DoD Global, Lab-Based Influenza Surveillance Program

USAF School of Aerospace Medicine Week 32 Report 9 - 15 Aug 2009 Data as of 17 Aug 2009 Prepared 19 Aug 2009 Influenza Surveillance 08-09 Seasonal Year (beginning 28 Sep 08) Total Specimens Collected Cumulative: 14,508 % Complete: 99.4% (14,414/14,508) % Complete for Week: 93.7% (342/365) Total Influenza Positive Cumulative %: 28.2% (4,070/14,414) % Excluding Known Positive Isolates: 27.9% % Flu Pos for Week: 26.3% (90/342) Influenza A (3,665/4,070) - A/H1N1 (novel) - A/H1 (seasonal) - A/H3 (seasonal) - A/pending subtype Influenza B (405/4,070) - B/Yamagata - B/Victoria - B/pending lineage 36 142 227 2,509 627 477 52 10.0% 90.0% DoD Global, Lab-Based Influenza Surveillance Program Respiratory Highlights During Week 32, USAFSAM received 365 specimens from 52 locations and shipped 205 nasal wash kits to 25 locations. Since enhanced surveillance began on 27 April, USAFSAM has received 11,045 specimens and shipped 13,130 nasal wash kits. Since Week 15 (beginning 12 April), USAFSAM identified 2,509 confirmed cases of Novel Influenza A/H1N1 (nH1N1) from over 100 locations worldwide. This includes 10 nH1N1 and Adenovirus co-infections, all from training bases: Lackland AFB, TX, USCG Cape May, NJ and NH Beaufort, SC. See tables below for a breakdown of nH1N1 cases by service and beneficiary status. For the first time, the number of Air Force nH1N1 cases has surpassed the number of Army nH1N1 cases due to an intentional decrease in Army submissions. Novel Influenza A/H1N1 (nH1N1) Cases by Service and Beneficiary Status Service Air Force Army Navy Marines Coast Guard Other Total nH1N1 Cases 1,044 986 286 123 37 33 2,509 Percent 41.6% 39.3% 11.4% 4.9% 1.5% 1.3% 100% Beneficiary Active Duty Child Spouse Other Total nH1N1 Cases 1,619 673 213 4 2,509 Percent 64.5% 26.8% 8.5% 0.2% 100% The weekly percent flu positive (of processed specimens) decreased in Week 32, after remaining relatively steady for the past several weeks. See Graph 1. During Week 32, the majority of processed specimens (70%) were negative, the majority of positive specimens (87%) were influenza and 100% of influenza positive specimens were nH1N1. See Graphs 2 & 3. Influenza-Like Illness (ILI) activity is within the normal range of expected for DoD overall at 3.8%. The Coast Guard overall continues to experience significantly elevated levels of ILI activity. Los Angeles AFB, CA is currently experiencing an increase in outpatient visits for ILI. Results presented are those certified at the USAFSAM laboratory. Seasonal Overview by Week Collected Click on the graphs to view them in a separate larger window. Graph 1. Percent Flu Positive by Week Collected Graph 2. Influenza Subtype by Week Collected Graph 3. Positive Results by Week Collected Note data from Weeks 52 and 53 are combined. Graph 1 had known positive influenza isolate submissions removed to more accurately reflect the percent positive trend. Distribution Statement A: Approved for public release; distribution is unlimited. 311 HSW/PA No. 09-400, 20 AUG 2009 DoD Global, Lab-Based Influenza Surveillance Program USAF School of Aerospace Medicine Page 2 Laboratory Results - Week & Month Table 1. Lab Results for the Week: 365 specimens were collected during Week 32 from 52 locations in 5 countries, 26 states and Washington DC. Column1 Influenza A Influenza A/H3 Germany Guam Iraq Japan United States Alabama Alaska Arizona Arkansas California Colorado Florida Georgia Illinois Kentucky Louisiana Maryland Mississppi Missouri Nevada New Jersey New Mexico New York North Carolina Ohio Oklahoma South Carolina South Dakota Texas Virginia Washington Washington, DC Total 0 0 Influenza A/H1N1 (novel) 4 4 Adenovirus Enterovirus RSV Parainfluenza Pending No Virus Isolated Total 4 4 1 1 3 3 3 2 1 2 13 16 11 6 3 7 1 4 2 6 2 1 2 6 1 1 7 1 8 5 130 3 3 238 7 2 2 3 19 21 21 10 3 5 7 1 2 5 4 12 1 1 7 2 1 9 6 193 1 4 4 365 3 1 1 5 5 10 4 5 1 1 1 1 1 1 28 1 1 1 90 11 1 23 11 0 0 3 23 Table 2. Lab Results for the Month: 1,005 specimens were collected thus far in the month of August from 71 locations in 7 countries, 29 states and Washington DC. Column1 Influenza A Influenza A/H3 England Germany Guam Iraq Japan South Korea United States Alabama Alaska Arizona Arkansas California Colorado Delaware Florida Georgia Illinois Kentucky Louisiana Maryland Massachusetts Mississppi Missouri Nevada New Jersey New Mexico New York North Carolina Ohio Oklahoma South Carolina South Dakota Texas 1 1 Utah Virginia Washington Washington, DC Total 1 1 Influenza A/H1N1 (novel) 4 7 9 Adenovirus Enterovirus RSV Parainfluenza Pending 1 No Virus Isolated Total 1 6 7 9 4 4 9 9 13 14 6 15 6 5 30 37 2 42 9 3 1 17 19 1 3 1 6 21 6 2 8 1 1 20 10 295 1 2 6 8 611 23 28 8 6 46 47 2 69 15 4 15 19 21 1 5 10 9 42 6 3 11 2 2 26 12 496 1 3 14 10 1,005 1 16 12 1 1 13 10 25 6 1 14 2 2 2 9 3 17 1 3 1 1 4 2 124 1 8 1 300 1 1 1 1 2 2 3 1 2 37 2 1 3 32 44 5 1 1 8 34 CONTACT US! Email: influenza@brooks.af.mil, https://gumbo2.brooks.af.mil/pestilence/influenza/ Distribution Statement A: Approved for public release; distribution is unlimited. 311 HSW/PA No. 09-400, 20 AUG 2009 DoD Global, Lab-Based Influenza Surveillance Program USAF School of Aerospace Medicine Page 3 Laboratory Results - Season Table 3. Lab Results for the Season: 14,415 specimens have been collected and processed since 28 Sept 2008 from 119 locations. Percentages shown describe the percent of total specimens with results (n=14,415), including those with negative results (n=7,967). Influenza Total Influenza Influenza A Influenza A/pending subtype Influenza A/pending subtype & no co-infection Influenza A/pending subtype & Adenovirus Influenza A/pending subtype & Adenovirus-14 Influenza A/H1N1 (novel) Influenza A/H1N1 & no co-infection Influenza A/H1N1 & Adenovirus No. 4,070 3,665 52 49 2 1 2,509 2,499 10 % 28.2% 25.4% 0.4% Influenza B Influenza B/pending lineage Influenza B/pending lineage & no co-infection Influenza B/pending lineage & Adenovirus Influenza B/pending lineage & Adenovirus-14 Influenza B/pending lineage & Parainfluenza Influenza B/pending lineage & Rhinovirus Influenza B/pending lineage & Enterovirus No. % 405 227 220 2 1 2 1 1 2.8% 1.6% 17.4% Influenza A/H3 (seasonal) Influenza A/H3 & no co-infection Influenza A/H3 & Adenovirus Influenza A/H3 & Parainfluenza Influenza A/H3 & Rhinovirus Influenza A/H1 (seasonal) Influenza A/H1 & no co-infection Influenza A/H1 & Adenovirus Influenza A/H1 & Rhinovirus 477 473 1 1 2 627 624 2 1 3.3% Influenza B/Yamagata Influenza B/Yamagata & no co-infection Influenza B/Yamagata & Metapneumovirus Influenza B/Yamagata & Rhinovirus 36 34 1 1 0.2% 4.3% Influenza B/Victoria Influenza B/Victoria & no co-infection Influenza B/Victoria & Adenovirus 142 141 1 1.0% Adenovirus Adenovirus Adenovirus Type 14 Adenovirus Type-14 & no co-infection Adenovirus Type-14 & co-infection Adenovirus - Not Otherwise Specified Adenovirus unsubtyped (NOT Ad14) & no co-infection Adenovirus unsubtyped (not tested) & no co-infection Adenovirus & Parainfluenza Adenovirus & Rhinovirus Adenovirus & Metapneumovirus Adenovirus & RSV Adenovirus & Rhinovirus & Parainfluenza Adenovirus & Rhinovirus & RSV No. 1,653 264 264 0 1,389 1,250 106 1 28 1 1 1 1 % 11.5% 1.8% Other Respiratory Viruses Rhinovirus Rhinovirus & Metapneumovirus Rhinovirus & RSV Metapneumovirus Enterovirus RSV Parainfluenza Rhinovirus & Parainfluenza Parainfluenza & RSV No. 191 2 16 10 64 84 355 1 1 % 1.3% 0.01% 0.1% 0.1% 0.4% 0.6% 2.5% 0.01% 0.01% 9.6% Laboratory Submissions Table 4. Submissions for the Week: 553 specimens were received during Week 32 from 61 locations. Note the number of submissions for the week reflects the number of specimens RECEIVED during that week, whereas data elsewhere in the report reflects specimens COLLECTED during that week. In addition, there may be more than one specimen per patient. Ali Al Salem AB, Kuwait Andersen AFB, Guam Andrews AFB, MD BAACH, South Korea Balad AB, Iraq Barksdale AFB, LA Bolling AFB, DC Camp Lejeune, NC Cannon AFB, NM CGS Cape May, NJ CGS St Petersberg, FL Charleston AFB, SC Columbus AFB, MS Davis-Monthan AFB, AZ Dover AFB, DE Dyess AFB, TX 2 7 4 4 20 10 14 3 4 19 1 4 2 3 2 1 Edwards AFB, CA Eglin AFB, FL Ellsworth AFB, SD Elmendorf AFB, AK Fairchild AFB, WA Ft Drum, NY Ft Irwin, CA Ft Knox, KY Ft Leonard Wood, MO Ft Lewis, WA Ft Sam Houston, TX Goodfellow AFB, TX Kadena AB, Japan Lackland AFB, TX Landstuhl RMC, Germany Langley AFB, VA 3 9 8 6 2 1 2 16 8 1 57 1 13 143 4 1 Laughlin AFB, TX Little Rock AFB, AR Luke AFB, AZ Macdill AFB, FL Maxwell AFB, AL McGuire AFB, NJ Nellis AFB, NV NH Beaufort, SC NH Bremerton, WA NH Lemoore, CA NH Yokosuka, Japan NS Rota, Spain Osan AB, South Korea Patrick AFB, FL Peterson AFB, CO 2 3 3 7 10 2 6 8 3 6 4 4 1 9 4 Randolph AFB, TX Robins AFB, GA Sather AB, Iraq Scott AFB, IL Seymour Johnson AFB, NC Shaw AFB, SC Sheppard AFB, TX Tallil AB, Iraq Tinker AFB, OK Travis AFB, CA USAF Academy, CO Vandenberg AFB, CA Wright-Patterson AFB, OH Yokota AB, Japan Total 2 11 5 3 4 6 8 17 1 14 27 4 2 2 553 CONTACT US! Email: influenza@brooks.af.mil, https://gumbo2.brooks.af.mil/pestilence/influenza/ Distribution Statement A: Approved for public release; distribution is unlimited. 311 HSW/PA No. 09-400, 20 AUG 2009 DoD Global, Lab-Based Influenza Surveillance Program USAF School of Aerospace Medicine Page 4 Influenza-Like Illness (ILI) Overview reviewed by seasonal year among all outpatient visits according to week and clinic/site/service. Click on the graphs to view them in a separate larger window. Methodology USAFSAM views ILI activity using a refined set of ILI ICD-9 codes. The codes are Overall DoD Current Situation ILI activity among DoD MTFs is within the normal range of expected for the season at 3.8%. The expected rate for ILI visits based on the 2002-2008 average is noted on all graphs as a solid red line. Note the increased activity in Week 17 associated with the appearance of novel influenza virus cases. Actions If an increase in ILI is identified (regardless of sentinel or non-sentinel status), USAFSAM contacts the site’s Public Health office for awareness and to request specimens. Increased ILI The Coast Guard continues to experience elevated rates of ILI activity. Andersen AFB, Guam had an elevated ILI rate in Week 31 but has since returned to normal levels. Los Angeles AFB, CA is currently experiencing an increase in ILI activity, greater than two standard deviations above the mean at 4.6%. Data from Weeks 52 and 53 are combined. Air Force data are updated through Week 32. Navy, Army, and Coast Guard data are updated through Week 30. Air Force Los Angeles AFB, CA Navy National Influenza Surveillance CDC Influenza Surveillance (as of 14 Aug 2009, cited 19 Aug 2009) During Week 31 (ending 8 Aug 2009), influenza activity decreased in the United States, however, there were still higher levels of influenza-like illness than is normal for this time of year; 19.1% of specimens tested were positive for influenza and over 98% of all subtyped Influenza A viruses were Novel Influenza A/H1N1 viruses. The proportion of outpatient visits for ILI was below the national baseline. See the CDC report for more detailed information on national surveillance. Army Highly Pathogenic Human H5N1 (as of 11 Aug 2009, cited 19 Aug 2009) CY 2009: 43 cases, 12 deaths (27.9% case fatality rate) confirmed in China, Egypt and Vietnam. CY 2003 to Present: 438 cases, 262 deaths (59.8% fatality rate) confirmed in Azerbaijan, Bangladesh, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Laos, Myanmar, Nigeria, Pakistan, Thailand, Turkey, and Vietnam. See also WHO’s H5N1 Avian Influenza: timeline of major events. Click on the following links for updates regarding human Highly Pathogenic Human H5N1. World Health Organization (WHO) Centers for Disease Control and Prevention (CDC) Global Emerging Infections System (GEIS) Avian Influenza H5N1 (non-Human) Updates: WHO Avian Influenza Useful Links National Center for Medical Intelligence Coast Guard Influenza Threat Level (as of 11 June 2009) WHO Phase 6 Minimize the impact of the pandemic. WHO Pandemic Phase CONTACT US! Email: influenza@brooks.af.mil, https://gumbo2.brooks.af.mil/pestilence/influenza/ Distribution Statement A: Approved for public release; distribution is unlimited. 311 HSW/PA No. 09-400, 20 AUG 2009 DoD Global, Lab-Based Influenza Surveillance Program USAF School of Aerospace Medicine USAF School of Aerospace Medicine Brooks City-Base, Texas For Public Health Services 210-536-3471; DSN 240-3471 For Laboratory Services 210-536-8378; DSN 240-8378 E-mail influenza@brooks.af.mil Page 5 DoD Global Laboratory-Based Influenza Surveillance Background The DoD-wide program was established by the Global Emerging Infections Surveillance and Response System (GEIS) in 1997. The surveillance network includes the US Air Force School of Aerospace Medicine (sentinel site respiratory surveillance), the Naval Health Research Center (recruit and shipboard population-based respiratory surveillance), the Naval Medical Research Unit [NAMRU-3] in Cairo, Egypt, the Naval Medical Research Unit [NAMRU-2] in Jakarta, Indonesia, the Armed Forces Research Institute of Medical Sciences [AFRIMS] in Bangkok, Thailand, the U.S. Naval Medical Research Center-Detachment [NMRC-D] in Lima, Peru, and the United States Army Medical Research Unit-Kenya [USAMRU-K] located in Nairobi, Kenya. Sentinel Site Surveillance at the US Air Force School of Aerospace Medicine (USAFSAM) In 1976, the US Air Force Medical Service began conducting routine, global, lab-confirmed influenza surveillance. Air Force efforts expanded to DoD-wide in 1997. With the Air Force as the Executive Agent, USAFSAM manages the surveillance program that includes global surveillance among DoD beneficiaries at over 70 sentinel sites (including deployed locations) and several non-sentinel sites (please see map on the left). Unique sentinel sites include three DoD overseas medical research laboratories (AFRIMS, NMRC-D, USAMRU-K) and the US Army Center for Health Promotion and Preventive Medicine-South (CHPPM-S). These sites collect specimens from local residents in surrounding countries that may not otherwise be covered in existing surveillance efforts. DoD-GEIS Network of Partners Since the 2006-2007 season, Landstuhl Regional Medical Center (LRMC) has served EUCOM as a USAFSAM contributing laboratory. The initiative provides for more timely results and efficient transport of specimens. Please see CHPPM-EUR report, describing EUCOM surveillance. For an expanded view of this report, visit our website. Also available on the website is a list of previous weekly surveillance reports, program information (including an educational briefing and instruction pamphlets for clinic staff), and an overview of historical data. Please visit the DoDGEIS website for an overview of influenza surveillance at all collaborating DoD-GEIS organizations. Contributions to the CDC for National Influenza Surveillance All sequence data are sent to the CDC and selected original specimens or isolates are sent for further characterization and possible use as influenza vaccine seed viruses. Specimens may also undergo antiviral testing. DoD Global Influenza Surveillance Program https://gumbo2.brooks.af.mil/ pestilence/Influenza/ Eratta: Nothing at this time. Note: Locations reported here reflect that of the submitting site, unless more specific information is available. For example, McGuire AFB and Ft Dix in New Jersey are colocated and share a medical clinic. Specimens submitted to USAFSAM from this clinic are labeled as being from McGuire, even though the patient’s duty location may be Ft Dix. Collaborating Partners In addition to all participating DoD military sentinel sites, several collaborating partners (described above) may be further understood by reviewing the partner’s website. Please click on the respective logo below. USAF SCHOOL OF AEROSPACE MEDICINE CONTACT US! Email: influenza@brooks.af.mil, https://gumbo2.brooks.af.mil/pestilence/influenza/ Distribution Statement A: Approved for public release; distribution is unlimited. 311 HSW/PA No. 09-400, 20 AUG 2009