Summit County Public Health Influenza Surveillance Report 2014 – 2015 Season Report #4 Centers for Disease Control and Prevention Week 45 (11/02 – 11/08) Summit County Influenza surveillance began October 05, 2014 in Summit County. Overall, influenza hospitalizations and lab testing have increased but the number of ED visits has slightly decreased. The influenza trend is still currently below or has remained the same as previous years according to the Week of the year. During the third week of surveillance, reporting Summit County labs performed 69 (Wk 45) tests for influenza and there were no positive test results for influenza A but 2 positive influenza B tests. Summit County hospital admissions, related to influenza had 1 hospitalization at Akron Children’s hospital (Summit County and Non-Summit County residents). Admissions during Wk 45, compared to Wk 44, were represented by the following age groups: Wk 44 Wk 45 0-1yr (0) 1-9yrs (0) 10-18yrs (0) 19-44yrs (0) 0-1yr (0) 1-9yrs (1) 10-18yrs (0) 19-44yrs (0) 45-64yrs (0) 45-64yrs (0) 65yrs> (0) 65yrs> (0) Weekly Total= 0 Weekly Total=0 Season Total=2 Season Total= 3 Of reporting Community Based Care Providers (CBCP), 27 reports of influenza-like illness (ILI) were received for Wk 45, which is a decrease from week 44 which had 31 reports. 10 cases of ILI were reported by Extended Care Facilities (ETC) in Wk 45. One report of ILI by Primary Care Providers (PCP) was received in Wk 45. During Wk 45, 4 Amantidine antiviral prescriptions were prescribed and 1 Oseltamivir (Tamiflu). According to EpiCenter, constitutional complaints accounted for 7.7% of Emergency Department visits compared to 7.3% in Wk 44. Fever and ILI remained the same as Wk 44 with 1.2% of Emergency Department visits for the week. ILI is defined as fever (temperature of 100 degrees or greater), cough, and/or sore throat. No deaths in Summit County were related to influenza in Wk 45. There was a decrease in the amount of pneumonia related deaths this week. 12 deaths were related to pneumonia in Wk 45 compared to 10 in Wk 44. Graphs with Summit County influenza trends can be found on pages 2 and 3. Summit County Public Health (SCPH), November 15, 2014 Ohio Influenza activity during Wk 45 was sporadic again indicating small numbers of laboratory-confirmed influenza cases or a single laboratory-confirmed influenza outbreak has been reported but there is no increase in cases of ILI. Sentinel providers across Ohio Regions reported the following influenza-associated hospitalizations: CDC Week 44 45 Central East Northeast Northwest Southeast Southwest West Weekly Season Central* Central Total Total 1 3 0 1 0 0 1 6 56 4 5 3 3 0 0 0 15 71 *Summit County is in the East Central Region. Statewide, 8.4% of Emergency Department (ED) visits were for constitutional illness symptoms in Wk 45 compared to 8.5% in Wk 44. This is a slight decrease. ED visits for fever and ILI remained the same compared with Wk 44 with 1.9% of Emergency Department (ED) visit for the week. As of November 08, 2014 the Ohio Department of Health (ODH) lab has reported 1 A/PdH1N1 and 4 A/h3N2 As of November 08, 2014, no pediatric influenza-related deaths have been reported during the 2013-14 influenza season. Ohio Department of Health (ODH), November 08, 2014 2014/2015 Summit County Influenza Trends 850 825 800 775 750 725 700 675 650 625 600 575 550 525 500 475 450 425 400 375 350 325 300 275 250 225 200 175 150 125 100 75 50 25 0 5-Oct ILI Lab test ordered Lab test positive A Lab test positive B antivirals ordered influenza deaths pneumonia deaths influenza hospitalizations 5-Nov 5-Dec 5-Jan 5-Feb 5-Mar 5-Apr 2014/2015 Summit County School Absenteeism 4000 3500 3000 2500 2000 School absenteeism 1500 1000 500 0 5-Oct 5-Nov 5-Dec 5-Jan 5-Feb 5-Mar 5-Apr Nation Influenza activity was low in the United States (US) during Wk 45. Three states reported regional influenza activity; Puerto Rico, the U.S Virgin Islands and 13 states reported local activity; the District of Columbia and 31 states reported sporadic activity; three states reported no influenza activity. Outpatient visits for Influenza-like Illness (ILI) accounted for 1.6% of total visits in Wk 45. During Wk 44 ILI counted for 1.5%, both were still below the national baseline of 2.0%. There was a 1.4% increase in the number of specimens tested for Wk 45 compared to WK 44 as shown below. During Wk 45, 9,138 specimens were tested; 678(7.4%) were positive.  567 (83.6. %) – Influenza A 2 – 2009 H1N1 192 – H3 373 – Subtyping not performed  111 (16.4%) – Influenza B During Wk 44, 8,439 specimens were tested; 504 (6.0%) were positive.  394 (78.2 %) – Influenza A 1 (0.2%) – 2009 H1N1 120 (30.5%) – H3 273 (69.3%) – Subtyping not performed  110 (21.8%) – Influenza B In the United States, all recently circulating influenza viruses have been susceptible to the neuraminidase inhibitor antiviral medications, Oseltamivir and Zanamivir; however, rare sporadic instances of Oseltamivir-resistant 2009 H1N1 and A (H3N2) viruses have been detected worldwide During week 45, 6.0% of all deaths reported through the 122 Cities Mortality Reporting System were due to Pneumonia & Influenza. This is below the epidemic threshold of 6.3% for week 45. No influenza-associated pediatric deaths were reported in Wk 45. One influenza-associated pediatric death has been reported during the 2014-2015 season. 2014-15 season totals for influenza-associated pediatric deaths = 1. 2013-14 season totals for influenza-associated pediatric deaths = 109. Centers for Disease Control and Prevention (CDC), November 14, 2014 Global th st Note: this data is for Week 43 to 44, October 19 - November 1 Influenza activity In North America has slightly increased but still remains low. Influenza activity in Europe has remained at inter-seasonal levels. In tropical countries of the Americas, influenza detections decreased with respiratory syncytial virus (RSV) causing most influenza-like illness (ILI) and severe acute respiratory infections (SARI). In Africa, eastern and, western Asia, influenza activity was low. In tropical Asia, influenza activity continued to decrease or remained low with influenza B predominant in India and Viet Nam. In the southern hemisphere, influenza activity reached inter-seasonal levels except in several Pacific Islands where ILI activity remained high. Based on FluNet reporting (as of 14 November 2014, 13:40 UTC), during weeks 43 to 44 (19 October 2014 to 1 November 2014), National Influenza Centres (NICs) and other national influenza laboratories from 51 countries, areas or territories reported data. The WHO GISRS laboratories tested more than 44 937 specimens. 1978 were positive for influenza viruses, of which 1434 (72.5%) were typed as influenza A and 544 (27.5%) as influenza B. Of the sub-typed influenza A viruses, 60 (6.9%) were influenza A (H1N1) pdm09 and 813 (93.1%) were influenza A (H3N2). Of the characterized B viruses, 87 (96.7%) belonged to the B-Yamagata lineage and 3 (3.3%) to the B-Victoria lineage. World Health Organization (WHO), November 03, 2014 2014 – 2015 Summit County Influenza Surveillance Participants: The Summit County Influenza Surveillance Program collects data from a variety of community sources to compare influenza activity locally to illness trends across Ohio, the nation, and the world. Sentinel providers across Summit County submit various data types based on their specific discipline, such as: Number of influenza-like illness diagnoses made by Primary Care Providers (PCP), Extended Care Facilities (ECF), and Community-Based Care Facilities (CBCF) Absentee data from local schools Number of influenza lab tests ordered as well as numbers of positive influenza test results Number of antiviral prescriptions ordered Number of influenza and pneumonia deaths reported to CDC Number of confirmed influenza-associated hospitalizations reported ED visit chief complaint data for illness possibly related to influenza reported by syndromic surveillance system (EpiCenter) Reporting from participants may not be complete each week. Numbers may change as updated reports are received. For questions, please contact Chenai Milton in the Communicable Disease Unit at 330-812-3992. Report was issued on November 17, 2014.