SUMMARY. U.S.V.I and 5 states. DEMOGRAPHICS INFLUENZA-ASSOCIATED HOSPITALIZATIONS

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1 Week ending 7 April 218 (week 14) SUMMARY Influenza Vaccination Coverage* The number of positive influenza A specimens submitted overall to APHC has plateaued around 11% since week 11 across the Army population. In week 14, the number decreased to 6%. Of all specimens submitted, 9% were positive for a respiratory illness; 35% influenza A and 52% influenza B. Five non- influenza-associated hospitalizations were reported to DRSi; none were vaccinated. Three were positive for influenza type A and two were type B. The majority of positive influenza A specimens received in surveillance week 14 came from RHC-Atlantic (4%), followed by RHC-Central (28%), RHC-Pacific (22%), and RHC-Europe (1%). As of 22 February 218 N/A DoD 97% Army Active Duty 88% Army Guard 82% Army Reserve *Data Source: MEDPROS, ASIMS, MRRS GEOGRAPHIC SPRE Click to enlarge images UNITED STATES In week 14, widespread influenza activity was reported to the CDC by 7 states. Regional activity was reported by Guam, Puerto Rico, and 22 states. Local activity was reported by the District of Columbia and 16 states, and sporadic activity was reported by the U.S.V.I and 5 states. DEMOGRAPHICS : I n w eek 14, there w as a total of 29 positive respiratory illness specimens from Active Duty () Service Members; 59% (17) from individuals in the age group, followed by 17% (5) in the 4-49 age group, 13% (4) in the 3-39 age group, and 1% (3) in the 5-59 age group. There were no cases in the 6+ group. Positive Respiratory Specimen Results from Army MTFs by Age Group and Beneficiary Status, Influenza Season Number of Positive Tests Non-: A total of 114 positive respiratory illness specimens were among non- beneficiaries. 65% (74) of specimens came from patients under 18 years old. 4 2 < Age Group Non- Ben INFLUENZA-ASSOCIATED HOSPITALIZATIONS In week 14, 5 influenza-associated hospitalizations were reported in DRSi in non- individuals. No cases were vaccinated. Three were positive for influenza type A, and two for influenza type B. In the same week last year, 13 cases were reported in DRSi. Army Influenza-Associated Hospitalizations Reported in DRSi by Week of Symptom Onset Cases Reported There has been a total of 195 hospitalizations this season; 166 non - and 29. By this time last season, 86 hospitalizations were reported in DRSi; 11 and 75 non Approximately 25% of all cases this season were vaccinated. Calendar Week Non Non- Additional Resources: Arm y I nfluenza R eports; ARD Reports; AFHSC Influenza Reports; NHRC FRI Reports; DoD Global Influenza Surveillance Program; 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 Week ending 7 April 218 (week 14) Army Influenza Activity Report 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 The number of patient visits due to influenza-like illness (ILI) reported to CDC in week 14 was 2.1%, below the national baseline of 2.2%. In week 14, there was a 7% decrease in the overall number of ILI-related visits in the Army population since week 13, and a 3% decrease in the number of ILI-related visits among patients. The majority of ILIrelated visits in week 14 were among non- (68%) patients. LABORATORY RESPIRATORY SPECIMEN TESTING 5 Total Tested (217-18) Average Tested (214-17) % Influenza A Positive Percent Positive Total Number of Patients Tested Proportion of Positive Influenza A Specimens for U.S. Army Week Nationwide, 37.4% of specimens tested positive for influenza A, and 62.6% were positive for influenza B in week 14. In the Army population, (6.6%) of 762 specimens tested were positive for influenza A. Of the positive influenza A specimens, 33 (66%) were from non-active duty individuals. RHC-A and RHC-C reported the most positive specimens, with 4% and 28%, respectively, followed by RHC-P (22%) and RHC-E (1%). Test Types Among RAT Positive Influenza A Culture Specimens PCR Influenza A Influenza B Adenovirus Army MTF Enterovirus Laboratory Results, Parainfluenza RSV Negative Total Week 11 Week 12 Week 13 Week 14 Season Total *The total number of positive specimens in week 14 decreased from week 13 by 45%. In week 14, 9% (143) of specimens tested positive for a respiratory pathogen. Influenza A and B accounted for 35% (5) and 52% (74) of the positive specimens, respectively. RSV accounted for 12% (17) of the positive specimens, and parainfluenza accounted for 1% (2) of the total positive specimens in week 14. There were no positive adenovirus or enterovirus specimens in week 14. Locations providing week 14 laboratory data as of 12 April 218: K orea, Ft Belvoir, Ft Benning, Ft B liss, 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, Redstone Arsenal, Tripler, Walter Reed, and West Point. *Missing data affected this week s results. 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 7 April 218 (week 14) Region RHCA LABORATORY RESPIRATORY SPECIMEN TESTING Influenza A Influenza B Adenovirus 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 FT Eustis FT Gordon FT Jackson FT Knox FT Lee FT Meade FT Rucker 8 8 FT Stewart Redstone Arsena 9 11 West Point FT Bliss FT Carson FT Hood FT Huachuca FT Irwin RHCC FT Leavenworth FT Leonard Wood 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 RHCA FT Drum FT Gordon FT Stewart West Point FT Bliss 16 FT Carson FT Hood FT Leavenworth 1 RHCC FT Leonard Wood FT Polk FT Riley FT Sam Houston FT Sill RHCE Landstuhl FT Wainwright RHCP Korea Tripler No. Tested: Number of specimens tested during MMWR week 14, 218. % Pos.: Percentage of positive specimens reported during MMWR week 14, 218. Baseline % Pos.: Weekly historical average of the percentage of positive specimens reported during influenza seasons from September May 217. Missing values indicate that specimens were not tested for the disease during the week of interest. Incidence rules: An individual can only test positive once per disease and season; if an individual has tested positive for a specific disease and returns at a later date to be tested for that same disease, their tested specimens will not contribute to the above calculations; an individual will contribute to the number of specimens tested column until they test positive for a disease. High baseline percent positive values may be due to low numbers of specimens tested. *Incomplete data for week 14.

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 7 April 218 (week 14) Proportion of Influenza A Positive Specimens by Week and Region, Army Medical Laboratories, as Compared to Regional Health Command - Atlantic (RHC-A) Total Tested (217-18) Average Tested (214-17) % Influenza A Positive Week Age Group Week 14 Non- Ben Season Total < Total Regional Health Command - Central (RHC-C) 3 Total Tested (217-18) Average Tested 25 % Influenza A Positive Week Age Group Week 14 Non- Ben Season Total < Total Regional Health Command - Europe (RHC-E) *Incomplete data in weeks 8 & Total Tested (217-18) Average Tested / Week 8 12 % Influenza A Positive Week Age Group Week 14 Non- Ben Season Total < Total Regional Health Command - Pacific (RHC-P) 16 Total Tested (216-17) Average Tested / Week 12 % Influenza A Positive Week Age Group Week 14 Non- Ben Season Total < Total Number of Positive Influenza A Specimens by Duty Status and Region Region Week 7 Week 8 Week 9 Week 1 Week 11 Week 12 Week 13 Week 14 Non- Non- Non- Non- Non- Non- Non- Non- RHC-A RHC-C RHC-E RHC-P CENTCOM

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6 Number of Positive Tests Positive Respiratory Specimen Results from Army MTFs by Age Group and Beneficiary Status, Influenza Season Age Group Week 14 Non- Ben Season Total < Total < Age Group Non- Ben

7 Cases Reported Army Influenza-Associated Hospitalizations Reported in DRSi by Week of Symptom Onset 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 1 April 218.

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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 13 April 218.

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11 Total Number of Patients Tested Proportion of Positive Influenza A Specimens for U.S. Army Total Tested (217-18) Average Tested (214-17) % Influenza A Positive Week Percent Positive

12 Test Types Among Positive Influenza A Specimens Army MTF Laboratory Results, Week 11 Week 12 Week 13 Week 14 Season Total RAT Culture PCR Influenza A Influenza B Adenovirus Enterovirus 1 16 Parainfluenza RSV Negative Total

13 Number of Positive Influenza A Specimens by Duty Status and Region Region Week 7 Week 8 Week 9 Week 1 Week 11 Week 12 Week 13 Week 14 Non- Non- Non- Non- Non- Non- Non- Non- RHC-A RHC-C RHC-E RHC-P CENTCOM