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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

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
Seasonal Influenza

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance

slide3

21 states and the District of Columbia reported sporadic influenza activity

  • 26 states reported no influenza activity ▪ 3 states reported local activity
slide4

33 states and the District of Columbia reported sporadic influenza activity

  • 13 states reported no influenza activity ▪ 4 states reported local activity
slide5

33 states, The District of Columbia and Puerto Rico reported sporadic influenza activity

  • 3 states reported no influenza activity ▪ 9 states reported local activity
  • 5 states reported regional activity
slide6

10 states and Puerto Rico reported sporadic influenza activity

  • 17 states and the District of Columbia reported local activity
  • 17 states reported regional activity ▪ 6 states reported widespread activity
slide7

4 states and Puerto Rico reported sporadic influenza activity

  • 9 states and the District of Columbia reported local activity
  • 26 states reported regional activity ▪ 11 states reported widespread activity
slide8

2 states and the District of Columbia reported local activity

  • 17 states reported regional activity ▪ 31 states reported widespread activity
slide9

1 state and the District of Columbia reported local activity

  • Puerto Rico reported sporadic activity
  • 5 states reported regional activity ▪ 44 states reported widespread activity
seasonal influenza10
Seasonal Influenza

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance

u s who nrevss collaborating laboratories national summary 2007 08
U.S. WHO/NREVSS Collaborating LaboratoriesNational 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

u s who nrevss collaborating laboratories national summary 2007 0812
U.S. WHO/NREVSS Collaborating LaboratoriesNational 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

seasonal influenza13
Seasonal Influenza

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance

pneumonia and influenza mortality for 122 u s cities week ending 02 16 2008
Pneumonia and Influenza Mortalityfor 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

seasonal influenza16
Seasonal Influenza

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance

slide17
Percentage of Visits for ILI & ARI Reportedby Sentinel Providers and BioSense Outpatient Facilities,National Summary
seasonal influenza18
Seasonal Influenza

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance

slide19

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

seasonal influenza20
Seasonal Influenza

Geographic Spread

Virus Monitoring

Mortality

Outpatient Illness

Hospitalizations

Antiviral Resistance

oseltamivir resistance 2007 8 influenza season u s
Oseltamivir resistance, 2007-8 Influenza Season, U.S.
  • 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
a h1n1 oseltamivir resistance europe canada asia as of 14 february 2008
A (H1N1) oseltamivir resistance – Europe, Canada, Asia(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

oseltamivir resistance plans to address
Oseltamivir resistance – Plans to address

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
interim estimation of influenza vaccine effectiveness during the 2007 08 season
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
draft acip agenda influenza session feb 27 2008
Draft ACIP Agenda: Influenza SessionFeb 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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