Influenza (FLU) Update for Week Ending 11-2-19

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Influenza (FLU) Update for Week Ending 11-2-19

Influenza (FLU) Update for Week #44 
Week Ending 11-2-19

The CDC reported that seasonal flu activity is low, but increased some from the previous week.  These lower levels are expected for this time of year although Louisiana and Puerto Rico reported continued high levels of ILI.  Influenza-like illness (ILI) is defined as a temperature at/above100o F [37.8o C] and cough and/or sore throat without a known cause other than flu.  A Flu case, that is included in CDC data, indicates a positive flu test read by either a Clinical or Public Health Lab.

Diagnosed Flu and ILI are expected to increase in the next few weeks and months. It is recommended by public health officials and health care providers that for all those 6 months or older, flu vaccinations should be completed ASAP, unless they have a valid medical contraindication. Most will receive a vaccination that covers 4 strains of influenza.

The severity of Flu & ILI for this season, as well as which viruses will dominate, is still too early to identify.  As more data is collected by the CDC further into the season, severity and predominating viruses, as well as other report components, will be included in this Summary.

See this link for more details, including charts, graphs, and maps: https://www.cdc.gov/flu/weekly/index.htm

FirstWatch RIN (Reginal Influenza Network) Alerts occurred more often than in previous weeks.

For the most recently reported week ending November 2, 2019, the CDC reported:

–ILI visits to clinics and other non-hospital facilities was at 2.1%, a little higher than last week’s 1.9% and below the national baseline of 2.4%, with a range between 1.2% and 3.8% for Week #44.  Eight (8) of 10 Regions reported that outpatient visits for ILI were below their own regional baselines, while Region 6 (AR, LA, NM, OK & TX) and Region 7 (IA, KS, MO & NE) were at their regional baselines.

–Flu cases (documented by positive Flu tests) remained low. Clinical lab testing for influenza was positive for Flu in 3.2% of the total tests, higher than 2.4% for the previous week.

In these early weeks of flu reporting, with limited numbers of flu cases, determining the most common circulating flu strain(s) may vary from report to report and certainly from region to region.  For Week #44, both the clinical and public health labs all reported Influenza B was the most commonly found flu virus.  However, the proportion of Influenzas B to A was different depending on whether it was clinical or public lab reporting.  Remember, clinical labs test a larger number of specimens, (18,126 for Week #44) versus (766 for Week #44) from public health labs. Public health labs provide more specific testing but test a significantly fewer number of specimens.  The CDC considers public health lab results to better represent the correct breakdown of flu types and subtypes.

Viewed from a national standpoint, Influenza A(H3N2) and Influenza B/Victoria viruses were reported more frequently, although Influenza A(H1N1)pdm09 was also found to be circulating.  The dominant strain varied by region.  To access specific state and regional information on circulating flu viruses, please see:  https://gis.cdc.gov/grasp/fluview/fluportaldashboard.html

This week, using the clinical lab results, Influenza B was predominant with 75.4% and Influenza A at 24.6%.  Looking at the public health lab data, Influenza B was more plentiful than Influenza A, but with a much narrower range — with Influenza B at 53.8% and Influenza A at 46.2%.  Further breakdown by public health labs, revealed that H3N2 is the dominant A with 58.5% and H1N1 at 41.5%; Influenza B showed 90.5% Victoria lineage and 9.5% Yamagata.

Per the CDC, clinical labs from the Southeast and South (Regions # 4 & 6, respectively) were responsible for the majority (63%) of all positive flu specimens and 75% of the Influenza B viruses reported.

–Vaccine Coverage:  will be determined later in the season when enough data has been collected.

The CDC provides an interactive U.S. map that will link to each state’s public health authorities, ILI and Flu information and processes, as well as other diseases and public health topics.  This site includes a tremendous amount of information at the State, and even Local, level.
Find it at this site:  https://www.cdc.gov/flu/weekly/usmap.htm

For Influenza-Like Illness (ILI)
High ILI Activity (Puerto Rico & 1 state):  Louisiana
Moderate ILI Activity (0):
Low Activity (9 states):  Alabama, Arkansas, Colorado, Georgia, Hawaii, Missouri, South Carolina, Texas, & Virginia
Minimal Activity (Washington D.C., New York City, U.S. Virgin Islands, & 40 states):  Alaska, Arizona, California, Connecticut, Delaware, Florida, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming 

For Flu (positive Flu tests)
Widespread Activity (2 states):  Louisiana & Maryland
Regional Activity (1 state):  Alabama,
Local Activity (Puerto Rico & 15 states):  Arizona, California, Florida, Georgia, Illinois, Indiana, Kentucky, Massachusetts, Mississippi, Nevada, New Hampshire, South Carolina, Tennessee, Texas and West Virginia,
Sporadic Activity (U.S. Virgin Islands, Washington D.C., & 31 states):  Alaska, Arkansas, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Utah, Vermont, Virginia, Washington, Wisconsin and Wyoming
No Activity: (1 state):  Rhode Island
No Report:  Guam

Other Data:
Hospitalizations from Flu:  will be determined later in the flu season when enough data has been collected.

Death rates for pneumonia & influenza in adults are not available because the NCHS Mortality Surveillance system had technical difficultly and the info was not reported.  Reporting will resume when the technical issues are resolved.

Zero (0) pediatric deaths associated with influenza were reported from week #44.   There have been two (2) flu-associated pediatric deaths for the 2019-20 Flu Season.   

International:

Canada:

Flu in Canada for Week #44 (10/27 – 11/2, 2019):
According to the Public Health Agency of Canada (PHAC), influenza activity remained at interseasonal levels nationally.  The number of Canadian regions reporting Flu decreased slightly for this week. Influenza A(H3N2) was the most common flu virus circulating.

Sporadic Activity:  in 24 Regions – Newfoundland & Labrador (3), NB (1), Quebec (4), Ontario (3), Manitoba (3), Saskatchewan (2), Alberta (3), British Columbia (3), Yukon Territory (1), Northwest Territory (1)

PHAC Flu Watch Summary & Influenza/ILI Activity Map for Week #44 seehttps://www.canada.ca/en/public-health/services/publications/diseases-conditions/fluwatch/2019-2020/week-44-october-27-november-2-2019.html#a1

PHAC Home Page for Surveillance on Flu:  http://www.phac-aspc.gc.ca/fluwatch/

Public Health Agency of Canada (PHAC) Home Page for Information on Flu:
https://www.canada.ca/en/public-health/services/diseases/flu-influenza.html

PHAC Provides Flu Watch Summary & Link to Full Influenza Reports Past & Present:
https://www.canada.ca/en/public-health/services/diseases/flu-influenza/influenza-surveillance/weekly-influenza-reports.html

PHAC Interactive Map for Flu Activity Across Canada:
https://www.canada.ca/en/public-health/services/diseases/flu-influenza/influenza-surveillance/map-activity-levels.html

PHAC Site that Explains How to Become a Canadian Flu Watcher:
https://www.canada.ca/en/public-health/services/diseases/flu-influenza/fluwatcher.html

Europe:

European Center for Disease Prevention & Control – Flu for Week #44 (10/28 – 11/3, 2019):
Influenza activity was low throughout Europe.  Flu viruses, both A & B, were found sporadically in specimens from those with respiratory illness seeking medical care. Data from 22 countries/regions reported mortality from all causes are at expected levels for this time of year.
For more info see:  http://flunewseurope.org/

Public Health England Flu Summary:
https://www.gov.uk/government/statistics/weekly-national-flu-reports

Global:

World Health Organization (WHO) Weekly Flu Summary (FluNet):
http://www.who.int/influenza/gisrs_laboratory/flunet/en/

WHO Global Flu Overview with Map and Text:
https://www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en/

Global Epidemiology Reports:
WHO Collaborating Centers for Flu in AustraliaJapan, & the United Kingdom

First Responder Specific Information

There are many websites that may be helpful in planning and managing seasonal flu within First Responder organizations.  A few of those websites are included here:  
NIOSH on Flu for Employers/Employees:
https://www.cdc.gov/niosh/topics/flu/

NIOSH Listing on Absenteeism in the Workplace throughout the US:
https://www.cdc.gov/niosh/topics/absences/default.html

Protection from Flu:
https://www.cdc.gov/flu/protect/habits/index.htm  

World Map Showing Flu & Other Infectious Diseases:
http://www.healthmap.org/en/

  • First Responders should be vaccinated for Flu each season to prevent getting flu themselves, taking it home to family members or transmitting it to patients in their care. Family members and patients may be at increased risk of complications from flu.
  • Perform proper hand hygiene including frequent handwashing with soap and water, and the use of hand sanitizers in general, and particularly when providing patient care or after touching surfaces.
  • Masks (N95 or 100) should be used in the presence of patients with cough and/or fever. Procedure or surgical masks can also be used but may not provide the same level of protection.
  • Care should be taken to avoid touching their own face and mucous membranes (eyes, mouth, nose) since the flu virus is frequently found on surfaces such as door knobs, cot and equipment handles, phones, as well as clothing, bed clothes, etc. Once picked up on the hands from touching inanimate objects or from the secretions of a patient, it can transmit the flu (or any respiratory infection virus) via the mucous membranes of the face and head.
  • Report signs/symptoms of flu to your physician or other appropriate provider for early assessment and care. Signs & symptoms suggest a period of contagiousness and out your patients and co-workers at risk.
  • Cough and sneeze into your sleeve, if a tissue is not available, and not onto your hands.
  • Stay away from others if you are sick.
  • Be aware of your exposure risk and history. Take extra precautions or avoid those with immunocompromise, when possible, if you have a known or likely exposure.
  • Antivirals may be indicated for the treatment of flu, particularly for those in high risk groups, those who are hospitalized or have severe, complicated or progressing flu. Those that present with 48 hours of the onset of symptoms may also be given antivirals, based on PCP judgement but make sure the practitioner is aware of their Frist Responder Role.  See https://www.cdc.gov/flu/antivirals/whatyoushould.htm
  • Flu is much more worrisome for the very young and the very old. Signs of ILI in this group requires careful assessment to rule out complications and these groups are much more likely to need to be transported to assure adequate care.  Young children and those over 65 are typically at greater risk for complications, hospitalization, and even death.  Hospitalization rates may also be elevated in those aged 50-64.  Consideration should perhaps be given to monitoring these groups more closely, with inclination for more comprehensive assessment and transport for further evaluation, when presented with possible flu and any signs of complications.

Complications of flu, sometimes requiring hospitalization and even leading to death, tend to occur after the person has begun to get better from the flu and then appears to relapse.  EMS personnel may want to look more closely at those patients when the call is not about the initial signs and symptoms of flu, but about increasing or different signs that have appeared.

  • A study was published by the Institute for Clinical Evaluative Sciences in NEJM:

Image courtesy of ICES/PHO “The researchers add that patients should not delay medical evaluation for heart symptoms particularly within the first week of an acute respiratory infection.”  (Lisa Schnirring, News Editor:  CIDRAP News; Jan 25, 2018)

For more information on the Influenza and Heart Attack Study, please see the link below.
https://www.eurekalert.org/pub_releases/2018-01/pho-rcl011818.php

 

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