FluView Summary ending on May 14, 2022

Viruses

Illness

Severe Disease

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

A description of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component is available on the surveillance methods page.

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

U.S. Virologic Surveillance

Nationally, the percentage of specimens testing positive for influenza in clinical laboratories decreased. However, activity varied by region; percent positivity increased by more than 0.1 percentage point this week in Regions 1 and 4, and was similar to or lower than the previous week in all other regions. Influenza A(H3N2) viruses have been the most frequently detected influenza viruses this season. Of the 11,681 influenza positives reported this season by the public health labs and also tested for SARS-CoV-2, 531 (4.5%) were also positive for SARS-CoV-2. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent live attenuated influenza vaccine (LAIV) receipt or found upon further testing to be a vaccine virus are not included as they are not circulating influenza viruses.

Clinical Laboratories

The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza) are used to monitor whether influenza activity is increasing or decreasing.

Influenza Virus Characterization

CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories using the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 1,379 influenza viruses collected since October 3, 2021. H3N2 viruses identified so far this season are genetically closely related to the vaccine virus, but there are some antigenic differences that have developed as H3N2 viruses have continued to evolve.

CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, B/Victoria and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2021-2022 Northern Hemisphere recommended egg-based and cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses

• A (H1N1)pdm09: Three A(H1N1)pdm09 viruses were antigenically characterized by HI, and 2 (67%) were well recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/588/2019-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines, and 2 (67%) were well recognized by ferret antisera to egg-grown A/Victoria/2570/2019-like reference viruses representing the A(H1N1)pdm09 component for the egg-based influenza vaccines.
• A (H3N2): A subset of 101 A(H3N2) viruses were antigenically characterized by HINT, and 4 (4%) were well recognized (reacting at titers that were within 8-fold of the homologous virus titer) by ferret antisera to cell-grown A/Cambodia/E0826360/2020-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines, and 19 (19%) were well recognized by ferret antisera to egg-grown A/Cambodia/E0826360/2020-like reference viruses representing the A(H3N2) component for egg-based influenza vaccines.

Influenza B Viruses

• B/Victoria: Fifteen B/Victoria lineage viruses were antigenically characterized by HI, and 11 (73%) were well recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Washington/02/2019-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines, and 11 (73%) were well recognized by ferret antisera to egg-grown B/Washington/02/2019-like reference viruses representing the B/Victoria component for egg-based influenza vaccines.
• B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.

One A(H3N2) virus had a PA-I38M amino acid substitution previously associated with reduced baloxavir susceptibility and showed ~8-fold reduced susceptibility to baloxavir in vitro.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended, and data from adamantane resistance testing are not presented.

Outpatient Respiratory Illness Surveillance

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza, and will therefore capture respiratory illness visits due to infection with any pathogen that can present with similar symptoms, including influenza, SARS-CoV-2, and RSV. Due to the COVID-19 pandemic, health care-seeking behaviors have changed, and people may be accessing the health care system in alternative settings not captured as a part of ILINet or at a different point in their illness than they might have before the pandemic. Therefore, it is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is tracking the COVID-19 pandemic in a weekly publication called COVID Data Tracker Weekly Review. Information about other respiratory virus activity can be found on CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) website.

Outpatient Respiratory Illness Visits

Nationwide during week 19, 2.4% of patient visits reported through ILINet were due to respiratory illness that included fever plus a cough or sore throat, also referred to as ILI. This remained stable (change of ≤ 0.1%) compared to week 18 but has been trending upward since early March. Seven of the 10 HHS Regions are below their region-specific baselines; Regions 1, 2, and 10 are above their respective baselines. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

* Effective October 3, 2021 (week 40), the ILI definition (fever plus cough or sore throat) no longer includes “without a known cause other than influenza.”

Outpatient Respiratory Illness Visits by Age Group

More than 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet is trending upward in all age groups (0-4 years, 5-24 years, 25-49 years, 50-64 years, and 65+ years).

* Effective October 3, 2021 (week 40), the ILI definition (fever plus cough or sore throat) no longer includes “without a known cause other than influenza.”

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Outpatient Respiratory Illness Activity Map

Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).

*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.

Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map

Long-term Care Facility (LTCF) Surveillance

LTCFs (e.g., nursing homes/skilled nursing, long-term care for the developmentally disabled, and assisted living facilities) from all 50 states and U.S. territories report data on influenza virus infections among residents through the National Healthcare Safety Network (NHSN) Long-term Care Facility Component. During week 19, 99 (0.7%) of 14,113 reporting LTCFs reported at least one influenza positive test among their residents.

Additional information about long-term care facility surveillance:
Surveillance Methods | Additional Data

Hospitalization Surveillance

FluSurv-NET

The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

Due to late-season activity during the 2021-2022 season, FluSurv-NET surveillance has been extended beyond the typical end date of April 30 (MMWR Week 17). For this reason, comparisons between cumulative end of season rates for prior seasons and cumulative hospitalization rates beyond week 17 of the 2021-2022 season should be interpreted with caution. Comparisons with similar late-season weekly rates is not possible since data from similar weeks in prior seasons is not available. A graph showing weekly rates for the 2021-2022 season beyond week 17 has been added to FluView.

A total of 4,225 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2021, and May 14, 2022. As of MMWR week 19, the overall cumulative hospitalization rate was 14.4 per 100,000 population and the overall weekly hospitalization rate was 0.6 per 100,000 population. The weekly rate for the 2021-22 season during MMWR week 17 (1.1) was the highest weekly rate observed during that week since the 2010-2011 season. While the cumulative hospitalization rate for the 2021-22 season is lower than the end of-season rates observed during the 4 seasons preceding the COVID-19 pandemic (these ranged from 62.0 to 102.9 per 100,000 during the 2016-17 through 2019-20 seasons), additional data (“backfill”) may change that rate subsequent to this report.

When examining rates by age, the highest rate of hospitalization per 100,000 population was among adults aged 65 and older (41.7). Among adults aged 65 and older, rates were highest among adults aged 85 and older (83.7). Among persons aged less than 65 years, hospitalization rates per 100,000 population were highest among children aged 0-4 years (18), followed by adults aged 50-64 years (13.4). When examining rates by race and ethnicity, the highest rate of hospitalization per 100,000 population was among non-Hispanic American Indian or Alaska Native persons (23.6), followed by non-Hispanic Black persons (16.7).

Among 4,225 hospitalizations, 4,087 (96.7%) were associated with influenza A virus, 125 (3%) with influenza B virus, 5 (0.1%) with influenza A virus and influenza B virus co-infection, and 8 (0.2%) with influenza virus for which the type was not determined. Among 960 hospitalizations with influenza A subtype information, 951 (99.1%) were A(H3N2), and 9 (0.9%) were A(H1N1)pdm09. Based on preliminary data, of the 4,225 laboratory-confirmed influenza-associated hospitalizations, 2.4% also tested positive for SARS-CoV-2.

Among 1848 hospitalized adults with information on underlying medical conditions, 93.8% had at least one reported underlying medical condition the most commonly reported were hypertension, cardiovascular disease, metabolic disorder, and obesity. Among 291 hospitalized children with information on underlying medical conditions, 67.7% had at least one reported underlying medical condition; the most commonly reported condition was asthma.

FluSurv-Net data are used to generate national estimates of the total numbers of influenza cases, medical visits, hospitalizations, and deaths. This season, CDC is reporting preliminary cumulative in-season estimates, which are available at https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

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Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods |FluView Interactive: Rates by Age, Sex, and Race/Ethnicity or Data on Patient Characteristics

FluSurv-Net data are used to generate national estimates of the total numbers of influenza cases, medical visits, hospitalizations, and deaths. This season, CDC is reporting preliminary cumulative in-season estimates, which are available at https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

HHS Protect Hospitalization Surveillance

Hospitals report to HHS Protect the number of patients admitted with laboratory-confirmed influenza. During week 19, 3,153 patients with laboratory-confirmed influenza were admitted to the hospital.

Effective February 2, 2022, hospitals are required to report laboratory-confirmed influenza hospitalizations to HHS Protect daily. Prior to this update, reporting influenza hospitalizations was optional. See COVID-19 Guidance for Hospital Reporting and FAQs for additional details on this guidance.

Additional HHS Protect hospitalization surveillance information:
Surveillance Methods |  Additional Data

Mortality Surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance

Based on NCHS mortality surveillance data available on May 19, 2022, 7.5% of the deaths that occurred during the week ending May 14, 2022 (week 19), were due to pneumonia, influenza, and/or COVID-19 (PIC). This percentage is above the epidemic threshold of 6.5% for this week. Among the 1,409 PIC deaths reported for this week, 592 had COVID-19 listed as an underlying or contributing cause of death on the death certificate, and 27 listed influenza, indicating that current PIC mortality is due primarily to COVID-19 and not influenza. The data presented are preliminary and may change as more data are received and processed.

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive

Influenza-Associated Pediatric Mortality

No influenza-associated pediatric deaths were reported to CDC during week 19.

A total of 24 influenza-associated pediatric deaths occurring during the 2021-2022 season have been reported to CDC.

Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive

Additional National and International Influenza Surveillance Information

FluView Interactive: FluView includes enhanced web-based interactive applications that can provide dynamic visuals of the influenza data collected and analyzed by CDC. These FluView Interactive applications allow people to create customized, visual interpretations of influenza data, as well as make comparisons across flu seasons, regions, age groups and a variety of other demographics.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.

World Health Organization:
Additional influenza surveillance information from participating WHO member nations is available through
FluNet and the Global Epidemiology Reports.

WHO Collaborating Centers for Influenza:
Australia, China, Japan, the United Kingdom, and the United States (CDC in Atlanta, Georgia)

Europe:
The most up-to-date influenza information from Europe is available from WHO/Europe and the European Centre for Disease Prevention and Control.

Public Health Agency of Canada:
The most up-to-date influenza information from Canada is available in Canada’s weekly FluWatch report.

Public Health England:
The most up-to-date influenza information from the United Kingdom is available from Public Health England.

Any links provided to non-Federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization web pages found at these links.

A description of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component is available on the surveillance methods page.