2016 Flu Update
National Flu Activity
During week 8 (February 21 - February 27, 2016), influenza activity increased in the United States.
- Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 8 was influenza A, with influenza A (H1N1)pdm09 viruses predominating. The percentage of respiratory specimens testing positive for influenza in clinical laboratories increased.
- Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below their system-specific epidemic threshold in both the NCHS Mortality Surveillance System and the 122 Cities Mortality Reporting System.
- Influenza-associated Pediatric Deaths: Four influenza-associated pediatric deaths was reported. A total of eighteen influenza-associated pediatric deaths have been reported during the 2015-2016 season.
- Influenza-associated Hospitalizations: A cumulative rate for the season of 7.8 laboratory confirmed influenza-associated hospitalizations per 100,000 population was reported.
- Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.2%, which is above the national baseline of 2.1%. Ninen of 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and eight states experienced high ILI activity; New York City and 9 states experienced moderate ILI activity; 13 states experienced low ILI activity; 20 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
- Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 33 states was reported as widespread; Guam and 14 states reported regional activity; the District of Colombia and one state reported local activity; and the U.S. Virgin Islands and two states reported sporadic activity.
- Antiviral Resistance: The majority of recently circulating influenza viruses are susceptible to the neuraminidase inhibitor antiviral medications, oseltamivir, zanamivir, and peramivir; however, rare sporadic instances of oseltamivir-resistant and peramivir-resistant influenza A (H1N1)pdm09 and oseltamivir-resistant influenza A (H3N2) viruses have been detected worldwide. Antiviral treatment as early as possible is recommended for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at high risk for serious influenza related complications.
Influenza Activity in Massachusetts
For week 8, influenza-like illness (ILI, defined by fever >100°F and cough and/or sore throat) activity was reported as widespread in Massachusetts, at minimal intensity.
Detailed weekly flu surveillance reports are posted on the Mass Public Health Blog.
Although influenza-like illness activity in Massachusetts has remained at low intensity so far this season, we do have influenza in Massachusetts. Providers are urged to treat suspected influenza in high-risk patients, those with progressive disease, and all hospitalized patients with antiviral medications ASAP, regardless of negative RIDT results and without waiting for RT-PCR testing results.
Influenza activity is increasing across the country and CDC has received reports of severe influenza illness. Clinicians are reminded to treat suspected influenza in high-risk outpatients, those with progressive disease, and all hospitalized patients with antiviral medications as soon as possible, regardless of negative rapid influenza diagnostic test (RIDT) results and without waiting for RT-PCR testing results. Early antiviral treatment works best, but treatment may offer benefit when started up to 4-5 days after symptom onset in hospitalized patients. Early antiviral treatment can reduce influenza morbidity and mortality.
Since October 2015, CDC has detected co-circulation of influenza A(H3N2), A(H1N1)pdm09, and influenza B viruses. However, H1N1pdm09 viruses have predominated in recent weeks. CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported. Some of these patients reportedly tested negative for influenza by RIDT; their influenza diagnosis was made later with molecular assays. Most of these patients were reportedly unvaccinated. H1N1pdm09 virus infection in the past has caused severe illness in some children and young- and middle-aged adults. Clinicians should continue efforts to vaccinate patients this season for as long as influenza viruses are circulating, and promptly start antiviral treatment of severely ill and high-risk patients if influenza is suspected or confirmed
See attached for full guidance including for institutional settings. If you have questions about influenza, influenza vaccine recommendations or vaccine, please call the Massachusetts Department of Public Health (MDPH) Immunization Program at 617-983-6800 and ask to speak to an immunization epidemiologist or nurse.
For additional information, see:
Questions and Resources
- CDC Influenza Antiviral Medications: Summary for Clinicians
- CDC Influenza Information for Health Professionals (including guidelines for long-term care facilities)
- CDC Influenza Vaccine Effectiveness: Questions and Answers for Health Professionals
- MDPH Recommendations and Resources for the Control of Influenza and Pneumococcal Disease (2015-2016)
- MDPH Control of Influenza and Pneumococcal Disease in Long-Term Care Facilities
- MDPH Influenza Information for School and Childcare Professionals
Immunization Clinic Resources
- Guidelines for Large-Scale Influenza Vaccination Clinic Planning. This webpage provides guidelines and recommendations to assist with planning influenza vaccination clinics. Topics include clinic logistics as well as vaccine storage, handling, and administration.
- CDC At-A-Glance Resource Guide - Vaccine Administration and Storage and Handling. This is a quick guide to key web resources on immunization, vaccine administration, and vaccine storage and handling. The guide includes CDC guidelines, an immunization checklist, educational webinars, and standing orders.
- MDPH Influenza Vaccine Guidelines and Tools. This webpage contains information about influenza vaccine and links to guidance about planning flu and other mass immunization campaigns, standing orders, screening forms, consent forms, and MDPH-specific vaccine management guidance.
- One & Only Campaign. The One & Only Campaign is a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices.
Vaccine Ordering and Locating Clinics
- Providers Wishing to Order Flu Vaccine for Private Purchase: The national Influenza Vaccine Availability Tracking System (IVATS) assists providers wishing to privately purchase flu vaccine. IVATS identifies available doses of influenza vaccine by formulation and distributor/vendor throughout the season.
- Location of Flu and Adult Vaccination Services: Flu vaccination clinics are listed on the www.mylocalclinic.com website sponsored by the Massachusetts Health Officers Association (MHOA). MDPH urges agencies to post their clinics on this website. Many boards of health (BOHs) may have clinics that make flu and other vaccines available to both adults and children. BOHs can be contacted individually for questions about possible flu vaccination clinics in Massachusetts municipalities, including the age groups served.
HealthMap Vaccine Finder assists the public with locating influenza and adult vaccination services within their communities. It is a free, online service where users can search for locations that offer immunizations. Its staff works with partners such as clinics, pharmacies, and health departments to provide accurate and up-to-date information about vaccination services. MDPH urges providers and other agencies to register their locations on the HealthMap Vaccine Finder site too.