INFLUENZA-ASSOCIATED HOSPITALIZATIONS

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1 Week ending 2 March 219 (week 9) Influenza Vaccination Coverage* As of 7 March 219 N/A DoD 97 Army Active Duty 9 Army Guard 83 Army Reserve *Data Source: MEDPROS, ASIMS, MRRS SUMMARY There was a slight increase (8) in the overall number of positive respiratory specimens in week 8 (114) when compared to week 9 (1195). A 47 increase in the number of influenza B cases was noted when comparing week 9 to the previous week; there were 17 cases in week 8 and 25 cases in week 9. The number of specimens positive for respiratory syncytial virus decreased by 44 in week 9, with 46 reported cases in comparison to the 82 cases reported during week 8. Most of the influenza A-positive specimens were reported from installations in RHC-C (571, 52) and RHC-A (43, 39). Eight influenza-associated hospitalizations with an onset date in week 9 were reported in the Disease Reporting System internet; two were Active Duty Service Members who were vaccinated. GEOGRAPHIC SPRE In the general U.S. population, widespread influenza activity was reported by Puerto Rico and 48 states. Local activity was reported by the District of Columbia, Hawaii, and Vermont. Sporadic activity was reported by the U.S. Virgin Islands. Guam did not report to the Centers for Disease Control and Prevention (CDC) in week 9. Number of Tests Respiratory Specimen Results from Army MTFs by Age Group and Beneficiary Status, Influenza Season < Age Group DEMOGRAPHICS Active Duty (): In week 9, 18 (n=217) of the total positive specimens (n=1195) were among Service Members (SMs). Fortysix percent (n=99) of the positive specimens were from individuals in the age group. Non-: The majority of the positive specimens continue to result from the non- population. In week 9, this group accounted for 82 (n=978) of the total positives. Individuals younger than 18 years were disproportionately affected; they accounted for 72 (n=72) of the positive respiratory specimens in week 9. Non- Ben INFLUENZA-ASSOCIATED HOSPITALIZATIONS Cases Reported Army Influenza-Associated Hospitalizations Reported in DRSi by Onset Date Calendar Week Non Non- Eight influenza-associated hospitalizations, with an onset date in week 9, were reported in DRSi. Five of the cases were SMs and they were both vaccinated. In total, five of the cases were vaccinated. To date, there have been 13 reported hospitalizations this season: 21 SMs and 82 non - individuals. *DRSi does not capture cases older than 65 years old for influenza-associated hospitalizations. Additional Resources: Army Influenza Reports; ARD Reports; AFHSB Influenza Reports; NHRC FRI Reports; DoD Pandemic Influenza Watchboard; CDC Key: ILI- Influenza-Like Illness; DRSi- Disease Reporting System Internet; NHRC- Naval Health Research Center; RSV- Respiratory Syncytial Virus; DEP- Disease Epidemiology Program Questions? APHC DEP

2 U.S. Army Public Health Center Army Influenza Activity Report Week ending 2 March 219 (week 9) ILI ACTIVITY - ARMY ILI ACTIVITY - UNITED STATES ESSENCE Weekly Outpatient Clinic Visits for Influenza-like Illness Army MTFs, All Services, , 14, 12, Number of Visits 1, 8, 6, 4, 2, Calendar Week Non All Nationwide in week 9, incidence of ILI activity was 4.7, which is above the national baseline of 2.2. Regionally, the percentage of ILI outpatient visits reported to the CDC ranged from 3.3 to 9.3. At Army medical treatment facilities, overall incidence of ILI activity increased by 13 when compared to the previous week. ILI activity among the population increased by 7 from week 8. When compared to week 9 of the season, there were 1 more ILI outpatient visits in week 9 of the current season. LABORATORY RESPIRATORY SPECIMEN TESTING Total Tested (218-19) 35 Average Tested (214-18) 3 Influenza A Percent Total Number of Patients Tested Proportion of Influenza A Specimens for U.S. Army Week Nationwide, 1995 specimens were tested and submitted to the CDC during week 9, of which 1 (55) were positive for influenza. The majority of the influenza A-positive specimens continue to be reported from RHC-C and RHC-A, with 52 (n=571) and 39 (n=43) specimens, respectively. Influenza A activity was markedly lower in RHC-E and RHC-P, accounting for 6 (n=7) and 6 (n=66) of the positive influenza A specimens, respectively. Test Types Among Influenza A Specimens RAT Culture PCR Influenza A Influenza B Adenovirus Army MTF Enterovirus Laboratory Results, Parainfluenza RSV Negative Total Week Week Week Week 9 Season Total The number of positive respiratory specimens increased by 8 from week 8 to week 9; there were 114 positive specimens in week 8 and 1195 in week 9. RSV and parainfluenza were the only respiratory pathogens that decreased in the number of positive specimens from week 8 to week 9, with a reduction of 44 and 13 noted, respectively. The number of influenza A-positive specimens increased by 12, influenza B increased by 47, and adenovirus increased by 21. There was no enterovirus activity in weeks 8 and 9. Locations providing week 8 laboratory data as of 27 February 219: Ft Belvoir, Ft Benning, Ft Bliss, Ft Bragg, Ft Cam pbell, Ft Carson, Ft Drum, Ft. Eustis, Ft Gordon, Ft Hood, Ft Huachuca, Ft Irwin, Ft Jackson, Ft Knox, Ft Leavenworth, Ft Lee, Ft Leonard Wood, Ft Meade, Ft Polk, Ft Riley, Ft Rucker, Ft Sam Houston, Ft Sill, Ft Stewart, Ft. Wainwright, Landstuhl, Korea, Redstone Arsenal, Tripler Army Medical Center, and Walter Reed National Military Medical Center.

3 U.S. Army Public Health Center Army Influenza Activity Report Week ending 2 March 219 (week 9) Region RHCA RHCC RHCE RHCP Installation LABORATORY RESPIRATORY SPECIMEN TESTING No. Tested Baseline No. Tested Baseline No. Tested No.: Number of specimens tested during MMWR week Pos.: Percentage of positive specimens reported during MMWR week 9, 219. Baseline Pos.: Percentage of positive specimens reported in MMWR week 9 during influenza seasons from September May 218. Missing values indicate that specimens were not tested for the disease during the week of interest. High baseline percent positive values may be due to low numbers of specimens tested. Baseline Ft. Belvoir Ft. Benning Ft. Bragg Ft. Campbell Ft. Drum Ft. Eustis Ft. Gordon Ft. Jackson Ft. Knox Ft. Lee Ft. Meade 7 14 Ft. Rucker Ft. Sam Houston Ft. Stewart Redstone Arsenal West Point Military Academy Ft. Bliss Ft. Carson Ft. Hood Ft. Huachuca Ft. Irwin Ft. Leavenworth Ft. Leonard Wood Ft. Polk Ft. Riley Ft. Sill Landstuhl Regional Medical Center Ft. Wainwright Korea Tripler Army Medical Center Influenza A Influenza B Adenovirus Enterovirus Parainfluenza RSV Region Installation No. Tested Baseline Pos. No. Tested Baseline Pos. No. Tested Baseline Pos. Ft. Belvoir Ft. Campbell Ft. Drum 1 RHCA Ft. Gordon Ft. Sam Houston Ft. Stewart 8 13 West Point Military Academy Ft. Bliss Ft. Carson Ft. Hood RHCC Ft. Leavenworth Ft. Polk 5 17 Ft. Riley Ft. Sill 3 5 RHCE Landstuhl Regional Medical Center Ft. Wainwright RHCP Korea Tripler Army Medical Center

4 Total Number of Patients Tested Percent Total Number of Patients Tested Percent Total Number of Patients Tested Percent Total Number of Patients Tested Percent U.S. Army Public Health Center Army Influenza Activity Report Week ending 2 March 219 (week 9) Proportion of Influenza A Specimens by Week and Region, Army Medical Laboratories, as Compared to Week 9 Regional Health Command - Atlantic (RHC-A) Age Non- Season Group Ben Total Total Tested (218-19) Average Tested (214-18) Influenza A Week Regional Health Command - Central (RHC-C) Regional Health Command - Europe (RHC-E) Total Tested (218-19) Average Tested (214-18) Influenza A Week Total Tested (218-19) Average Tested (214-18) Influenza A Week < Total Age Group Week 9 Non- Ben Season Total < Total Age Group Week 9 Non- Ben Season Total < Total Regional Health Command - Pacific (RHC-P) Total Tested (216-17) Average Tested (214-18) Influenza A Week Age Group Week 9 Non- Ben Season Total < Total Region Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Non- Non- Non- Non- Non- Non- Non- Non- RHC-A RHC-C RHC-E RHC-P CENTCOM

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6 Number of Tests Respiratory Specimen Results from Army MTFs by Age Group and Beneficiary Status, Influenza Season < Age Group Non- Ben Age Group Week 9 Non- Ben Season Total < Total

7 Cases Reported Army Influenza-Associated Hospitalizations Reported in DRSi by Onset Date Calendar Week Non Non- Note: Reportable influenza cases are defined as only cases that have been hospitalized and are under the age of 65. See Armed Forces Reportable Medical Events Guidelines and Case Definitions for more information. Data as of 6 March 219.

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9 ESSENCE Weekly Outpatient Clinic Visits for Influenza-like Illness Army MTFs, All Services, , 14, 12, Number of Visits 1, 8, 6, 4, 2, Calendar Week Non All Clinic visits for ILI are obtained from ESSENCE. Data as of 7 March 219.

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11 Total Number of Patients Tested Proportion of Influenza A Specimens for U.S. Army Total Tested (218-19) Average Tested (214-18) Influenza A Week Percent

12 Test Types Among Influenza A Specimens Army MTF Laboratory Results, Week 6 Week 7 Week 8 Week 9 Season Total RAT Culture PCR Influenza A Influenza B Adenovirus Enterovirus 5 Parainfluenza RSV Negative Total

13 Number of Influenza A Specimens by Duty Status and Region Region Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Non- Non- Non- Non- Non- Non- Non- Non- RHC-A RHC-C RHC-E RHC-P CENTCOM