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Influenza Picking Up Speed Across US

Troy Brown, RN
December 31, 2018

The number of states reporting high influenza-like illness activity have expanded sharply across the United States to include New York City and nine states, up from just two states during the previous flu report from the Centers for Disease Control and Prevention (CDC).

New York State is getting hit particularly hard. Influenza cases in the state have risen by 72% during the past week, Governor Andrew Cuomo announced in a statement on December 27.

"With an increase in flu cases in every corner of this state, I want to remind New Yorkers who have not been vaccinated against the flu that it is not too late to take this critical action," Cuomo said in the statement. "Flu season is in full swing, and as the number of cases and hospitalizations continue to rise, we must do everything we can to protect ourselves and our loved ones."

Four more children have died from influenza-associated causes, bringing the official total to 11 for this season. In addition, an 8-year-old Guatemalan boy who died in New Mexico on Christmas Eve while being detained by Customs and Border Protection with his father was infected with influenza B virus at the time of his death, according to multiple media reports.

The cumulative rate of laboratory-confirmed influenza-associated hospitalizations was 3.6 per 100,000 population during week 51, compared with 2.9 per 100,000 population during week 50 and 1.9 per 100,000 population during week 49.

Pediatric Deaths Have Risen Sharply

The hospitalization rate was much higher among children younger than 5 years, at 10.0 per 100,000 population.

The CDC received reports of the four additional influenza-related pediatric deaths during week 51. One child's death occurred during the week ending December 8 (week 49) and was related to influenza A virus for which no subtyping was performed. Three children's deaths occurred during week 49 and the week ending December 15 (week 50) and were related to influenza A(H1N1)pdm09 virus.

State, Regional Activity Intensifying

The proportion of outpatient healthcare visits for influenza-like illness increased to 3.3%, which is above the national baseline of 2.2%. The proportion of outpatient visits for influenza-like illness was 2.7% for week 50 and has been at or above the national baseline for 5 consecutive weeks.

"By this measure, the past five flu seasons have lasted between 11 and 20 weeks with an average of 16 weeks. H1N1 viruses have been the most commonly identified flu viruses nationally. However, in the most recent 4 weeks, H3N2 viruses have predominated in the southeastern region of the United States," the CDC reports.

The number of states reporting high influenza-like illness activity expanded sharply during the week ending December 22 (week 51) to include New York City and nine states (Alabama, Colorado, Georgia, Kentucky, Louisiana, Maryland, New Jersey, New Mexico, and South Carolina) — up from just Colorado and Georgia during the previous week, according to a CDC report. Influenza-like illness activity has now been high in Georgia for 5 weeks in a row.

Puerto Rico and seven states (Arkansas, Arizona, Indiana, Mississippi, Oklahoma, Utah, and Virginia) experienced moderate influenza-like illness activity during week 51, down from New York City and nine states (Alabama, Arizona, Arkansas, Kentucky, Louisiana, Missouri, New Jersey, South Carolina, and Virginia) that reported moderate influenza-like illness activity during week 50. Four states with moderate activity during week 50 reported high activity during week 51 (Alabama, South Carolina, Kentucky). Puerto Rico and four states (Colorado, Connecticut, Kentucky, and Louisiana) reported moderate activity during week 49.

"Among the four states along the southern US border, influenza-like illness activity increased to moderate in Arizona and high in New Mexico," according to the CDC's situation update for week 51.

Nine of 10 regions in the United States reported influenza-like illness at or above their region-specific baseline level. Region 10 — Alaska, Idaho, Oregon, and Washington — is the only region still reporting normal influenza activity.

The geographic spread of influenza was widespread in Guam and 11 states (Arizona, California, Connecticut, Delaware, Florida, Georgia, Massachusetts, Nebraska, New Mexico, New York, and North Carolina) during week 51, compared with Guam and six states (Alabama, California, Delaware, Georgia, Massachusetts, and New York) during week 50. Just three states (California, Georgia, and Massachusetts) and only Massachusetts reported widespread activity during weeks 49 and 48, respectively.

Puerto Rico and 19 states reported regional activity during week 51, up from Puerto Rico and 18 states during week 50.

Local activity was reported in 15 states. The District of Columbia, US Virgin Islands, and three states (Alaska, Hawaii, and Maine) reported sporadic activity. Maryland and Tennessee did not report.

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Reviewed on 1/2/2019

SOURCE: Medscape, December 31, 2018.

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