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CDC Health Advisory: Flu Season Begins — Severe Influenza Illness Reported

Tuesday, February 2nd, 2016

CDC

CDC urges rapid antiviral treatment of very ill and high risk suspect
influenza patients without waiting for testing

This is an official
CDC HEALTH ADVISORY
Distributed via the CDC Health Alert Network
February 1, 2016, 0850 EST (8:50 AM EST)
CDCHAN-00387

Flu Season Begins: Severe Influenza Illness Reported
CDC urges rapid antiviral treatment of very ill and high risk suspect
influenza patients without waiting for testing

Summary
Influenza activity is increasing across the country and CDC has received reports of severe influenza illness. Clinicians are reminded to treat suspected influenza in high-risk outpatients, those with progressive disease, and all hospitalized patients with antiviral medications as soon as possible, regardless of negative rapid influenza diagnostic test (RIDT) results and without waiting for RT-PCR testing results. Early antiviral treatment works best, but treatment may offer benefit when started up to 4-5 days after symptom onset in hospitalized patients. Early antiviral treatment can reduce influenza morbidity and mortality.

Since October 2015, CDC has detected co-circulation of influenza A(H3N2), A(H1N1)pdm09, and influenza B viruses. However, H1N1pdm09 viruses have predominated in recent weeks. CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported. Some of these patients reportedly tested negative for influenza by RIDT; their influenza diagnosis was made later with molecular assays. Most of these patients were reportedly unvaccinated. H1N1pdm09 virus infection in the past has caused severe illness in some children and young- and middle-aged adults. Clinicians should continue efforts to vaccinate patients this season for as long as influenza viruses are circulating, and promptly start antiviral treatment of severely ill and high-risk patients if influenza is suspected or confirmed.

Recommendations

  1. Clinicians should encourage all patients who have not yet received an influenza vaccine this season to be vaccinated against influenza. This recommendation is for patients 6 months of age and older. There are several influenza vaccine options for the 2015-2016 influenza season (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm ), and all available vaccine formulations this season contain A(H3N2), A(H1N1)pdm09, and B virus strains. CDC does not recommend one influenza vaccine formulation over another.
  2. Clinicians should encourage all persons with influenza-like illness who are at high risk for influenza complications (see list below) to seek care promptly to determine if treatment with influenza antiviral medications is warranted.
  3. Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza. Clinicians using RIDTs to inform treatment decisions should use caution in interpreting negative RIDT results. These tests, defined here as rapid antigen detection tests using immunoassays or immunofluorescence assays, have a high potential for false negative results. Antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative by RIDT; initiation of empiric antiviral therapy, if warranted, should not be delayed.
  4. CDC guidelines for influenza antiviral use during 2015-16 season are the same as during prior seasons (see http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm ).
  5. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. Clinical benefit is greatest when antiviral treatment is administered early. However, antiviral treatment might still be beneficial in patients with severe, complicated, or progressive illness, and in hospitalized patients and in some outpatients when started after 48 hours of illness onset, as indicated by clinical and observational studies.
  6. Treatment with an appropriate neuraminidase inhibitor antiviral drugs (oral oseltamivir, inhaled zanamivir, or intravenous peramivir) is recommended as early as possible for any patient with confirmed or suspected influenza who
    • is hospitalized;
    • has severe, complicated, or progressive illness; or
    • is at higher risk for influenza complications. This list includes:
      • children aged younger than 2 years;
      • adults aged 65 years and older;
      • persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
      • persons with immunosuppression, including that caused by medications or by HIV infection;
      • women who are pregnant or postpartum (within 2 weeks after delivery);
      • persons aged younger than 19 years who are receiving long-term aspirin therapy;
      • American Indians/Alaska Natives;
      • persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and
      • residents of nursing homes and other chronic-care facilities.
  7. Antiviral treatment can also be considered for suspected or confirmed influenza in previously healthy, symptomatic outpatients not at high risk on the basis of clinical judgment, especially if treatment can be initiated within 48 hours of illness onset.
  8. Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for outpatients.
  9. While influenza vaccination is the best way to prevent influenza, a history of influenza vaccination does not rule out influenza virus infection in an ill patient with clinical signs and symptoms compatible with influenza. Vaccination status should not impede the initiation of prompt antiviral treatment.

Background
Seasonal influenza contributes to substantial morbidity and mortality each year in the United States. In the most recent influenza season—the 2014-2015 season—CDC estimates that there were approximately 19 million influenza-associated medical visits and 970,000 influenza-associated hospitalizations [1]. The spectrum of illness observed thus far during the 2015-2016 season has ranged from mild to severe and is consistent with that of other influenza seasons. Although influenza activity nationally is low compared to this time last season, it is increasing; and some localized areas of the United States are already experiencing high activity. Further increases are expected in the coming weeks. Typically, influenza seasons begin with increases in influenza-like-illness and the percent of respiratory specimens testing positive for influenza in clinical laboratories. Those indicators are rising at this time. Increases in severity indicators tend to lag behind. At this time, national surveillance systems that track severity are not elevated, but CDC will continue to watch for indications of increased severity from influenza virus infection this season.

Laboratory data so far show that most circulating flu viruses are still like the viruses recommended for the 2015-2016 influenza vaccines. CDC will continue to monitor circulating influenza viruses for changes that might impact vaccine effectiveness and publish these data weekly in FluView (http:/www.cdc.gov/flu/weekly/summary.htm). CDC also is conducting epidemiologic field studies to determine vaccine effectiveness this season.

For more information:

Endnotes

 

 

 

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Weekly U.S. Influenza Surveillance Report

Sunday, January 31st, 2016

CDC

During week 3 (January 17-23, 2016), influenza activity increased slightly in the United States.

    • Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 3 was influenza A, with influenza A (H1N1)pdm09 viruses predominating. The percentage of respiratory specimens testing positive for influenza in clinical laboratories increased.

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  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below their system-specific epidemic threshold in both the NCHS Mortality Surveillance System and the 122 Cities Mortality Reporting System.
  • Influenza-associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 2.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.2%, which is above the national baseline of 2.1%. Six of 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico experienced high ILI activity; three states experienced moderate ILI activity; five states experienced low ILI activity; New York City and 42 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in four states was reported as widespread; Puerto Rico and 14 states reported regional activity; Guam and 12 states reported local activity; and the District of Columbia, the U.S. Virgin Islands and 20 states reported sporadic activity.

Click on map to launch interactive tool

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2015-2016 Influenza Season Week 2 ending January 16, 2016

Sunday, January 24th, 2016

CDC

During week 2 (January 10-16, 2016), influenza activity increased slightly in the United States.

  • Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 2 was influenza A, with influenza A (H1N1)pdm09 viruses predominating. The percentage of respiratory specimens testing positive for influenza in clinical laboratories increased.
  • 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 system-specific epidemic threshold in the NCHS Mortality Surveillance System and above the system-specific epidemic threshold in the 122 Cities Mortality Reporting System.
  • Influenza-associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 1.8 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.1%, which is at the national baseline of 2.1%. Six of 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico experienced high ILI activity; three states experienced moderate ILI activity; New York City and four states experienced low ILI activity; 43 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in three states was reported as widespread; Puerto Rico and 10 states reported regional activity; Guam and 12 states reported local activity; the U.S. Virgin Islands and 24 states reported sporadic activity; and the District of Columbia and one state reported no influenza activity.

Region and state-specific data are available at http://www.cdc.gov/flu/weekly/nchs.htm.

INFLUENZA Virus Isolated

Pneumonia And Influenza Mortality

 

Click on graph to launch interactive tool

 

 

national levels of ILI and ARI
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CDC: 2015-2016 Influenza Season Week 1 ending January 9, 2016

Monday, January 18th, 2016

CDC

Background:

The Centers for Disease Control and Prevention’s (CDC) Influenza Division collects, compiles, and analyzes information on influenza activity year-round in the United States and produces FluView, a weekly influenza surveillance report, and FluView Interactive. The U.S. influenza surveillance system provides information in five categories collected from nine data sources. This is the first report of the 2015-2016 influenza season, which began on October 4, 2015.

The five categories and nine data components of CDC influenza surveillance are:

  • Viral Surveillance:U.S. World Health Organization (WHO) collaborating laboratories, the National Respiratory and Enteric Virus Surveillance System (NREVSS), and human infection with novel influenza A virus case reporting;
  • Mortality:National Center for Health Statistics (NCHS) Mortality Surveillance System, 122 Cities Mortality Reporting System and influenza-associated pediatric deaths;
  • Hospitalizations:Influenza Hospitalization Network (FluSurv-NET) including the Emerging Infections Program (EIP) and three additional states;
  • Outpatient Illness Surveillance:U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet);
  • Geographic Spread of Influenza:State and territorial epidemiologists’ reports.

An overview of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component, is available at: http://www.cdc.gov/flu/weekly/overview.htm.

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Synopsis:

During week 1 (January 3-9, 2016), laboratory data indicated that influenza activity increased slightly in the United States.

    • Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 1 was influenza A, with influenza A (H1N1)pdm09 viruses predominating. The percentage of respiratory specimens testing positive for influenza in clinical laboratories was low.

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  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below their system-specific epidemic threshold in both the NCHS Mortality Surveillance System and the 122 Cities Mortality Reporting System.
  • Influenza-associated Pediatric Deaths: One influenza-associated pediatric death was reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 1.5 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.0%, which is below the national baseline of 2.1%. Four of 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and one state experienced high ILI activity; New York City and seven states experienced low ILI activity; 42 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in Guam, Puerto Rico, and nine states were reported as regional; 11 states reported local activity; the U.S. Virgin Islands and 28 states reported sporadic activity; and the District of Columbia and two states reported no influenza activity.

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Weekly U.S. Influenza Surveillance Report: 2015-2016 Influenza Season Week 52 ending January 2, 2016

Monday, January 11th, 2016

CDC

Synopsis:

During week 52 (December 26, 2015-January 2, 2016), influenza activity increased slightly in the United States.

    • Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 52 was influenza A, with influenza A (H1N1)pdm09 viruses predominating. The percentage of respiratory specimens testing positive for influenza in clinical laboratories was low.
    • 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 their system-specific epidemic threshold in both the NCHS Mortality Surveillance System and the 122 Cities Mortality Reporting System.
    • Influenza-associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported.

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  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.8%, which is above the national baseline of 2.1%. Seven of 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and two states experienced high ILI activity; New York City and two states experienced moderate ILI activity; seven states experienced low ILI activity; 39 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in Guam and two states were reported as widespread; six states reported regional activity; 13 states reported local activity; the U.S. Virgin Islands and 27 states reported sporadic activity; the District of Columbia and two states reported no influenza activity; and Puerto Rico did not report.

INFLUENZA Virus Isolated

 

Click on image to launch interactive tool

 

national levels of ILI and ARI

Click on map to launch interactive tool

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An estimated 43,900 excess winter deaths occurred in England and Wales in 2014/15.

Thursday, November 26th, 2015

UK Office for National Statistics

An estimated 43,900 excess winter deaths occurred in England and Wales in 2014/15; the highest number since 1999/00, with 27% more people dying in the winter months compared with the non-winter months.

  • The majority of deaths occurred among people aged 75 and over; there were an estimated 36,300 excess winter deaths in this age group in 2014/15, compared with 7,700 in people aged under 75.
  • There were more excess winter deaths in females than in males in 2014/15, as in previous years. Male excess winter deaths increased from 7,210 to 18,400, and female deaths from 10,250 to 25,500 between 2013/14 and 2014/15.
  • Respiratory diseases were the underlying cause of death in more than a third of all excess winter deaths in 2014/15.
  • The excess winter mortality index was highest in the South West in 2014/15 and joint lowest in Yorkshire and The Humber, and Wales.
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