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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.


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


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)”.


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


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+.


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 †


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

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4

5

6

7

8

9

10

11

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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


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


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


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)

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