1

TheNewYorkStateDepartmentofHealth(NYSDOH)collects,compiles,andanalyzesinformationoninfluenzaactivity
yearroundinNewYorkState(NYS)andproducesthisweeklyreportduringtheinfluenzaseason(Octoberthroughthe
followingMay).
1

DuringtheweekendingDecember14,2013:
Influenzaactivitylevelwascategorizedasgeographicallywidespread
2
withlaboratoryconfirmedinfluenzareported
in34countiesplusNewYorkCity.
Therewere284laboratoryconfirmedinfluenzareports,a54%increaseoverlastweek.
OfthespecimenssubmittedtoNYSWHO/NREVSSlaboratories,24werepositiveforinfluenza.
Nineofthe45specimenssubmittedtotheNYSDOHlaboratorywerepositiveforinfluenza.SevenwereinfluenzaA
(H1)andtwowereinfluenzaB.
Reportsofpercentofpatientvisitsforinfluenzalikeillness(ILI
3
)fromILINetproviderswas1.01%,whichisbelowthe
regionalbaselineof2.2%.
Thenumberofpatientsadmittedtothehospitalwithlaboratoryconfirmedinfluenzaorhospitalizedpatientsnewly
diagnosedwithlaboratoryconfirmedinfluenzawas43,a19%decreaseoverlastweek.
Therewerenoinfluenzaassociatedpediatricdeathsreportedthisweek.Therehavebeennoinfluenzaassociated
pediatricdeathsreportedthisseason.

NYSEpidemiologistsReporttotheCentersforDiseaseControlandPrevention(CDC)
ThisgraphrepresentsthegeographicspreadoflaboratoryconfirmedinfluenzaactivityinNYS(includingNYC),not
necessarilytheintensityofinfluenzaactivity.

1
InformationaboutinfluenzamonitoringinNewYorkCity(NYC)isavailablefromtheNYCDepartmentofHealthandMentalHygienewebsiteat:
http://www.nyc.gov/html/doh/.NationalinfluenzasurveillancedataisavailableonCDCsFluViewwebsiteathttp://www.cdc.gov/flu/weekly/.
2
NoActivity:NolaboratoryconfirmedcasesofinfluenzareportedtotheNYSDOH.
Sporadic:Smallnumbersoflabconfirmedcasesofinfluenzareported.
Local:IncreasedorsustainednumbersoflabconfirmedcasesofinfluenzareportedinasingleregionofNewYorkState;sporadicinrestofstate.
Regional:Increasedorsustainednumbersoflabconfirmedcasesofinfluenzareportedinatleastthreeregionsbutinfewerthan31of62counties.
Widespread:Increasedorsustainednumbersoflabconfirmedcasesofinfluenzareportedinatleast31ofthe62counties.
3
ILI=influenzalikeillness,definedastemperature100Fwithcoughand/orsorethroatintheabsenceofaknowncauseotherthaninfluenza.

BUREAU OF COMMUNICABLE DISEASE CONTROL

STATEWIDE INFLUENZA SURVEILLANCE REPORT
FOR WEEK ENDING
December 14, 2013
2

LaboratoryReportsofInfluenza(includingNYC)
AllclinicallaboratoriesthatperformtestingonresidentsofthestatereportallpositiveinfluenzatestresultstoNYSDOH.

Basedonlaboratoryreports
toNYSDOH:
Influenzawasreportedin
34countiesthisweekand
all5boroughsofNYC.
Influenzawasreportedin
11countiespreviouslythis
season,butnotthisweek.
Testresultsmayidentifyinfluenza
TypeA,influenzaTypeB,orinfluenza
withoutspecifyingTypeAorB.Some
testsonlygiveapositiveornegative
resultandcannotidentifyinfluenza
type(notspecified).
3

WorldHealthOrganization(WHO)andNationalRespiratory&EntericVirusSurveillance
System(NREVSS)CollaboratingLaboratories
ElevenclinicalvirologylaboratoriesinNYSandNYC,includingtheWadsworthCenter,areWHOand/orNREVSS
collaboratinglaboratoriesforinfluenzavirussurveillance.

InfluenzaVirusTypesandSubtypesIdentifiedbyWadsworthCenter(excludingNYC)
WadsworthCenter,theNYSDOHpublichealthlaboratory,testsspecimensfromsourcesincluding,butnotlimitedto,
outpatienthealthcareproviders(ILINetprogram)andhospitals(EIPprogram).

Thereare2commonsubtypesofTypeA
influenzavirusesH1andH3.Each
subtypehasaslightlydifferentgenetic
makeupfromtheother.Rarely,an
influenzavirusisunabletobetypedbythe
laboratory.
Theselabsreportthenumberof
respiratoryspecimenstestedand
thenumberpositiveforinfluenza
typesAandBtoCDCeach
week.Fiveoftheselabsalsoreport
theinfluenzaAsubtype(H1or
H3).Becausedenominatordatais
provided,theweeklypercentageof
specimenstestingpositivefor
influenzaiscalculated.
4

InfluenzaAntiviralResistanceTesting
TheWadsworthCenterVirologyLaboratoryperformssurveillancetestingforantiviraldrugresistance.
4

NYSAntiviralResistanceTestingResultsonSamplesCollectedSeasontoDate,201314
Oseltamivir Zanamivir
Sampl es
tested
Resi stant Vi ruses,
Number (%)
Sampl es
tested
Resi stant Vi ruses,
Number (%)
Infl uenza A (H3N2)
i
4 0(0.0) 2 0(0.0)
Infl uenza B
i i
0 0(0.0) 0 0(0.0)
2009 Infl uenza A (H1N1)
i i i
10 0(0.0) 2 0(0.0)
i. AllsamplestestedforoseltamivirresistancebypyrosequencingforE119V,R292K,andN294Sintheneuraminidasegene(NA),andasubsettestedbyNA
dideoxysequencingforothervariationsknowntocause,orsuspectedofcausing,resistancetoneuraminidaseinhibitordrugsincludingzanamivirand
oseltamivir.
ii. Samplestestedbywholegenedideoxysequencingoftheneuraminidasegene.Sequencedatareviewedforvariationsknowntocause,orsuspectedofcausing,
resistancetoneuraminidaseinhibitordrugsincludingzanamivirandoseltamivir.
iii. AllsamplestestedbypyrosequencingfortheH275Yvariantintheneuraminidasegenewhichconfersresistancetooseltamivir,andasubsettestedbyNA
dideoxysequencingforothervariationsknowntocause,orsuspectedofcausing,resistancetoneuraminidaseinhibitordrugsincludingzanamivirand
oseltamivir.

OutpatientDoctorsOfficeVisitsforILIILINetSurveillanceProgram(excludingNYC)
TheNYSDOHworkswithILINethealthcareproviderswhoreportthetotalnumberofpatientsseenandthetotalnumber
ofthosepatientswithcomplaintsofILIeveryweek.


EmergencyDepartmentVisitsforILISyndromicSurveillance(excludingNYC)
HospitalsaroundNYSreportthenumberofpatientsseenintheiremergencydepartmentswithcomplaintsofILI.Thisis
calledsyndromicsurveillance.

4
Additionalinformationregardingnationalantiviralresistancetesting,aswellasrecommendationsforantiviraltreatmentandchemoprophylaxisofinfluenzavirus
infection,canbefoundathttp://www.cdc.gov/flu/weekly/.
TheCDCusestrendsfrompast
yearstodeterminearegional
baselinerateofdoctors'office
visitsforillnessconsistentwith
influenza.ForNYS,theregional
baselineiscurrently2.2%.
Numbersabovethisregional
baselinesuggesthighlevelsof
illnessconsistentwithinfluenza
inthestate.
Anincreaseinvisitstohospital
emergencydepartmentsforILIcan
beonesignthatinfluenzahas
arrivedinthatpartofNYS.

Syndromicsurveillancedoesnot
revealtheactualcauseofillness,
butisthoughttocorrelatewith
emergencydepartmentvisitsfor
influenza.
5

PatientsHospitalizedwithLaboratoryConfirmedInfluenza(includingNYC)
HospitalsinNYSandNYCreportthenumberofhospitalizedpatientswithlaboratoryconfirmedinfluenzatoNYSDOH.
5

UnderlyingHealthConditionsamongHospitalizedPatients
AspartoftheCDCsInfluenzaHospitalizationNetwork,theNYSEmergingInfectionsProgram(EIP)conductsenhanced
surveillanceforhospitalizedcasesoflaboratoryconfirmedinfluenzaamongresidentsof15counties.
6
Medicalchart
reviewsarecompletedonallidentifiedcasesfromOctober1throughApril30ofthefollowingyear.EIPestimated
hospitalizationrateswillbeupdatedweeklystartinglaterthisseason.

5
151(77%)of197hospitalsreportedthisweek.
6
Countiesinclude,intheCapitalDistrict:Albany,Columbia,Greene,Montgomery,Rensselaer,Saratoga,Schenectady,andSchoharie;intheWesternRegion:
Genesee,Livingston,Monroe,Ontario,Orleans,Wayne,andYates.
6

HealthcareassociatedInfluenzaActivity(includingNYC)
HospitalsandnursinghomesinNewYorkStateselfreportoutbreaksofinfluenza.Ahealthcareassociatedoutbreakis
definedasoneormoreconfirmedortwoormoresuspectcasesofinfluenzainpersonswhowereadmittedtothe
facilitywithnosignsorsymptomsofinfluenzainfection.Outbreaksareconsideredconfirmedonlywithpositive
laboratorytesting.Thismayincludeapositiverapidantigentestifnoothermoreadvancedtesting(polymerasechain
reaction,viralculture)isperformed.
7

Pediatricinfluenzaassociateddeathsreported(includingNYC)
LocalhealthdepartmentsreportpediatricinfluenzaassociateddeathstoNYSDOH.

7
Formoreinformationonreportingofhealthcareassociatedinfluenza,visithttp://www.health.ny.gov/diseases/communicable/control/respiratory_disease_checklist.htm
WeektoDate(CDCweek50) CapitalRegion CentralRegion MetroRegion WesternRegion Statewide(Total)
12/8/13 through12/14/13 ACF LTCF Total ACF LTCF Total ACF LTCF Total ACF LTCF Total ACF LTCF Total
#Outbreaks*LabconfirmedInfluenza(any
type)
0 0 0 0 0 0 0
#Outbreaks*viralrespiratoryillness** 1 1 0 0 0 0 1 1
Total#Outbreaks
0 1 1 0 0 0 0 0 0 0 0 0 0 1 1

SeasontoDate(CDCweek50) CapitalRegion CentralRegion MetroRegion WesternRegion Statewide(Total)
9/29/13 through12/14/13 ACF LTCF Total ACF LTCF Total ACF LTCF Total ACF LTCF Total ACF LTCF Total
#Outbreaks*LabconfirmedInfluenza(any
type)
1 1 1 1 2 1 3 0 3 2 5
#Outbreaks*viralrespiratoryillness** 1 5 6 1 1 2 2 3 3 1 11 12
Total#Outbreaks 2 5 7 0 2 2 2 3 5 0 3 3 4 13 17
ACFArticle28AcuteCareFacility
LTCFArticle28LongTermCareFacility
*Outbreaksarereportedbasedontheonsetdateofsymptomsinthefirstcase
**Includesoutbreaksofsuspectinfluenzaand/orotherviralupperrespiratorypathogens

Fluassociateddeathsin
childrenyoungerthan18
yearsoldarenationally
notifiable.
Allpediatricfluassociated
deathsincludedinthis
reportarelaboratory
confirmed.