SUMMARY GEOGRAPHIC SPREAD DEMOGRAPHICS

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1 Week ending 1 December 18 (week 48) SUMMARY Influenza Vaccination Coverage* The number of positive respiratory specimens in week 48 increased by 33% from the previous week, with 121 positive specimens in week 47 to 161 positive specimens in week 48. Influenza A and B accounted for 32% and 6% of the total respiratory specimen tests, respectively. The majority of positive respiratory tests (116, 83%) were in the nonactive Duty population under 18 years old. One influenza-associated hospitalization was reported to DRSi with an onset date in week 48. The influenza season typically peaks around the holidays, so it is strongly recommended to get an influenza vaccination to protect against respiratory illness, and follow appropriate hand hygiene practices at all times. As of 7 November 18 N/A DoD 85% Army Active Duty 71% Army Guard 68% Army Reserve *Data Source: MEDPROS, ASIMS, MRRS GEOGRAPHIC SPRE Click to enlarge image In the civilian population, influenza activity remains generally sporadic, though the number of states reporting regional activity has increased from week 47. In week 48, widespread influenza activity was reported by Massachusetts; this is the first state this influenza season to report widespread influenza activity to the CDC. Regional influenza activity was reported to the CDC by nine states, local activity was reported by eighteen states, and sporadic activity was reported by the District of Columbia, Puerto Rico, the US Virgin Islands, and 22 states. No reports were submitted by Guam. DEMOGRAPHICS : I n w eek 48, a total of 12 cases tested positive for a respiratory specimen in the population. The majority of them (75%) were in the 3-39 age group, followed by 8% in the 18-29, -49, and 5-59 age groups. There were no Active Duty cases reported in the + age group in week 48. Positive Respiratory Specimen Results from Army MTFs by Age Group and Beneficiary Status, Influenza Season Number of Positive Tests 1 Non-: Of the 139 positive specim ens am ong non - individuals, 83% (116) were among individuals less than 18 years old. < Age Group Non- Ben INFLUENZA-ASSOCIATED HOSPITALIZATIONS One influenza-associated hospitalization was reported to DRSi in week 48 in a dependent under 18 years old. This case tested positive with influenza type A and was not previously vaccinated. So far this season, seven cases of non- influenza-associated hospitalizations have been reported; no cases have been reported. This time last season, a total of twelve cases had been reported for 4 cases and 8 non- cases. Of the cases reported so far this season, three had been previously vaccinated. Army Influenza-Associated Hospitalizations Reported in DRSi by Onset Date Cases Reported Calendar Week Non Non- *DRSi does not capture cases older than 65 years old for influenza-associated hospitalizations. Additional Resources: Army I nfluenza R eports; ARD Reports; AFHSC Influenza Reports; NHRC FRI Reports; DoD Pandemic Influenza Watchboard; CDC Key: I LI -Influenza-Like Illness; DRSi- Disease Reporting System Internet; NHRC- Naval Health Research Center; V-Adenovirus; RSV-Respiratory Syncytial Virus; DED- Disease Epidemiology Division; SM-Service Member Questions? APHC DEP

2 U.S. Army Public Health Center Army Influenza Activity Report Week ending 1 December 18 (week 48) ILI ACTIVITY - ARMY ILI ACTIVITY - UNITED STATES ESSENCE Weekly Outpatient Clinic Visits for Influenza-like Illness Army MTFs, All Services, , 14, Number of Visits 12, 1, 8, 6, 4, 2, Calendar Week Non All Nationwide in week 48, incident ILI activity was 2.2%, equal to the national baseline of 2.2%. Regionally, the percentage of ILI outpatient visits reported to the CDC ranged from.8% to 3.2%. At Army medical treatment facilities, incident ILI activity increased from week 47 to week 48, but was 22% lower than in the same week last year. The majority of ILI encounters (67%) were from non- patients. LABORATORY RESPIRATORY SPECIMEN TESTING 25 Total Tested (18-19) Average Tested (14-18) % Influenza A Positive Percent Positive Total Number of Patients Tested Proportion of Positive Influenza A Specimens for U.S. Army Week Nationwide, 67 specimens were tested, of which 1 (27%) were positive. Influenza A accounted for 94% of the total positive specimens submitted to the CDC in week 48. In the Army population, 161 (6.5%) of 2475 specimens tested were positive for a respiratory illness; of that, 32% tested positive for influenza A. Eighteen (35%) of the positive influenza A specimens were from Active Duty individuals. RHC-A and RHC-P reported the majority of positive influenza A specimens, with 24 (46%) and 14 (27%) of the total influenza A positive specimens, respectively. Test Types Among Positive Influenza A Specimens RAT Culture PCR Influenza A Influenza B Adenovirus Army MTF Enterovirus Laboratory Results, Parainfluenza RSV Negative Total Week 45 Week 46 Week 47 Week 48 Season Total The number of positive specimens in week 48 increased by 33%, from 121 positive specimens in week 47 to 161 positive specimens in week 48. RSV accounted for 48% of the positive specimens. Influenza A and B accounted for 32% and 6% of the specimens, respectively. Parainfluenza accounted for 8% of positive specimens, and adenovirus accounted for 5% of positive specimens. The majority of positive tests in week 48 were from rapid antigen tests (RATs), followed by PCR. Locations providing week 48 laboratory data as of 6 December 18: 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 Rucker, Ft Sam Houston, Ft Sill, Ft Stewart, Ft. Wainwright, Korea, Landstuhl, Redstone Arsenal, Tripler, West Point, and Walter Reed. *NOTE: Madigan AMC data was not received due to the switch from AHLTA/CHCS to MHS Genesis

3 U.S. Army Public Health Center Army Influenza Activity Report Week ending 1 December 18 (week 48) LABORATORY RESPIRATORY SPECIMEN TESTING Influenza A Influenza B Adenovirus Region Installation No. Tested % Positive Baseline % Pos. No. Tested % Positive Baseline % Pos. No. Tested % Positive Baseline % Pos. Ft. Belvoir Ft. Benning Ft. Bragg Ft. Campbell Ft. Drum 14 1 Ft. Eustis Ft. Gordon RHCA Ft. Jackson Ft. Knox Ft. Lee Ft. Meade Ft. Rucker Ft. Stewart Redstone Arsenal 9 16 West Point 7 Ft. Bliss Ft. Carson Ft. Hood Ft. Irwin RHCC Ft. Leavenworth Ft. Polk Ft. Riley Ft. Sam Houston Ft. Sill RHCE Landstuhl Ft. Wainwright RHCP Korea Tripler Enterovirus Parainfluenza RSV Region Installation No. Tested % Positive Baseline % Pos. No. Tested % Positive Baseline % Pos. No. Tested % Positive Baseline % Pos. Ft. Belvoir Ft. Campbell 2 1 RHCA Ft. Drum 1 2 Ft. Gordon 5 11 Ft. Stewart West Point 1 Ft. Bliss Ft. Carson Ft. Hood RHCC Ft. Leavenworth Ft. Polk Ft. Riley 8 5 Ft. Sam Houston 3 Ft. Sill RHCE Landstuhl Ft. Wainwright 8 RHCP Korea Tripler No.: Number of specimens tested during MMWR week 48, 18. % Pos.: Percentage of positive specimens reported during MMWR week 48, 18. Baseline % Pos.: Percentage of positive specimens reported in MMWR week 48 during influenza seasons from September 12 - May 18. Missing values indicate that specimens were not tested for the disease during the week of interest.

4 Total Number of Patients Tested Percent Positive Total Number of Patients Tested Percent Positive Total Number of Patients Tested Percent Positive Total Number of Patients Tested Percent Positive U.S. Army Public Health Center Army Influenza Activity Report Week ending 1 December 18 (week 48) Proportion of Influenza A Positive Specimens by Week and Region, Army Medical Laboratories, as Compared to Regional Health Command - Atlantic (RHC-A) 1 1 Total Tested (18-19) Average Tested (14-18) % Influenza A Positive Week Regional Health Command - Central (RHC-C) 1 1 Total Tested (18-19) Average Tested (14-18) % Influenza A Positive Week Regional Health Command - Europe (RHC-E) Total Tested (18-19) Average Tested (14-18) % Influenza A Positive Week Regional Health Command - Pacific (RHC-P) Total Tested (16-17) Average Tested (14-18) % Influenza A Positive Week Age Group Week 48 Non- Ben Season Total < Total Age Group Week 48 Non- Ben Season Total < Total Age Group Week 48 Non- Ben Season Total < Total Age Group Week 48 Non- Ben Season Total < Total Number of Positive Influenza A Specimens by Duty Status and Region Region Week 41 Week 42 Week 43 Week 44 Week 45 Week 46 Week 47 Week 48 Non- Non- Non- Non- Non- Non- Non- Non- RHC-A RHC-C RHC-E RHC-P CENTCOM

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6 1 Positive Respiratory Specimen Results from Army MTFs by Age Group and Beneficiary Status, Influenza Season Number of Positive Tests < Age Group Age Group Week 48 Non- Ben Season Total < Total Non- Ben

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 28 November 18.

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9 Number of Visits ESSENCE Weekly Outpatient Clinic Visits for Influenza-like Illness Army MTFs, All Services, , 14, 12, 1, 8, 6, 4, 2, Calendar Week Non All Clinic visits for ILI are obtained from ESSENCE. Data as of 6 December 18.

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11 Total Number of Patients Tested Proportion of Positive Influenza A Specimens for U.S. Army Total Tested (18-19) Average Tested (14-18) % Influenza A Positive Week Percent Positive

12 Test Types Among Positive Influenza A Specimens Army MTF Laboratory Results, Week 45 Week 46 Week 47 Week 48 Season Total RAT Culture PCR Influenza A Influenza B Adenovirus Enterovirus 1 3 Parainfluenza RSV Negative Total

13 Number of Positive Influenza A Specimens by Duty Status and Region Region Week 41 Week 42 Week 43 Week 44 Week 45 Week 46 Week 47 Week 48 Non- Non- Non- Non- Non- Non- Non- Non- RHC-A RHC-C RHC-E RHC-P CENTCOM