2009/18: 27 April – 3 May 2009
In the past week, a total of 77 consultations for influenza-like illness were reported from 62
general practices1 in 19 out of 24 health districts. This gives a weekly consultation rate of
27.2 per 100 000 patient population.
The graph below compares the consultation rates for influenza-like illness for each health
district over the past week. Central Auckland had the highest consultation rate (75.3 per 100
000, 24 cases), followed by Rotorua (60.2 per 100 000, 1 case) and North West Auckland
(57.7 per 100 000, 10 cases). Figure 1: Weekly consulation rates for influenza-like illness by health district
Table 2: Laboratory-based influenza viruses by Health District
Code:
Table 2: Laboratory-based influenza viruses by Health District
Antigenic Strain CA WK HB WN CB Total
A (yet to be sub-typed) 25 2 1 0 1 29
AH1 by PCR 2 0 0 0 0 2
AH3 by PCR 0 0 0 1 0 1
Grand Total 27 2 1 1 1 32
Last edited by Sally Furniss; May 10th, 2009 at 11:17 PM.
Reason: fix table
If this belongs in a discussion forum please move it.
Any word on why the sudden jump in H3, H1 (unsubtyped) and H1 (unknown) in week 17? Is it just increased surveillance?
The number tested increased significantly, which led to more positives across the board, but there is a resurgence of H3N2, which may represent an emerging sub-clade (or false positives due to some odd cross reactivity with the sub-typing antisera).
The number tested increased significantly, which led to more positives across the board, but there is a resurgence of H3N2, which may represent an emerging sub-clade (or false positives due to some odd cross reactivity with the sub-typing antisera).
I can see that, but there was also a lot of cases in weeks 5-9. It may be a fair statement that the high number of A/H1 (unknown) were the novel strain. But there is also a huge jump in the unsubtypable in week 17 versus any other week.
I can see that, but there was also a lot of cases in weeks 5-9. It may be a fair statement that the high number of A/H1 (unknown) were the novel strain. But there is also a huge jump in the unsubtypable in week 17 versus any other week.
No, the unknowns are simply samples that are not sub-typed. If sub-typed they would have been similar to those that were sub-typed.
During week 17 (April 26 - May 2, 2009), influenza activity increased in the United States.
One thousand eight hundred ninety-two (13.2%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
No influenza-associated pediatric deaths were reported
The proportion of outpatient visits for influenza-like illness (ILI) was 2.6% which is above the national baseline.
Seven states reported widespread activity, 12 states reported regional activity, the District of Columbia and 14 states reported local influenza activity; and Puerto Rico and 17 states reported sporadic influenza activity.
WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C. report to CDC the number of respiratory specimens tested for influenza.
During the 2008-09 season, influenza A (H1), A (H3), and B viruses have co-circulated in the United States. On April 17, 2009, CDC and the California Department of Public Health determined that two cases of febrile respiratory illness occurring in children who reside in adjacent counties in southern California were caused by infection with a novel influenza A (H1N1) virus. As of May 8, 2009, 1,639 confirmed infections with novel influenza A (H1N1) infections have been identified by CDC and state and local public health departments. Reporting of novel influenza A (H1N1) viruses by US WHO collaborating laboratories began during week 17 and are included in the table below.
During week 17, seasonal influenza A (H1), A (H3), and B viruses co-circulated with novel influenza A (H1N1). The relative proportion of influenza A (H3N2) viruses increased nationally and in six (Region I, II, VI, VIII, IX, and X) of the ten surveillance regions*.
The number of specimens tested by WHO and NREVSS collaborating laboratories during week 17 increased in response to the ongoing novel influenza A (H1N1) virus circulations and investigations. The increase in the percentage of specimens testing positive for influenza also may be due in part to changes in testing practices by healthcare providers, triaging of specimens by public health laboratories, an increase in the number of specimens collected from outbreaks, and other factors.
Since October 1, 2008, 825 seasonal influenza A (H1N1), 132 influenza A (H3N2), and 403 influenza B viruses have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). Eight hundred thirty-two influenza A (H1N1) and 141 influenza A (H3N2) viruses have been tested for resistance to the adamantanes (amantadine and rimantadine). Sixty-eight novel influenza A (H1N1) viruses have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). Ninety-six novel influenza A (H1N1) viruses have been tested for resistance to the adamantanes (amantadine and rimantadine). The results of antiviral resistance testing performed on these viruses are summarized in the table below.
Isolates tested (n)
Resistant Viruses,
Number (%)
Isolates tested (n)
Resistant Viruses, Number (%)
Oseltamivir
Zanamivir
Adamantanes
Seasonal Influenza A (H1N1)
825
820 (99.4%)
0 (0)
832
4 (0.5%)
Influenza A (H3N2)
132
0 (0)
0 (0)
141
141 (100%)
Influenza B
403
0 (0)
0 (0)
N/A*
N/A*
Novel Influenza A (H1N1)
68
0 (0)
0 (0)
96
96 (100%)
*The adamantanes (amantadine and rimantadine) are not effective against influenza B viruses.
Antiviral treatment with either oseltamivir or zanamivir is recommended for all patients with confirmed, probable or suspected cases of novel influenza A (H1N1) virus infection who are hospitalized or who are at higher risk for seasonal influenza complications. The novel influenza A (H1N1) virus is susceptible to both neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. It is resistant to the adamantane antiviral medications, amantadine and rimantadine. Additional information on antiviral recommendations for treatment and chemoprophylaxis of novel influenza A (H1N1) infection is available at http://www.cdc.gov/h1n1flu/recommendations.htm
In areas that continue to have seasonal influenza activity, especially those with circulation of oseltamivir-resistant seasonal human influenza A (H1N1) viruses, clinicians might prefer to use either zanamivir or a combination of oseltamivir and either rimantadine or amantadine to provide adequate empiric treatment or chemoprophylaxis for patients who might have seasonal human influenza A (H1N1) virus infection. Pneumonia and Influenza (P&I) Mortality Surveillance
During week 17, 7.0% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below to the epidemic threshold of 7.5% for week 17.
No influenza-associated pediatric deaths were reported to CDC during week 17. Since September 28, 2008, CDC has received 56 reports of influenza-associated pediatric deaths that occurred during the current season.
Laboratory-confirmed influenza-associated hospitalizations are monitored in two population-based surveillance networks: the New Vaccine Surveillance Network (NVSN) and the Emerging Infections Program (EIP). These two systems provide updates of surveillance data every two weeks.
During October 12, 2008 to May 2, 2009, the preliminary laboratory-confirmed influenza-associated hospitalization rate for children 0-4 years old in the NVSN was 3.8 per 10,000. Because of case identification methods utilized in this study, there is a delay from the date of hospitalization to the date of report.
During October 1, 2008 – May 2, 2009, preliminary laboratory-confirmed influenza-associated hospitalization rates reported by the EIP for children aged 0-4 years and 5-17 years were 3.5 per 10,000 and 0.6 per 10,000, respectively. For adults aged 18-49 years, 50-64 years, and = 65 years, the rates were 0.4 per 10,000, 0.5 per 10,000, and 1.3 per 10,000, respectively.
Nationwide during week 17, 2.6% 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 influenza activity reported by state and territorial epidemiologists indicates geographic spread of both seasonal influenza and novel influenza A (H1N1) viruses and does not measure the severity of influenza activity.
During week 17, the following influenza activity was reported:
Widespread influenza activity was reported by seven states (Alabama, Arizona, California, Delaware, New Mexico, South Carolina, and Virginia).
Regional influenza activity was reported by 12 states (Alaska, Colorado, Florida, Georgia, Hawaii, Indiana, Maine, Massachusetts, Nevada, New Hampshire, New Jersey, and Texas).
Local influenza activity was reported by the District of Columbia and 14 states (Connecticut, Idaho, Iowa, Kansas, Michigan, Montana, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, Washington, and Wyoming).
Sporadic activity was reported by Puerto Rico and 17 states (Arkansas, Illinois, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Tennessee, Utah, Vermont, West Virginia, and Wisconsin).
--------------------------------------------------------------------------------
A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
*HHS regions (Region I: CT, ME, MA, NH, RI, VT; Region II: NJ, NY, Puerto Rico, U.S. Virgin Islands; Region III: DE, DC, MD, PA, VA, WV; Region IV: AL, FL, GA, KY, MS, NC, SC, TN; Region V: IL, IN, MI, MN, OH, WI; Region VI: AR, LA, NM, OK, TX; Region VII: IA, KS, MO, NE; Region VIII: CO, MT, ND, SD, UT, WY; Region IX: AZ, CA, Guam, HI, NV; and Region X: AK, ID, OR, WA)
Re: the increased numbers for seasonal H1N1, H3N2 etc.
It is likely that increased numbers of people suffering from flu like symptoms have come forward for testing. These CDC figures usually are only representative samples of the total flu burden - given fears over swine flu it is likely that people have come forward even when disease is only mild, artifically inflating the seasonal flu numbers for all types.
However, the unsubtypable flu's are more concerning - these may indicate new substrains that do not match current PCR primers.
Re: the increased numbers for seasonal H1N1, H3N2 etc.
It is likely that increased numbers of people suffering from flu like symptoms have come forward for testing. These CDC figures usually are only representative samples of the total flu burden - given fears over swine flu it is likely that people have come forward even when disease is only mild, artifically inflating the seasonal flu numbers for all types.
However, the unsubtypable flu's are more concerning - these may indicate new substrains that do not match current PCR primers.
No. The unsubtypable column just reflects a testing backlog. 97% of unsubtypable isolates are subtyped as swine H1N1.
The table represents updated data, which shows a reduction in unsubtypable isolates and an increase in swine H1N1.
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Human and Swine H1N1 Co-circulation
Linear Mode
