Utah Influenza Report This report contains data through the week ending 12/15/2012 (MMWR week 50).

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This report contains data through the week ending 12/15/212 (MMWR week 5). Overview of Influenza Surveillance: Surveillance for the 212 213 influenza season officially began on September 3, 212. The Utah Department of Health publishes a weekly report throughout the active influenza season that synthesizes data from a variety of sources to give the most complete and up to date picture of influenza activity in the state of Utah. Data in this report should be considered provisional, and may change as more complete reports are recieved. Influenza like Illness (ILI): The U.S. Outpatient Influenza like Illness Surveillance Network (ILINet) is a national system that conducts surveillance for influenza like illness (ILI) in outpatient healthcare facilities. ILINet providers report weekly the total number of patients seen for any reason and the number of patients seen with ILI (defined as a fever 1 F and a cough or sore throat). These data are used to determine the amount of ILI circulating in the community, as well as provide insight into regional differences in ILI activity. Currently, more than 5 facilities throughout Utah participate in ILINet. Figure 1. ly Influenza like Illness Activity Influenza like illness (ILI) activity as measured by the number of standard deviations from the epidemic threshold Utah, 212 213 Flu Season 28 29 29 21 21 211 211 212 212 213 1/6 1/27 11/17 12/8 12/29 1/19 2/9 3/2 3/23 4/13 5/4 5/25 6/15 7/6 7/27 8/17 9/7 9/28 Table 1. Influenza like Illness (ILI) Activity Levels by Utah, Current Bear River Central Davis Salt Lake Southeastern Southwest Summit Tooele TriCounty Utah Wasatch Weber Morgan State Page 1 of 5 http://health.utah.gov/flu 81 538 6191 epi@utah.gov

This report contains data through the week ending 12/15/212 (MMWR week 5). Influenza Hospitalizations: Influenza hospitalizations are a reportable condition in Utah. A person meets the case definition for an influenza hospitalization if they are hospitalized for any length of time and have an influenza positive serology, DFA, PCR, or culture test (confirmed case) or a positive rapid influenza diagnostic test (probable case). Public health in Utah gathers a variety of data on influenza hospitalizations including clinical features, course of illness, risk and protective factors, and influenza type and subtype. Data from influenza hospitalizations allows public health in Utah to better understand subgroups of the Utah population that are most severely effected by influenza and help to guide prevention messages and interventions. Figure 2. Influenza Hospitalizations Number of influenza hospitalizations by event date* Utah, 212 213 Number of influenza hospitalizations 18 16 14 12 1 Flu Season 28 29 29 21 21 211 211 212 212 213 8 6 4 2 1/6 1/27 11/17 12/8 12/29 1/19 2/9 3/2 3/23 4/13 5/4 5/25 6/15 7/6 7/27 8/17 9/7 9/28 *Event date is calculated based on a hierarchy of dates: 1. onset date 2. specimen collection date 3. date reported to public health. Table 2. Influenza Hospitalizations by Case Status Utah Current Case Status Total % of Cases Total % of Cases Confirmed 8 88.9 52 98.1 Probable 1 11.1 1 1.9 Total 9 1. 53 1. Table 3. Influenza Hospitalizations by Utah Bear River Current 3 Central 1 1 Davis 2 8 Salt Lake 3 23 Southeastern Southwest 1 9 Summit Tooele 1 1 TriCounty 1 Utah 1 5 Wasatch 1 Weber Morgan 1 State 9 53 Page 2 of 5 http://health.utah.gov/flu 81 538 6191 epi@utah.gov

This report contains data through the week ending 12/15/212 (MMWR week 5). Table 4. Influenza Hospitalizations by Age Group Utah, Age Group Total Cases % of Cases Rate* 4 1 18.9 3.7 5 24 1 18.9 1.6 25 49 1 18.9 1.1 5 64 5 9.4 1.25 65+ 18 34. 7.29 Total 53 1. 1.86 *Rate is calculated as the number of cases per 1, population Table 5. Influenza Hospitalizations by Sex and Race Utah, Variable Num. of Cases % of Cases % in Utah Pop p value* Sex Male 27 5.9 5.3.9256 Female 26 49.1 49.7.9256 Unknown. NA Race White, Not Hispanic 42 79.2 82..5962 Hispanic 8. 11.6.425 Native Hawaiian/Pacific Islander..7.5478 Black/African American 1..9.47 American Indian. 1.1.4359 Asian 2. 1.9.359 Unknown. NA *If a p value is.5, there is a significant difference between the percentage seen in influenza hospitalizations and the general Utah population. Table 6. Summary Data for Influenza Hospitalizations Utah, Yes No Unknown Variable Total % of Cases Total % of Cases Total % of Cases ICU 9 17. 31 58.5 13 24.5 Ventilator 4 7.5 36 67.9 13 24.5 Died. 41 77.4 12 22.6 Neurological Symptoms 3 5.7 35 66. 15 28.3 Healthcare Worker. 3 56.6 23 43.4 Pregnant 2 3.8 48 9.6 3 5.7 Heart Disorder 1 18.9 29 54.7 14 26.4 Blood Disorder 2 3.8 38 71.7 13 24.5 Kidney Disorder 3 5.7 37 69.8 13 24.5 Metabolic Disorder 8 15.1 32 6.4 13 24.5 Chronic Respiratory Disorder 16 3.2 24 45.3 13 24.5 Immunosuppressed 7 13.2 33 62.3 13 24.5 Neurological Disorder 3 5.7 35 66. 15 28.3 Seizure Disorder 1 1.9 39 73.6 13 24.5 Bacterial Co infection. 39 73.6 14 26.4 Obese* 4 11.8 16 47.1 14 41.2 Morbidly Obese* 1 2.9 19 55.9 14 41.2 Risk Factor 51 96.2 2 3.8. Vaccinated 19 35.8 17 32.1 17 32.1 *Obesity and morbid obesity is not considered for individuals under 18 years or pregnant women. Thus total counts will not equal the total number of influenza associated hospitalizations Risk factors for influenza include: persons < 5 years, persons 65 years, pregnant women, and persons with a chronic medical condition. Page 3 of 5 http://health.utah.gov/flu 81 538 6191 epi@utah.gov

This report contains data through the week ending 12/15/212 (MMWR week 5). Student Absenteeism: School age children are at high risk for respiratory virus infections, including influenza. Aggregate, all cause absenteeism data is collected weekly from over 35 schools throughout Utah. These data are analyzed to identify elevated absenteeism rates that could indicate the circulation of influenza in school age children. Figure 3. Student Absenteeism by Rates for absences due to all causes Utah, 211 212 and previous 3 year average Absences per 1 Students per Day 7 Holiday Break 6 5 4 3 2 1 1/6 1/2 11/3 11/17 12/1 12/15 12/29 1/12 1/26 2/9 2/23 3/9 3/23 4/6 4/2 5/4 5/18 3 Year Average 212 213 Absenteeism Table 7. ly Student Absenteeism Utah, Current Absences per 1 students/day Bear River 3.7 Central 5.3 Davis 4.9 Salt Lake 5. Southeast 6.1 Southwest 6. Summit 4.5 Tooele 6.1 TriCounty 5.6 Utah 2.5 Wasatch 5.4 Weber Morgan 6.6 State 5.2 Pneumonia and Influenza Deaths: Each week the total number of death certificates received and the number of those for which pneumonia or influenza was listed as an underlying or contributing cause of death is collected. The percentage of deaths due to pneumonia and influenza are compared with a seasonal baseline and epidemic threshold value calculated for each week. These data are used to monitor the severity of influenza illness in the community. Figure 4. Pneumonia and Influenza Deaths Percentage of deaths attributable to pneumonia and influenza by week of death Utah, 27 213 Percentage of Deaths 18 16 14 12 1 8 6 4 2 Year Page 4 of 5 http://health.utah.gov/flu 81 538 6191 epi@utah.gov Epidemic Threshold Seasonal Baseline

This report contains data through the week ending 12/15/212 (MMWR week 5). Laboratory Surveillance: The Unified State Laboratory: Public Health recieves specimens from all over the state for comprehensive influenza testing. All specimens are tested to determine influenza type and subtype. A portion of specimens are also sent to the Centers for Disease Control and Prevention for addtional testing, including gene sequencing, antiviral resistance testing and antigenic characterization. Figure 5. Influenza Positive Tests Influenza positive specimens tested by Unified State Laboratory: Public Health Utah, 212 213 Number of Positive Specimens 7 6 5 4 3 2 1 B A (subtyping not done) A (H1) Percent Positive Percent Positive 1 A (unknown subtype) A (H3) 9 A (29 H1N1) 8 7 6 5 4 3 2 1 1/6 1/2 11/3 11/17 12/1 12/15 12/29 1/12 1/26 2/9 2/23 3/9 3/23 4/6 4/2 5/4 5/18 of Test Table 8. Unified State Laboratory: Public Health Influenza Testing Data Current Total Percent Total Percent Specimens tested 61 374 Positive specimens 45 73.8 216 57.8 Positive Specimens by Type/Subtype Influenza A 3 66.7 12 47.2 A (29 H1N1). 1 1. A (H1).. A (H3) 3 1. 11 99. A (subtyping not performed).. A (unable to subtype).. Influenza B 15 33.3 114 52.8 Page 5 of 5 http://health.utah.gov/flu 81 538 6191 epi@utah.gov