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The New York State Department of Health (NYSDOH) collects, compiles, and analyzes information on influenza activity year round in New York State (NYS) and produces this weekly report during the influenza season (October through the following May). 1 Weekly Influenza Surveillance Report During the week ending June 4, 2016 Influenza activity level was categorized as geographically local. This is the 1st week that local activity has been reported following 1 week of geographically regional activity. There were 228 laboratory-confirmed influenza reports, a 42% decrease over last week. Of the 1,052 specimens tested by NYS WHO/NREVSS laboratories, 64 (6.08%) were positive for influenza. Of the specimens tested at Wadsworth Center, 32 were positive for influenza. 30 were influenza A (H1), 1 were influenza A (H3), 0 were influenza B (Yamagata), and 0 were influenza B (Victoria), Reports of percent of patient visits for influenza-like illness (ILI3) from ILINet providers was which is below the regional baseline of 2.3%. The number of patients hospitalized with laboratory-confirmed influenza was 34, a 52% decrease over last week. There were no influenza-associated pediatric deaths reported this week. There have been four influenza-associated pediatric deaths reported this season. 1 Information about influenza monitoring in New York City (NYC) is available from the NYC Department of Health and Mental Hygiene website at: http://www.nyc.gov/ html/doh/. National influenza surveillance data is available on CDC’s FluView website at http://www.cdc.gov/flu/weekly/. 2 No Activity: No laboratory-confirmed cases of influenza reported to the NYSDOH. Sporadic: Small numbers of lab-confirmed cases of influenza reported. Local: Increased or sustained numbers of lab-confirmed cases of influenza reported in a single region of New York State; sporadic in rest of state. Regional: Increased or sustained numbers of lab-confirmed cases of influenza reported in at least two regions but in fewer than 31 of 62 counties. Widespread: Increased or sustained numbers of lab-confirmed cases of influenza reported in greater than 31 of the 62 counties. Increased or sustained is defined as 2 or more cases of laboratory-confirmed influenza per 100,000 population. 3 ILI = influenza-like illness, defined as temperature 100° F with cough and/or sore throat in the absence of a known cause other than influenza Laboratory Reports of Influenza (including NYC) All clinical laboratories that perform testing on residents of NYS report all positive influenza test results to NYSDOH. 33 counties reported cases this week. County incidence ranged from 0.00–21.38 cases/100,000 population. ---PAGE BREAK--- Laboratory Reports of Influenza (including NYC) Test results may identify influenza Type A, influenza Type B, or influenza without specifying Type A or B. Some tests only give a positive or negative result and can- not identify influenza type (not specified). Page 2 WEEKLY INFLUENZA SURVEILLANCE REPORT 0 1000 2000 3000 4000 5000 6000 7000 10-Oct 24-Oct 7-Nov 21-Nov 5-Dec 19-Dec 2-Jan 16-Jan 30-Jan 13-Feb 27-Feb 12-Mar 26-Mar 9-Apr 23-Apr 7-May 21-May 4-Jun Number of Reports Week Ending Positive Influenza Laboratory Results reported to NYSDOH, by Week, 2015-16 (N=48,639) Influenza Type Not Specified Influenza B Influenza A 0-4 Years, 9,375 5-17 Years, 9,799 18-49 Years, 15,962 50-64 Years, 7,288 65+ years, 5,416 Positive Influenza Laboratory Results reported to NYSDOH, By Age Group, 2015-16 Season (N=48,639) * The totals by age groups exclude 799 cases for which age was not reported. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 10-Oct 24-Oct 7-Nov 21-Nov 5-Dec 19-Dec 2-Jan 16-Jan 30-Jan 13-Feb 27-Feb 12-Mar 26-Mar 9-Apr 23-Apr 7-May 21-May 4-Jun Laboratory-Confirmed Cases /100,000 Persons Week Ending Incidence of Positive Influenza Laboratory Results Reported to NYSDOH, by Region - 2015-16 Western Central Capital District Metro Area NYC 0 1000 2000 3000 4000 5000 6000 7000 10-Oct 24-Oct 7-Nov 21-Nov 5-Dec 19-Dec 2-Jan 16-Jan 30-Jan 13-Feb 27-Feb 12-Mar 26-Mar 9-Apr 23-Apr 7-May 21-May 4-Jun Number of Reports Week Ending Positive Influenza Laboratory Results Reported to NYSDOH - By Season 2015-16 (N=48,639) 2014-15 (N=50,874) 2013-14 (N=37,251) 2012-13 (N=45,620) ---PAGE BREAK--- Seventeen clinical virology laboratories in NYS and NYC, including the Wadsworth Center, are WHO and/or NREVSS collaborating laboratories for influenza surveillance. These labs report weekly the number of respiratory specimens tested and the number positive for influenza types A and B to CDC. Some labs also report the influenza A subtype (H1 or H3) and influenza B lineage (Victoria or Yamagata). Because denominator data is provided, the weekly percentage of specimens testing positive for influenza is calculated. Influenza A (H1), 687 Influenza A (H3), 60 Influenza B Yamagata, 73 Influenza B Victoria, 85 Influenza A Not Subtyped, 1 Influenza A&B Co-infection, 2 All Influenza Viruses Detected by Wadsworth Center, 2015-16 Season (N=2,092 tested) Influenza Virus Types and Subtypes Identified at Wadsworth Center (excluding NYC) Page 3 World Health Organization (WHO) and National Respiratory & Enteric Virus Surveillance System (NREVSS) Collaborating Laboratories Wadsworth Center, the NYSDOH public health laboratory, tests speci- mens from sources including, outpatient healthcare providers (ILINet) and hospitals (FluSurv-NET). There are 2 common subtypes of influenza A viruses – H1 and H3. Each subtype has a different genetic makeup. Wadsworth also identifies the lineage of influenza B specimens –Yamagata or Victoria. Rarely, an influenza virus is unable to have it’s subtype or lineage identified by the laboratory. Wadsworth sends a subset of positive influenza specimens to the CDC for further virus testing and characterization. Influenza A (H1), 529 Influenza A (H3), 21 Influenza B Yamagata, 51 Influenza B Victoria, 36 Influenza A Not Subtyped, 1 Subset of Influenza Viruses Detected by Wadsworth Center in FluSurv-NET Specimens, 2015-16 Season (N=1,468 tested) 0% 5% 10% 15% 20% 25% 30% 35% 0 100 200 300 400 500 600 700 [PHONE REDACTED] 1100 10-Oct 24-Oct 7-Nov 21-Nov 5-Dec 19-Dec 2-Jan 16-Jan 30-Jan 13-Feb 27-Feb 12-Mar 26-Mar 9-Apr 23-Apr 7-May 21-May 4-Jun Percent Positive Number of Positive Specimens Week Ending Positive Influenza Tests Reported by NYS WHO/NREVSS Collaborating Laboratories, 2015-2016 Season Influenza A 2009 (H1) Influenza A (H3) A (Subtyping not Performed) Influenza B Yamagata Influenza B Victoria Influenza B (Lineage not determined) Percent Positive Influenza A (H1), 85 Influenza A (H3), 26 Influenza B Yamagata, 4 Influenza B Victoria, 22 Influenza A Not Subtyped, 1 Subset of Influenza Viruses Detected by Wadsworth Center in ILINet Specimens, 2015-16 Season (N=359 tested) ---PAGE BREAK--- Emergency Department Visits for Surveillance (excluding NYC) Page 4 Influenza Antiviral Resistance Testing WEEKLY INFLUENZA SURVEILLANCE REPORT Hospitals around NYS report the number of patients seen in their emergency departments with complaints of ILI. This is called surveillance. An increase in visits to hospital emergency de- partments for ILI can be one sign that influenza has arrived in that part of NYS. surveillance does not reveal the ac- tual cause of illness, but is thought to correlate with emergency department visits for influenza. Outpatient Influenza-like Illness Surveillance Network (ILINet) (excluding NYC) The NYSDOH works with ILINet healthcare providers who report the total number of patients seen and the total number of those with complaints of influenza-like illness (ILI) every week in an outpatient setting. The CDC uses trends from past years to determine a regional baseline rate of doctors' office visits for ILI. For NYS, the regional baseline is currently 2.3%. Numbers above this regional baseline suggest high levels of ill- ness consistent with influenza in the state. Note that surrounding holiday weeks, it is not uncom- mon to notice a fluctuation in the ILI rate. This is a re- sult of the different pattern of patient visits for non- urgent needs. 4Additional information regarding national antiviral resistance testing, as well as recommendations for antiviral treatment and chemoprophylaxis of influenza virus infection, can be found at http://www.cdc.gov/flu/weekly/. 2% 4% 6% 8% 10% 12% 6/13/15 6/27/15 7/11/15 7/25/15 8/8/15 8/22/15 9/5/15 9/19/15 10/3/15 10/17/15 10/31/15 11/14/15 11/28/15 12/12/15 12/26/15 1/9/16 1/23/16 2/6/16 2/20/16 3/5/16 3/19/16 4/2/16 4/16/16 4/30/16 5/14/16 5/28/16 % Emergency Department Visits for Influenza-like Illness Week Ending Percent of Weekly Emergency Department Visits for Influenza-like Illness By Region, Previous 52 Weeks Buffalo & Rochester Central Capital & Northeast Hudson Valley Long Island 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 10-Oct 24-Oct 7-Nov 21-Nov 5-Dec 19-Dec 2-Jan 16-Jan 30-Jan 13-Feb 27-Feb 12-Mar 26-Mar 9-Apr 23-Apr 7-May 21-May 4-Jun Percent ILI Week Ending Percent of Influenza-like Illness (ILI) based on total ILINet Provider Patient Visits each week in NYS, by Season 2015-16 Season 2014-15 Season Regional Baseline 2.3% The Wadsworth Center Virology Laboratory performs surveillance testing for antiviral drug resistance. 4 Oseltamivir Zanamivir Samples tested Resistant Viruses, Number Samples tested Resistant Viruses, Number Influenza A (H3N2) i 35 0 (0.0) 0 0 (0.0) Influenza B ii 0 0 (0.0) 0 0 (0.0) 2009 Influenza A (H1N1) iii 188 6 (3.2) 0 0 (0.0) NYS Antiviral Resistance Testing Results on Samples Collected Season to date, 2015-16 I. All samples tested for oseltamivir resistance by pyrosequencing for E119V, R292K, and N294S in the neuraminidase gene (NA), and a subset tested by NA dideoxy sequencing for other variations known to cause, or suspected of causing, resistance to neuraminidase inhibitor drugs including zanamivir and oseltamivir. II. Samples tested by whole gene dideoxysequencing of the neuraminidase gene. Sequence data reviewed for variations known to cause, or suspected of causing, resistance to neuraminidase inhibitor drugs including zanamivir and oseltamivir. III. All samples tested by pyrosequencing for the H275Y variant in the neuraminidase gene which confers resistance to oseltamivir, and a subset tested by NA dideoxy sequencing for other variations known to cause, or suspected of causing, resistance to neuraminidase inhibitor drugs including zanamivir and oseltamivir. ---PAGE BREAK--- Hospitals in NYS and NYC report the number of hospitalized patients with laboratory-confirmed influenza to NYSDOH. 137 (74%) of 184 hospitals reported this week. Influenza Hospitalization Surveillance Network (FluSurv-NET) Page 5 Patients Hospitalized with Laboratory-Confirmed Influenza (including NYC) As part of the CDC’s FluSurv-Net, the NYS Emerging Infections Program (EIP) conducts enhanced surveillance for hospitalized cases of laboratory-confirmed influenza among residents of 15 counties.5 Medical chart reviews are completed, and underlying health condi- tions noted on all identified cases from October 1 through April 30 of the following year. 5Counties include, in the Capital District: Albany, Columbia, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, and Schoharie; in the Western Region: Genesee, Livingston, Monroe, Ontario, Orleans, Wayne, and Yates 0 200 400 [PHONE REDACTED] 1200 10-Oct 24-Oct 7-Nov 21-Nov 5-Dec 19-Dec 2-Jan 16-Jan 30-Jan 13-Feb 27-Feb 12-Mar 26-Mar 9-Apr 23-Apr 7-May 21-May 4-Jun Number of Hospitalizations Week Ending Patients Hospitalized with Laboratory-confirmed Influenza reported to NYSDOH, by Week, 2015-16 (N=9,000) 0 250 [PHONE REDACTED] 1250 1500 10-Oct 24-Oct 7-Nov 21-Nov 5-Dec 19-Dec 2-Jan 16-Jan 30-Jan 13-Feb 27-Feb 12-Mar 26-Mar 9-Apr 23-Apr 7-May 21-May 4-Jun Number of Hospitalizations Week Ending Patients Hospitalized with Laboratory-confirmed Influenza Reported to NYSDOH - By Season 2015-16 (N=9,000) 2014-15 (N=11,624) 2013-14 (N=8,735) 2012-13 (N=9,537) 0-4 Years, 1,085 5-17 Years, 650 18-49 Years, 1,981 50-64 Years, 2,261 65+ years, 3,023 Patients Hospitalized with Laboratory- confirmed Influenza reported to NYSDOH, By Age Group, 2015-16 Season (N=9,000) ---PAGE BREAK--- Pediatric influenza-associated deaths reported (including NYC) Page 6 WEEKLY INFLUENZA SURVEILLANCE REPORT Local health departments report pediatric influenza-associated deaths to NYSDOH. Flu-associated deaths in children younger than 18 years old are nationally notifiable. Influenza-associated deaths in persons 18 years and older are not notifiable. All pediatric flu-associated deaths included in this report are laboratory-confirmed. Healthcare-associated Influenza Activity (including NYC) Hospitals and nursing homes in NYS self-report outbreaks of influenza. A healthcare-associated outbreak is defined as one or more confirmed or two or more suspect cases of influenza in persons who were admitted to the facility with no signs or of influenza infection. Outbreaks are considered confirmed only with positive laboratory testing. This may include a positive rapid antigen test if no other more advanced testing (polymerase chain reaction, viral culture) is performed.6 6For more information on reporting of healthcare-associated influenza, visit http://www.health.ny.gov/diseases/communicable/control/respiratory_disease_checklist.htm For information about the flu mask regulation and the current status of the Commissioner's declaration, please visit www.health.ny.gov/FluMaskReg 0 2 4 6 8 10 Oct 12 Dec 12 Feb 13 Apr 13 Jun 13 Aug 13 Oct 13 Dec 13 Feb 14 Apr 14 Jun 14 Aug 14 Oct 14 Dec 14 Feb 15 Apr 15 Jun 15 Aug 15 Oct 15 Dec 15 Feb 16 Apr 16 Jun 16 Aug 16 Number of Deaths Month and Year of Death Number of Influenza-Associated Pediatric Deaths Reported by Month and Year of Death 2012-13 season to present 2012-13 Number of Deaths Reported = 14 2013-14 Number of Deaths Reported = 6 2015-16 Number of Deaths Reported = 4 2014-15 Number of Deaths Reported = 6 Week-to-Date (CDC week - 22) 5/29/16 through 6/4/16 ACF LTCF Total ACF LTCF Total ACF LTCF Total ACF LTCF Total ACF LTCF Total # Outbreaks* Lab-confirmed Influenza (any type) 0 0 0 0 0 0 0 # Outbreaks* viral respiratory illness** 0 0 0 0 0 0 0 Total # Outbreaks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Season-to-Date (CDC week - 22) 10/4/15 through 6/4/16 ACF LTCF Total ACF LTCF Total ACF LTCF Total ACF LTCF Total ACF LTCF Total # Outbreaks* Lab-confirmed Influenza (any type) 13 22 35 12 38 50 181 142 323 35 40 75 241 242 483 # Outbreaks* viral respiratory illness** 21 21 1 15 16 11 11 2 16 18 3 63 66 Total # Outbreaks 13 43 56 13 53 66 181 153 334 37 56 93 244 305 549 ACF - Article 28 Acute Care Facility LTCF - Article 28 Long Term Care Facility *Outbreaks are reported based on the onset date of in the first case Includes outbreaks of suspect influenza and/or other viral upper respiratory pathogens Capital Region Central Region Metro Region Western Region Statewide (Total) Capital Region Central Region Metro Region Western Region Statewide (Total)