Weekly Influenza & Respiratory Illness Activity Report A summary of influenza surveillance indicators prepared by the Division of Infectious Disease Epidemiology Prevention & Control Week Ending April 15, 2017 | WEEK 15 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 April 15, 2017 (Week 15), surveillance indicators showed regional geographic spread of influenza. Since the start of the influenza season, 2 pediatric influenza-related deaths have been reported. Based on CDC’s Activity Estimates Definitions: http://www.cdc.gov/flu/weekly/overview.htm 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 http://www.idph.state.ia.us/IdphArchive/Archive.aspx?channel=FluReports Wisconsin http://www.dhs.wisconsin.gov/communicable/influenza/surveillance.htm North Dakota http://www.ndflu.com/default.aspx South Dakota http://doh.sd.gov/diseases/infectious/flu/ Minnesota Department of Health 651-201-5414 or 1-877-676-5414 www.health.state.mn.us 4/20/2017 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*) B (no genotype) 450 B (Yamagata) 400 A (not subtyped) B (Victoria) Current week A H3 350 A H1 (unspecified) A (H1N1)pdm09 300 A (H1N2v) A (H3N2v) 250 A&B 200 Unknown 150 100 Number of Hospitalizations Number of Hospitalizations 500 Hospitalized Influenza Cases by Season, Minnesota (FluSurv-NET*) 750 700 650 600 550 500 450 400 350 300 250 200 150 100 50 0 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 Current week 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 MMWR Week 50 0 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 MMWR Week Hospitalizations this week Hospitalizations last week Total hospitalizations (to date) 99 211 3,643 *Influenza Surveillance Network Season 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 Total hospitalizations (historic) 556 3,068 1,540 4,138 1,541 3,643 (to date) Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 2 Hospitalized Influenza Surveillance (continued) 400.0 3500 Incidence (cases) per 100,000 Persons 350.0 3000 300.0 2500 250.0 2000 200.0 1500 150.0 1000 65.6 500 73.9 57.6 79.7 26.1 0 69.9 72.4 38.9 100.0 50.0 0.0 4000 Number of Hospitalizations # of hospitalizations Number of Influenza Hospitalizations and Incidence by Age, Minnesota October 2, 2016 – April 15, 2017 3500 296.3 350.0 300.0 2500 250.0 2000 200.0 1500 150.0 1000 500 100.0 55.3 26.0 16.7 17.2 0-4 5-24 25-49 50.0 50-64 65+ 0.0 Age Group (years) Region Central Metro Northeast Northwest South Central Southeast Southwest West Central Incidence (cases) per 100,000 Persons 3000 0 Region 400.0 # of hospitalizations Hospitalizations per 100,000 Persons 4000 Hospitalizations per 100,000 Persons Number of Hospitalizations Number of Influenza Hospitalizations and Incidence by Region, Minnesota October 2, 2016 – April 15, 2017 Hospitalizations this week Total (to date) 11 (11%) 58 (59%) 4 (4%) 2 (2%) 11 (11%) 8 (8%) 3 (3%) 2 (2%) 478 (13%) 2,106 (58%) 188 (5%) 41 (1%) 232 (6%) 346 (10%) 161 (4%) 91 (3%) Median age (years) at time of admission 73.0 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 3 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. Number of influenza-like illness outbreaks Influenza-like Illness (ILI) in Schools by Season 300 2012-13 2013-14 2014-15 250 2015-16 2016-17 200 150 100 Current week 50 0 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 MMWR Week New school outbreaks this week New school outbreaks last week Total this season (to date) 5 16 378 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 4 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 70 Number of lab-confirmed outbreaks 65 2012-13 60 2013-14 55 2014-15 50 2015-16 45 2016-17 40 35 30 25 Current week 20 15 10 5 0 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 MMWR Week New LTC outbreaks this week New LTC outbreaks last week Total this season (to date) 6 12 164 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 5 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 2012-13 8 2013-14 7 2014-15 6 2016-17 2015-16 Current week* 5 4 3 2 1 0 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 MMWR Week % of outpatients with ILI this week % of outpatients with ILI last week 3.1% 3.7% *Indicates current week-data may be delayed by 1 or more weeks Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 6 Laboratory Surveillance The MN Lab System (MLS) Laboratory Influenza Surveillance Program is made up of more than 310 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 450 350 300 250 200 A (not subtyped) 30 A H3 A (H1N1) pdm09 Current week 2013-14 % + by PCR 2014-15 % + by PCR 25 20 2015-16 % + by PCR 2016-17 % + by PCR 15 150 10 100 5 50 0 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 MMWR Week % molecular tests positive this week % molecular tests positive last week 17.1% 21.3% Percent of positive molecular tests Number of positive molecular tests 400 35 B 0 *Beginning in 2016-17, 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 April 15, 2017 | WEEK 15 7 Laboratory Surveillance (continued) MLS Laboratories – Influenza Testing MLS Laboratories – RSV Testing Specimens Positive by Influenza Rapid Antigen Test, by Week Specimens Positive by RSV Rapid Antigen Test, by Week Number of Positive Influenza Specimens 2013-14 % + 45 2014-15% + 2015-16 % + Current week 40 35 2016-17 % + 30 25 20 15 10 5 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 MMWR Week Region Northeast South Central Southwest Southeast Metro Central West Central Northwest State (overall) 0 % rapid antigen influenza tests + (current week) 21% 33% 25% 33% 24% 23% 24% 15% 24% 240 Number + 220 2013-14 % + 200 2014-15 % + 180 160 2015-16 % + 2016-17 % + 140 120 Current week 100 80 60 40 20 0 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 MMWR Week Region Northeast South Central Southwest Southeast Metro Central West Central Northwest State (overall) 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 Percentage of Rapid Antigen RSV Tests Positive A/B+ (2015-16 Season) 50 Percentage of Rapid Antigen Influenza Tests Positive A+ (2015-16 Season) 1500 1400 1300 1200 1100 1000 900 800 700 600 500 400 300 200 100 0 Number of Positive RSV Tests B+ (2015-16 Season) % rapid antigen RSV tests + (current week) 0% 0% 14% 33% 13% 18% 13% 12% 13% Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 8 Laboratory Surveillance (continued) Minnesota Influenza Incidence Surveillance Project (MIISP) Positive Respiratory Pathogens by PCR, by MMWR Week 40 Influenza B Influenza A H3 Influenza A (H1N1) pdm09 Influenza A Unspecified Influenza C RSV Human Metapneumovirus Rhinovirus/Enterovirus Adenovirus Coronavirus NL63 Coronavirus OC43 Coronavirus 229E Coronavirus HKU1 Parainfluenza-1 Parainfluenza-2 Parainfluenza-3 Parainfluenza-4 Number Positive by RT-PCR 35 30 25 20 15 10 5 0 30 32 34 36 38 40 42 44 46 48 50 52 1 2 4 6 8 10 12 14 16 18 20 MMWR Week* *Indicates current week-data may be delayed by 2 or more weeks Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 9 Laboratory Surveillance (continued) Severe Acute Respiratory Surveillance (SARI) - Inpatients Number Positive by RT-PCR Positive Respiratory Pathogens by PCR, by MMWR Week 120 115 110 105 100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 Parainfluenza 4 Coronavirus 229E Human Metapneumovirus Influenza B Bocavirus 32 34 36 38 40 Parainfluenza 3 Coronavirus OC43 RSV Legionella 42 44 *Indicates current week-data may be delayed by 2 or more weeks 46 Parainfluenza 2 Coronavirus NL63 Influenza A Unspecified Mycoplasma pneumoniae 48 50 52 2 4 Parainfluenza 1 Adenovirus Influenza A (H1N1) pdm09 Chlamydophila pneumoniae 6 8 10 12 14 Coronavirus HKU1 Rhinovirus/Enterovirus Influenza A H3 Influenza C 16 18 20 20 MMWR Week* Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 10 Weekly U.S. Influenza Surveillance Report National Influenza Surveillance (CDC): http://www.cdc.gov/flu/weekly/ During week 14 (April 2-8, 2017), influenza activity decreased but remained elevated in the United States. Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 14 was influenza B. The percentage of respiratory specimens testing positive for influenza in clinical laboratories decreased. 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: Five influenza-associated pediatric deaths were reported, four that occurred during the 2016-2017 season and one that occurred during the 2010-2011 season. Influenza-associated Hospitalizations: A cumulative rate for the season of 59.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.6%, which is above the national baseline of 2.2%. Five of ten regions reported ILI at or above their region-specific baseline levels. Two states experienced high ILI activity; seven states experienced moderate ILI activity; New York City and 11 states experienced low ILI activity; Puerto Rico and 30 states experienced minimal ILI activity; and the District of Columbia had insufficient data. Geographic Spread of Influenza: The geographic spread of influenza in 18 states was reported as widespread; Guam, Puerto Rico, and 18 states reported regional activity; the District of Columbia and 12 states reported local activity; two states reported sporadic activity; and the U.S. Virgin Islands reported no activity. Influenza-Like Illness (ILI) Activity Level Indicator Determined by Data Reported to ILINet 2016-2017 Influenza Season Week 14 ending April 8, 2017 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending April 15, 2017 | WEEK 15 11
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