N.C. Weekly Influenza Summary - May 19, 2018 1
Final Summary 2017-2018
NORTH CAROLINA WEEKLY INFLUENZA SURVEILLANCE SUMMARY2017-2018 INFLUENZA SEASON
WEEK 20: ENDING MAY 19, 2018
By Week: North Carolina
Percentage of Outpatient Visits with Influenza-like Illness (ILI)
04/28 05/05 05/12 05/19
Week Ending Date
0
1
2
% IL
I
StatewideUpdates
Influenza-like illness (ILI) decreased slightly during week 20.
The geographic spread of flu was SPORADIC for the week ending 5/19/2018.
Of the 4 samples submitted to the State Laboratory of Public Health (SLPH) for viral testing this week, 0were positive for influenza virus.
Hospital-based Public Health Epidemiologists (PHEs) reported 15 positive influenza results out of 354samples tested during week 20 (ending 5/19/2018); 10 were positive for influenza B virus, 4 were positivefor influenza A(unknown) and 1 was positive for influenza A(H1) virus.
RegionalUpdates
The proportion of visits due to ILI in Region 4 (Southeastern US) was at 1.00% for week 19 (ending5/12/2018). The baseline for the region is 1.9%.
NationalUpdates
The proportion of outpatient visits due to ILI nationally was at 1.15% for week 19 (ending 5/12/2018). The national baseline for ILI is 2.2%.
InternationalUpdates
May 14, 2018 - Influenza activity returned to inter-seasonal levels in most of the countries in thetemperate zone of the northern hemisphere except for some countries in Eastern Europe. In the temperatezone of the southern hemisphere, influenza activity increased but remained below the seasonal thresholds.Worldwide, seasonal influenza subtypes A and B accounted for approximately the same proportion ofinfluenza detections. Influenza indicators continued to decrease in Canada and the United States, withinfluenza A and B viruses predominating, respectively. Influenza like illness (ILI) rate and the proportionof other respiratory viruses increased slightly in Canada. In Mexico, influenza activity was reported asdecreased, and respiratory illness indicators returned to inter-seasonal levels. In Europe, influenza activitygenerally decreased. In Africa, influenza activity decreased across the region with moderate flu virusdetections in some countries. In Western and Eastern Asia, low influenza activity returned tointer-seasonal levels. In Northern and Southern Asia influenza activity remained low. In the Caribbean,influenza activity (all seasonal subtypes) continued in several countries while respiratory syncytial virus(RSV) activity was low in the region. In Central American countries, influenza activity remained low. Inthe temperate zone of the Southern Hemisphere, influenza activity increased slightly in most countries butstayed below thresholds.
N.C. Weekly Influenza Summary - May 19, 2018 2
INFLUENZA-LIKE ILLNESSES REPORTED BY SENTINEL SITES, 2017-2018
Week # - Ending (Sentinels Reporting) # ILI # Patients % ILI
#40 - 10/07/2017 44 149 13,369 1.11
#41 - 10/14/2017 47 189 14,695 1.29
#42 - 10/21/2017 47 160 15,803 1.01
#43 - 10/28/2017 48 244 17,751 1.37
#44 - 11/04/2017 49 282 19,014 1.48
#45 - 11/11/2017 51 263 16,822 1.56
#46 - 11/18/2017 51 354 19,329 1.83
#47 - 11/25/2017 50 276 10,764 2.56
#48 - 12/02/2017 51 324 18,856 1.72
#49 - 12/09/2017 49 340 16,903 2.01
#50 - 12/16/2017 49 305 15,768 1.93
#51 - 12/23/2017 47 214 11,074 1.93
#52 - 12/30/2017 45 234 6,155 3.80
#1 - 01/06/2018 47 260 8,593 3.03
#2 - 01/13/2018 47 606 14,469 4.19
#3 - 01/20/2018 47 773 11,790 6.56
#4 - 01/27/2018 50 1616 20,076 8.05
#5 - 02/03/2018 52 1804 20,879 8.64
#6 - 02/10/2018 51 1999 19,470 10.3
#7 - 02/17/2018 51 1445 18,240 7.92
#8 - 02/24/2018 46 832 16,096 5.17
#9 - 03/03/2018 42 462 15,052 3.07
#10 - 03/10/2018 44 347 12,561 2.76
#11 - 03/17/2018 47 361 14,326 2.52
#12 - 03/24/2018 44 337 15,231 2.21
#13 - 03/31/2018 43 361 14,058 2.57
#14 - 04/07/2018 43 265 12,745 2.08
#15 - 04/14/2018 40 196 15,319 1.28
#16 - 04/21/2018 37 172 14,289 1.20
#17 - 04/28/2018 37 176 14,685 1.20
#18 - 05/05/2018 36 152 13,243 1.15
#19 - 05/12/2018 34 93 11,147 0.83
#20 - 05/19/2018 21 26 4,859 0.54
N.C. Weekly Influenza Summary - May 19, 2018 3
Influenza-Like Illness in ILINET Outpatient VisitsINFLUENZA SURVEILLANCE, NC 2015-2018
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
11%
12%
% IL
I
10/07
10/14
10/21
10/28
11/04
11/11
11/18
11/25
12/02
12/09
12/16
12/23
12/30
01/06
01/13
01/20
01/27
02/03
02/10
02/17
02/24
03/03
03/10
03/17
03/24
03/31
04/07
04/14
04/21
04/28
05/05
05/12
05/19
Week Ending Date
2017-20182016-20172015-2016
For more information about comparable national data, visit www.cdc.gov/ncidod/diseases/flu/weekly.htm and in particular, clickon the link “View Chart Data” below “Percentage of Visits for Influenza-like Illness Reported by the US Outpatient Influenza-likeIllness Surveillance Network (ILINet)”.
N.C. Weekly Influenza Summary - May 19, 2018 4
PHE Respiratory Viral Pathogen Surveillance
Positive test results for selected respiratory viruses are reported on a weekly basis by Public Health Epidemiologists (PHEs) locatedin seven of the largest hospital networks across North Carolina. The graph below shows the number of positive tests for respiratorysyncytial virus (RSV), parainfluenza, adenovirus, rhinovirus, and human metapneumovirus (hMPV) by week.
These data provide a useful indication of which other respiratory viruses are circulating and possibly contributing to ILI in the state.Please note that the total number of tests performed is not available from all hospital networks, so the overall proportion testingpositive cannot be calculated. Also, testing protocols and practices differ among hospitals. Finally, these numbers reflect testresults from participating hospitals only and might not be reflective of the entire state.
Data source: NC DETECT
PHE Surveillance: Positive Respiratory Virus Test Results by Week
* Most facilities use tests that do not distinguish rhinoviruses from enteroviruses.
0
100
200
300
400
500
600
700
800
900
1000
1100
1200
1300
1400
1500
1600
Co
un
t
10/07
10/14
10/21
10/28
11/04
11/11
11/18
11/25
12/02
12/09
12/16
12/23
12/30
01/06
01/13
01/20
01/27
02/03
02/10
02/17
02/24
03/03
03/10
03/17
03/24
03/31
04/07
04/14
04/21
04/28
05/05
05/12
05/19
Week Ending Date
InfluenzahMPVRhinovirus*AdenovirusParainfluenzaRSV
Data in
shad
ed area m
ay be in
com
plete
● Rhinovirus* was the most frequently identified respiratory viral pathogen during week 20 (ending 05/19/2018) followed by Parainfluenza.
INFLUENZA VIRUS ISOLATES IDENTIFIED BY PHE FACILITIES FOR 2017–2018 SEASON*
Virus Type # New positive results(5/13/2018-5/19/2018)
# Cumulative positive results(10/1/2017-5/19/2018)
A(H1) 1 546
A/H3 0 1829
A (subtype unknown) 4 6699
B 10 3322
Total 15 12396
N.C. Weekly Influenza Summary - May 19, 2018 5
PHE Acute Respiratory Admissions Surveillance
The number of patients admitted to the hospital with fever plus respiratory symptoms in the absence of a known cause other thaninfluenza is reported on a weekly basis by Public Health Epidemiologists (PHEs) located in seven of the largest hospital networksacross North Carolina. The graph below shows the number of acute respiratory illness admissions to participating hospitals by agegroup.
In conjunction with other surveillance information, these data help us monitor for changes in severity of respiratory illness duringperiods when influenza is circulating. Please note that these reports are not limited to patients with laboratory-confirmedinfluenza infection. Also, these numbers reflect admissions to participating hospitals only and are not be reflective of the entirestate.
Data source: NC DETECT
PHE Surveillance: Hospital Admissions for Acute Respiratory Illness by Week
0
40
80
120
160
200
240
280
320
360
400
440
Co
un
t
10/07
10/14
10/21
10/28
11/04
11/11
11/18
11/25
12/02
12/09
12/16
12/23
12/30
01/06
01/13
01/20
01/27
02/03
02/10
02/17
02/24
03/03
03/10
03/17
03/24
03/31
04/07
04/14
04/21
04/28
05/05
05/12
05/19
Week Ending Date
TotalAge UnknownAge 65+Age 25 - 64Age 5 - 24Age 0 - 4
Data in
shad
ed area m
ay be in
com
plete
● Acute respiratory admissions decreased during week 20 (ending 05/19/2018).
● The highest number of acute respiratory admissions during week 20 was for patients Age 25 - 64 followed by Age 65+.
N.C. Weekly Influenza Summary - May 19, 2018 6
By Week Ending Date
Influenza Positive Tests Reported by the NC State Laboratory of Public Health (SLPH)
† Percent of submitted specimens for any influenza
0
10
20
30
# Po
siti
ve S
peci
men
s
10/0710/14
10/2110/28
11/0411/11
11/1811/25
12/0212/09
12/1612/23
12/3001/06
01/1301/20
01/2702/03
02/1002/17
02/2403/03
03/1003/17
03/2403/31
04/0704/14
04/2104/28
05/0505/12
05/19
Week Ending Date
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% P
osi
tive
†
B (not subtyped)B (Yamagata)B (Victoria)Seasonal A (H3)2009 A (H1N1)A (not subtyped)
Percent Positive †
INFLUENZA VIRUS ISOLATES FROM IN-STATE PATIENTS IDENTIFIED BY THE STATE LABORATORY OF PUBLIC HEALTH 2017–2018 SEASON*
Virus Type # New Positive Results (5/13/2018-5/19/2018)
# Cumulative Positive Results(10/1/17 - 5/19/18)
A (unknown) 0 5
2009 A(H1N1) 0 27
A(H3) 0 106
B (unknown) 0 4
B (Victoria) 0 24
B (Yamagata) 0 59
Total 0 225
* 2017-2018 influenza season began October 1, 2017.NOTE: This table includes isolates tested as of 10/01/2017
This table does not include influenza isolates identified by other laboratories
By Week Ending Date
Influenza Positive Tests Reported by the NC State Laboratory of Public Health (SLPH) and PHE Facilities
† Percent of submitted specimens for any influenza
0
500
1000
1500
# Po
siti
ve S
peci
men
s
10/0710/14
10/2110/28
11/0411/11
11/1811/25
12/0212/09
12/1612/23
12/3001/06
01/1301/20
01/2702/03
02/1002/17
02/2403/03
03/1003/17
03/2403/31
04/0704/14
04/2104/28
05/0505/12
05/19
Week Ending Date
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% P
osi
tive
†
Seasonal BSeasonal A (H3)A (H1)A (not subtyped)
Percent Positive †
N.C. Weekly Influenza Summary - May 19, 2018 7
North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) ILI Surveillance
Near real-time syndromic surveillance for ILI is conducted through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool(NC DETECT). This system uses a variety of data sources including emergency departments (EDs). NC DETECT is currently receiving data dailyfrom 122 of the 123 24/7 EDs in North Carolina. The NC DETECT ILI syndrome case definition includes any case with the term 'flu' or 'influenza',or at least one fever term and one influenza-related symptom.
The proportion of ED visits meeting the ILI syndrome definition is monitored throughout the year and compared to data obtained fromInfluenza-like Illness Surveillance Network (ILINet). In past years, data from the two systems have shown similar trends (below). The higherproportion of ILI seen in NC DETECT compared to ILINet reflects differences in the case definitions and patient populations rather than adifference in the sensitivity of these surveillance systems.
Hospital Emergency Department Visits (NC DETECT) and Outpatient Provider Visits (ILINet)
Influenza-Like Illness Surveillance in North Carolina, 2017-2018
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
% IL
I
10/0710/14
10/2110/28
11/0411/11
11/1811/25
12/0212/09
12/1612/23
12/3001/06
01/1301/20
01/2702/03
02/1002/17
02/2403/03
03/1003/17
03/2403/31
04/0704/14
04/2104/28
05/0505/12
05/19
Week Ending Date
2017-18 ILInet2017-18 ED NC DETECT
Past Two Influenza Seasons: Shown For Comparison
Hospital Emergency Department Visits (NC DETECT) and Outpatient Provider Visits (ILINet)
Influenza-Like Illness Surveillance in North Carolina, Past Two Seasons
0
1
2
3
4
5
6
7
8
9
10
11
12
% IL
I
10/07
10/14
10/21
10/28
11/04
11/11
11/18
11/25
12/02
12/09
12/16
12/23
12/30
01/06
01/13
01/20
01/27
02/03
02/10
02/17
02/24
03/03
03/10
03/17
03/24
03/31
04/07
04/14
04/21
04/28
05/05
05/12
05/19
Week Ending Date
2016-17 ILInet2016-17 ED NC DETECT2015-16 ILInet2015-16 ED NC DETECT
N.C. Weekly Influenza Summary - May 19, 2018 8
NC DETECT ED Influenza-Like Illness (ILI), 2017-2018Percentage of Total Visits by Week, Grouped by Flu Surveillance Regions:
5
10
15
20
% IL
I
10/0710/14
10/2110/28
11/0411/11
11/1811/25
12/0212/09
12/1612/23
12/3001/06
01/1301/20
01/2702/03
02/1002/17
02/2403/03
03/1003/17
03/2403/31
04/0704/14
04/2104/28
05/0505/12
05/19
Week Ending Date
Region 7Region 6Region 5Region 4Region 3Region 2Region 1
NOTE: This graph begins with data starting week ending October 7, 2017 for the 2017-2018 influenza season.
Flu Surveillance Regions
Regions 1 2 3 4 5 6 7
ALAMANCE
ALEXANDER
ALLEGHANY
ANSON
ASHE
AVERY
BEAUFORT
BERTIE
BLADEN
BRUNSWICK
BUNCOMBE
BURKE
CABARRUS
CALDWELL
CAMDEN
CARTERET
CASWELL
CATAWBA CHATHAM
CHEROKEE
CHOWAN
CLAY
CLEVELAND
COLUMBUS
CRAVEN
CUMBERLAND
CURRITUCK
DAREDAVIDSON
DAVIE
DUPLIN
DURHAM
EDGECOMBE
FORSYTH
FRANKLIN
GASTON
GATES
GRAHAM
GRANVILLE
GREENE
GUILFORD
HALIFAX
HARNETT
HAYWOOD
HENDERSON
HERTFORD
HOKE
HYDE
IREDELL
JACKSON
JOHNSTON
JONES
LEE
LENOIR
LINCOLN
MC DOWELL
MACON
MADISON MARTIN
MECKLENBURG
MITCHELL
MONTGOMERY
MOORE
NASH
NEW HANOVER
NORTHAMPTON
ONSLOW
ORANGE
PAMLICO
PASQUOTANK
PENDER
PERQUIMANS
PERSON
PITT
POLK
RANDOLPH
RICHMOND
ROBESON
ROCKINGHAM
ROWAN
RUTHERFORD
SAMPSON
SCOTLAND
STANLY
STOKESSURRY
SWAIN
TRANSYLVANIA
TYRRELL
UNION
VANCE
WAKE
WARREN
WASHINGTON
WATAUGA
WAYNE
WILKES
WILSON
YADKIN
YANCEY
3
45
6
1
7
2
N.C. Weekly Influenza Summary - May 19, 2018 9
NC Influenza-Associated Deaths*Influenza-Associated Deaths
This Week (05/13/2018 – 05/19/2018)Total Influenza-Associated DeathsThis Season (starting 10/01/2017)
1 389
*Influenza-associated Deaths – This number is based on reports submitted by providers to the NC Division of Public Health. Aninfluenza-associated death is defined for surveillance purposes as a death (adult or pediatric) resulting from a clinically compatible illness thatwas confirmed to be influenza by an appropriate laboratory or rapid diagnostic test with no period of complete recovery between the illness anddeath. Data are preliminary and subject to change as updated information becomes available. Deaths that occurred on or after 10/01/2017 willbe reflected in this report for the 2017-2018 season.
North Carolina by Age Group*Laboratory Confirmed Influenza-Associated Deaths Reported in
01836547290
108126144162180198216234252270288
No
. of
Rep
ort
ed D
eath
s
0-4 5-17 18-24 25-49 50-64 65+
Age Group (Years)
Reported in North Carolina by Week of Death*Laboratory Confirmed Influenza-Associated Deaths
0 0 1 1 1 0 02
02
6
2
10 11
22
34
38
47
36
56
29
22
14
9
14
7
12
4
0 13 4
1
048
121620242832364044485256
No
. of
Rep
ort
ed D
eath
s
10/07
10/14
10/21
10/28
11/04
11/11
11/18
11/25
12/02
12/09
12/16
12/23
12/30
01/06
01/13
01/20
01/27
02/03
02/10
02/17
02/24
03/03
03/10
03/17
03/24
03/31
04/07
04/14
04/21
04/28
05/05
05/12
05/19
Week Ending Date
PediatricAdult
N.C. Weekly Influenza Summary - May 19, 2018 10
PARTICIPANTS IN NORTH CAROLINA’S INFLUENZA SENTINEL SURVEILLANCE PROGRAM THAT HAVE REPORTED DATA TO CDC
LOCAL HEALTH DEPARTMENT/DISTRICT OFFICES - 22
Alamance County Health Department
Cabarrus Health Alliance
Caldwell County Health Department
Craven County Health Department
Duplin County Health Department
Franklin County Health Department
Henderson County Health Department
Johnston County Health Department
Lee Primary Care
Montgomery County Health Department
Northampton County Health Department
Pender County Health Department
Pitt County Public Health Center
Richmond County Health Department
Rockingham County Health Department
Rowan County Health Department
Stanly County Health Department
Stokes Family Health Center
Surry County Health and Nutrition Center
Union County Health Department
Wake County Health Department, Children’s Clinic
Wilkes County Health Department
COLLEGES AND UNIVERSITIES STUDENT HEALTH PROGRAMS - 15
Appalachian State University Student Health Services
Davidson College Student Health Center
ECU Student Health Services
Elizabeth City State University Student Health Services
Elon University R. N. Ellington Health and Counseling Center
Fayetteville State University
Meredith College Student Health Center
NC Agricultural &Technical State University Student Health Services
NC State University Student Health Services
UNC-Chapel Hill Student Health Services
UNC-Charlotte Student Health Services
UNC-Greensboro Student Health Services
UNC-Pembroke Student Health Services
Wake Forest University Student Health Services
Winston-Salem State University
PRIVATE PRACTITIONERS - 24
Bakersville Community Medical Center
Blue Cross and Blue Shield of N.C.
Blue Ridge Community Health Services
Butner-Creedmoor Family Medicine
Coastal Childrens Clinic
Colerain Primary Care
Creswell Primary Care
Dilworth Pediatrics
ECU Brody School of Medicine – Department of Pediatrics
Family Care Center
Haywood Pediatric and Adolescent Medicine Group, PA
Hot Springs Health Program
MEDAC Health Services at Shipyard Blvd.
MEDAC Health Services at Porter’s Neck
MEDAC Health Services at Military Cutoff
Minute Clinic - Cary
Murfreesboro Primary Care
Novant Health Urgent Care
Oxford Family Physicians
PrimeCare of Northpoint
Roanoke Chowan Community Health Center
SAS Institute Health Care Center
Sisters of Mercy Urgent Care, South
Stanly Family Care Clinic
HOSPITALS - 3
Blue Ridge Regional Hospital
Durham VAMC
Scotland Healthcare System
Total Sentinels Enrolled - 64
Counties Covered - 42:Alamance (2), Alexander (1), Bertie (1), Buncombe (1), Cabarrus (1), Caldwell (1), Craven (2), Cumberland (1), Duplin (1), Durham (2), Forsyth (4), Franklin (1),Granville (2), Guilford (2), Haywood (1), Henderson (2), Hertford (2), Johnston (1), Lee (1), Madison (1), Mecklenburg (3), Mitchell (2), Montgomery (1), New Hanover(3), Northampton (1), Orange (1), Pasquotank (1), Pender (1), Pitt (3), Richmond (1), Robeson (1), Rockingham (1), Rowan (1), Scotland (1), Stanly (2), Stokes (1),Surry (1), Union (1), Wake (5), Washington (1), Watauga (1), Wilkes (1)