Tarrant County Influenza Surveillance Weekly Report CDC Week ...
[Pages:7]Tarrant County Public Health Division of Epidemiology and Health Information
Tarrant County Influenza Surveillance Weekly Report CDC Week 3: Jan 13-19, 2019
Influenza Activity Code: County and State Levels
Tarrant County: Week 2
Widespread
Tarrant County: Week 2
Widespread
Texas: Week 2
Regional
Respiratory Virus Activity Summary
? The percentage of reported influenza-like illness (ILI) in Tarrant County increased from 4.3%
in week 2 to 4.4% in week 3 and is currently above the 2018-2019 Tarrant County baseline (2.7%).
? The percentage of all cause school absenteeism was 4.8% during week 3 in Tarrant County.
Absenteeism due to ILI and school nurse office visits due to ILI were 3.9% and 2.1% respectively during week 3 in Tarrant County.
? The percentage of rapid flu test positives in Tarrant County increased from 15.0% in week 2 to
18.7% in week 3.
? Based on data from 11 voluntarily reporting hospitals, the percentage of reported ICU admissions
due to influenza in Tarrant County was 3.0% in week 3.
? During the 2018-2019 influenza season, 0 Tarrant County influenza-associated pediatric
deaths have been reported. As of week 1, 3 influenza-associated pediatric deaths has been reported in Texas, with a total of 19 reported nationwide for the 2018-2019 season.
? During the 2018-2019 influenza season, 0 influenza outbreaks have been reported in Tarrant
County schools and 6 localized influenza outbreaks have been reported within institutions in Tarrant County.
? Since last report, 10 surveillance specimens were tested by The North Texas Regional
Laboratory. The following types and number of viruses were detected in these specimens: Influenza A/H3 (4), Influenza A/H1 (1), and Influenza B (2). Cumulatively this season, the North Texas Regional Laboratory at Tarrant County Public Health has tested 132 surveillance specimens and of these, 46 have been positive for influenza.
? In Texas during week 2, the proportion of outpatient visits for ILI, 5.0%, was below the state
baseline of 5.6%.
? Nationally during week 2, 12.4% of specimens tested and reported to the CDC were positive
for influenza. The proportion of outpatient visits for ILI (3.1%) was above the national baseline (2.2%). The proportion of deaths in week 1 attributed to pneumonia and influenza from the National Center for Health Statistics (6.9%) was below the epidemic threshold (7.0%).
% ILI
Influenza Like Illness (ILI): Local and State Levels
Graph 2. Texas and Tarrant County % ILI
15.0%
14.0%
Tarrant County % ILI
13.0% 12.0%
Texas % ILI
11.0%
10.0%
9.0%
8.0%
7.0% 6.0%
Texas Baseline
5.0%
4.0% 3.0%
Tarrant County Baseline
2.0%
1.0%
0.0%
40 42 44 46 48 50 52 02 04 06 08 10 12 14 16 18 20 22 24 26 28 30 32 34
Oct
Nov
Dec
Jan
Feb March April
May
June July Aug
CDC Week
100.0%
7.0%
Graph 3. ILI % by Age Groups, Tarrant County
4.0%
3.2%
3.9%
6.9%
9.8%
8.0%
5.8%
80.0% 60.0%
36.4%
30.4%
27.3%
30.5%
32.4%
45.4%
44.9%
37.9%
ILI %
40.0%
25.2%
37.9%
42.2%
44.6%
34.8%
23.2%
26.1%
36.0%
20.0% 0.0%
31.4%
48
27.7%
27.3%
21.1%
25.9%
21.6%
21.0%
49
50
51
52
01
02
CDC Week
Age 0-4 Age 5-24 Age 25-64 Age >65
20.3%
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In week 3, 4.4% of visits to health care providers were due to ILI. ILI levels are currently above the county established baseline of 2.7% and are lower than the state of Texas levels from the week prior. In Tarrant County, of the 961 reported patients presenting with ILI during week 3, the age group with the largest percentage of the reported ILI patients, 37.9%, was the 25-64 age group.
NOTE: Tarrant County ILI activity is assessed using information provided by surveillance participants and the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). For week 3, 23 surveillance participants - 19 Hospitals, 1 Clinic, 2 Colleges/ Universities, and 1 Business - reported ILI information to Tarrant County Public Health. Texas ILI activity is assessed using information provided by a network of providers . For week 2, 99 providers reported information to the Texas Department of State Health Services.
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% ILI
40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
Tarrant County Historical ILI and ESSENCE Geographical Distribution Map
Graph 4. Tarrant County % of patient visits due to ILI during
flu season 2015-2016 through 2018-2019
14.0%
13.0%
2015-2016 Season
12.0% 11.0% 10.0%
2016-2017 Season 2017-2018 Season
9.0% 8.0%
2018-2019 Season
7.0%
6.0%
5.0%
4.0% 3.0%
Tarrant County Baseline
2.0%
1.0%
0.0%
Oct
Nov
Dec
Jan
Feb
March April May
CDC Week
Map 1. Tarrant County ER ILI Cases by Zip Code, Week 3
Zip codes with 5 cases are assigned 0. Tarrant County ILI data by zip code is obtained from ESSENCE and includes ILI numbers from 46 hospitals that voluntarily provide data based on chief complaints of Tarrant County residents admitted to Emergency Departments in North Central Texas. Zip code population data is obtained from American Community Survey 2016 5 year estimate.
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Rapid Influenza Test Results and School Absenteeism
Graph 5. Absenteeism and ILI, Tarrant County
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0% 2.0%
Winter Break
1.0%
0.0%
49
50
51
Average Daily % Absent Average Daily % ILI School Nurse Visits
52
01
02
03
CDC Week
Average Daily % Absent due to ILI
For week 2, 12 school districts provided general absenteeism data, 10 school districts provided data regarding absenteeism due to ILI, and 11 school districts provided data regarding nurses' office visits due to ILI.
Table 1. Influenza Rapid Test Results, Tarrant County
CDC Week Number
1 (Dec 30-Jan 5)
2 (Jan 6-12)
3 (Jan 13-19)
# Influenza Tests Performed
2929
2059
1686
% Influenza Positive
16.4%
15.0%
18.7%
# Influenza A Positive
440
289
296
% Influenza A Positive
91.9%
93.8%
94.0%
# Influenza B Positive
39
19
19
% Influenza B Positive
8.1%
6.2%
6.0%
# Non-differentiated Positive
0
0
0
% Non-differentiated Positive
0.0%
0.0%
0.0%
NOTE: Tarrant County rapid influenza test results are reported weekly by influenza surveillance participants. For CDC week 3, rapid influenza test results were reported by 13 hospitals, 1 clinic, and 1 colleges/universities.
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Influenza Confirmatory Test Results: Tarrant County
Table 2. North Texas Regional Laboratory: Respiratory Virus Results1
Number of Specimens Tested Positive Specimens
Current Week 10
7 (70.0%)
2018-2019 Season 132
81 (61.4%)
Influenza A Influenza B
5 (71.4%) 2 (28.6%)
44 (54.3%) 2 (2.5%)
Respiratory Syncytial Virus
0 (0.0%)
14 (17.3%)
Adenovirus
0 (0.0%)
5 (6.2%)
Human Metapneumovirus
0 (0.0%)
4 (4.9%)
Parainfluenza-1
0 (0.0%)
0 (0.0%)
Parainfluenza-2
0 (0.0%)
1 (1.2%)
Parainfluenza-3
0 (0.0%)
0 (0.0%)
Rhinovirus
0 (0.0%)
15 (18.5%)
Inconclusive2
0 (0.0%)
0 (0.0%)
1 Laboratory results based on real-time PCR analysis; information is -for the 2018-2019 season. 2 Inconclusive for influenza A and influenza B; not included in positive specimens count. NOTE: Percentages do not add up to 100% due to co-infections. 1 specimen has tested positive with a coinfection: Adenovirus and
Rhinovirus (1), Respiratory Syncytial Virus and Rhinovirus (1), Respiratory Syncytial Virus and Adenovirus (1), Rhinovirus
and Human Metapneumovirus (1)
Table 3. North Texas Regional Laboratory: Influenza Results1
Current Week
2018-2019 Season
Influenza A
5
44
Influenza A H1
1 (20.0%)
10 (22.7%)
Influenza A H3
4 (80.0%)
34 (77.3%)
Influenza A, Inconclusive subtype
0 (0.0%)
0 (0.0%)
Influenza A, Unsubtypeable2
0 (0.0%)
0 (0.0%)
Influenza B
0
0
Influenza B Yamagata3
-
-
Influenza B Victoria3
-
-
Influenza B, Inconclusive
-
-
1 Laboratory results based on real-time PCR analysis; information is for the 2018-2019 season. 2 Influenza A subtype not determined; further analysis pending 3 Influenza B genotyping is only included in current week column if genotyping occurred in the same week as original PCR testing.
Graph 6. North Texas Regional Laboratory: Influenza Virus Results1
Number of Positive Influenza Specimens
% of Positive Influenza Specimens
11 10
Infl uenza A H1
9
Infl uenza A H3
8
7
Infl uenza A, Inconclusive
6
s ubtype
5
Infl uenza B
4
3
Percent Pos i tive
2
1
0
40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38
Oct
Nov
Dec
Jan
Feb March April May June July
Aug Sept
CDC Week
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
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Texas and National Influenza and ILI Activity Map 2: Texas County Specific Influenza Activity, CDC Week 2
Influenza activity level corresponds to current MMWR week only and does not reflect previous weeks' activity. The majority of influenza cases are not reportable by law to the Texas Department of State Health Services. This map contains data from sentinel sites and does not represent all influenza cases in the state. Positive laboratory results are reported according to specimen collection date or date received in the lab if the former is unknown. surveillance/2019.aspx
Map 3: ILINet Activity Indicator Map, CDC Week 2
Data collected in ILINet are used to produce a measure of ILI activity by state. Activity levels are based on the percent of outpatient visits in a state due to ILI and are compared to the average percent of ILI visits that occur during spring and fall weeks with little or no influenza virus circulation. This map uses the proportion of outpatient visits to health care providers for influenzalike illness to measure the ILI activity level within a state. It does not, however, measure the extent of geographic spread of flu within a state. Therefore, outbreaks occurring in a single city could cause the state to display high activity levels. Data collected in ILINet may disproportionately represent certain populations within a state, and therefore, may not accurately depict the full picture of influenza activity for the whole state.
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The Tarrant County Influenza Surveillance Weekly Report is available on the Tarrant County Public
Health web site at:
heaflltuh..ttaarrrraannttccoouunnttyy..ccoomm/flu
If you have questions or comments regarding influenza surveillance, please contact:
Laura Lockwood, MPH, CPH Influenza Surveillance Specialist lblockwood@
Tarrant County Public Health
Influenza Surveillance Epidemiology and Health Information
1101 South Main Street, Suite 2200 Fort Worth, TX 76104
Veerinder (Vinny) Taneja, MBBS; MPH Director, Tarrant County Public Health
NOTE: Influenza-like Illness (ILI) is defined as fever (temperature 100?F) plus a cough OR a sore throat, in the absence of a known cause other than influenza. Tarrant County reporting quadrants consist of Northwest, Northeast, Southwest and Southeast regions within the boundaries of Interstate 35 and Interstate 30. Tarrant County ILI baselines were determined using a similar method as the Centers for Disease Control Prevention Regional ILI baselines and Texas Department of State Health Services Texas baseline. Regional ILI baselines are determined by the Centers for Disease Control and Prevention and can be accessed at http:// flu/weekly/overview.htm
Additional information regarding Tarrant County, Texas and national ILI activity can be accessed at flu.
Russ Jones, MPH Division Manager & Chief Epidemiologist
Epidemiology and Health Information Tarrant County Public Health
Main Epidemiology Division Number : (817) 321-5350 Disease Reporting Fax Number: (817) 850-2366
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