Weekly Influenza & Respiratory Illness Activity Report A summary of influenza surveillance indicators prepared by the Division of Infectious Disease Epidemiology Prevention & Control Week Ending February 23, 219 WEEK 8 All data are preliminary and may change as more information is received Minnesota Influenza Geographic Spread No Activity Sporadic Local Regional Widespread During the week ending February 23, 219 (Week 8), surveillance indicators showed widespread geographic spread of influenza (based on CDC s Activity Estimates Definitions). Since the start of the influenza season, no pediatric influenza-related deaths have been reported. Minnesota Influenza Surveillance (http://www.health.state.mn.us/divs/idepc/diseases/flu/stats/) Weekly U.S. Influenza Surveillance Report (http://www.cdc.gov/flu/weekly/) World Health Organization (WHO) Surveillance (http://www.who.int/influenza/surveillance_monitoring/updates/en/) Neighboring states influenza information: Iowa: Iowa Flu Reports (http://idph.iowa.gov/influenza/reports) Wisconsin: Influenza (Flu) (http://www.dhs.wisconsin.gov/communicable/influenza/) North Dakota: Reported Seasonal Influenza Activity in North Dakota (http://www.ndflu.com/default.aspx) South Dakota: South Dakota Influenza Information (http://doh.sd.gov/diseases/infectious/flu/) Minnesota Department of Health 651-21-5414 or 1-877-676-5414 www.health.state.mn.us 2/28/219
Hospitalized Influenza Surveillance Hospitalized influenza cases are based on disease reports of laboratory-positive influenza (via DFA, IFA, viral culture, EIA, rapid test, paired serological tests or RT-PCR) and specimens from hospitalized patients with acute respiratory illness submitted to MDH-PHL by hospitals and laboratories. Due to the need to confirm reports and reporting delays, consider current week data preliminary. Hospitalized Influenza Cases by Type Minnesota (FluSurv-NET*) Hospitalized Influenza Cases by Season, Minnesota (FluSurv-NET*) 225 175 125 75 25 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 Hospitalizations this week *Influenza Surveillance Network Hospitalizations last week B (no genotype) B (Yamagata) B (Victoria) A (not subtyped) A H3 A H1 (unspecified) A (H1N1)pdm9 A (H1N2v) A (H3N2v) A&B Unknown Total hospitalizations (to date) 167 158 1,5 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 2 7 7 6 6 5 4 4 3 3 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 Season Total hospitalizations (historic) 213-214 1,578 214-215 4,81 215-216 1,538 216-217 3,695 217-218 6,446 218-219 1,5 (to date) 213-14 214-15 215-16 216-17 217-18 218-19
Hospitalized Influenza Surveillance (continued) Number of Influenza Hospitalizations and Incidence by Region, Minnesota September 3, 218 February 23, 219 Number of Influenza Hospitalizations and Incidence by Age, Minnesota September 3, 218 February 23, 219 7 6 4 3 13.9 Region 17.1 19.4 15.1 Region 25.8 27.4 Hospitalizations this week # of hospitalizations Incidence (cases) per, Persons 2.7 15.8 Total (to date) 7. 6.. 4. 3. 2. 1.. Hospitalizations per, Persons Central 1 (1%) 14 (12%) Metro 95 (57%) 518 (%) 59. Northeast 15 (9%) 63 (5%) Northwest 3 (2%) 24 (2%) South Central 7 (4%) 75 (9%) Southeast 24 (14%) 138 (14%) Southwest 4 (2%) 45 (5%) West Central 9 (5%) 38 (4%) Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 3 7 6 4 3 25.5 # of hospitalizations Incidence (cases) per, Persons 4.8 1.8 22.9 47.9-4 5-24 25-49 -64 65+ Age Group (years) Median age (years) at time of admission 7. 6.. 4. 3. 2. 1.. Hospitalizations per, Persons
Influenza-Associated Death Surveillance Influenza deaths are collected via reports from Minnesota s death certificate database, hospitals, and long-term care facilities. Decedents with influenza listed as a cause of or contributor to death, have recent laboratory confirmation of influenza, or are part of an ongoing influenza outbreak at a long-term care facility are reported to influenza surveillance. Due to the need to confirm reports and reporting delays, consider current week data preliminary. Deaths Associated with Influenza by Season, Minnesota Deaths Associated with Influenza by Age Group and Season, Minnesota 7 6 4 3 2 213-14 214-15 215-16 216-17 217-18 218-19 Number of Deaths 3 213-14 214-15 215-16 216-17 217-18 218-19 1 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 Season Total deaths Total pediatric (<18 years) deaths (historic) (historic) 213-214 83 2 214-215 368 1 215-216 76 3 216-217 273 2 217-218 435 5 218-219 26 (to date) (to date) *Influenza Surveillance Network Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 4 Season -17 18-49 -64 65-79 8+ Age Group (years) Median age (years) at time of death 213-214 63 214-215 85 215-216 68 216-217 86 217-218 85 218-219 73. (to date)
Respiratory Disease Outbreak Surveillance School Outbreaks K-12 schools report an outbreak of influenza-like illness (ILI) when the number of students absent with ILI reaches 5% of total enrollment or three or more students with ILI are absent from the same elementary classroom. 3 Influenza-like Illness (ILI) in Schools by Season Number of Influenza-like Illness Outbreaks 213-14 214-15 215-16 216-17 217-18 218-19 4 41 42 43 44 45 46 47 48 49 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 New school outbreaks this week New school outbreaks last week Total this season (to date) 24 38 192 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 5
Respiratory Disease Outbreak Surveillance (continued) Long-Term Care (LTC) Outbreaks LTC facilities report to MDH when they suspect an outbreak of influenza in their facility. Laboratory-confirmed outbreaks are reported here. Confirmed Influenza Outbreaks in LTC by Season Number of lab-confirmed outbreaks 45 4 35 3 25 2 15 1 213-14 214-15 215-16 216-17 217-18 218-19 5 4 41 42 43 44 45 46 47 48 49 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 New LTC outbreaks this week New LTC outbreaks last week Total this season (to date) 4 3 24 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 6
Sentinel Provider Surveillance (Outpatients) MDH collaborates with healthcare providers who report the total number of patients seen and the total number of those patients presenting to outpatient clinics with influenza-like illness. Percentage of Persons Presenting to Outpatient Clinics with Influenza-Like Illness (ILI) Percent with Influenza-like Illness 9 8 7 6 5 4 3 2 * 213-14 214-15 215-16 216-17 217-18 218-19 1 4 41 42 43 44 45 46 47 48 49 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 % of outpatients with ILI this week % of outpatients with ILI last week 2.8% 2.2% * Indicates current week-data may be delayed by 1 or more weeks Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 7
Laboratory Surveillance The MN Lab System (MLS) Laboratory Influenza Surveillance Program is made up of more than 31 clinic- and hospital-based laboratories, voluntarily submitting testing data weekly. These laboratories perform rapid testing for influenza and Respiratory Syncytial Virus (RSV). Significantly fewer labs perform PCR testing for influenza and three also perform PCR testing for other respiratory viruses. MDH-PHL provides further characterization of submitted influenza isolates to determine the hemagglutinin serotype to indicate vaccine coverage. Tracking the laboratory results assists healthcare providers with patient diagnosis of influenza-like illness and provides an indicator of the progression of the influenza season as well as prevalence of disease in the community. Specimens Positive for Influenza by Molecular Testing*, by Week Number of Positive Molecular Tests 4 4 3 3 B A (not subtyped) A H3 A (H1N1) pdm9 214-15 % + by PCR 215-16 % + by PCR 216-17 % + by PCR 217-18 % + by PCR 218-19 % + by PCR 35 3 25 2 15 1 5 Percent of Positive Molecular Tests 4 41 42 43 44 45 46 47 48 49 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 % molecular tests positive this week % molecular tests positive last week 26.% 25.8% * Beginning in 216-17, laboratories report results for rapid molecular influenza tests in addition to RT-PCR results Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 8
Laboratory Surveillance (continued) MLS Laboratories Influenza Testing Specimens Positive by Influenza Rapid Antigen Test, by Week MLS Laboratories RSV Testing Specimens Positive by RSV Rapid Antigen Test, by Week Number of Positive Influenza Specimens 7 6 6 5 4 4 3 3 B+ (218-19 Season) A+ (218-19 Season) A/B+ (218-19 Season) 214-15% + 215-16 % + 216-17 % + 217-18% + 218-19% + 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 45 4 35 3 25 2 15 1 5 Percentage of Rapid Antigen Influenza Tests Positive Number of Positive RSV Tests 225 175 125 75 25 Number + 214-15 % + 215-16 % + 216-17 % + 217-18 % + 218-19 % + 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 9 8 7 6 4 3 2 1 Region % rapid antigen influenza tests + (current week) Northeast 32% South Central 3% Southwest 26% Southeast 51% Metro 25% Central 25% West Central 26% Northwest 19% State (overall) 29% Region % rapid antigen RSV tests + (current week) Northeast 11% South Central 37% Southwest 42% Southeast 19% Metro 12% Central 33% West Central 29% Northwest 33% State (overall) 21% Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 9
Hospitalized RSV Surveillance Surveillance for respiratory syncytial virus (RSV) began in September 216. Hospitalized inpatients of all ages who reside in the 7-county Twin Cities metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington) with laboratory-confirmed RSV are reportable. Due to the need to confirm reports and reporting delays, consider current week data preliminary. 9 8 7 6 4 3 2 1 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 Hospitalizations this week Hospitalized RSV Cases by Subtype, Minnesota Hospitalizations last week RSV A RSV B RSV, Unspecified Total hospitalizations 15 15 784 Number of RSV Hospitalizations and Incidence by Age, Minnesota 6 4 3 343.4 32.8 2.9.7 2.1 9.3 <2 2-4 5-17 18-49 -64 65+ Age Group (years) # of hospitalizations Incidence (cases) per, Persons Median age at time of admission 1 months 4. 3. 3....... Hospitalizations per, Persons Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 1
Weekly U.S. Influenza Surveillance Report 218-219 Influenza Season Week 7 ending February 16, 219 CDC National Influenza Surveillance (http://www.cdc.gov/flu/weekly/) Influenza activity continues to increase in the United States. Viral Surveillance: The percentage of respiratory specimens testing positive for influenza viruses in clinical laboratories increased. While influenza A(H1N1)pdm9 viruses predominated in most areas of the country, influenza A(H3) viruses have predominated in HHS Region 4 and accounted for 47% of subtyped influenza A viruses detected nationally during week 7. During the most recent three weeks, influenza A(H3) viruses were reported more frequently than influenza A(H1N1)pdm9 viruses in HHS Regions 6 and 7 and influenza A(H1N1)pdm9 and influenza A(H3) viruses were reported in approximately equal numbers in HHS Region 2. Influenza-like Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) increased to 5.1%, which is above the national baseline of 2.2%. All 1 regions reported ILI at or above their region-specific baseline level. ILI State Activity Indictor Map: New York City and 3 states experienced high ILI activity; the District of Columbia and 11 states experienced moderate ILI activity; six states experienced low ILI activity; the U.S. Virgin Islands and three states experienced minimal ILI activity; and Puerto Rico had insufficient data. Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 48 states was reported as widespread; one state reported regional activity; the District of Columbia reported local activity; the U.S. Virgin Islands and one state reported sporadic activity; and Guam did not report. Influenza-associated Hospitalizations A cumulative rate of 27.4 laboratory-confirmed influenza-associated hospitalizations per, population was reported. The highest hospitalization rate is among adults 65 years and older (75.6 hospitalizations per, population). Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System. Influenza-associated Pediatric Deaths: Seven influenza-associated pediatric deaths were reported to CDC during week 7. A Weekly Influenza Surveillance Report Prepared by the Influenza Division Weekly Influenza Activity Estimates Reported by State and Territorial Epidemiologists* A Weekly Influenza Surveillance Report Prepared by the Influenza Division Influenza-Like Illness (ILI) Activity Level Indicator Determined by Data Reported to ILINet *This map indicates geographic spread and does not measure the severity of influenza activity. Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending February 23, 219 WEEK 8 11