Week ending 24 November 2018 (week 47)

The number of positive respiratory specimens in week 47 decreased by 20% from the previous week, with 132 positive specimens in week 46 compared to 105 positive speci-mens in week 47. Influenza A and B accounted for 17% and 15%, respectively, of the positive respiratory specimen tests. The majority (83, 86%) of positive respiratory tests were in the non-Active Duty population under 18 years old. No influenza-associated hospitalizations were reported in DRSi in week 47. The influenza season typically peaks around the holidays, so it is strongly recommended to get an influenza vaccination to protect against respiratory illness, and follow appropriate hand hygiene practices at all times.

Additional Resources: Army Influenza Reports; ARD Reports; AFHSC Influenza Reports; NHRC FRI Reports; DoD Pandemic Influenza Watchboard; CDC Key: ILI -Influenza-Like Illness; DRSi- Disease Reporting System Internet; NHRC- Naval Health Research Center; ADV-Adenovirus; RSV-Respiratory Syncytial Virus; DED- Disease Epidemiology Division; SM-Service Member

Questions? Email APHC DEP 410-436-7605

*Data Source: MEDPROS, ASIMS, MRRS

INFLUENZA-ASSOCIATED HOSPITALIZATIONS

DEMOGRAPHICS

Influenza Vaccination Coverage*

As of 7 November 2018

N/A DoD

75% Army Active Duty

62% Army Guard

63% Army Reserve

SUMMARY

AD: In w eek 47, a total of 9 cases tested positive for a respiratory specimen in the AD population. The majority of them (56%) were in the 18-29 age group, followed by 33% in the 30-39 age group, and 11% in the 40-49 age group. There were no cases under 18 or over 50 years old.

Non-AD: Of the 96 posit ive specimens among non -AD individuals, 86% (83) were among individuals less than 18 years old.

In the civilian population, influenza activity remains generally sporadic. In week 45, regional influenza activity was report-ed to the CDC by five, local activity was reported by sixteen states, and sporadic activity was reported by the District of Columbia, Puerto Rico, the US Virgin Islands, and 28 states. No influenza activity was reported by Guam and Virginia.

No influenza-associated hospitalizations were reported to DRSi in week 47. So far this season, five cases of non-AD influenza-associated hospitalizations have been reported; no AD cases have been reported. This time last season, a total of nine cases had been reported in 3 AD cases and 6 non-AD cases. Of the cases reported so far this year, three had been previously vaccinated. Three tested positive with influenza A.

*DRSi does not capture cases older than 65 years old for influenza-associated hospitalizations.

Click to enlarge image GEOGRAPHIC SPREAD

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Army Influenza-Associated Hospitalizations Reported in DRSi by Onset Date

2018-2019 AD 2018-2019 Non-AD 2017-2018 AD 2017-2018 Non-AD

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Positive Respiratory Specimen Results from Army MTFs by Age Group and Beneficiary Status, 2018-2019 Influenza Season

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Week ending 24 November 2018 (week 47) Army Influenza Activity Report U.S. Army Public Health Center

LABORATORY RESPIRATORY SPECIMEN TESTING

ILI ACTIVITY - ARMY ILI ACTIVITY - UNITED STATES

The number of positive specimens in week 47 decreased by 20%, from 132 positive specimens in week 46 to 105 positive specimens in week 47. RSV accounted for 54% of the positive speci-mens. Influenza A and B accounted for 17% and 15% of the specimens, respectively. Parainfluen-za accounted for 9% of positive specimens, and adenovirus accounted for 5% of positive speci-mens. The majority of positive tests in week 47 were from rapid antigen tests (RATs), followed by PCR.

Nationwide, 374 specimens were tested, of which 88 were positive. Influenza A accounted for 95.5% of the total posi-tive specimens submitted to the CDC in week 47. In the Army population, 105 (4.6%) of 996 specimens tested were positive for a respiratory illness; of that, 17% tested positive for influenza A. Four (22%) of the positive influenza A specimens were from Active Duty individuals. RHC-A and RHC-C reported the majority of positive influenza A specimens, with 7 (39%) and 8 (44%) of the total influenza A positive specimens, respectively.

Nationwide in week 47, incident ILI activity was 2.3%, above the national baseline of 2.2%. Regionally, the percentage of ILI outpatient visits reported to the CDC ranged from 1.0% to 3.5%. At Army medical treatment facilities, incident ILI activity was 17% lower than the same time last year. The majority of ILI encounters (69%) were from non-AD patients.

Locations providing week 47 laboratory data as of 14 November 2018: Korea, Ft Belvoir, Ft Benning, Ft Bliss, Ft Bragg, Ft Campbell, Ft Carson, Ft Drum, Ft Eustis, Ft Gordon, Ft Hood, Ft Huachuca, Ft Irwin, Ft Jackson, Ft Knox, Ft Leavenworth, Ft Lee, Ft Leonard Wood, Ft Meade, Ft Polk, Ft Rucker, Ft Sam Houston, Ft Sill, Ft Stewart, Ft. Wainwright, Landstuhl, Redstone Arsenal, Tripler, West Point, and Walter Reed.

*NOTE: Madigan AMC data was not received due to the switch from AHLTA/CHCS to MHS Genesis

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Proportion of Positive Influenza A Specimens for U.S. Army 2018-2019

Total Tested (2018-19)

Average Tested (2014-18)

% Influenza A Positive

Week 44 Week 45 Week 46 Week 47 Season Total

RAT 21 18 21 15 111

Culture 2 3 0 1 15

PCR 3 2 9 2 28

Influenza A 26 23 30 18 154

Influenza B 13 5 8 16 77

Adenovirus 17 19 7 5 70

Enterovirus 1 0 0 0 2

Parainfluenza 31 24 19 9 130

RSV 52 65 68 57 312

Negative 2146 2422 2304 2135 16219

Total 2286 2558 2436 2240 16964

Test Types Among

Positive Influenza A

Specimens

Army MTF

Laboratory Results,

2018-19

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Calendar Week

ESSENCE Weekly Outpatient Clinic Visits for Influenza-like Illness Army MTFs, All Services, 2016-2019

AD 2018-2019 Non-AD 2018-2019 2016-2017 2017-2018 All 2018-2019

Week ending 24 November 2018 (week 47) Army Influenza Activity Report U.S. Army Public Health Center

LABORATORY RESPIRATORY SPECIMEN TESTING

No.: Number of specimens tested during MMWR week 47, 2018.

% Pos.: Percentage of positive specimens reported during MMWR week 47, 2018.

Baseline % Pos.: Percentage of positive specimens reported in MMWR week 47 during influenza seasons from September 2012 - May 2018.

Missing values indicate that specimens were not tested for the disease during the week of interest.

No.

Tested

%

Positive

Baseline

% Pos.

No.

Tested

%

Positive

Baseline

% Pos.

No.

Tested

%

Positive

Baseline

% Pos.

Ft. Belvoir 83 8.4 3.9 1 100 100

Ft. Benning 73 2.7 8.6 72 0 0

Ft. Bragg 74 6.8 1.4

Ft. Campbell 35 0 0 55 0 0 1 100 100

Ft. Drum 5 0 0

Ft. Eustis 4 0 5.8

Ft. Gordon 90 5.6 6.6 36 16.7 8.6 1 100 100

Ft. Jackson 25 4 1.6 25 0 0

Ft. Knox 3 0 0 3 0 0

Ft. Rucker 3 0 9.6 1 0 1.8

Ft. Stewart 33 12.1 4.7 51 13.7 6.4

Redstone Arsenal 8 0 25 9 0 0

West Point 7 0 0 1 100 100

Ft. Bliss 41 2.4 0.5 30 0 0 11 9.1 9.7

Ft. Carson 51 23.5 11.4 1 100 100

Ft. Hood 112 4.5 10.9 112 2.7 1

Ft. Huachuca 1 0 0 2 0 4.2

Ft. Irwin 3 0 0 3 0 0

Ft. Leavenworth 3 33.3 11.7 3 0 0

Ft. Polk 15 20 10.9 1 100 100

Ft. Riley 13 0 0 13 0 0

Ft. Sam Houston 130 13.8 8 128 3.1 1.2 1 100 100

Ft. Sill 18 16.7 3.3

RHCE Landstuhl 30 3.3 0.7 26 7.7 1.5 25 4 3

Ft. Wainwright 1 0 15.2 2 0 0

Korea 14 7.1 1.4 13 0 0 13 7.7 6.5

Tripler 85 0 3 74 1.4 50.7 73 0 80

Influenza B Adenovirus

Region Installation

Influenza A

RHCA

RHCC

RHCP

No.

Tested

%

Positive

Baseline

% Pos.

No.

Tested

%

Positive

Baseline

% Pos.

No.

Tested

%

Positive

Baseline

% Pos.

Ft. Belvoir 2 100 100 8 12.5 24.4

Ft. Campbell 4 100 100 3 100 100

Ft. Drum 1 100 100 2 0 33.3

Ft. Gordon 3 100 100 9 100 100

Ft. Stewart 15 26.7 25

West Point 1 100 100

Ft. Bliss 12 16.7 12.2

Ft. Carson 17 17.6 5.5

Ft. Hood 2 50 43.2

Ft. Leavenworth 1 0 10

Ft. Polk 1 0 33.3

Ft. Riley 10 0 5.4

Ft. Sam Houston 1 100 100

Ft. Sill 1 0 0

RHCE Landstuhl 26 3.8 5.6 28 14.3 13.7

Ft. Wainwright 1 0 0

Korea 4 0 0 13 0 0 16 37.5 21.3

Tripler 74 1.4 50.7 75 2.7 80.5 6 100 100

RHCA

RHCC

RHCP

RSV

Region Installation

Enterovirus Parainfluenza

Week ending 24 November 2018 (week 47) Army Influenza Activity Report U.S. Army Public Health Center

Regional Health Command - Atlantic (RHC-A)

Regional Health Command - Central (RHC-C)

Regional Health Command - Europe (RHC-E)

Regional Health Command - Pacific (RHC-P)

Proportion of Influenza A Positive Specimens by Week and Region, Army Medical Laboratories, 2018-2019 as Compared to 2014-2018

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Total Tested (2018-19)

Average Tested (2014-18)

% Influenza A Positive

Age

GroupAD

Non-AD

Ben

Season

Total

< 18 0 6 38

18-29 2 0 4

30-39 0 2 10

40-49 0 1 3

50-59 0 0 6

60+ 0 2 5

Total 2 11 66

Week 47

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Total Tested (2018-19)

Average Tested (2014-18)

% Influenza A Positive

Age

GroupAD

Non-AD

Ben

Season

Total

< 18 0 0 4

18-29 0 0 2

30-39 1 1 3

40-49 0 0 0

50-59 0 0 1

60+ 0 0 0

Total 1 1 10

Week 47

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Total Tested (2016-17)

Average Tested (2014-18)

% Influenza A Positive

Age

GroupAD

Non-AD

Ben

Season

Total

< 18 0 1 14

18-29 1 0 4

30-39 0 0 5

40-49 0 1 4

50-59 0 0 0

60+ 0 0 0

Total 1 2 27

Week 47

Age

GroupAD

Non-AD

Ben

Season

Total

< 18 0 4 29

18-29 2 1 11

30-39 0 0 3

40-49 0 0 2

50-59 0 0 2

60+ 0 0 3

Total 2 5 50

Week 47

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Week

Total Tested (2018-19)

Average Tested (2014-18)

% Influenza A Positive

AD Non-AD AD Non-AD AD Non-AD AD Non-AD AD Non-AD AD Non-AD AD Non-AD AD Non-AD

RHC-A 1 3 2 5 0 4 0 6 3 9 1 4 2 4 2 5

RHC-C 0 1 0 5 1 4 2 9 1 10 2 11 0 12 1 7

RHC-E - - 0 1 1 0 0 1 1 2 1 1 0 2 - -

RHC-P 1 3 3 0 0 2 0 2 - - 1 2 4 6 1 2

CENTCOM - - - - - - - - - - - - - - - -

Number of Positive Influenza A Specimens by Duty Status and Region

RegionWeek 40 Week 41 Week 42 Week 43 Week 44 Week 45 Week 46 Week 47

Age Group AD

Non-AD Ben

Season Total

< 18 0 83 8518-29 5 3 2230-39 3 3 2140-49 1 2 950-59 0 3 960+ 0 2 8

Total 9 96 154

Week 47

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Positive Respiratory Specimen Results from Army MTFs by Age Group and Beneficiary Status, 2018-2019 Influenza Season

AD Non-AD Ben

Note: Reportable influenza cases are defined as only cases that have been hospitalized and are under the age of 65. See Armed Forces Reportable Medical Events Guidelines and Case Definitions for more information.Data as of 28 November 2018.

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Army Influenza-Associated Hospitalizations Reported in DRSi by Onset Date

2018-2019 AD 2018-2019 Non-AD 2017-2018 AD 2017-2018 Non-AD

Clinic visits for ILI are obtained from ESSENCE. Data as of 30 November 2018.

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ESSENCE Weekly Outpatient Clinic Visits for Influenza-like Illness Army MTFs, All Services, 2016-2019

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Proportion of Positive Influenza A Specimens for U.S. Army 2018-2019Total Tested (2018-19)

Average Tested (2014-18)

% Influenza A Positive

Week 44 Week 45 Week 46 Week 47 Season TotalRAT 21 18 21 15 111

Culture 2 3 0 1 15PCR 3 2 9 2 28

Influenza A 26 23 30 18 154Influenza B 13 5 8 16 77Adenovirus 17 19 7 5 70Enterovirus 1 0 0 0 2

Parainfluenza 31 24 19 9 130RSV 52 65 68 57 312

Negative 2146 2422 2304 2135 16219Total 2286 2558 2436 2240 16964

Test Types Among Positive Influenza A

Specimens

Army MTF Laboratory Results,

2018-19

AD Non-AD AD Non-AD AD Non-AD AD Non-AD AD Non-AD AD Non-AD AD Non-AD AD Non-ADRHC-A 1 3 2 5 0 4 0 6 3 9 1 4 2 4 2 5RHC-C 0 1 0 5 1 4 2 9 1 10 2 11 0 12 1 7RHC-E - - 0 1 1 0 0 1 1 2 1 1 0 2 - -RHC-P 1 3 3 0 0 2 0 2 - - 1 2 4 6 1 2

CENTCOM - - - - - - - - - - - - - - - -

Number of Positive Influenza A Specimens by Duty Status and Region

Region Week 40 Week 41 Week 42 Week 43 Week 44 Week 45 Week 46 Week 47