Update: Influenza Activity --- United States, January 1--7, 2006

During January 1--7, 2006,* the number of states reporting widespread influenza activity^† remained at seven (Figure 1). Eleven states reported regional activity, nine reported local activity, and 21 reported sporadic activity.^§

The percentage of specimens testing positive for influenza decreased in the United States overall. Since October 2, 2005, the largest numbers of specimens testing positive for influenza have been reported from the Mountain (580 positives) and Pacific (332) regions, accounting for 37.3% and 21.3%, respectively, of positive tests reported during the 2005--06 influenza season. The percentage of outpatient visits for influenza-like illness (ILI)^¶ decreased during the week ending January 7 but is above the national baseline.** The percentage of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold for the week ending January 7.

Laboratory Surveillance

During January 1--7, World Health Organization (WHO) collaborating laboratories and National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories in the United States reported testing 2,223 specimens for influenza viruses, of which 203 (9.1%) were positive. Of these, 90 were influenza A (H3N2) viruses, 105 were influenza A viruses that were not subtyped, and eight were influenza B viruses.

Since October 2, 2005, WHO and NREVSS laboratories have tested 38,932 specimens for influenza viruses, of which 1,557 (4.0%) were positive. Of these, 1,499 (96.3%) were influenza A viruses, and 58 (3.7%) were influenza B viruses. Of the 1,499 influenza A viruses, 765 (51.0%) have been subtyped; 760 (99.3%) were influenza A (H3N2) viruses, and five (0.7%) were influenza A (H1N1) viruses.

P&I Mortality and ILI Surveillance

During the week ending January 7, P&I accounted for 7.3% of all deaths reported through the 122 Cities Mortality Reporting System. This percentage is below the epidemic threshold^†† of 8.0% (Figure 2).

The percentage of patient visits for ILI was 2.7%, which is above the national baseline of 2.2% (Figure 3). The percentage of patient visits for ILI ranged from 1.5% in the New England region to 5.5% in the West South Central region.

Pediatric Deaths and Hospitalizations

From October 2, 2005 through January 7, 2006, CDC received reports of six influenza-associated deaths in U.S. residents aged <18 years. Four of the deaths occurred during the current influenza season, and two occurred during the 2004--05 influenza season.

During October 1--December 24, 2005, the preliminary influenza-associated hospitalization rate for children aged 0--4 years reported by the Emerging Infections Program (EIP)^§§ was 0.17 per 10,000. The EIP also monitors hospitalizations in children aged 5--17 years. The preliminary influenza-associated hospitalization rate for this age group reported by EIP was 0.01 per 10,000. During October 30--December 24, the New Vaccine Surveillance Network^¶¶ reported no laboratory-confirmed influenza-associated hospitalizations among children aged 0--4 years.

Human Cases of Avian Influenza A (H5N1)

No human case of avian influenza A (H5N1) virus infection has ever been identified in the United States. From December 2003 through January 14, 2006, a total of 148 laboratory-confirmed human cases of avian influenza A (H5N1) infections were reported to WHO.*** Of these, 79 (53%) were fatal (Table). Cases were reported from Cambodia, China, Indonesia, Thailand, Turkey, and Vietnam. This represents an increase of one case and one death in Indonesia reported since January 10, 2006. The majority of cases appear to have been acquired from direct contact with infected poultry. No evidence of sustained human-to-human transmission of H5N1 has been detected, although rare cases of human-to-human transmission likely have occurred (1).

Reference

1. Ungchusak K, Auewarakul P, Dowell SF, et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med 2005;352:333--40.

* Provisional data reported as of January 13, 2006. Additional information regarding influenza activity is updated each Friday and is available from CDC at http://www.cdc.gov/flu.

† Levels of activity are 1) widespread: outbreaks of influenza or increases in influenza-like illness (ILI) cases and recent laboratory-confirmed influenza in at least half the regions of a state; 2) regional: outbreaks of influenza or increases in ILI cases and recent laboratory-confirmed influenza in at least two but less than half the regions of a state; 3) local: outbreaks of influenza or increases in ILI cases and recent laboratory-confirmed influenza in a single region of a state; 4) sporadic: small numbers of laboratory-confirmed influenza cases or a single influenza outbreak reported but no increase in cases of ILI; and 5) no activity.

§ Widespread: Arizona, California, Colorado, Nevada, New Mexico, Oregon, and Texas; regional: Alaska, Connecticut, Idaho, Iowa, Kansas, Mississippi, Pennsylvania, Tennessee, Utah, Washington, and Wyoming; local: Georgia, Indiana, Kentucky, Massachusetts, Montana, Nebraska, Ohio, Oklahoma, and Virginia; sporadic: Alabama, Arkansas, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Missouri, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wisconsin; no activity: Louisiana and Vermont; no report: None.

¶ Temperature of >100.0°F (>37.8°C) and cough and/or sore throat in the absence of a known cause other than influenza.

** The national baseline was calculated as the mean percentage of visits for ILI during noninfluenza weeks for the preceding three seasons plus two standard deviations. Noninfluenza weeks are those in which <10% of laboratory specimens are positive for influenza. Wide variability in regional data precludes calculating region-specific baselines; therefore, applying the national baseline to regional data is inappropriate.

^†† The expected seasonal baseline proportion of P&I deaths reported by the 122 Cities Mortality Reporting System is projected using a robust regression procedure in which a periodic regression model is applied to the observed percentage of deaths from P&I that occurred during the preceding 5 years. The epidemic threshold is 1.645 standard deviations above the seasonal baseline.

^§§ The EIP Influenza Project conducts surveillance in 60 counties associated with the following 12 metropolitan areas: San Francisco, California; Denver, Colorado; New Haven, Connecticut; Atlanta, Georgia; Baltimore, Maryland; Minneapolis/St. Paul, Minnesota; Albuquerque, New Mexico; Las Cruces, New Mexico; Albany, New York; Rochester, New York; Portland, Oregon; and Nashville, Tennessee.

^¶¶ The New Vaccine Surveillance Network conducts surveillance in Monroe County, New York; Hamilton County, Ohio; and Davidson County, Tennessee.

*** Available at http://www.who.int/csr/disease/avian_influenza/en

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Date last reviewed: 1/19/2006