Tarrant County Influenza Surveillance Weekly Report CDC Week 35, August 27-September 2, 2017

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Tarrant County Public Health Division of Epidemiology and Health Information Tarrant County Influenza Surveillance Weekly Report 35, August 27-September 2, 2017 Influenza Activity Code, County and State Levels Tarrant County: Week 35 Tarrant County: Week 34 Texas: Week 34 Sporadic Sporadic Not determined Respiratory Virus Activity Summary The percentage of reported influenza-like illness (ILI) in Tarrant County increased from 0.7% in week 34 to 1.0% in week 35 and is below the 2016-2017 Tarrant County baseline of 3.8%. Due to the closing of the traditional school year, data on student absenteeism, absenteeism due to ILI, and nurses office visits due to ILI will not be reported until the commencement of the 2017-2018 flu season in October. The percentage of rapid flu test positives in Tarrant County decreased from 4.0% in week 34 to 2.2% in week 35. During the 2016-2017 influenza season, 0 Tarrant County influenza-associated pediatric deaths have been reported. As of week 33, 8 influenza-associated pediatric deaths have been reported in Texas, with a total of 104 reported nationwide for the 2016-2017 season. During the 2016-2017 influenza season, 2 influenza outbreaks have been reported in Tarrant County schools and 7 localized influenza outbreaks have been reported within institutions in Tarrant County. Since last report, 8 surveillance specimens were tested by The North Texas Regional Laboratory. The following types and number of viruses were detected in these specimens: Rhinovirus(3). Cumulatively this season, the North Texas Regional Laboratory at Tarrant County Public Health has tested 356 surveillance specimens and of these, 116 have been positive for influenza. In Texas during week 34, the proportion of outpatient visits for ILI, 1.6%, was below the state baseline of 6.6%. Nationally during week 34, 1.6% of specimens tested and reported to the CDC were positive for influenza. The proportion of outpatient visits for ILI (0.9%) was below the national baseline (2.2%). The proportion of deaths in week 32 attributed to pneumonia and influenza from the National Center for Health Statistics (5.1%) was below the epidemic threshold (5.9%).

ILI % % ILI Influenza Like Illness (ILI): Local and State Levels 12.0% 11.0% 1 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% Graph 1. Texas and Tarrant County % ILI 40 42 44 46 48 50 52 02 04 06 08 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 Tarrant County % ILI Tarrant County % ILI Baseline Texas % ILI Texas % ILI Baseline 10 Graph 2. ILI % by Age Groups, Tarrant County 8 6 4 2 28 29 30 31 32 33 34 35 Age 0-4 Age 5-24 Age 25-64 Age >65 In week 35, 1.0% of visits to health care providers were due to ILI. Levels are currently below the county established baseline of 3.8% and are lower than the state of Texas levels. In Tarrant County, of 229 reported patients presenting with ILI the largest percentage, 37.1%, was in the 5-24 age group. NOTE: Tarrant County ILI activity is assessed using information provided by surveillance participants and the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). For week 35, 22 surveillance participants - 19 Hospitals, 1 Business, and 2 Colleges/ Universities reported ILI information to Tarrant County Public Health. Texas ILI activity is assessed using information provided by a network of providers. For week 34, 63 providers reported information to the Texas Department of State Health Services. 2

% ILI Tarrant County Historical ILI and ESSENCE Geographical Distribution Map 12.0% 11.0% 1 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% Graph 3. Tarrant County % of patient visits due to ILI during flu season 2013-2014 through 2016-2017 Baseline 2013-2014 Season 2014-2015 Season 2015-2016 Season 2016-2017 Season 40 42 44 46 48 50 52 02 04 06 08 10 12 14 16 18 20 Map 1. Tarrant County ER ILI Cases by Zip Code, Week 35 NOTE Tarrant County ILI distribution map is from ESSENCE and includes data from 46 hospitals that voluntarily provide data based on chief complaints of Tarrant County residents admitted to Emergency Departments in North Central Texas. This map represents the number of cases from each zip code, not the percent. Zip codes with larger populations are expected to have more cases. 3

Rapid Influenza Test Results and School Absenteeism Graph 4. Absenteeism and ILI, Tarrant County 1.0% Summer Break 29 30 31 32 33 34 35 Average Daily % Absent Average Daily % ILI School Nurse Visits Average Daily % Absent due to ILI For week 29-35, no data are reported due to the end of the traditional school year. Reporting will recommence at the beginning of the 2017-2018 flu season in October 2017. Table 1. Influenza Rapid Test Results, Tarrant County Number 33 (Aug 13-19) 34 (Aug 20-26) 35 (Aug 27-Sept 2) # Influenza Tests Performed 147 177 232 % Influenza Positive 2.7% 4.0% 2.2% # Influenza A Positive 3 4 5 % Influenza A Positive 75.0% 57.1% 100% # Influenza B Positive 1 3 0 % Influenza B Positive 25.0% 42.9% 0% # Non-differentiated Positive 0 0 0 % Non-differentiated Positive 0% 0% 0% NOTE: Tarrant County rapid influenza test results are reported weekly by influenza surveillance participants. For CDC week 35, rapid influenza test results were reported by 13 hospitals and 1 College/University. 4

Number of Positive Influenza Specimens % of Positive Influenza Specimens Influenza Confirmatory Test Results: Tarrant County Table 2. North Texas Regional Laboratory: Respiratory Virus Results 1 Current Week 5 2016-2017 Season Number of Specimens Tested 8 356 Positive Specimens 3 (37.5%) 190 (53.4%) Influenza A 0 (0%) 81 (42.6%) Influenza A H1 0 (0%) 9 (11.1%) Influenza A H3 0 (0%) 71 (87.7%) Influenza A, Inconclusive subtype 0 (0%) 0 (0%) Influenza A, Unsubtypeable 2 0 (0%) 0 (0%) Influenza B 0 (0%) 35 (18.4%) Influenza B Yamagata 3 0 (0%) 25 (83.3%) Influenza B Victoria 3 0 (0%) 5 (16.7%) Respiratory Syncytial Virus 0 (0%) 13 (6.8%) Adenovirus 0 (0%) 11 (5.8%) Human Metapneumovirus 0 (0%) 8 (4.2%) Parainfluenza-1 0 (0%) 1 (0.5%) Parainfluenza-2 0 (0%) 4 (2.1%) Parainfluenza-3 0 (0%) 8 (4.2%) Rhinovirus 3 (100%) 36 (18.9%) Inconclusive 4 0 (0%) 1 (0.3%) 1 Laboratory results based on real-time PCR analysis; information is 0 for the 2016-2017 season. 2 Influenza A subtype not determined; further analysis pending. 3 Influenza B genotyping is only included in current week column if genotyping occurred in the same week as original PCR testing. Reported percentages for B genotyping is based on previous typing by the lab and may not reflect the total number of cases. 4 Inconclusive for influenza A and influenza B; not included in positive specimens count. NOTE: Percentages may not add up to 100% due to co-infections, 5 specimens have tested positive with a co-infection: 5 rhinovirus and adenovirus, 1 RSV and flu H3. Graph 5. North Texas Regional Laboratory: Influenza Virus Results 1 11 100% 10 90% 9 80% 8 70% 7 60% 6 50% 5 40% 4 3 30% 2 20% 1 10% 0 0% 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 Influenza A H1 Influenza A H3 Influenza A, Inconclusive subtype Influenza B Percent Positive

Texas and National Influenza and ILI Activity Map 2: Texas County Specific Influenza Activity, 34 Influenza activity level corresponds to current MMWR week only and does not reflect previous weeks' activity. The majority of influenza cases are not reportable by law to the Texas Department of State Health Services. This map contains data from sentinel sites and does not represent all influenza cases in the state. Positive laboratory results are reported according to specimen collection date or date received in the lab if the former is unknown. http://www.dshs.state.tx.us/idcu/disease/influenza/ surveillance/2017/ Map 3: ILINet Activity Indicator Map, 20* *Note: The most recent ILINet Activity Indicator Map was released by the CDC at the end of the flu season, Week 20 (ending May 20, 2017). Data collected in ILINet are used to produce a measure of ILI activity by state. Activity levels are based on the percent of outpatient visits in a state due to ILI and are compared to the average percent of ILI visits that occur during spring and fall weeks with little or no influenza virus circulation. This map uses the proportion of outpatient visits to health care providers for influenzalike illness to measure the ILI activity level within a state. It does not, however, measure the extent of geographic spread of flu within a state. Therefore, outbreaks occurring in a single city could cause the state to display high activity levels. Data collected in ILINet may disproportionately represent certain populations within a state, and therefore, may not accurately depict the full picture of influenza activity for the whole state. http://www.cdc.gov/flu/weekly/ 6

The Tarrant County Influenza Surveillance Weekly Report is available on the Tarrant County Public Health web site at: health.tarrantcounty.com/flu Tarrant County Public Health Influenza Surveillance Epidemiology and Health Information 1101 South Main Street, Suite 2200 Fort Worth, TX 76104 If you have questions or comments regarding influenza surveillance, please contact: Laura Lockwood, MPH, CPH Influenza Surveillance Specialist lblockwood@tarrantcounty.com Veerinder (Vinny) Taneja, MBBS; MPH Director, Tarrant County Public Health NOTE: Influenza-like Illness (ILI) is defined as fever (temperature 100 F) plus a cough OR a sore throat, in the absence of a known cause other than influenza. Tarrant County reporting quadrants consist of Northwest, Northeast, Southwest and Southeast regions within the boundaries of Interstate 35 and Interstate 30. Tarrant County ILI baselines were determined using a similar method as the Centers for Disease Control and Prevention Regional ILI baselines and Texas Department of State Health Services Texas baseline. Regional ILI baselines are determined by the Centers for Disease Control and Prevention and can be accessed at http:// www.cdc.gov/flu/weekly/overview.htm Additional information regarding Tarrant County, Texas and national ILI activity can be accessed at http://health.tarrantcounty.com/flu http://dshs.texas.gov/idcu/disease/influenza/surveillance/2017/ http://www.cdc.gov/flu/weekly/ Russ Jones, MPH Division Manager & Chief Epidemiologist Epidemiology and Health Information Tarrant County Public Health Main Epidemiology Division Number : (817) 321-5350 Disease Reporting Fax Number: (817) 850-8921 7