Weekly US Influenza Surveillance Report: Key Updates for Week 46, ending November 16, 2024

Summary

Viruses

Illness

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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

A description of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component is available on the surveillance methods page.¹

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

U.S. virologic surveillance

Nationally and in HHS regions 6, 8, 9, and 10, the percentage of respiratory specimens testing positive for influenza virus in clinical laboratories increased (change of ≥0.5 percentage points) compared to the previous week. In regions 3, 4, and 5, percent positivity has trended upward during the past few weeks. Influenza A(H1N1)pdm09 and A(H3N2) viruses are co-circulating; however, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive. Viruses known to be associated with recent receipt of live attenuated influenza vaccine (LAIV) 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 virus) are used to monitor whether influenza activity is increasing or decreasing.

Public Health Laboratories

The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.

_{*These data reflect specimens tested, and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). The data do not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 virus testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 virus than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the "How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation"}

^†_{When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a "variant" influenza virus. Most human infections with variant influenza viruses occur following exposure to swine, but human-to-human transmission can occur. It is important to note that in most cases, variant influenza viruses have not shown the ability to spread easily and sustainably from person to person.}

_{*This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.}

Novel Influenza A Virus Infections

Six confirmed human infections with influenza A(H5) viruses were reported to CDC this week. To date, human-to-human transmission of influenza A(H5) virus has not been identified in the United States.

Five confirmed cases were reported by the California Department of Public Health. Four of these cases occurred in workers at commercial dairy cattle farms in areas where highly pathogenic avian influenza (HPAI) A(H5N1) viruses had been detected in cows, and one case occurred in a child with no known contact with influenza A(H5N1) virus-infected animals. The investigation into the source of infection for this case is ongoing, but there is currently no evidence of human-to-human transmission. There have now been 29 total confirmed human cases and one probable human case in California.

One confirmed case was reported by the Oregon Health Authority. This case was in a worker who performed depopulation activities at a commercial poultry facility where HPAI A (H5N1) viruses had been detected in birds. This is the first human case identified in Oregon.

Five of the six individuals reported this week are more than 18 years old and one was less than 18 years old. All six individuals had mild symptoms. Specimens from all six individuals were tested at state or public health laboratories using the CDC influenza A (H5) assay before being sent to CDC for further testing. Specimens from all six confirmed cases were positive for influenza A(H5) virus using diagnostic RT-PCR or genetic sequencing at CDC. Additional analysis including genetic sequencing is underway.

In response to these detections, additional case investigations and surveillance activities are being conducted by public health officials in California and Oregon.

The CSTE position statement, which includes updated case definitions for confirmed, probable, and suspect cases is available at http://www.cste.org/resource/resmgr/position_statements_files_2023/24-ID-09_Novel_Influenza_A.pdf

An up-to-date human case summary during the 2024 outbreak by state and exposure source is available at www.cdc.gov/bird-flu/situation-summary/index.html

Information about avian influenza is available at https://www.cdc.gov/flu/avianflu/index.htm.

Interim recommendations for Prevention, Monitoring, and Public Health Investigations are available at https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html.

The latest case reports on avian influenza outbreaks in wild birds, commercial poultry, backyard or hobbyist flocks, and mammals in the United States are available from the USDA at https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/animal-disease-information/avian/avian-influenza/2022-hpai.

Influenza Virus Characterization

CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to 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 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 polymerase acidic protein (PA) endonuclease inhibitor baloxavir. The HA clade and subclades were assigned using Nextclade (https://clades.nextstrain.org).

CDC has genetically characterized 863 influenza viruses collected since May 19, 2024.

CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, and B/Victoria viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2024-2025 Northern Hemisphere recommended 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 or equal to 8-fold. Viruses selected for antigenic characterization are a subset of the recent genetically characterized viruses and are chosen based on the genetic changes in their surface proteins and may not be proportional to the number of such viruses circulating in the United States.

Influenza A Viruses

• A(H1N1)pdm09: 97 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 94 (96.9%) were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
• A(H3N2): 203 A(H3N2) viruses were antigenically characterized by HI or HINT, and 149 (73.4%) were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Massachusetts/18/2022-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.

Influenza B Viruses

• B/Victoria: 28 influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
• B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.

Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods.

Viruses collected in the U.S. since May 19, 2024, were tested for antiviral susceptibility as follows:

Two A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution conferring highly reduced inhibition by oseltamivir and peramivir. One A(H1N1)pdm09 virus had NA-I223V and NA-S247N amino acid substitutions and showed reduced inhibition by oseltamivir.

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 and Emergency Department Illness Surveillance

Outpatient respiratory illness visits

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as 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 virus, SARS-CoV-2, and RSV. 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.

Nationally, during Week 46, 2.7% 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 week's percentage increased (change of > 0.1 percentage points) compared to Week 45 and has been trending upward for the past four weeks but remains below baseline. Region 4 is at its baseline while the remaining nine HHS regions are below their respective baselines. The percentage of visits for ILI increased this week compared to last week in regions 4, 6, 9, and 10 , and has been trending upward in regions 2 and 8. ILI activity remained stable (change of ≤ 0.1 percentage points) in all other regions (1, 3, 5, and 7) in Week 46 compared to Week 45. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infections to ILI varies by location.

Outpatient respiratory illness visits by age group

About 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. Based on these data, the percentage of visits for respiratory illness increased (change of > 0.1 percentage point) in the 0-4 years, 5-24 years, and 25-49 years age groups and remained stable (change of ≤ 0.1 percentage point) in the 50-64 years and 65+ years age groups in Week 46 compared to Week 45.

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).

National Syndromic Surveillance System (NSSP)

The overall percentage of emergency department (ED) visits with a discharge diagnosis of influenza reported in NSSP was 0.5% during Week 46 and has been trending up slightly over the past few weeks. In Region 9, the percentage of ED visits increased in Week 46 compared to the previous week and in regions 4 and 6 it has been trending upward over the past few weeks. In the remaining seven HHS regions, the percentage of ED visits for influenza remained stable (change of ≤ 0.1 percentage point) compared to the previous week. This percentage increased among the 0-4 years and 5-17 years age groups and remained stable (change of ≤ 0.1 percentage point) among the 18-64 years and 65+ age groups.

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.

A total of 365 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2024 and November 16, 2024. The weekly hospitalization rate observed in Week 46 was 0.3 per 100,000 population. The cumulative hospitalization rate observed in Week 46 was 1.2 per 100,000 population.

_{**In this figure, weekly rates for all seasons prior to the 2024-2025 season reflect end-of-season rates. For the 2024-2025 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.}

National healthcare safety network (NHSN) hospitalization surveillance

Effective November 1, 2024, all acute care and critical access hospitals are required to report the number of patients admitted with laboratory-confirmed influenza to NHSN. These data will be updated weekly in FluView and on FluView Interactive once sufficient data has been collected. Public datasets, including data reported on a voluntary basis prior to November 1, 2024, can be found here: https://data.cdc.gov/Public-Health-Surveillance/Weekly-United-States-Hospitalization-Metrics-by-Ju/aemt-mg7g/about_data.

Mortality surveillance

Based on NCHS mortality surveillance data available on November 21, 2024, 0.03% of the deaths that occurred during the week ending November 16, 2024 (Week 46), were due to influenza. This percentage remained stable (≤ 0.1 percentage point change) compared to Week 45. The data presented are preliminary and may change as more data are received and processed.

Influenza-Associated Pediatric Mortality

One influenza-associated pediatric death occurring during the 2024-2025 season was reported to CDC during week 46. The death was associated with an influenza A(H3) virus and occurred during Week 45 (the week ending November 9, 2024). This is the second seasonal influenza-associated pediatric death occurring during the 2024-2025 season that has been reported to CDC.

Additional National and International Influenza Surveillance Information

Indicators Status by System

Additional surveillance information