visits for ILI during week 49 compared to week 48 may be influenced in part by a reduction in routine healthcare visits surrounding the Thanksgiving holiday (occurring during week 48) as has occurred during previous seasons.

      national levels of ILI and ARI
      View Chart Data | View Full Screen
      On a regional level, the percentage of outpatient visits for ILI ranged from 1.8% to 5.7% during week 49. All regions reported a percentage of outpatient visits for ILI which is equal to or above their region-specific baselines.

      ILI Activity Map

      Data collected in ILINet are used to produce a measure of ILI activity* by state.

      During week 49, the following ILI activity levels were experienced:

      • High – Puerto Rico and 11 states (Alabama, Arkansas, Georgia, Mississippi, Nebraska, New Mexico, South Carolina, Tennessee, Texas, Virginia, and Washington)
      • Moderate – New York City and 11 states (Arizona, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Minnesota, Nevada, New Jersey, Oklahoma, and Oregon)
      • Low – District of Columbia and nine states (California, Florida, Illinois, Kansas, Massachusetts, New York, North Carolina, Pennsylvania, and Wisconsin)
      • Minimal – 18 states (Alaska, Delaware, Idaho, Indiana, Iowa, Maine, Michigan, Missouri, Montana, New Hampshire, North Dakota, Ohio, Rhode Island, South Dakota, Utah, Vermont, West Virginia, and Wyoming)
      • Data were insufficient to calculate an ILI activity level from the U.S. Virgin Islands and Louisiana.

      *Data collected in ILINet may disproportionally represent certain populations within a state, and therefore, may not accurately depict the full picture of influenza activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

      Additional information about medically attended visits for ILI for current and past seasons:
      Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map

      Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists

      The influenza activity reported by state and territorial epidemiologists indicates geographic spread of influenza viruses but does not measure the severity of influenza activity.

      During week 49 the following influenza activity was reported:

      • Widespread – 23 states (Alabama, Arizona, California, Connecticut, Georgia, Idaho, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Nebraska, Nevada, New Mexico, New York, North Carolina, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and Washington)
      • Regional – Puerto Rico and 14 states (Arkansas, Colorado, Florida, Illinois, Michigan, Minnesota, Mississippi, Montana, New Jersey, Ohio, Oklahoma, Rhode Island, Utah and Wisconsin)
      • Local – 12 states (Delaware, Hawaii, Iowa, Kansas, Maine, Missouri, New Hampshire, North Dakota, South Dakota, Vermont, West Virginia and Wyoming)
      • Sporadic – the District of Columbia, the U.S. Virgin Islands and one state (Alaska)
      • Guam did not report.

      Additional geographic spread surveillance information for current and past seasons:
      Surveillance Methods | FluView Interactive

      Influenza-Associated Hospitalizations

      The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in the Emerging Infections Program (EIP) states and Influenza Hospitalization Surveillance Project (IHSP) states.

      A total of 1,139 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2019 and December 7, 2019. The overall hospitalization rate was 3.9 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 (9.4 per 100,000 population), followed by children aged 0-4 (7.5 per 100,000 population) and adults aged 50-64 (4.1 per 100,000 population). Among 1,139 hospitalizations, 627 (55.0%) were associated with influenza A virus, 499 (43.8%) with influenza B virus, 6 (0.5%) with influenza A virus and influenza B virus co-infection, and 7 (0.6%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 103 (70.5%) were A(H1N1)pdm09 virus and 43 (29.5%) were A(H3N2).

      Click on graph to launch interactive tool

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      Additional hospitalization surveillance information for current and past seasons and additional age groups:
      Surveillance Methods | FluView Interactive

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      Click on graph to launch interactive tool2

      FluSurv-NET data are preliminary and displayed as they become available. Therefore, figures are based on varying denominators as some variables represent information that may require more time to be collected. Data are refreshed and updated weekly. Asthma includes a medical diagnosis of asthma or reactive airway disease; Cardiovascular diseases include conditions such as coronary heart disease, cardiac valve disorders, congestive heart failure, and pulmonary hypertension; does not include isolated hypertension; Chronic lung diseases include conditions such as chronic obstructive pulmonary disease, bronchiolitis obliterans, chronic aspiration pneumonia, and interstitial lung disease; Immune suppression includes conditions such as immunoglobulin deficiency, leukemia, lymphoma, HIV/AIDS, and individuals taking immunosuppressive medications; Metabolic disorders include conditions such as diabetes mellitus; Neurologic diseases include conditions such as seizure disorders, cerebral palsy, and cognitive dysfunction; Neuromuscular diseases include conditions such as multiple sclerosis and muscular dystrophy; Obesity was assigned if indicated in patient’s medical chart or if body mass index (BMI) >30 kg/m2; Pregnancy percentage calculated using number of female cases aged between 15 and 44 years of age as the denominator; Renal diseases include conditions such as acute or chronic renal failure, nephrotic syndrome, glomerulonephritis, and impaired creatinine clearance; No known condition indicates that the case did not have any known high risk medical condition indicated in medical chart at the time of hospitalization.

      View Full Screen

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      Pneumonia and Influenza (P&I) Mortality Surveillance

      Based on National Center for Health Statistics (NCHS) mortality surveillance data available on December 12, 2019, 5.0% of the deaths occurring during the week ending November 30, 2019 (week 48) were due to P&I. This percentage is below the epidemic threshold of 6.5% for week 48.


      View Chart Data | View Full Screen
      Additional pneumonia and influenza mortality surveillance information for current and past seasons:
      Surveillance Methods | FluView Interactive

      Influenza-Associated Pediatric Mortality

      Four influenza-associated pediatric deaths were reported to CDC during week 49. One death occurred during week 47 (the week ending November 23, 2019) and was associated with an influenza A virus for which no subtyping was performed. Three deaths occurred during week 48 (the week ending November 30, 2019). One death was associated with an influenza B/Victoria virus, one was associated with an influenza B virus with no lineage determined, and one was associated with an influenza A(H1N1)pdm09 virus.

      A total of 10 influenza-associated pediatric deaths occurring during the 2019-2020 season have been reported to CDC. Six cases tested positive for influenza B; three of these cases had the lineage determined and all were B/Victoria viruses. Four cases tested positive for influenza A. Two of these cases had subtyping performed and both were A(H1N1)pdm09 viruses.

       

      View Full Screen
      Additional pediatric mortality surveillance information for current and past seasons:
      Surveillance Methods | FluView Interactive

      Additional National and International Influenza Surveillance Information

      FluView Interactive: FluView includes enhanced web-based interactive applications that can provide dynamic visuals of the influenza data collected and analyzed by CDC. These FluView Interactive applications allow people to create customized, visual interpretations of influenza data, as well as make comparisons across flu seasons, regions, age groups and a variety of other demographics. To access these tools, visit http://www.cdc.gov/flu/weekly/fluviewinteractive.htm

      National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH at https://www.cdc.gov/niosh/topics/absences/default.html

      U.S. State and local influenza surveillance:Select a jurisdiction below to access the latest local influenza information

      Alabama Alaska Arizona Arkansas California
      Colorado Connecticut Delaware District of Columbia Florida
      Georgia Hawaii Idaho Illinois Indiana
      Iowa Kansas Kentucky Louisiana Maine
      Maryland Massachusetts Michigan Minnesota Mississippi
      Missouri Montana Nebraska Nevada New Hampshire
      New Jersey New Mexico New York North Carolina North Dakota
      Ohio Oklahoma Oregon Pennsylvania Rhode Island
      South Carolina South Dakota Tennessee Texas Utah
      Vermont Virginia Washington West Virginia Wisconsin
      Wyoming New York City Puerto Rico Virgin Islands

      World Health Organization: Additional influenza surveillance information from participating WHO member nations is available through FluNet and the Global Epidemiology Reports.

      WHO Collaborating Centers for Influenza located in Australia, China, Japan, the United Kingdom, and the United States (CDC in Atlanta, Georgia).

      Europe: For the most recent influenza surveillance information from Europe, please see WHO/Europe and the European Centre for Disease Prevention and Control at http://www.flunewseurope.org/.

      Public Health Agency of Canada: The most up-to-date influenza information from Canada is available at http://www.phac-aspc.gc.ca/fluwatch/

      Public Health England: The most up-to-date influenza information from the United Kingdom is available at https://www.gov.uk/government/statistics/weekly-national-flu-reports


    White Island Volcano Timeline


    White Island: SAS soldiers recover six bodies while divers hunt for missing two Kiwi tour guides

    Daily Mail

    “……

    • New Zealand Defence Force have recovered six of the eight bodies of the White Island volcano victims Friday 
    • Two bodies could not be found because they are under water but police say they will continue the search
    • Divers have been sent out to search the waters after one of the bodies was spotted in the ocean on Tuesday
    • Mission started at first light despite increased chance volcano would erupt again, with high alert being issued
    • Six Australians and two New Zealanders were believed to be on island when the deadly eruption happened
    • Relieved families were seen hugging, crying and clapping when told bodies had been removed from island….”


    WHO and its consultants

    VOX

    “…..But Tedros appears to have embraced change, of a sort. Halfway through his five-year term, his reform — known as “the transformation” — is still in progress. And while he has offered WHO staff opportunities to engage in the process, the agency is also crawling with outside consultants, current and former WHO staffers told Vox.

    “The one thing that WHO staff didn’t want,” a senior official who was involved in the reform process, “is a McKinsey type of reform,” using the well-known firm as a shorthand for what they’ve seen consultants bring to WHO and other health agencies over the years: “musical chairs,” “cost cutting,” and “debunked management fads.”

    In addition to McKinsey, WHO confirmed they’ve worked with five other consultancies during the transformation: BCG, Deloitte, Preva Group, Seek Development, and most recently, Deliver Associates, which has a multi-year contract worth $3.85 million. The total value of the consultant contracts is about $12 million, at least a quarter of which has been paid for directly by the Bill and Melinda Gates Foundation, one of the most powerful players in global health…..”

    See the source image


    CDC: PFAs


    Georgia: Police were searching for a gunman who entered the Dart Container Corporation plant and shot an employee.

    CNN

    “……At least one person has been shot at a food-service container plant near Atlanta, and the shooter is believed still inside the plant, a federal source with knowledge of the situation said Friday.

    Gunfire was reported Friday morning at Dart Container Corp. in Conyers, about 25 miles east of downtown Atlanta, and authorities are looking for a shooter, Rockdale County Sheriff’s Deputy Lee Thomas said.,,,,”

    Radiation-Nuclear Emergency Resources


    Saving Lives After a Nuclear Detonation

    Brooke Buddemeier’s PrepTalk, “Saving Lives After a Nuclear Detonation,” emphasizes the importance of sheltering after a nuclear detonation and provides emergency managers with tools to help citizens, responders, and city officials get ready.

    “The most important life-saving decisions are those made in the first few minutes and hours of an event, and those decisions are not going to be coming from Washington, D.C.,” Buddemeier said. “State and local communities need to be prepared to make them.”


    Aaron Titus’s PrepTalk “Let the Community Lead: Rethinking Command and Control Systems.”


    Six people were killed in a shooting in a hospital in the eastern Czech Republic today


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