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U.S. Influenza Surveillance Update, 2007-8 Season. Joseph Bresee MD Epidemiology and Prevention Branch, Influenza Division, CDC VRBPAC Meeting Feb 21, 2008 Gaithersburg, MD. Seasonal Influenza. Geographic Spread Virus Monitoring Mortality Outpatient Illness Hospitalizations

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U s influenza surveillance update 2007 8 season l.jpg

U.S. Influenza Surveillance Update, 2007-8 Season

Joseph Bresee MD

Epidemiology and Prevention Branch, Influenza Division, CDC

VRBPAC Meeting

Feb 21, 2008

Gaithersburg, MD


Seasonal influenza l.jpg
Seasonal Influenza

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance


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Seasonal Influenza activity

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance


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U.S. WHO/NREVSS Collaborating Laboratories activityNational Summary, 2007-08

Since Sept 30-

14%of109,089specimens tested positive for influenza viruses

83% A

17% B

of 28% of A viruses subtyped:

-37%A (H1) viruses

-63%A (H3) viruses


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U.S. WHO/NREVSS Collaborating Laboratories activityNational Summary, 2007-08

In most recent week-

34% of 6,889 specimens tested positive for influenza viruses

79% A

21% B

of 23% of A viruses subtyped:

-11% A (H1) viruses

-89% A (H3) viruses


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Seasonal Influenza activity

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance


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Pneumonia and Influenza Mortality activityfor 122 U.S. CitiesWeek Ending 02/16/2008

EpidemicThreshold

SeasonalBaseline

2008

2004

2005

2006

2007

40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10


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Number of Influenza-Associated Pediatric Deaths activity by Week of Death: 2005-06 season to present


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Seasonal Influenza activity

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance


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Percentage of Visits for ILI & ARI Reported activityby Sentinel Providers and BioSense Outpatient Facilities,National Summary


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Seasonal Influenza activity

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance


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EIP Influenza Laboratory-Confirmed Cumulative Hospitalization Rates for Children Aged 0-4 and 5-17 yrs, 2007-2008 and Previous 2 SeasonsSeptember 30 – February 2, 2008


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Seasonal Influenza Hospitalization Rates for Children Aged 0-4 and 5-17 yrs, 2007-2008 and Previous 2 Seasons

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance


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Oseltamivir resistance, 2007-8 Influenza Season, U.S. Hospitalization Rates for Children Aged 0-4 and 5-17 yrs, 2007-2008 and Previous 2 Seasons

  • 5.7% (27/471) of influenza isolates tested were oseltamivir-resistant

    • 27 (8.1%) of 312 H1N1 resistant (all with H274Y mutation)

    • 0 / 76 H3N2

    • 0 / 83 B

    • All regions of the country

    • No travel history known for any case

    • No oseltamivir exposure known

    • Apparent typical clinical illness and severity

  • All H1N1 oseltamivir-resistant viruses tested susceptible to zanamivir and adamantanes

  • 31% (88/282) influenza A viruses tested resistant to adamantanes

    • 99% of H3N2 viruses and 7.2% of H1N1 viruses


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A (H1N1) oseltamivir resistance – Europe, Canada, Asia Hospitalization Rates for Children Aged 0-4 and 5-17 yrs, 2007-2008 and Previous 2 Seasons(as of 14 February 2008)

Global – 14% (237 / 1703)

  • Europe – 20% (202 / 987)

    • 13 of 22 countries with resistant H1s

  • Asia - 2.1% (7 / 319)

    • 2 of 7 countries (no resistance in Japan)

  • Africa – 0% (0 / 18)

  • Americas

    • Canada – 6% (8/128)

    • Latin America – 0% (0/9)

WHO data


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Oseltamivir resistance – Plans to address Hospitalization Rates for Children Aged 0-4 and 5-17 yrs, 2007-2008 and Previous 2 Seasons

Enhanced Surveillance

  • Increased numbers of viruses for testing

  • Collect detailed clinical, epi data on each case

    • Standard reporting form that is sent to SHDs

      Communications

  • Talking points and Q&As developed and distributed

  • Share materials with international and national partners (e.g. WHO, ECDC, CSTE, APHL, ACIP)

  • Press briefings

    Policy

  • No change in policy for use of antivirals at this point

  • ACIP Influenza WG discussed antiviral policy


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Interim Estimation of Influenza Vaccine Effectiveness During the 2007-08 Season

CDC partnered to develop capacity to provide annual VE estimates

  • This season, will conduct studies to provide VE estimates during the season

    Methods

  • Population: People recommended by ACIP to receive annual vaccination

  • Outcome: Medically attended influenza diagnosed by RT-PCR

  • Exposure: Vaccination status confirmed by validated vaccine registry

    Status

  • From Jan 21 through Feb 8, 616 (69%) of 896 eligible patients were tested

    • 191 (31%) were PCR-positive for influenza; 144 (75%) of those had influenza A

  • Preliminary results indicates vaccine provides

    • Some protection against infections with influenza A viruses

    • No protection against infections with influenza B viruses

      Plans

  • Continue enrollment

  • Type/subtype data pending – for type/subtype-specific analyses

  • Report of data during the season


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Draft ACIP Agenda: Influenza Session the 2007-08 SeasonFeb 27, 2008

  • Influenza vaccine effectiveness among 6-23 month old children, 2005-6 and 2006-7 seasons

  • Influenza vaccine strain selections 2008-09

  • Oseltamivir-resistant influenza A (H1N1)

  • Expanding influenza vaccination recommendations to include all 5-18 year old children

  • Influenza vaccination recommendations, 2008

    • Vote

    • VFC Vote


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