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N.C. Weekly Influenza Summary - May 20, 2017 1

Final Summary 2016-2017

NORTH CAROLINA WEEKLY INFLUENZA SURVEILLANCE SUMMARY2016-2017 INFLUENZA SEASON

WEEK 20: ENDING MAY 20, 2017

By Week: North Carolina

Percentage of Outpatient Visits with Influenza-like Illness (ILI)

04/29 05/06 05/13 05/20

Week Ending Date

0

1

% IL

I

StatewideUpdates

Influenza-like illness (ILI) decreased during week 20.

The geographic spread of flu was SPORADIC for week 20 ending 5/20/2017.

Of the 4 samples submitted to the State Laboratory of Public Health (SLPH) for viral testing this week; 1was positive for influenza A(H3) and 3 positive for influenza B.

Hospital-based Public Health Epidemiologists (PHEs) reported 4 positive influenza results out of 251samples tested during week 20 (ending 5/20/2017); 2 positive for influenza B and 2 positive for influenzaA(H3).

RegionalUpdates

The proportion of visits due to ILI in Region 4 (Southeastern US) was below baseline at 0.5% for week 19(ending 5/13/2017). The baseline for the region is 1.7%.

NationalUpdates

The proportion of outpatient visits due to ILI nationally was at 1.3% for week 19 (ending 5/13/2017). Thenational baseline for ILI is 2.2%.

InternationalUpdates

May 15, 2017 - Influenza activity in the temperate zone of the northern hemisphere continued to decrease.In the temperate zone of the southern hemisphere, influenza activity reached seasonal thresholds in somecountries, but remained low in general. In tropical South America, influenza activity remained low in mostof the region. Other respiratory virus activities remained low in general, except in Colombia whereelevated activity of respiratory syncytial virus (RSV) continued to be reported. In the Caribbean andCentral America countries, respiratory virus activity remained low. In East Asia, influenza activitycontinued to be reported with all seasonal influenza types/subtypes detected. In Southern Asia, influenzaactivity decreased. In Western Asia, low influenza activity was reported with influenza B virusespredominant. In East and West Africa, low influenza activity was reported in recent weeks, with allseasonal influenza types/subtypes detected. In Northern Africa, influenza activity remained low. In Europe,influenza activity continued to decrease. In Northern and Eastern Europe, influenza activity continued todecrease with influenza B viruses predominant. In North America, overall influenza activity continued todecrease with predominantly influenza B viruses reported in recent weeks. In Mexico, low levels of allseasonal influenza types/subtypes continued to be detected.

Flu Information and Guidance

North Carolinawww.flu.nc.gov

CDCwww.cdc.gov/flu



INFLUENZA-LIKE ILLNESSES REPORTED BY SENTINEL SITES, 2016-2017

Week # - Ending (Sentinels Reporting) # ILI # Patients % ILI

#40 - 10/08/2016 38 122 14,693 0.83

#41 - 10/15/2016 41 129 13,992 0.92

#42 - 10/22/2016 45 154 16,190 0.95

#43 - 10/29/2016 44 184 17,269 1.07

#44 - 11/05/2016 47 171 18,014 0.95

#45 - 11/12/2016 47 243 17,343 1.40

#46 - 11/19/2016 45 265 16,777 1.58

#47 - 11/26/2016 47 218 11,138 1.96

#48 - 12/03/2016 48 280 17,358 1.61

#49 - 12/10/2016 50 252 16,435 1.53

#50 - 12/17/2016 47 294 13,609 2.16

#51 - 12/24/2016 45 273 9,073 3.01

#52 - 12/31/2016 44 194 5,687 3.41

#1 - 01/07/2017 50 293 11,433 2.56

#2 - 01/14/2017 48 290 13,276 2.18

#3 - 01/21/2017 48 397 14,885 2.67

#4 - 01/28/2017 48 431 15,138 2.85

#5 - 02/04/2017 47 773 14,918 5.18

#6 - 02/11/2017 46 877 15,516 5.65

#7 - 02/18/2017 45 1044 15,644 6.67

#8 - 02/25/2017 47 1178 15,227 7.74

#9 - 03/04/2017 48 994 16,634 5.98

#10 - 03/11/2017 45 670 12,758 5.25

#11 - 03/18/2017 47 423 12,958 3.26

#12 - 03/25/2017 47 848 15,523 5.46

#13 - 04/01/2017 44 603 14,739 4.09

#14 - 04/08/2017 43 560 15,368 3.64

#15 - 04/15/2017 41 217 11,869 1.83

#16 - 04/22/2017 42 190 13,107 1.45

#17 - 04/29/2017 35 60 11,754 0.51

#18 - 05/06/2017 29 64 10,438 0.61

#19 - 05/13/2017 27 31 7,855 0.39

#20 - 05/20/2017 22 15 5,997 0.25



Influenza-Like Illness in ILINET Outpatient VisitsINFLUENZA SURVEILLANCE, NC 2014-2017

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

% IL

I

10/08

10/15

10/22

10/29

11/05

11/12

11/19

11/26

12/03

12/10

12/17

12/24

12/31

01/07

01/14

01/21

01/28

02/04

02/11

02/18

02/25

03/04

03/11

03/18

03/25

04/01

04/08

04/15

04/22

04/29

05/06

05/13

05/20

Week Ending Date

2016-20172015-20162014-2015

For more information about comparable national data, visit www.cdc.gov/ncidod/diseases/flu/weekly.htm and in particular, clickon the link “View Chart Data” below “Percentage of Visits for Influenza-like Illness Reported by the US Outpatient Influenza-likeIllness Surveillance Network (ILINet)”.



PHE Respiratory Viral Pathogen Surveillance

Positive test results for selected respiratory viruses are reported on a weekly basis by Public Health Epidemiologists (PHEs) locatedin seven of the largest hospital networks across North Carolina. The graph below shows the number of positive tests for respiratorysyncytial virus (RSV), parainfluenza, adenovirus, rhinovirus, and human metapneumovirus (hMPV) by week.

These data provide a useful indication of which other respiratory viruses are circulating and possibly contributing to ILI in the state.Please note that the total number of tests performed is not available from all hospital networks, so the overall proportion testingpositive cannot be calculated. Also, testing protocols and practices differ among hospitals. Finally, these numbers reflect testresults from participating hospitals only and might not be reflective of the entire state.

Data source: NC DETECT

PHE Surveillance: Positive Respiratory Virus Test Results by Week

* Most facilities use tests that do not distinguish rhinoviruses from enteroviruses.

050

100150200250300350400450500550600650700750800850900950

10001050

Co

un

t

10/08

10/15

10/22

10/29

11/05

11/12

11/19

11/26

12/03

12/10

12/17

12/24

12/31

01/07

01/14

01/21

01/28

02/04

02/11

02/18

02/25

03/04

03/11

03/18

03/25

04/01

04/08

04/15

04/22

04/29

05/06

05/13

05/20

Week Ending Date

InfluenzahMPVRhinovirus*AdenovirusParainfluenzaRSV

Da

ta in

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d a

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y be

inc

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te

● Rhinovirus* was the most frequently identified respiratory viral pathogen during week 20 (ending 05/20/2017) followed by Parainfluenza.

INFLUENZA VIRUS ISOLATES IDENTIFIED BY PHE FACILITIES FOR 2016–2017 SEASON*INFLUENZA VIRUS ISOLATES IDENTIFIED BY PHE FACILITIES FOR 2016–2017 SEASON*

Virus Type # New positive results(5/14/2017-5/20/2017)

# Cumulative positive results(10/2/2016-5/20/2017)

A(H1) 0 254

A(H3) 2 1772

A (subtype unknown) 0 3269

B 2 2418

Total 4 7713



PHE Acute Respiratory Admissions Surveillance

The number of patients admitted to the hospital with fever plus respiratory symptoms in the absence of a known cause other thaninfluenza is reported on a weekly basis by Public Health Epidemiologists (PHEs) located in seven of the largest hospital networksacross North Carolina. The graph below shows the number of acute respiratory illness admissions to participating hospitals by agegroup.

In conjunction with other surveillance information, these data help us monitor for changes in severity of respiratory illness duringperiods when influenza is circulating. Please note that these reports are not limited to patients with laboratory-confirmedinfluenza infection. Also, these numbers reflect admissions to participating hospitals only and are not be reflective of the entirestate.

Data source: NC DETECT

PHE Surveillance: Hospital Admissions for Acute Respiratory Illness by Week

0

30

60

90

120

150

180

210

240

270

300

330

360

390

420

Co

un

t

10/08

10/15

10/22

10/29

11/05

11/12

11/19

11/26

12/03

12/10

12/17

12/24

12/31

01/07

01/14

01/21

01/28

02/04

02/11

02/18

02/25

03/04

03/11

03/18

03/25

04/01

04/08

04/15

04/22

04/29

05/06

05/13

05/20

Week Ending Date

TotalAge UnknownAge 65+Age 25 - 64Age 5 - 24Age 0 - 4

Da

ta in

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y be

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● Acute respiratory admissions decreased during week 20 (ending 05/20/2017).

● The highest number of acute respiratory admissions during week 20 was for patients Age 25 - 64 followed by Age 65+.



By Week Ending Date

Influenza Positive Tests Reported by the NC State Laboratory of Public Health (SLPH)

† Percent of submitted specimens for any influenza

0

10

20

30

40

50

# P

osi

tive

Sp

eci

me

ns

10/08

10/15

10/22

10/29

11/05

11/12

11/19

11/26

12/03

12/10

12/17

12/24

12/31

01/07

01/14

01/21

01/28

02/04

02/11

02/18

02/25

03/04

03/11

03/18

03/25

04/01

04/08

04/15

04/22

04/29

05/06

05/13

05/20

Week Ending Date

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% P

osi

tive

†

B (not subtyped)B (Yamagata)B (Victoria)Seasonal A (H3)2009 A (H1N1)A (not subtyped)

Percent Positive †

INFLUENZA VIRUS ISOLATES FROM IN-STATE PATIENTS IDENTIFIED BY THE STATE LABORATORY OF PUBLIC HEALTH 2016–2017 SEASON*INFLUENZA VIRUS ISOLATES FROM IN-STATE PATIENTS IDENTIFIED BY THE STATE LABORATORY OF PUBLIC HEALTH 2016–2017 SEASON*

Virus Type # New Positive Results(5/14/2017 - 5/20/2017)

# Cumulative Positive Results(10/2/16 - 5/20/17)

A (unknown) 0 3

2009 A(H1N1) 0 32

A(H3) 1 243

B (unknown) 0 5

B (Victoria) 0 25

B (Yamagata) 3 53

Total 4 361

* 2016-2017 influenza season began October 2, 2016.NOTE: This table includes isolates tested as of 10/02/2016

This table does not include influenza isolates identified by other laboratories

By Week Ending Date

Influenza Positive Tests Reported by the NC State Laboratory of Public Health (SLPH) and PHE Facilities

† Percent of submitted specimens for any influenza

0

200

400

600

800

1000

# P

osi

tive

Sp

eci

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10/08

10/15

10/22

10/29

11/05

11/12

11/19

11/26

12/03

12/10

12/17

12/24

12/31

01/07

01/14

01/21

01/28

02/04

02/11

02/18

02/25

03/04

03/11

03/18

03/25

04/01

04/08

04/15

04/22

04/29

05/06

05/13

05/20

Week Ending Date

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% P

osi

tive

†

Seasonal BSeasonal A (H3)A (H1)A (not subtyped)

Percent Positive †



North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) ILI Surveillance

Near real-time syndromic surveillance for ILI is conducted through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool(NC DETECT). This system uses a variety of data sources including emergency departments (EDs). NC DETECT is currently receiving data dailyfrom 122 of the 123 24/7 EDs in North Carolina. The NC DETECT ILI syndrome case definition includes any case with the term 'flu' or 'influenza',or at least one fever term and one influenza-related symptom.

The proportion of ED visits meeting the ILI syndrome definition is monitored throughout the year and compared to data obtained fromInfluenza-like Illness Surveillance Network (ILINet). In past years, data from the two systems have shown similar trends (below). The higherproportion of ILI seen in NC DETECT compared to ILINet reflects differences in the case definitions and patient populations rather than adifference in the sensitivity of these surveillance systems.

Hospital Emergency Department Visits (NC DETECT) and Outpatient Provider Visits (ILINet)

Influenza-Like Illness Surveillance in North Carolina, 2016-2017

0

1

2

3

4

5

6

7

8

9

10

11

12

% I

LI

10/0810/15

10/2210/29

11/0511/12

11/1911/26

12/0312/10

12/1712/24

12/3101/07

01/1401/21

01/2802/04

02/1102/18

02/2503/04

03/1103/18

03/2504/01

04/0804/15

04/2204/29

05/0605/13

05/20

Week Ending Date

2016-17 ILInet2016-17 ED NC DETECT

Past Two Influenza Seasons: Shown For ComparisonHospital Emergency Department Visits (NC DETECT) and Outpatient Provider Visits (ILINet)

Influenza-Like Illness Surveillance in North Carolina, Past Two Seasons

0

1

2

3

4

5

6

7

8

9

10

11

% I

LI

10/08

10/15

10/22

10/29

11/05

11/12

11/19

11/26

12/03

12/10

12/17

12/24

12/31

01/07

01/14

01/21

01/28

02/04

02/11

02/18

02/25

03/04

03/11

03/18

03/25

04/01

04/08

04/15

04/22

04/29

05/06

05/13

05/20

Week Ending Date

2015-16 ILInet2015-16 ED NC DETECT2014-15 ILInet2014-15 ED NC DETECT



NC DETECT ED Influenza-Like Illness (ILI), 2016-2017Percentage of Total Visits by Week, Grouped by Flu Surveillance Regions:

5

10

15

% IL

I

10/0810/15

10/2210/29

11/0511/12

11/1911/26

12/0312/10

12/1712/24

12/3101/07

01/1401/21

01/2802/04

02/1102/18

02/2503/04

03/1103/18

03/2504/01

04/0804/15

04/2204/29

05/0605/13

05/20

Week Ending Date

Region 7Region 6Region 5Region 4Region 3Region 2Region 1

NOTE: This graph begins with data starting week ending October 8, 2016 for the 2016-2017 influenza season.

Flu Surveillance Regions

Regions 1 2 3 4 5 6 7

ALAMANCE

ALEXANDER

ALLEGHANY

ANSON

ASHE

AVERY

BEAUFORT

BERTIE

BLADEN

BRUNSWICK

BUNCOMBE

BURKE

CABARRUS

CALDWELL

CAMDEN

CARTERET

CASWELL

CATAWBA CHATHAM

CHEROKEE

CHOWAN

CLAY

CLEVELAND

COLUMBUS

CRAVEN

CUMBERLAND

CURRITUCK

DAREDAVIDSON

DAVIE

DUPLIN

DURHAM

EDGECOMBE

FORSYTH

FRANKLIN

GASTON

GATES

GRAHAM

GRANVILLE

GREENE

GUILFORD

HALIFAX

HARNETT

HAYWOOD

HENDERSON

HERTFORD

HOKE

HYDE

IREDELL

JACKSON

JOHNSTON

JONES

LEE

LENOIR

LINCOLN

MC DOWELL

MACON

MADISON MARTIN

MECKLENBURG

MITCHELL

MONTGOMERY

MOORE

NASH

NEW HANOVER

NORTHAMPTON

ONSLOW

ORANGE

PAMLICO

PASQUOTANK

PENDER

PERQUIMANS

PERSON

PITT

POLK

RANDOLPH

RICHMOND

ROBESON

ROCKINGHAM

ROWAN

RUTHERFORD

SAMPSON

SCOTLAND

STANLY

STOKESSURRY

SWAIN

TRANSYLVANIA

TYRRELL

UNION

VANCE

WAKE

WARREN

WASHINGTON

WATAUGA

WAYNE

WILKES

WILSON

YADKIN

YANCEY

3

45

6

1

7

2



NC Influenza-Associated Deaths*Influenza-Associated Deaths

This Week (05/14/2017 – 05/20/2017)Total Influenza-Associated DeathsThis Season (starting 10/02/2016)

0 218

*Influenza-associated Deaths – This number is based on reports submitted by providers to the NC Division of Public Health. Aninfluenza-associated death is defined for surveillance purposes as a death (adult or pediatric) resulting from a clinically compatible illness thatwas confirmed to be influenza by an appropriate laboratory or rapid diagnostic test with no period of complete recovery between the illness anddeath. Deaths that occurred on or after 10/02/2016 will be reflected in this report for the 2016-2017 season.

North Carolina by Age Group*Laboratory Confirmed Influenza-Associated Deaths Reported in

0102030405060708090

100110120130140150

No

. of

Re

po

rte

d D

ea

ths

0-4 5-17 18-24 25-49 50-64 65+

Age Group (Years)

Reported in North Carolina by Week of Death*Laboratory Confirmed Influenza-Associated Deaths

10 0

10 0 0 0 0 0

2

0

43

4 4 4

2

11

16

22

30

32

16

10

21

16

7

3

6

3

0 00

3

6

9

12

15

18

21

24

27

30

No

. o

f R

ep

ort

ed

De

ath

s

10/08

10/15

10/22

10/29

11/05

11/12

11/19

11/26

12/03

12/10

12/17

12/24

12/31

01/07

01/14

01/21

01/28

02/04

02/11

02/18

02/25

03/04

03/11

03/18

03/25

04/01

04/08

04/15

04/22

04/29

05/06

05/13

05/20

Week Ending Date

PediatricAdult



PARTICIPANTS IN NORTH CAROLINA’S INFLUENZA SENTINEL SURVEILLANCE PROGRAM THAT HAVE REPORTED DATA TO CDC

LOCAL HEALTH DEPARTMENT/DISTRICT OFFICES - 25

Alamance County Health Department

Cabarrus Health Alliance

Caldwell County Health Department

Craven County Health Department

Duplin County Health Department

Franklin County Health Department

Henderson County Health Department

Johnston County Health Department

Lee Primary Care

Martin County Office [Martin-Tyrrell-Washington County Health District]

Montgomery County Health Department

Northampton County Health Department

Pender County Health Department

Pitt County Public Health Center

Richmond County Health Department

Rockingham County Health Department

Stanly County Health Department

Stokes Family Health Center

Surry County Health and Nutrition Center

Tyrrell County Office [Martin-Tyrrell-Washington County Health District]

Union County Health Department

Wake County Health Department, Children’s Clinic

Washington County [Martin-Tyrell-Washington County Health District]

Wilkes County Health Department

Wilson County Health Department

COLLEGES AND UNIVERSITIES STUDENT HEALTH PROGRAMS - 14

Appalachian State University Student Health Services

Davidson College Student Health Center

ECU Student Health Services

Elizabeth City State University Student Health Services

Elon University R. N. Ellington Health and Counseling Center

Fayetteville State University

NC Agricultural &Technical State University Student Health Services

NC State University Student Health Services

UNC-Chapel Hill Student Health Services

UNC-Charlotte Student Health Services

UNC-Greensboro Student Health Services

UNC-Pembroke Student Health Services

Wake Forest University Student Health Services

Winston-Salem State University

PRIVATE PRACTITIONERS - 26

Bakersville Community Medical Center

Blue Cross and Blue Shield of N.C.

Blue Ridge Community Health Services

Butner-Creedmoor Family Medicine

Coastal Childrens Clinic

Colerain Primary Care

Dilworth Pediatrics

ECU Brody School of Medicine – Department of Pediatrics

Family Care Center

Growing Child Pediatrics

Haywood Pediatric and Adolescent Medicine Group, PA

High Country Community Health

Hot Springs Health Program

MEDAC Health Services at Shipyard Blvd.

MEDAC Health Services at Porter’s Neck

MEDAC Health Services at Military Cutoff

Murfreesboro Primary Care

Oxford Family Physicians

PrimeCare

PrimeCare of Kernersville

PrimeCare of Northpoint

Roanoke Chowan Community Health Center

SAS Institute Health Care Center

Sisters of Mercy Urgent Care, South

Sisters of Mercy Urgent Care, West

Stanly Family Care Clinic

HOSPITALS - 3

Blue Ridge Regional Hospital

Durham VAMC

Scotland Healthcare System

Total Sentinels Enrolled - 68

Counties Covered - 45:Alamance (2), Alexander (1), Avery (1), Bertie (1), Buncombe (2), Cabarrus (1), Caldwell (1), Craven (2), Cumberland (1), Duplin (1), Durham (2), Forsyth (5),Franklin (1), Granville (2), Guilford (2), Haywood (1), Henderson (2), Hertford (2), Johnston (1), Lee (1), Madison (1), Martin (1), Mecklenburg (3), Mitchell (2),Montgomery (1), New Hanover (3), Northampton (1), Orange (1), Pasquotank (1), Pender (1), Pitt (3), Richmond (1), Robeson (1), Rockingham (1), Scotland(1), Stanly (2), Stokes (1), Surry (1), Tyrrell (1), Union (1), Wake (4), Washington (1), Watauga (1), Wilkes (1), Wilson (1)

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