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A Highly Pathogenic #Avian #H7N9 #Influenza Virus Isolated from A #Human Is Lethal in Some #Ferrets Infected via #Respiratory #Droplets (Cell Host Microbe, abstract)

Title : A Highly Pathogenic #Avian #H7N9 #Influenza Virus Isolated from A #Human Is Lethal in Some #Ferrets Infected via #Respiratory #Drop...

17 Feb 2018

#Influenza and other #Respiratory #Viruses #Research #References #Library– February 17 2018 Issue


Title: #Influenza and other #Respiratory #Viruses #Research #References #Library– February 17 2018 Issue.

Subject: Human and Animal Influenza Viruses, other respiratory pathogens research, weekly references library update.

Source: AMEDEO, homepage: (LINK).

Code: [  R  ]

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This Issue:

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  1. HOLMAN R.
    • Questions arising when NHS staff who refuse flu vaccine have to explain why.
  2. WU DBC, Chaiyakunapruk N, Pratoomsoot C, Lee KKC, et al.
    • Cost-utility analysis of antiviral use under pandemic influenza using a novel approach - linking pharmacology, epidemiology and heath economics.
      • Epidemiol Infect. 2018 Feb 15:1-12. doi: 10.1017/S0950268818000158.
  3. COATES BM, Staricha KL, Koch CM, Cheng Y, et al.
    • Inflammatory Monocytes Drive Influenza A Virus-Mediated Lung Injury in Juvenile Mice.
      • J Immunol. 2018 Feb 14. pii: jimmunol.1701543. doi: 10.4049/jimmunol.1701543.
  4. ANDERSON AM, Baranowska-Hustad M, Braathen R, Grodeland G, et al.
    • Simultaneous Targeting of Multiple Hemagglutinins to APCs for Induction of Broad Immunity against Influenza.
      • J Immunol. 2018 Feb 2. pii: jimmunol.1701088. doi: 10.4049/jimmunol.1701088.
  5. XIANG D, Shen X, Pu Z, Irwin DM, et al.
    • Convergent Evolution of Human-Isolated H7N9 Avian Influenza A Viruses.
      • J Infect Dis. 2018 Feb 9. pii: 4846861. doi: 10.1093.
  6. JEGASKANDA S, Mason RD, Andrews SF, Wheatley AK, et al.
    • Intranasal live influenza vaccine priming elicits localized B cell responses in mediastinal lymph nodes.
      • J Virol. 2018 Feb 14. pii: JVI.01970-17. doi: 10.1128/JVI.01970.
  7. BUDD AP, Wentworth DE, Blanton L, Elal AIA, et al.
    • Update: Influenza Activity - United States, October 1, 2017-February 3, 2018.
      • MMWR Morb Mortal Wkly Rep. 2018;67:169-179.
  8. FLANNERY B, Chung JR, Belongia EA, McLean HQ, et al.
    • Interim Estimates of 2017-18 Seasonal Influenza Vaccine Effectiveness - United States, February 2018.
      • MMWR Morb Mortal Wkly Rep. 2018;67:180-185.
  9. PANDO R, Sharabi S, Mandelboim M.
    • Exceptional influenza morbidity in summer season of 2017 in Israel may predict the vaccine efficiency in the coming winter.
      • Vaccine. 2018 Feb 8. pii: S0264-410X(18)30158.
  10. DE BEKKER-GROB EW, Veldwijk J, Jonker M, Donkers B, et al.
    • The impact of vaccination and patient characteristics on influenza vaccination uptake of elderly people: A discrete choice experiment.
      • Vaccine. 2018 Feb 6. pii: S0264-410X(18)30103.
  11. HILGERS LAT, Platenburg PPLI, Bajramovic J, Veth J, et al.
    • Carbohydrate fatty acid monosulphate esters are safe and effective adjuvants for humoral responses.
      • Vaccine. 2017;35:3249-3255.
  12. WONG CKH, Liao Q, Guo VYW, Xin Y, et al.
    • Cost-effectiveness analysis of vaccinations and decision makings on vaccination programmes in Hong Kong: A systematic review.
      • Vaccine. 2017 May 2. pii: S0264-410X(17)30542.
  13. SHANG M, Blanton L, Brammer L, Olsen SJ, et al.
    • Influenza-Associated Pediatric Deaths in the United States, 2010-2016.
      • Pediatrics. 2018 Feb 12. pii: peds.2017-2918. doi: 10.1542/peds.2017-2918.
  14. EDWARDS KM.
    • What Have We Learned About Influenza Deaths in Children and How Can We Do Better?
      • Pediatrics. 2018 Feb 12. pii: peds.2017-4313. doi: 10.1542/peds.2017-4313.

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Keywords: Research; Abstracts; Influenza References Library.

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16 Feb 2018

#China, #Influenza [B, #H1N1pdm09, #H3N2, #H7N9] Weekly #Report - Wk 06 2018 (CNIC, Feb. 16 ‘18)


Title: #China, #Influenza [B, #H1N1pdm09, #H3N2, #H7N9] Weekly #Report - Wk 06 2018.

Subject: Human and Animal Influenza Viruses, A (H1, H3, H7) & B subtypes, seasonal winter epidemic in China, current situation.

Source: China National Influenza Center, full page: (LINK).

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China, Influenza Weekly Report - Week 06 2018

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(All data are preliminary and may change as more reports are received)


Summary

  • During week 6, influenza activity continued to decrease in both South and North China, with southern provinces higher than northern provinces.
  • Influenza A(H1N1)pdm09 and B Yamagata-lineage viruses are the dominant viruses with A(H3N2) and B Victoria-lineage virus co-circulating at low levels.
  • Among influenza viruses antigenically characterized by CNIC since April, 2017:
    • 1278(91.6%) influenza A(H1N1)pdm09 viruses were characterized as A/Michigan/45/2015-like;
    • 217(35.5%) influenza A(H3N2) viruses were characterized as A/Hong Kong/4801/2014 (H3N2)(EGG)-like,
    • 564(92.3%) influenza A(H3N2) viruses were characterized as A/Hong Kong/4801/2014 (H3N2)(CELL)-like;
    • 648(82.0%) influenza B/Victoria viruses were characterized as B/Brisbane/60/2008-like;
    • 540(96.9%) influenza B/Yamagata viruses were characterized as B/Phuket/3073/2013-like.
  • Among the influenza viruses tested by CNIC for antiviral resistance analysis since April, 2017:
    • all influenza A(H1N1)pdm09 and all influenza A(H3N2) viruses were resistant to adamantine;
    • All influenza H3N2 and B viruses were sensitive to neuraminidase inhibitors.
    • All but 3 influenza A(H1N1)pdm09 viruses were sensitive to neuraminidase inhibitors.


Outbreak Surveillance

  • During week 6 (Feb 5th –Feb 11th, 2018), there were 6 outbreaks reported nationwide, 1 of them was A(H1N1)pdm09, 3 of them were B, 1 of them was mixed, 1 of them was untyped.


Surveillance of outpatient or emergency visits for Influenza-like Illness (ILI)

  • During week 6, the percentage of outpatient or emergency visits for ILI (ILI %) at national sentinel hospitals in south China was 4.7%, lower than last week (5.1%), higher than the same week of 2015-2017 (2.8%、4.6% and 2.6%). (Figure 1)
  • During week 6, ILI% at national sentinel hospitals in north China was 3.7%, lower than last week and the same week of 2016 (4.2% and 5.1%), higher than the same week of 2015 and 2017 (both 2.9%). (Figure 2)

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Figure 1. Percentage of Visits for ILI at Sentinel Hospitals in South China (2014-2018)

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Figure 2. Percentage of Visits for ILI at Sentinel Hospitals in North China (2014-2018)

W020180216739094791857

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Virologic Surveillance

  • During week 6, influenza network laboratories tested 8057 specimens, of which 2929 (36.4%) were positive for influenza, influenza A and influenza B viruses were 1910 (65.2%) and 1019 (34.8%), respectively (Table 1).
  • During week 6, the percentage of specimens that were tested positive for influenza in south China was 40.4%, which was lower than the previous week (41.7%) (Figure 3).
  • During week 6, the percentage of specimens that were tested positive for influenza in north China was 32.6%, which was lower than the previous week (36.8%). (Figure 4).


Table 1 - Laboratory Detections of ILI Specimens (Week 6, 2018)

[South China - North China – Total]

  • No. of specimens tested – 3882 – 4175 – 8057
    • No. of positive specimens (%) - 1568(40.4%) - 1361(32.6%) - 2929(36.4%)
      • Influenza A - 1063(67.8%) - 847(62.2%) - 1910(65.2%)
        • A(H3N2) - 27(2.5%) - 137(16.2%) - 164(8.6%)
        • A(H1N1)pdm09 - 1035(97.4%) - 706(83.4%) - 1741(91.2%)
        • A (subtype not determined) - 1(0.1%) - 4(0.5%) - 5(0.3%)
      • Influenza B - 505(32.2%) - 514(37.8%) - 1019(34.8%)
        • B (lineage not determined) - 12(2.4%) - 13(2.5%) - 25(2.5%)
        • Victoria - 70(13.9%) - 11(2.1%) - 81(7.9%)
        • Yamagata - 423(83.8%) - 490(95.3%) - 913(89.6%)

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Figure 3. Influenza Positive Tests Reported by Southern Network Laboratories (Week 14, 2016–Week 6, 2018)

W020180216739094803065

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Note: Analysis in this part was based on the test results of network laboratories. If it were not consistent with the results of CNIC confirmation, the results of CNIC confirmation were used.

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Figure 4. Influenza Positive Tests Reported by Northern Network Laboratories (Week 14, 2016–Week 6, 2018)

W020180216739094813646

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Note: Analysis in this part was based on the result of network laboratories. If it were not consistent with the results of CNIC confirmation, the results of CNIC confirmation were used.

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H7N9 case report

  • Since the notification of human infection with novel reassortant influenza A(H7N9) virus on 31 March 2013, in total 1564 laboratory-confirmed cases have been reported to WHO.
  • Among them, 32 cases were infected with HPAI A(H7N9) virus, which have mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry.
  • These 32 cases are from Taiwan (the case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan provinces, with illness onset date before October 2017.
  • No increased transmissibility or virulence to human case was detected in the HPAI A(H7N9) virus.

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|-- china flu report 1806.pdf –|

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Keywords: China; Updates; Seasonal Influenza; Avian Influenza; H1N1pdm09; H3N2; B, H7N9.

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Weekly #US [B, #H3N2, #H1N1pdm09] #Influenza #Surveillance #Report - 2017-18 Season, Wk 6 ending Feb. 10 ‘18 (@CDCgov, summary)


Title: Weekly #US [B, #H3N2, #H1N1pdm09] #Influenza #Surveillance #Report - 2017-18 Season, Wk 6 ending Feb. 10 ‘18.

Subject: Human Influenza Viruses, A & B subtypes, seasonal winter epidemic in the US, current situation.

Source: US Centers for Disease Control and Prevention (CDC), FluView, full page: (LINK). Summary, edited.

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Weekly U.S. Influenza Surveillance Report - 2017-2018 Influenza Season Week 6 ending February 10, 2018

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Language: [ English (US) | Español ]

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All data are preliminary and may change as more reports are received.


Synopsis:

    • During week 6 (February 4-10, 2018), influenza activity remained elevated in the United States.
  • Viral Surveillance:
    • The most frequently identified influenza virus subtype reported by public health laboratories during week 6 was influenza A(H3).
    • The percentage of respiratory specimens testing positive for influenza in clinical laboratories remained elevated.
  • Pneumonia and Influenza Mortality:
    • The proportion of deaths attributed to pneumonia and influenza (P&I) was above the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths:
    • Twenty-two influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations:
    • A cumulative rate of 67.9 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 7.5%, which is above the national baseline of 2.2%.
    • All 10 regions reported ILI at or above region-specific baseline levels.
    • New York City, the District of Columbia, Puerto Rico and 43 states experienced high ILI activity; two states experienced moderate ILI activity; three states experienced low ILI activity; and two states experienced minimal ILI activity.
  • Geographic Spread of Influenza:
    • The geographic spread of influenza in Puerto Rico and 48 states was reported as widespread; one state reported regional activity; the District of Columbia, Guam and one state reported local activity; and the U.S. Virgin Islands reported no activity.

(…)

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Keywords: US CDC; USA; Updates; Seasonal Influenza.

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#Avian #Influenza [#H5N1, #H5N6, #H7N9, #H7N4] Weekly #Update No. 624 – 16 February 2018 (@WHO WPRO, edited)


Title: #Avian #Influenza [#H5N1, #H5N6, #H7N9, #H7N4] Weekly #Update No. 624 – 16 February 2018.

Subject: Avian Influenza, H5 & H7 subtypes, global poultry panzootic and human cases in the Asian Region.

Source: World Health Organization (WHO), Office for the Western Pacific Region, full PDF file: (LINK).

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Avian Influenza Weekly Update Number 624 – 16 February 2018

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Keywords: WHO; Updates; Asian Region; H5N1; H5N6; H7N4; H7N9; Avian Influenza; Human.

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#Human #infection with #avian #influenza A(#H7N4) virus in #China (@WHO WPRO, Feb. 16 ‘18)


Title: #Human #infection with #avian #influenza A(#H7N4) virus in #China.

Subject: Avian Influenza, H7N4 subtype, human case in Jiangsu province of China.

Source: World Health Organization (WHO), Office for the Western Pacific Region, full PDF file: (LINK).

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Human infection with avian influenza A(H7N4) virus in China

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The case was a 68 year old woman from Jiangsu Province with pre-existing developed symptoms on  25 December 2017

On 1 January 2018, she was admitted for treatment of “severe pneumonia” and discharged on 22 January 2018. 

On 12 February, China CDC confirmed that the case’s samples were positive for avian influenza A(H7N4), and the NHFPC confirmed the diagnosis on 13 February 2018. 

The case had a history of exposure to live poultry before onset of symptoms. (LINK)  

On 14 February 2018, one new case of human infection with avian influenza A(H7N4) virus was reported to the WHO in the Western Pacific Region by the National Health and Family Planning Commission (NHFPC) of China. 

This is the first human case of avian influenza A(H7N4) infection to be reported worldwide.

The case was a 68 year old woman from Jiangsu Province with pre-existing developed symptoms on  25 December 2017.  On 1 January 2018, she was admitted for treatment of “severe pneumonia” and discharged on 22 January 2018.  On 12 February, China CDC confirmed that the case’s samples were positive for avian influenza A(H7N4), and the NHFPC confirmed the diagnosis on 13 February 2018.  The case had a history of exposure to live poultry before onset of symptoms.

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Keywords: WHO; Updates; China; Avian Influenza; H7N4; Human; Jiangsu.

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15 Feb 2018

Interim #Estimates of 2017–18 Seasonal #Influenza #Vaccine #Effectiveness — #USA, February 2018 (@CDCgov, abstract)


Title: Interim #Estimates of 2017–18 Seasonal #Influenza #Vaccine #Effectiveness — #USA, February 2018.

Subject: Human Influenza Viruses, vaccines effectiveness estimates.

Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.

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Interim Estimates of 2017–18 Seasonal Influenza Vaccine Effectiveness — United States, February 2018

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Weekly / February 16, 2018 / 67(6);180–185

Format: [ PDF [248K] ]

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Brendan Flannery, PhD1; Jessie R. Chung, MPH1; Edward A. Belongia, MD2; Huong Q. McLean, PhD2; Manjusha Gaglani, MBBS3; Kempapura Murthy, MPH3; Richard K. Zimmerman, MD4; Mary Patricia Nowalk, PhD4; Michael L. Jackson, PhD5; Lisa A. Jackson, MD5; Arnold S. Monto, MD6; Emily T. Martin, PhD6; Angie Foust, MS1; Wendy Sessions, MPH1; LaShondra Berman, MS1; John R. Barnes, PhD1; Sarah Spencer, PhD1; Alicia M. Fry, MD1


Summary

  • What is already known about this topic?
    • Effectiveness of seasonal influenza vaccine can vary by season and has generally been higher against influenza A(H1N1)pdm09 and B viruses than against A(H3N2) viruses.
  • What is added by this report?
    • So far this season, influenza A(H3N2) viruses have predominated, but other influenza viruses are also circulating. Based on data from 4,562 children and adults with acute respiratory illness enrolled during November 2, 2017–February 3, 2018, at five study sites with outpatient medical facilities in the United States, the overall estimated effectiveness of the 2017–18 seasonal influenza vaccine for preventing medically attended, laboratory-confirmed influenza virus infection was 36%.
  • What are the implications for public health practice?
    • CDC continues to monitor influenza vaccine effectiveness. Influenza vaccination is still recommended; vaccination reduces the risk for influenza illnesses and serious complications. Treatment with influenza antiviral medications, where appropriate, is especially important this season.


Abstract

In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months (1). During each influenza season since 2004–05, CDC has estimated the effectiveness of seasonal influenza vaccine to prevent laboratory-confirmed influenza associated with medically attended acute respiratory illness (ARI). This report uses data from 4,562 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness Network (U.S. Flu VE Network) during November 2, 2017–February 3, 2018. During this period, overall adjusted vaccine effectiveness (VE) against influenza A and influenza B virus infection associated with medically attended ARI was 36% (95% confidence interval [CI] = 27%–44%). Most (69%) influenza infections were caused by A(H3N2) viruses. VE was estimated to be 25% (CI = 13% to 36%) against illness caused by influenza A(H3N2) virus, 67% (CI = 54%–76%) against A(H1N1)pdm09 viruses, and 42% (CI = 25%–56%) against influenza B viruses. These early VE estimates underscore the need for ongoing influenza prevention and treatment measures. CDC continues to recommend influenza vaccination because the vaccine can still prevent some infections with currently circulating influenza viruses, which are expected to continue circulating for several weeks. Even with current vaccine effectiveness estimates, vaccination will still prevent influenza illness, including thousands of hospitalizations and deaths. Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated.

(…)

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Keywords: US CDC; USA; Updates; Seasonal Influenza; Vaccines.

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#Update: #Influenza #Activity — #USA, Oct. 1 ‘17–Feb. 3 ‘18 (@CDCgov, edited)


Title: #Update: #Influenza #Activity — #USA, Oct. 1 ‘17–Feb. 3 ‘18.

Subject: Human Influenza Viruses, A (H1, H3) & B subtypes, seasonal winter epidemic in the US, update.

Source: US Centers for Disease Control and Prevention (CDC), full page: (LINK). Edited.

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Update: Influenza Activity — United States, October 1, 2017–February 3, 2018

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Weekly / February 16, 2018 / 67(6);169–179

Format: [ PDF [352K] ]

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Alicia P. Budd, MPH1; David E. Wentworth, PhD1; Lenee Blanton, MPH1; Anwar Isa Abd Elal1; Noreen Alabi, MPH1; John Barnes, PhD1; Lynnette Brammer, MPH1; Erin Burns, MA1; Charisse N. Cummings, MPH1; Todd Davis, PhD1; Brendan Flannery, PhD1; Alicia M. Fry, MD1; Shikha Garg, MD1; Rebecca Garten, PhD1; Larisa Gubareva, PhD1; Yunho Jang, PhD1; Krista Kniss, MPH1; Natalie Kramer1; Stephen Lindstrom, PhD1; Desiree Mustaquim, MPH1; Alissa O’Halloran, MSPH1; Sonja J. Olsen, PhD1; Wendy Sessions, MPH1; Calli Taylor, MPH1; Xiyan Xu, MD1; Vivien G. Dugan, PhD1; Jacqueline Katz, PhD1; Daniel Jernigan, MD1



Summary

  • What is already known about this topic?
    • CDC collects, compiles, and analyzes data on influenza activity year-round in the United States. Timing of influenza activity and predominant circulating influenza viruses vary by season.
  • What is added by this report?
    • Influenza activity in the United States began to increase in early November 2017 and rose sharply from December through February 3, 2018.
    • Influenza A viruses have been most commonly identified, with influenza A(H3N2) viruses predominating, but influenza A(H1N1)pdm09 and influenza B viruses were also detected.
    • Influenza illness this season has been substantial, with some of the highest levels of influenza-like illness and hospitalization rates in recent years, and elevated activity occurring in most of the country simultaneously.
    • Elevated influenza activity is expected to continue for several more weeks.
  • What are the implications for public health practice?
    • With several more weeks of elevated influenza activity expected, the increasing proportion of influenza A(H1N1)pdm09 and influenza B viruses, and the potential to prevent significant illness through influenza vaccination, CDC continues to recommend influenza vaccination at this time.
    • In influenza seasons with increased severity, influenza antiviral medications are an increasingly important adjunct to vaccination in the treatment of influenza.
    • Early treatment with neuraminidase inhibitor antiviral medications is recommended for patients with severe, complicated, or progressive influenza illness and those at higher risk for influenza complications, including adults aged ≥65 years who develop influenza symptoms.

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Abstract

Influenza activity in the United States began to increase in early November 2017 and rose sharply from December through February 3, 2018; elevated influenza activity is expected to continue for several more weeks. Influenza A viruses have been most commonly identified, with influenza A(H3N2) viruses predominating, but influenza A(H1N1)pdm09 and influenza B viruses were also reported. This report summarizes U.S. influenza activity* during October 1, 2017–February 3, 2018, and updates the previous summary (1).


Viral Surveillance

U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System laboratories, which include both public health and clinical laboratories throughout the 50 U.S. states, Puerto Rico, and the District of Columbia, contribute to virologic surveillance for influenza. During October 1, 2017–February 3, 2018, clinical laboratories tested 666,493 specimens for influenza virus, 124,316 (18.7%) of which tested positive (Figure 1). During this period, the percentage of specimens testing positive for any influenza virus increased to 26.4% during the week ending January 13 and remained at approximately that level (26.3%–26.7%) through the week ending February 3, 2018. The percentage of specimens testing positive for influenza A viruses peaked at 21.8% during the week ending January 13; however, the percentage testing positive for influenza B viruses continued to increase through the week ending February 3, during which 8.1% of specimens tested were positive for influenza B. On a regional level, the percentage of specimens testing positive for any influenza virus has decreased for 2 or more consecutive weeks in U.S. Department of Health and Human Services (HHS) Regions§ 6, 7, 9, and 10 but has continued to increase or remain level in the remaining regions (Regions 1, 2, 3, 4, 5, and 8) through the week ending February 3.

Public health laboratories tested 51,014 specimens collected during October 1, 2017–February 3, 2018. Among these, 27,669 tested positive for influenza virus, including 23,257 (84.1%) for influenza A and 4,412 (15.9%) for influenza B viruses (Figure 2). Among the 22,810 seasonal influenza A viruses subtyped, 20,512 (89.9%) were influenza A(H3N2) viruses, and 2,298 (10.1%) were influenza A(H1N1)pdm09 viruses; influenza A(H3N2) viruses accounted for 74.1% of all influenza viruses reported. Influenza B virus lineage information was available for 3,319 (75.2%) influenza B viruses; 3,010 (90.7%) belonged to the B/Yamagata lineage and 309 (9.3%) to the B/Victoria lineage. Whereas influenza A(H3N2) viruses accounted for the majority of circulating viruses in all HHS regions, the proportion of subtyped influenza A viruses that were identified as A(H1N1)pdm09 regionally ranged from 5% (Region 7) to 21% (Region 6), and the proportion of circulating viruses reported to be influenza B ranged from 9% (Region 5) to 28% (Region 10).

Data on age were available for 23,578 influenza-positive patients whose specimens were tested by public health laboratories. Overall, 1,863 (7.9%) were aged 0–4 years, 5,208 (22.1%) were aged 5–24 years, 7,576 (32.1%) were aged 25–64 years, and 8,931 (37.9%) were aged ≥65 years. Influenza A(H3N2) viruses were predominant among all age groups, accounting for 68%–72% of viruses identified among persons aged 0–4 years, 5–24 years, and 25–64 years and 84% of viruses reported among persons aged ≥65 years. The largest proportion of reported influenza B virus infections occurred in persons aged 5–24 years; influenza B viruses accounted for 21.9% of the viruses reported in this age group.


Novel Influenza A Viruses

Six human infections with novel influenza A viruses were reported to CDC during October 1, 2017–February 3, 2018. All of these were variant virus infections (human infections with influenza viruses that normally circulate in swine). Five of these infections were previously described (1). The sixth human infection with a novel influenza A virus was caused by an influenza A(H3N2) variant (A[H3N2]v) virus in Iowa in an adult patient with onset of respiratory symptoms in November 2017. This patient reported exposure to swine during the week preceding illness onset, was not hospitalized, and has fully recovered. No sustained human-to-human transmission was identified.

The A(H3N2)v virus detected in Iowa had a hemagglutinin (HA) gene segment derived from a seasonal human H3N2 virus that was likely introduced into swine by reverse zoonosis (i.e., human infection of swine) in 2010. This virus was closely related to H3N2 viruses known to circulate in the U.S. swine population (2), as well as to variant virus infections detected in Delaware, Maryland, Michigan, Nebraska, North Dakota, Ohio, and Pennsylvania during May–December 2017 (1,2).


Antigenic and Genetic Characterization of Influenza Viruses

In the United States, public health laboratories participating in influenza surveillance as WHO collaborating laboratories are asked to submit a subset of influenza-positive respiratory specimens to CDC for virus characterization according to specific guidelines.** CDC characterizes influenza viruses through one or more laboratory tests, including genomic sequencing, antigenic characterization by hemagglutination inhibition (HI), or neutralization assays. Circulating viruses that have been isolated and propagated in mammalian cell culture are evaluated for antigenic similarity to cell culture–propagated reference viruses representing the recommended vaccine components of the Northern Hemisphere 2017–18 vaccine.†† This process is used to assess whether antigenic drift from the vaccine reference viruses has occurred.

All influenza-positive specimens submitted for surveillance and received by CDC are sequenced by next generation sequencing (NGS), using previously described genomic enrichment practices (3,4) adapted by CDC. NGS uses advanced molecular detection to identify gene sequences from each virus in a sample and thus reveals the genetic variations among many different influenza virus particles in a single sample; these methods also reveal the entire coding region of the genomes. The genomic data are analyzed to determine the genetic identity of circulating viruses and submitted to public databases (GenBank or GISAID EpiFlu). Data obtained from antigenic characterization are important in the assessment of the similarity between reference vaccine viruses and circulating viruses. In vitro antigenic characterization data generated through HI assays or virus neutralization assays are used to assess whether genetic changes in circulating viruses affect antigenicity, which might subsequently affect vaccine effectiveness.

Since the 2014–15 season, many influenza A(H3N2) viruses propagated in tissue culture have lacked sufficient hemagglutination titers for antigenic characterization using HI assays. Therefore, a subset of influenza A(H3N2) viruses are selected for antigenic characterization using the virus neutralization focus reduction assay to assess the ability of various antisera to neutralize infectivity of the test viruses. CDC has antigenically or genetically characterized 1,365 influenza viruses collected and submitted by laboratories in the United States since October 1, 2017, including 276 influenza A(H1N1)pdm09 viruses, 695 influenza A(H3N2) viruses, and 394 influenza B viruses.

Phylogenetic analysis of the HA gene segments from 276 A(H1N1)pdm09 viruses collected since October 1, 2017, showed that all belonged to subclade 6B.1 (Figure 3). Of the 205 A(H1N1)pdm09 viruses analyzed using HI assays with ferret antisera, 100% were antigenically similar to the cell culture–propagated 6B.1 virus A/Michigan/45/2015, the reference virus representing the A(H1N1)pdm09 vaccine virus for the 2017–18 Northern Hemisphere influenza season.

A total of 695 influenza A(H3N2) viruses were sequenced, and phylogenetic analysis of the HA gene segments illustrated that multiple clades/subclades were cocirculating (Figure 3). Circulating viruses possessed HA gene segments that belonged to clade 3C.2a, subclade 3C.2a1, or clade 3C.3a with 3C.2a predominating (Figure 3). Among the 262 representative A(H3N2) viruses that were antigenically characterized, 257 (98.1%) were well-inhibited (reacting at titers that were within fourfold of the homologous virus titer) by ferret antisera raised against A/Michigan/15/2014 (3C.2a), a cell-propagated A/Hong Kong/4801/2014–like reference virus representing the A(H3N2) component of the 2017–18 Northern Hemisphere influenza vaccines. Although considerable genetic diversity (i.e., multiple cocirculating genetic subgroups) has been observed among the HA gene segments of H3N2 viruses, there have been very few (1.9%) H3N2 viruses showing antigenic drift in the HA this season. In contrast to the 98.1% of viruses that were well-inhibited by ferret antisera raised against cell-propagated A/Michigan/15/2014, only 64.4% of viruses tested were well-inhibited by ferret antiserum raised against the egg-propagated A/Hong Kong/4801/2014 reference virus representing the A(H3N2) vaccine component. This is likely because of egg-adaptive amino acid changes in the HA of the egg-propagated virus. The majority of influenza vaccines used in the United States are produced with egg-based manufacturing.

Among influenza B viruses, phylogenetic analysis of 338 influenza B/Yamagata-lineage viruses showed that all the HA gene segments belonged to clade Y3 (Figure 3). A total of 202 B/Yamagata lineage viruses were antigenically characterized, and all were antigenically similar to cell culture–propagated B/Phuket/3073/2013, the reference virus representing the B/Yamagata-lineage component of quadrivalent vaccines for the 2017–18 Northern Hemisphere influenza season.

Among the 56 influenza B/Victoria-lineage viruses sequenced and phylogenetically analyzed, the HA gene segment of all viruses belonged to genetic clade V1A, the same genetic clade as the vaccine reference virus, B/Brisbane/60/2008. However, the HA gene segment of 28 viruses (50.0%) had a six-nucleotide deletion (encoding amino acids 162 and 163), and viruses like these, abbreviated as V1A-2Del, were previously reported (5). Of the 29 influenza B/Victoria viruses that were antigenically characterized, 17 (58.6%) were antigenically similar to cell culture–propagated B/Brisbane/60/2008, the reference virus representing the B/Victoria lineage component of 2017–18 Northern Hemisphere vaccines. All 12 B/Victoria viruses that were poorly inhibited (reacting at titers that were eightfold or more reduced compared with the homologous virus titer) by antisera raised to cell culture–propagated B/Brisbane/60/2008 were V1A-2Del viruses.


Antiviral Resistance of Influenza Viruses

The WHO Collaborating Center for Surveillance, Epidemiology, and Control of Influenza at CDC tested 1,666 influenza virus specimens collected since October 1, 2017, from the United States for resistance to the influenza neuraminidase inhibitor antiviral medications currently approved for use against seasonal influenza: oseltamivir, peramivir, and zanamivir.

Among 376 influenza A(H1N1)pdm09 viruses tested for oseltamivir and peramivir susceptibility, four (1.1%) were resistant to both drugs and contain H275Y, the established NA marker of resistance to oseltamivir.

A total of 265 of those influenza A (H1N1)pdm09 viruses also were tested for zanamivir susceptibility, and all were susceptible.

All 903 influenza A(H3N2) viruses tested for oseltamivir and zanamivir susceptibility were susceptible to both of these medications.

A total of 638 of those A(H3N2) viruses also were tested for peramivir susceptibility, and all were susceptible.

All 387 influenza B viruses tested for oseltamivir, peramivir, and zanamivir susceptibility were sensitive to all three recommended antiviral medications.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and A(H3N2) viruses. Adamantane drugs are not recommended for use against influenza at this time.


Outpatient Illness Surveillance

During October 1, 2017–February 3, 2018, the weekly percentage of outpatient visits to heath care providers participating in the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) for influenza-like illness§§ (ILI) ranged from 1.3% to 7.7% (Figure 4). The percentage first exceeded the national baseline¶¶ level of 2.2% during the week ending November 25, 2017 (week 47) and has remained at or above the baseline for 11 consecutive weeks so far this season. From the week ending December 23, 2017, (week 51), through the week ending February 3, 2018, (week 5), all 10 HHS regions reported a percentage of outpatient visits for ILI at or above their region-specific baseline levels. ILINet data are also used to produce a weekly jurisdiction-level measure of ILI activity*** ranging from minimal to high. Since the week ending December 30, 2017, more than half of the 53 jurisdictions (50 states, District of Columbia, New York City, and Puerto Rico) experienced high ILI activity each week, with the largest number of jurisdictions (46, 87%) experiencing high ILI activity during the week ending February 3, 2018. During the past five seasons, the largest number of jurisdictions experiencing high ILI activity in a single week ranged from 16 (30%) during the 2015–16 season to 31 (58%) during the 2012–13 and 2014–15 seasons.


Geographic Spread of Influenza Activity

Influenza activity levels reported by state and territorial epidemiologists indicate the geographic spread of influenza activity††† within their jurisdiction (50 states, District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands). During the 2017–18 season, the peak number of jurisdictions reporting widespread activity in a single week was 50 (93%); this occurred for the 3 consecutive weeks (weeks ending January 6, January 13, and January 20, 2018). During the previous five influenza seasons, the peak number of jurisdictions reporting widespread activity in a single week during each season has ranged from 41 (76%) in the 2015–16 season to 48 (89%) during the 2012–13 season.


Influenza-Associated Hospitalizations

CDC monitors hospitalizations associated with laboratory-confirmed influenza infections in adults and children through the Influenza Hospitalization Surveillance Network (FluSurv-NET),§§§ which covers approximately 27 million persons (9% of the U.S. population). During October 1, 2017–February 3, 2018, 17,101 laboratory-confirmed influenza-related hospitalizations were reported, representing a cumulative incidence among all age groups of 59.9 per 100,000 population. The hospitalization rate was highest among persons aged ≥65 years, who accounted for 59% of reported influenza-associated hospitalizations.

The cumulative influenza hospitalization rates per 100,000 population during October 1, 2017–February 3, 2018, for persons aged 0–4 years, 5–17 years, 18–49 years, 50–64 years, and ≥65 years were 40.0, 10.3, 18.3, 63.1, and 263.6, respectively. Among all hospitalizations, 14,770 (86.4%) were associated with influenza A virus infection, 2,251 (13.2%) with influenza B virus infection, 43 (0.3%) with influenza A virus and influenza B virus coinfection, and 37 (0.2%) with influenza virus infection for which the type was not determined. Among the 3,841 patients for whom influenza A subtype information was available, 3,308 (86.1%) were infected with influenza A(H3N2) viruses and 533 (13.9%) with influenza A(H1N1)pdm09 viruses. Among hospitalized persons aged 0–64 years for whom influenza A subtype information was available, 23.6% were infected with influenza A(H1N1)pdm09 viruses, compared with only 7.0% of those aged ≥65 years.

Information on underlying medical conditions was available for 2,147 (12.6%) hospitalized patients with laboratory-confirmed influenza as of February 3, 2018. Among 1,955 hospitalized adults with information on underlying medical condition available, 1,325 (67.8%) had at least one underlying medical condition that placed them at high risk for influenza-associated complications. The most commonly reported medical conditions were cardiovascular disease (35.5%), metabolic disorders (33.0%), obesity (25.2%), and chronic lung disease (23.6%). Among 192 hospitalized children with information on underlying medical conditions available, 97 (50.5%) had at least one underlying medical condition, the most commonly reported being asthma (22.8%), neurologic disorders (14.4%), and obesity (10.1%). Among 151 hospitalized women aged 15–44 years with information on pregnancy status, 36 (23.8%) were pregnant.


Pneumonia and Influenza–Associated Mortality

CDC tracks pneumonia and influenza (P&I)–attributed deaths through the National Center for Health Statistics (NCHS) Mortality Reporting System. The percentages of deaths attributed to P&I are released 2 weeks after the week of death to allow for collection of sufficient data to produce a stable P&I mortality percentage. From October 1, 2017, to January 20, 2018, the weekly percentage of deaths attributed to P&I has ranged from 5.8% to 10.1% and has exceeded the epidemic threshold¶¶¶ for 5 consecutive weeks. P&I percentages for recent weeks are likely to be artificially low because of a delay in manual coding for deaths occurring in 2018, and the percentage of deaths caused by P&I is higher among manually coded death certificates than among machine-coded death certificates. The percentage of deaths caused by P&I will likely increase as more data become available.


Influenza-Associated Pediatric Mortality

As of February 3, 2018, (week 5), 63 laboratory-confirmed influenza-associated pediatric deaths occurring during the 2017–18 season were reported to CDC. Fifteen deaths were associated with an influenza A(H1N1)pdm09 virus infection, 16 were associated with an influenza A(H3N2) virus infection, 14 were associated with infection with an influenza A virus for which no subtyping was performed, and 18 were associated with an influenza B virus infection. Since influenza-associated pediatric mortality became a nationally notifiable condition in 2004, the number of influenza-associated pediatric deaths per season has ranged from 37 to 171, excluding the 2009 pandemic, when there were 358 pediatric deaths during April 15, 2009–October 2, 2010. The mean age of the reported pediatric deaths reported this season was 7.4 years (range 2 months to 17 years); 40 (63%) of the children died after admission to the hospital. Among the 56 children with a known medical history, 30 (54%) had at least one underlying medical condition recognized by ACIP as placing them at increased risk for influenza-related complications. Among the 54 children who were eligible for influenza vaccination (≥6 months of age at date of onset) and for whom vaccination status was known, 14 (26%) had received at least 1 dose of influenza vaccine before onset of illness (13 were fully vaccinated according to 2017 ACIP recommendations, and one had received 1 of 2 recommended doses).


Discussion

Influenza illness this season has been substantial, with some of the highest levels of ILI and hospitalization rates in recent years and elevated activity occurring in most of the country simultaneously. Influenza A(H3N2) is the predominant influenza virus circulating this season. Past A(H3N2) virus–predominant seasons such as the 2012–13 and 2014–15 seasons had increased numbers of influenza related infections, hospitalizations, and deaths compared with A(H1N1)pdm09 virus-predominant seasons, and the 2017–18 season is on track to reach or exceed estimates from those seasons.

The percentage of outpatient visits to doctors’ offices, urgent care centers, and emergency departments that were for ILI rose sharply in late 2017 to 7.7% in early February. This is the highest level of ILI activity since the pandemic in 2009 which peaked at 7.7%. During the previous five influenza seasons, the peak weekly percentages of outpatient visits for ILI ranged from 3.6% to 6.1% and remained above baseline levels for an average of 16 weeks (range = 11–20 weeks). The weekly percentage of outpatient visits for ILI this season has been above the national baseline for 11 weeks, suggesting that influenza activity is likely to continue for several more weeks.

The cumulative hospitalization rate attributed to laboratory-confirmed influenza for the week ending February 3, 2018, (59.9/100,000) exceeded the rate for the same week in 2014–15 (50.9/100,000), an A(H3N2) virus–predominant season categorized as high severity, and is the highest rate observed for this week since the system expanded to include adults during the 2005–06 season. Persons aged ≥65 years account for the majority of cases (59%); however, hospitalization rates for all adult age groups (18–49 years, 50–64 years, and ≥65 years) are higher than those observed during the same week in 2014–15. These hospitalization rates are not adjusted for testing practices, which can vary from season to season; therefore, caution should be used when comparing hospitalization rates across seasons.

P&I-related deaths also rose sharply in the first weeks of 2018, accounting for 10.1% of all deaths recorded on death certificates during the week ending January 20, 2018. It is anticipated that the number of P&I-related deaths will continue to increase for several more weeks and might exceed the peaks in past recent A(H3N2) virus–predominant seasons (11.1% in 2012–13 and 10.8% in 2014–15). Through the week ending January 20, P&I-related mortality has been above the epidemic threshold for 5 consecutive weeks. During the past five seasons, the average number of weeks this indicator was above threshold was 11 (range of 7–15 weeks).

Sixty-three laboratory-confirmed influenza-associated pediatric deaths have been reported to CDC as of February 3, 2018; 46% of these children were otherwise healthy. Among those children who were eligible for vaccination and for whom vaccination status was known, only 14 (26%) had received any influenza vaccine this season before the onset of illness (13 were fully vaccinated, and one had received 1 of 2 recommended doses). In a previous analysis of pediatric deaths with a similar percentage of eligible children vaccinated (26%), influenza vaccination was associated with a 65% reduction in risk for laboratory-confirmed influenza-associated pediatric death (6).

With several more weeks of elevated influenza activity anticipated this season, it is too early to assess overall severity of the season. However, estimates of the burden of influenza disease from the 2012–13 and 2014–15 seasons provide an indication of what might be anticipated for the 2017–18 season. CDC estimated that during each of those seasons influenza accounted for as many as 35.6 million illnesses, 16.6 million medically attended visits, 710,000 hospitalizations and 56,000 deaths.****

Interim estimates of 2017–18 season vaccine effectiveness (VE) against influenza A and influenza B virus infection associated with medically attended acute respiratory illness in the United States was 36% (95% confidence interval [CI] = 27%–44%). VE was estimated to be 25% (95% CI = 13%–36%) against illness caused by influenza A(H3N2) virus, 67% (95% CI = 54%–76%) against A(H1N1)pdm09 virus and 42% (95% CI = 25%–56%) against influenza B virus (7). During the 2014–15 season, an A(H3N2) virus–predominant season with high severity and low vaccine effectiveness, influenza vaccine was estimated to have prevented millions of illnesses and tens of thousands of influenza-related hospitalizations. With several more weeks of elevated influenza activity expected, an increasing proportion of influenza A(H1N1)pdm09 and influenza B viruses, and the potential to prevent significant illness through influenza vaccination, CDC continues to recommend influenza vaccination at this time.

During influenza seasons with increased severity, influenza antiviral medications are an increasingly important adjunct to vaccination in the treatment of influenza. Three neuraminidase inhibitor antiviral medications are approved and recommended for use in the United States during the 2017–18 influenza season: oral oseltamivir (available as a generic or under the trade name Tamiflu [Genentech, South San Francisco, California]), inhaled zanamivir (Relenza [GlaxoSmithKline, London, England]) and intravenous peramivir (Rapivab [Seqirus, Summit, New Jersey]). Resistance to these medications is not a concern at this time because only four influenza viruses (all A[H1N1]pdm09 viruses) collected in the United States since October 1, 2017, were identified as not being sensitive to oseltamivir and peramivir.

Treatment with neuraminidase inhibitors has been shown to reduce illness duration and severe outcomes of influenza based on evidence from randomized controlled trials, meta-analyses of randomized controlled trials, and observational studies (8,9). Treatment with influenza antiviral medications initiated as close to the onset of illness as possible is recommended for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are not hospitalized but who are at high risk for developing serious influenza complications. Treatment should not be delayed while waiting for results of testing or even if rapid antigen-detection influenza diagnostic test results are negative. Clinical benefit of antiviral treatment is greatest when treatment begins within 48 hours after symptom onset; however, antiviral treatment initiated later than 48 hours after illness onset can still be beneficial for some patients (8,10). A CDC health advisory released on December 27, 2017, regarding treatment with antiviral medications is available at https://emergency.cdc.gov/han/han00409.asp.

Influenza surveillance reports for the United States are posted online weekly (https://www.cdc.gov/flu/weekly). Additional information regarding influenza viruses, influenza surveillance, influenza vaccine, influenza antiviral medications, and novel influenza A infections in humans is available online (https://www.cdc.gov/flu).


Acknowledgments

State, county, city, and territorial health departments and public health laboratories; U.S. World Health Organization collaborating laboratories; National Respiratory and Enteric Virus Surveillance System laboratories; U.S. Outpatient Influenza-Like Illness Surveillance Network sites; the National Center for Health Statistics, CDC; the World Health Organization, FluNet; Angie Foust, Elisabeth Blanchard, Priya Budhathoki, Thomas Rowe, Lizheng Guo, LaShondra Berman, Shannon Emery, Janná Murray, Ji Liu, Bo Shu, Brian Lynch, Ewelina Lyszkowicz, Shoshona Le, Malania Wilson, Juliana DaSilva, Alma Trujillo, Thomas Stark, Samuel Shepard, Sujatha Seenu, Ha Nguyen, Vasiliy Mishin, Juan De la Cruz, Roxana Cintron, Norman Hassell, Influenza Division, National Center for Immunization and Respiratory Diseases, CDC.


Conflict of Interest

No conflicts of interest were reported.

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Corresponding author: Alicia P. Budd, acp4@cdc.gov, 404-639-3747.

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1Influenza Division, National Center for Immunization and Respiratory Diseases, CDC.

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* The CDC influenza surveillance system collects five categories of information from eight data sources: 1) viral surveillance (U.S. World Health Organization collaborating laboratories, the National Respiratory and Enteric Virus Surveillance System, and novel influenza A virus case reporting); 2) outpatient illness surveillance (U.S. Outpatient Influenza-Like Illness Surveillance Network); 3) mortality (National Center for Health Statistics Mortality Surveillance System and influenza-associated pediatric mortality reports); 4) hospitalizations (FluSurv-NET, which includes the Emerging Infections Program and surveillance in three additional states); and 5) summary of the geographic spread of influenza (state and territorial epidemiologist reports). https://www.cdc.gov/flu/weekly/fluactivitysurv.htm.

Data as of February 9, 2018.

§ The 10 regions include the following jurisdictions. Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; Region 2: New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands; Region 3: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; Region 7: Iowa, Kansas, Missouri, and Nebraska; Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; Region 9: Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau; Region 10: Alaska, Idaho, Oregon, and Washington.

Influenza viruses that circulate in swine are called swine influenza viruses when isolated from swine but are called variant influenza viruses when isolated from humans. Seasonal influenza viruses that circulate worldwide in the human population have important antigenic and genetic differences from influenza viruses circulating in swine.

** Association of Public Health Laboratories. Influenza Virologic Surveillance Right Size Roadmap. https://www.aphl.org/AboutAPHL/publications/Documents/ID_July2013_Influenza-Virologic-Surveillance-Right-Size-Roadmap.pdf.

†† 2017–2018 U.S. trivalent influenza vaccines contain an A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)–like virus and a B/Brisbane/60/2008–like virus (Victoria lineage). Quadrivalent vaccines will include an additional vaccine virus strain, a B/Phuket/3073/2013–like virus (Yamagata lineage).

§§ Defined as a fever (temperature ≥100°F [≥37.8°C], oral or equivalent) and cough or sore throat, without a known cause other than influenza.

¶¶ The national and regional baselines are the mean percentage of visits for ILI during noninfluenza weeks for the previous three seasons plus two standard deviations. Noninfluenza weeks are defined as periods of ≥2 consecutive weeks in which each week accounted for <2% of the season’s total number of specimens that tested positive for influenza in public health laboratories. National and regional percentages of patient visits for ILI are weighted based on state population. Use of the national baseline for regional data is not appropriate.

*** Activity levels are based on the percentage of outpatient visits in a jurisdiction attributed to ILI and are compared with the average percentage of ILI visits that occur during weeks with little or no influenza virus circulation. Activity levels range from minimal, corresponding to ILI activity from outpatient clinics at or below the average, to high, corresponding to ILI activity from outpatient clinics much higher than the average. Because the clinical definition of ILI is nonspecific, not all ILI is caused by influenza; however, when combined with laboratory data, the information on ILI activity provides a clearer picture of influenza activity in the United States.

††† Levels of activity are 1) no activity; 2) sporadic: isolated laboratory-confirmed influenza cases or a laboratory-confirmed outbreak in one institution, with no increase in activity; 3) local: increased ILI or two or more institutional outbreaks (ILI or laboratory-confirmed influenza) in one region of the state, with recent laboratory evidence of influenza in that region; virus activity no greater than sporadic in other regions; 4) regional: increased ILI activity or institutional outbreaks (ILI or laboratory-confirmed influenza) in two or more outbreaks but less than half of the regions in the state with recent laboratory evidence of influenza in those regions; and 5) widespread: increased ILI activity or institutional outbreaks (ILI or laboratory-confirmed influenza) in at least half the regions in the state, with recent laboratory evidence of influenza in the state.

§§§ FluSurv-NET conducts population-based surveillance for laboratory-confirmed, influenza-associated hospitalizations in children and adolescents aged <18 years (since the 2003–04 influenza season) and adults aged ≥18 years (since the 2005–06 influenza season). The FluSurv-NET covers approximately 70 counties in the 10 Emerging Infections Program states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee) and additional Influenza Hospitalization Surveillance Project (IHSP) states. IHSP began during the 2009–10 season to enhance surveillance during the 2009 H1N1 pandemic. IHSP sites included Idaho, Iowa, Michigan, Oklahoma, and South Dakota during the 2009–10 season; Idaho, Michigan, Ohio, Oklahoma, Rhode Island, and Utah during the 2010–11 season; Michigan, Ohio, Rhode Island, and Utah during the 2011–12 season; Iowa, Michigan, Ohio, Rhode Island, and Utah during the 2012–13 season; and Michigan, Ohio, and Utah during the 2013–14, 2014–15, 2015–16, 2016–17, and 2017–18 seasons. Cumulative unadjusted incidence rates are calculated using CDC’s National Center for Health Statistics population estimates for the counties included in the surveillance catchment area. Laboratory confirmation is dependent on clinician-ordered influenza testing, and testing for influenza often is underused because of the poor reliability of rapid test results and greater reliance on clinical diagnosis for influenza. Therefore, cases identified as part of influenza hospitalization surveillance likely are an underestimation of the actual number of persons hospitalized with influenza.

¶¶¶ The seasonal baseline proportion of P&I deaths 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 were reported by the National Center for Health Statistics Mortality Surveillance System during the preceding 5 years. The epidemic threshold is set at 1.645 standard deviations above the seasonal baseline.

**** Estimates of influenza disease burden and burden of disease averted by influenza vaccination can be found at https://www.cdc.gov/flu/about/disease/burden.htm.


References

  1. Dugan VG, Blanton L, Elal AIA, et al. Update: influenza activity—United States, October 1–November 25, 2017. MMWR Morb Mortal Wkly Rep 2017;66:1318–26. CrossRef PubMed
  2. Bowman AS, Walia RR, Nolting JM, et al. Influenza A/H3N2 virus in swine at agricultural fairs and transmission to humans, Michigan and Ohio, USA, 2016. Emerg Infect Dis 2017;23:1551–5. CrossRef PubMed
  3. Zhou B, Wentworth DE. Influenza A virus molecular virology techniques. Methods Mol Biol 2012;865:175–92. CrossRef PubMed
  4. Zhou B, Lin X, Wang W, et al. Universal influenza B virus genomic amplification facilitates sequencing, diagnostics, and reverse genetics. J Clin Microbiol 2014;52:1330–7. CrossRef PubMed
  5. Blanton L, Wentworth DE, Alabi N, et al. Update: influenza activity—United States and worldwide, May 21–September 23, 2017. MMWR Morb Mortal Wkly Rep 2017;66:1043–51. CrossRef PubMed
  6. Flannery B, Reynolds S, Blanton L, et al. Influenza vaccine effectiveness against pediatric deaths: 2010–2014. Pediatrics 2017;139(5)e:20164244. http://pediatrics.aappublications.org/content/139/5/e20164244
  7. Flannery B, Chung JR, Belongia EA, et al. Interim estimates of 2017–18 seasonal influenza vaccine effectiveness—United States, February 2018. Morb Mortal Wkly Rep 2018;67:180–5.
  8. Doll MK, Winters N, Boikos C, Kraicer-Melamed H, Gore G, Quach C. Safety and effectiveness of neuraminidase inhibitors for influenza treatment, prophylaxis, and outbreak control: a systematic review of systematic reviews and/or meta-analyses. J Antimicrob Chemother 2017;72:2990–3007. CrossRef PubMed
  9. Malosh RE, Martin ET, Heikkinen T, Brooks WA, Whitley RJ, Monto AS. Efficacy and safety of oseltamivir in children: systematic review and individual patient data meta-analysis of randomized controlled trials. Clin Infect Dis 2017. Epub November 23, 2017. CrossRef PubMed
  10. Fry AM, Goswami D, Nahar K, et al. Efficacy of oseltamivir treatment started within 5 days of symptom onset to reduce influenza illness duration and virus shedding in an urban setting in Bangladesh: a randomised placebo-controlled trial. Lancet Infect Dis 2014;14:109–18. CrossRef PubMed

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Suggested citation for this article: Budd AP, Wentworth DE, Blanton L, et al. Update: Influenza Activity — United States, October 1, 2017–February 3, 2018. MMWR Morb Mortal Wkly Rep 2018;67:169–179. DOI: http://dx.doi.org/10.15585/mmwr.mm6706a1.

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Keywords: US CDC; USA; Updates; Seasonal Influenza.

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#Cholera #Outbreak in #Yemen – 15 February 2018 #Update (@WHO EMRO, edited)


Title: #Cholera #Outbreak in #Yemen – 15 February 2018 #Update.

Subject: Acute Watery Diarrhea and Cholera Outbreak in Yemen, current situation.

Source: World Health Organization (WHO), Office for the Eastern Mediterranean Region, full page: (LINK).

Code: [     ]

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Outbreak update – cholera in Yemen, 15 February 2018

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15 February 2018

The Ministry of Public Health and Population of Yemen has recorded 3633 suspected cases of cholera, including 1 associated death in the country for week 5 (29 January – 4 February). The cumulative total of suspected cholera cases stands at 1 055 788 suspected cholera cases and 2255 associated deaths (case-fatality rate 0.21%) since April 2017.

The number of cases has been declining for the past 21 consecutive weeks. The proportion of severe cases now represents only 16.2% of suspected cases. Out of 305 districts, 118 have not reported new cases for the last three consecutive weeks. The five governorates with the highest cumulative attack rates are Amran, Al Mahwit, Al Dhale’e, Hajjah and Sana’a.

WHO, Health cluster and WASH partners continue to support the Ministry in responding and containing the outbreak through technical and logistic support to improve the response efforts at the national and local levels. This includes training the health workforce in case management and rapid response; supporting diarrhoea treatment centres and oral rehydration points; deploying rapid response teams; ensuring availability of safe water; and sensitizing and mobilizing the community for early reporting of cases to the health facilities.

The support provided for laboratories in sampling and diagnostics ability has greatly improved early laboratory detection and quick sharing of results. Diagnostic culture tests conducted in the labs confirmed cholera for 1102 of 2723 samples. This is in addition to 28 999 rapid diagnostics tests (RDT) conducted in the community to confirm presence of cholera.

Cholera is endemic in Yemen. However, the country has experienced a surge in cholera cases since April 2017. Ongoing conflict, destroyed health, water and sanitation infrastructure and malnutrition have caused the people to be more vulnerable to various epidemic-prone diseases, including cholera.

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Keywords: WHO; Updates; Cholera; Yemen.

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Highly pathogenic #avian #influenza #H5N6, #UK [infected #wildbirds] (#OIE, Feb. 15 ‘18)


Title: Highly pathogenic #avian #influenza #H5N6, #UK [infected #wildbirds].

Subject: Avian Influenza, H5N6 subtype, wild birds epizootics in UK (England).

Source: OIE, full page: (LINK).

Code: [     ]

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Highly pathogenic influenza A viruses (infection with) (non-poultry including wild birds) H5N6, United Kingdom

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Information received on 14/02/2018 from Dr Nigel Gibbens, Chief Veterinary Officer, Department for Environment, Food and Rural Affairs, Department for Environment, Food and Rural Affairs, LONDON, United Kingdom

  • Summary
    • Report type    Follow-up report No. 6
    • Date of start of the event    09/01/2018
    • Date of confirmation of the event    09/01/2018
    • Report date    14/02/2018
    • Date submitted to OIE    14/02/2018
    • Reason for notification    New strain of a listed disease in the country
    • Causal agent    Highly pathogenic influenza A virus
    • Serotype    H5N6
    • Nature of diagnosis    Clinical, Necropsy
    • This event pertains to    a defined zone within the country
  • New outbreaks (1)
    • Outbreak 1 (WB AIV 2018/12)    - Oxfordshire, ENGLAND
      • Date of start of the outbreak    14/02/2018
      • Outbreak status    Continuing (or date resolved not provided)
      • Epidemiological unit    Natural park
      • Affected animals: Species    - Susceptible    - Cases    - Deaths    - Killed and disposed of – Slaughtered
        • Mute Swan:Cygnus olor(Anatidae)   - … – 1    - 1    - 0    - 0
          • Affected population:    One mute swan (Cygnus olor) found dead tested positive for H5N6.
  • Summary of outbreaks   
    • Total outbreaks: 1
      • Total animals affected: Species    - Susceptible    - Cases    - Deaths    - Killed and disposed of – Slaughtered
        • Mute Swan:Cygnus olor(Anatidae)  - … – 1    - 1    - 0    - 0
      • Outbreak statistics: Species    - Apparent morbidity rate    - Apparent mortality rate    - Apparent case fatality rate    - Proportion susceptible animals lost*
        • Mute Swan:Cygnus olor(Anatidae)    - **    - **    - 100.00%    - **
          • *Removed from the susceptible population through death, destruction and/or slaughter
          • **Not calculated because of missing information
  • Epidemiology
    • Source of the outbreak(s) or origin of infection   
      • Contact with wild species
  • Epidemiological comments   
    • The virus is a reassortant between H5N8 HPAI circulating in Europe and a European N6.

(...)

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Keywords: OIE; Updates; Avian Influenza; H5N6 ; Wild Birds; UK.

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#Statement of the 16th #IHR EC Regarding the #International #Spread of #Poliovirus (@WHO, Feb. 15 ‘18)


Title: #Statement of the 16th #IHR EC Regarding the #International #Spread of #Poliovirus.

Subject: Poliovirus (wild and vaccine-derived) circulation, International Health Regulations (IHR) Emergency Committee Meeting conclusions.

Source: World Health Organization (WHO), full page: (LINK).

Code: [     ]

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Statement of the Sixteenth IHR Emergency Committee Regarding the International Spread of Poliovirus

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WHO statement / 14 February 2018

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The sixteenth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director General on 7 February 2018 at WHO headquarters with members, advisers and invited member states attending via teleconference.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties presented an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 14 November 2017: Afghanistan, Democratic Republic of Congo (DR Congo), Nigeria, Pakistan and Syrian Arab Republic.


Wild polio

Overall the Committee was encouraged by continued progress in WPV1 eradication, with the number of cases globally falling to an all-time low in 2017. In addition, there has been no international spread of WPV since the fifteenth meeting in November 2017.

The Committee commended the continued high level commitment seen in both Afghanistan and Pakistan, and the high degree of cooperation and coordination, particularly targeting the high risk mobile populations that cross the international border, such as nomadic groups, local populations straddling the border, seasonal migrant workers and their families, repatriating refugees (official and informal), and guest children (children staying with relatives across the border). Stopping transmission in these populations remains a major challenge that cannot be under-estimated, underlining the critical continuing need for cross border activities in surveillance and vaccination.

The Committee commended the achievements in Pakistan that have resulted in the number of cases falling to just eight cases in 2017 and no cases so far in 2018; these achievements included the improved accessibility, improved communication to reduce missed children and better quality supplementary immunization activities (SIA). However, environmental surveillance continues to detect WPV1 transmission in many high risk areas of the country, with the highest rates of positive samples in Karachi, Peshawar and the Quetta Block. Orphan viruses (viruses that are not closely related to any other virus based on genetic analysis) were detected in Karachi, Kila Abdullah, Pishin and Punjab, indicating missed transmission and gaps in surveillance. The Committee was very saddened to learn of the murder of two front line polio workers in Quetta, and acknowledged the extraordinary commitment of the Pakistan program to carry on with eradication activities.

The Committee was concerned by the stagnation in progress in Afghanistan and the ongoing risks to eradication posed by the number of inaccessible and missed children, particularly in the southern region, resulting in fourteen cases in 2017, and already three cases in 2018. While inaccessibility can fluctuate over time, approximately 23,000 children are chronically unreached by the polio program. The current increase in violence and insecurity in parts of the country with consequent impact on all international program operations was of grave concern.

The Committee commended the innovations that continue to be made in Nigeria to reach children in Borno. While the number of inaccessible settlements has fallen, there still remains a substantial population in Borno state that is totally inaccessible, including around 160,000 children aged under five. While certain cross border activities are being undertaken, such as international synchronization of vaccination campaigns, these efforts appeared to be insufficient to ensure no poliovirus still circulating undetected is exported to neighboring Lake Chad basin countries. There also seemed to be signs of decreasing political commitment and increasing fatigue in fighting polio; the Federal Government only released 2017 funding for polio in early 2018, the Presidential Task Team had not met regularly, and the Nigeria Governors’ Forum is no longer actively involved in the polio programme. The Committee also noted that routine immunization coverage is low, particularly in high risk areas of northern Nigeria. The country however has declared routine immunization a national public health emergency and is actively planning for Gavi transition. Although it is over 16 months since the last detection of WPV1, the recent outbreak response assessment by global polio experts concluded ongoing undetected transmission could not be ruled out.

There is ongoing concern about the districts of the neighboring countries of the Lake Chad basin region that have been affected by the Boko Haram insurgency, with the consequent lack of services and presence of IDPs and refugees. The risk of international spread from Nigeria to the Lake Chad basin countries or further afield in sub-Saharan Africa remains substantial. The Committee was encouraged that the Lake Chad basin countries, Cameroon, Chad, the Central African Republic (CAR), Niger and Nigeria continued to be committed to sub-regional coordination of immunization and surveillance activities. However, there are widespread persistent gaps in population immunity across these countries, and the ongoing population movement in the sub-region and insecurity are major challenges.


Vaccine derived poliovirus

In DR Congo, there has been further transmission particularly in Tanganyika province, necessitating further rounds with mOPV2. Risks are compounded by poor surveillance in many areas, and widespread gaps in population immunity. The Committee was particularly concerned that the response had not been put on a sufficient emergency footing, and there was a lack of urgency in some aspects of the response, including apparent lack of attention to minimizing the risk of international spread. It was noted that upcoming elections with the possibility of civil unrest posed an additional risk to the ability of the country to halt the outbreak.

The Committee remains concerned by the size of cVDPV2 outbreak in Syrian Arab Republic but was encouraged by the efforts being made, noting the great difficulty in reaching all target populations because of the ongoing conflict. Although there is ongoing cross border coordination particularly with Lebanon, it remains unclear whether similar efforts are required and are being undertaken with other neighbouring countries. This is particularly important as poliovirus type 2 population immunity rapidly wanes globally, and the risk of spread beyond Syria’s borders will increase substantially, meaning urgent action is needed to stop transmission.

The Committee remained concerned about the recent detection of three highly diverged type 2 VDPV viruses in the sewage in Mogadishu in Somalia . With substantial areas inaccessible to vaccination, the mOPV2 and IPV response in December, January and February will need to be carefully assessed to determine if transmission has been interrupted.

Since the last committee meeting, there has been no new detection of cVDPV2 in Pakistan. As it is now over 16 months since the most recent cVDPV2 was detected, Pakistan no longer meets the criteria for a cVDPV2 infected country. However, based on the outbreak assessment in Nigeria, ongoing transmission could not be ruled out.


Conclusion

The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:

  • The potential risk of further spread through population movement, whether for family, social or cultural reasons, or in the context of populations displaced by insecurity, returning refugees, or nomadic populations, and the need for international coordination to address these risks, particularly between Afghanistan and Pakistan, Nigeria and its Lake Chad neighbors, and countries bordering the Syrian Arab Republic.
  • The current special and extraordinary context of being closer to polio eradication than ever before in history, with the incidence of WPV1 cases in 2017 the lowest ever recorded.
  • The risk and consequent costs of failure to eradicate globally a highly debilitating vaccine preventable disease. Even though global transmission of WPV1 has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur now would be even more grave and a major set-back to achieving eradication.
  • The risk of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a tangible reality soon.
  • The outbreak of WPV1 (and cVDPV) in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears considerable.
  • The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
  • The importance of a regional approach and strong cross­border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
  • Additionally with respect to cVDPV:
    • cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
    • The large number of cases in the Syrian outbreak within a short space of time and close to the international border with Iraq in the context of ongoing population movement because of conflict, considerably heightens the risk of international spread;
    • The ongoing circulation of cVDPV2 in DR Congo, and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame;
    • The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016, noting that population immunity to type 2 polioviruses is rapidly waning in many countries;
    • The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies;
    • The global shortage of IPV which poses an additional risk, in that the cohort of children with no type 2 immunity is growing in number in countries affected by the shortage.


Risk categories

The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows:

  • States infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread.
  • States infected with cVDPV2, with potential risk of international spread.
  • States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.

Criteria to assess States as no longer infected by WPV1 or cVDPV:

  • Poliovirus Case: 12 months after the onset date of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer.
  • Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period.
  • These criteria may be varied for the endemic countries, where more rigorous assessment is needed in reference to surveillance gaps (eg Borno)

Once a country meets these criteria as no longer infected, the country will be considered vulnerable for a further 12 months. After this period, the country will no longer be subject to Temporary Recommendations, unless the Committee has concerns based on the final report.


TEMPORARY RECOMMENDATIONS

States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread

  • Afghanistan
  • Pakistan
  • Nigeria

These countries should:

  • Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained.
  • Ensure that all residents and long­term visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
  • Ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers..
  • Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination.
  • Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea).
  • Further intensify cross­border efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk cross­border populations. Improved coordination of cross­border efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.
  • Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
  • Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.
  • Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.

States infected with cVDPV2s, with potential risk of international spread

  • Democratic Republic of the Congo
  • Nigeria
  • Syrian Arab Republic


These countries should:

  • Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained.
  • Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, consider requesting vaccines from the global mOPV2 stockpile based on the recommendations of the Advisory Group on mOPV2
  • Encourage residents and long­term visitors to receive a dose of IPV (if available in country) four weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within four weeks) should be encouraged to receive a dose at least by the time of departure.
  • Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.
  • Intensify regional cooperation and cross­border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and cross­border populations, according to the advice of the Advisory Group.
  • Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
  • Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a ‘state no longer infected’.
  • At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV

  • Cameroon (last case 9 Jul 2014)
  • Central African Republic (last case 8 Dec 2011)
  • Chad (last case 14 Jun 2012)
  • Niger (last case 15 Nov 2012)

These countries should:

  • Urgently strengthen routine immunization to boost population immunity.
  • Enhance surveillance quality, including considering introducing supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations.
  • Intensify efforts to ensure vaccination of mobile and cross­border populations, Internally Displaced Persons, refugees and other vulnerable groups.
  • Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high risk population groups.
  • Maintain these measures with documentation of full application of high quality surveillance and vaccination activities.
  • At the end of 12 months* without evidence of reintroduction of WPV1 or new emergence and circulation of cVDPV, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

*For the Lake Chad countries, this will be linked to when Nigeria is considered no longer infected by WPV1 or cVDPV2.


Additional considerations

The Committee noted that in all the infected and vulnerable countries, routine immunization was generally quite poor, if not nationally, then in sub-national pockets. The Committee also noted that surveillance in these areas may also be sub-optimal, particularly where access is compromised by conflict. The Committee strongly encourages all these countries to make further efforts to improve routine immunization and strengthen surveillance in such areas, and requested international partners to support these countries in rapidly improving routine immunization coverage to underpin eradication.

The Committee also urged that Nigeria and the Lake Chad countries increase cross border efforts and joint planning and response. Intensified effort is needed to identify and reach vulnerable populations in the sub-region, particularly in the Lake Chad islands. Noting the low number of international travelers being vaccinated in Nigeria, the committee again recommended that the country needs to improve implementation of the Temporary Recommendations regarding traveler vaccination, including reporting of achievements, and requests the secretariat to report back on this aspect of Nigeria’s response to the next Committee meeting. Nigeria should ensure continuing political commitment and take measures to counter fatigue in the fight against polio. Similarly, the DR Congo government needs to regard the current outbreak of cVDPV2 as a public health emergency and pay more attention to prevention of international spread of cVDPV2 from DR Congo, noting that neighboring countries are affected by the global shortage of IPV.

Noting the issues that continue in countries previously subject to Temporary Recommendations such as the Ukraine and Somalia, the Committee requested the secretariat to continue to monitor these and other previously infected countries, and highlight to the Committee issues that pose a risk of international spread. The Committee requested an update on the situation in Somalia at its next meeting.

Based on the current situation regarding WPV1 and cVDPV, and the reports made by Afghanistan, DR Congo, Nigeria, Pakistan, and the Syrian Arab Republic, the Director-General accepted the Committee’s assessment and on 13 February 2018 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 13 February 2018.

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Keywords: WHO; Updates; Worldwide; Poliovirus; VDPV.

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