Weekly Influenza & Respiratory Illness Activity Report A summary of influenza surveillance indicators prepared by the Division of Infectious Disease Epidemiology Prevention & Control

Week Ending October 29, 2016 | WEEK 43 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 October 29, 2016 (Week 43), surveillance indicators showed sporadic geographic spread of influenza. Since the start of the influenza season, 0 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

11/03/2016

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)

45

B (Yamagata)

40

A (not subtyped)

B (Victoria) A H3

35

A H1 (unspecified) A (H1N1)pdm09

30

A (H1N2v) A (H3N2v)

25

A&B

20

Unknown

Current week

15 10

Number of Hospitalizations

Number of Hospitalizations

50

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

5 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)

3

2

9

*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 9 (to date)

Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending October 29, 2016 | WEEK 43

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Hospitalized Influenza Surveillance (continued)

Number of Hospitalizations

10

1.00

8

4

0

0.80

0.6

6

2

1.20

0.60 0.40

0.2 0.0

0.0

0.0

0.0

0.0

0.0

0.20 0.00

14

# of hospitalizations

12

Incidence (cases) per 100,000 Persons

1.2 1.0

8

0.8

6

0.6

4

0.4

2

0.0

0.0

0-4

5-24

0.1

0.2

0.0

25-49

50-64

65+

0.0

Age Group (years)

Region

Central Metro Northeast Northwest South Central Southeast Southwest West Central

1.2

10

0

Region

1.4

Hospitalizations per 100,000 Persons

Incidence (cases) per 100,000 Persons

12

1.40

Hospitalizations per 100,000 Persons

# of hospitalizations

14

Number of Influenza Hospitalizations and Incidence by Age, Minnesota October 2, 2016 – October 29, 2016

Number of Hospitalizations

Number of Influenza Hospitalizations and Incidence by Region, Minnesota October 2, 2016 – October 29, 2016

Hospitalizations this week

Total (to date)

0 (0%) 3 (100%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

0 (0%) 6 (67%) 0 (0%) 0 (0%) 0 (0%) 3 (33%) 0 (0%) 0 (0%)

Median age (years) at time of admission 74.0

Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending October 29, 2016 | WEEK 43

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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)

1

0

3

Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending October 29, 2016 | WEEK 43

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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 20 15

Current week

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)

0

0

0

Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending October 29, 2016 | WEEK 43

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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) 9

2012-13

Percent with Influenza-like Illness

8

2013-14 2014-15

7

2015-16

6 5 4

2016-17

Current week*

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

1.9%

1.1%

*Indicates current week-data may be delayed by 1 or more weeks

Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending October 29, 2016 | WEEK 43

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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 25

B A H3

20

A (H1N1) pdm09 2013-14 % + by PCR

15

2014-15 % + by PCR 2015-16 % + by PCR

10

Current week

2016-17 % + by PCR

30 25 20 15 10

5

0

5

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

0.89%

0.54%

Percent of positive molecular tests

Number of positive molecular tests

A (not subtyped)

35

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 October 29, 2016 | WEEK 43

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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

60 50 40

2013-14 % +

45

2014-15% +

40

2015-16 % +

35

2016-17 % +

30 25

Current week

20

30

15

20

10

10 0

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) 0% 0% 5% 0% 10% 0% 0% 3% 6%

50

Number +

45

2013-14 % +

40

2014-15 % +

35

2015-16 % + 2016-17 % +

30 25 20

Current week

15 10 5 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

70

A/B+ (2015-16 Season)

50

Percentage of Rapid Antigen Influenza Tests Positive

A+ (2015-16 Season)

80

Number of Positive RSV Tests

B+ (2015-16 Season)

% rapid antigen RSV tests + (current week) 8% 0% 0% 0% 14% 17% 0% 13% 9%

Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending October 29, 2016 | WEEK 43

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Laboratory Surveillance (continued) Minnesota Influenza Incidence Surveillance Project (MIISP)

Positive Respiratory Pathogens by PCR, by MMWR Week

Number Positive by RT-PCR

20

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

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 October 29, 2016 | WEEK 43

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Laboratory Surveillance (continued) Severe Acute Respiratory Surveillance (SARI) - Inpatients

Positive Respiratory Pathogens by PCR, by MMWR Week Influenza B

Influenza A H3

Influenza A (H1N1) pdm09

Influenza A Unspecified

Legionella

RSV

Human Metapneumovirus

Rhinovirus/Enterovirus

Adenovirus

Coronavirus NL63

75

Coronavirus OC43

Coronavirus 229E

Coronavirus HKU1

Parainfluenza 1

Parainfluenza 2

70

Parainfluenza 3

Parainfluenza 4

Number Positive by RT-PCR

65 60 55 50 45 40 35 30 25 20 15 10 5 0

32

34

36

38

40

42

44

46

48

50

52

2

4

6

8

10

12

14

16

18

20

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 October 29, 2016 | WEEK 43

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Weekly U.S. Influenza Surveillance Report 2016-2017 Influenza Season Week 42 ending October 22, 2016

National Influenza Surveillance (CDC): http://www.cdc.gov/flu/weekly/ Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 42 was influenza A. The percentage of respiratory specimens testing positive for influenza in clinical laboratories was low. 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: No influenza-associated pediatric deaths were reported. Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.3%, which is below the national baseline of 2.2%. All 10 regions reported ILI below region-specific baseline levels. New York City, Puerto Rico, and all 50 states experienced minimal ILI activity and the District of Columbia had insufficient data. Geographic Spread of Influenza: The geographic spread of influenza in Guam was reported as widespread; Puerto Rico reported regional activity; one state reported local activity; the District of Columbia, the U.S. Virgin Islands and 41 states reported sporadic activity; and eight states reported no activity.

Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending October 29, 2016 | WEEK 43

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