Influenza Surveillance Weekly Report
CDC MMWR Week 201709 , February 26, 2017 to March 1, 2017
Summary
The Houston Health Department (HHD) conducts seasonal influenza surveillance from October (week 40) 2016 to May (week 22) 2017. Flu activity typically peaks between December and February. Flu vaccine is recommended for individuals that are 6 months and older.
During February 12 to February 18, 2017, Influenza Like Illness activity from hospital emergency centers [increased/decreased] by 0.1115125 percent and school settings [increased/decreased] by a count of -39 compared to the previous week. Clinical laboratory positives [increased/decreased] by a count of NA from the previous week.
Influenza activity in Houston is [high/low] and [change]. Cumulatively this season Influenza A [count] and Influenza B [count] viruses have been detected. Flu activity typically peaks between December and February.
Institutional outbreaks are lab confirmed outbreak in a nursing home, hospital, prison, school, etc. Outbreaks that are Influenza related occured [where, when, how many, type of virus, who].
Influenza Like Illness (ILI)
Influenza Like Illness (ILI) is monitored with several data sources. A description of each surveillance activity, including the definition for ILI, can be found in the components section of this report. Each of the following plots corresponds to a different surveillance system. ILI activity is reported in percents per week.
Table .Summary of ILI activity per week and surveillance activity 
Hospital emergency centers (EC) visits for ILI represent individuals whose symptoms were severe enough to warrant a visit to an EC. Hospitals transmit data to the syndromic surveillance system at the Houston Health Department on a real-time basis.
From February 26, 2017 to March 1, 2017, ILI accounted for 2.051067 EC visits.
Figure. ILI related visits percent per week, 2016-2017
[insert risk factors: ZIP, gender, age]
Figure. Number of ILI related visits by age group per week, 2016-2017 
Outpatient visits for ILI represent individuals whose symptoms require a visit to a healthcare provider. ILI activity in outpatient settings is obtained on a weekly basis from ILINet and Athena. The last page describes how healthcare providers can particpate in ILInet.
From February 26, 2017 to March 1, 2017, ILI accounted for 0.3762613 of outpatient visits in the Athena network. The age group(s) that accounted for the highest counts of ILI outpatient visits were [insert age group(S) and count in parenthesis]
Figure. Athena: Total number of weekly ILI visits by age group 
ILInet participation in Houston is low at this time. Please see the last page for information on how healthcare providers can participate.
Crowd sourced reports for ILI represent individuals who have symptoms for ILI ranging in severity and may or may not have accessed the healthcare system. This form of public health surveillance complements other surveillance for ILI activity in that it may provide information for earlier detection of increased ILI activity. Flu Near You platform provides data collected via participatory surveillance. See the last page to learn how to participate.
From February 26, 2017 to March 1, 2017, ILI was reported by 1.83 of [total number of reporters] Flu Near You participants.
Figure. Participatory surveillance from Flu Near You: Weekly percent of ILI, 2016-2017 
Flu activity in school settings
The Houston Independent School District collects data on student ILI and influenza cases from 286 schools. Schools will be counted more than once if more than one case from the same school is reported during the month.
From February 26, 2017 to March 1, 2017, ILI was reported by 17 in school settings.
Table .Summary of ILI activity per week in school settings 
Figure. Houston Independent School District: Total number of ILI visits per school type 
Influenza type
Test performed at the Houston Health Department (HHD)
Influenza viral surveillance summary During the 2016-2017 flu season HHD tested [insert cumulative total number tested] specimens from sentinel providers and detected 33 percent of flu positives out of the total number of specimens tested.
Non-influenza respiratory virus surveillance During the 2016-2017 season, among the specimens tested by culture or respiratory virus panel, the following non-influenza viruses were detected: [list percent of test positive labs and percent of total in parathesis per organism]
Tests performed by clinical labs
HHD receives reports of flu positives from clinical labs via two methods: 1) electronic lab report (ELR) and 2) non-electronic lab reports.
Electronic lab reports from clinical laboratories are transmitted to HHD.
Cumulatively this season, flu [insert type] activity accounts for [percent] of flu positives this season. Week [insert week] had the highest count, with NA flu positives this season.
Non-electronic lab reports from clinical laboratories are reported to HHD.
Cumulatively this season, flu [insert type] activity accounts for [percent]. Week [insert week] had the highest count (321) of flu postivies this season.
Prevention and Control
Note: For the 2016-2017 season, CDC recommends use of the flu shot (inactivated influenza vaccine or IIV) and the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017. The 2016-2017 influenza vaccination recommendations are now available.
Additional information regarding Houston, Texas and national ILI activity can be accessed at: http://www.houstontx.gov/health/
http://http://www.dshs.state.tx.us/idcu/disease/influenza/surveillance/2015/
http://www.cdc.gov/flu/weekly/
http://www.who.int/csr/don/en/
Components
Seasonal influenza surveillance at the Houston Health Department consists of the following components: Influenza Like Illness, Virology, school settings, and influenza associated pediatric mortalities.
Influenza LIke Illness
Influenza Like Illness acitivty is monitored with three types of data sources. The data sources for ILI consist of hospital emergency center visits, outpatient visits, and Flu Near You.
Hospital Emergency Center (EC) visits which include symptoms for ILI are obtained from hospital participating in syndromic surveillance on a real-time basis. The Houston/Harris County ILI activity is tracked and monitored based on chief complaint data. The number of healthcare providers reporting ILI information to Houston Health Department ranges from 30 to 40. These data do not represent laboratory confirmed cases of influenza nor do they represent all EC visits in Houston/Harris County.
Outpatient visits due to ILI are obtained from Athena and ILInet on a weekly basis. Please see the last page for information on how providers can participate in ILInet.
Flu Near You uses crowd sourcing to collect reports of ILI from the public. Reports of ILI are obtained from the Flu Near You platform on a weekly basis. In order to register, indivdiuals must be 13 years of age or older Visit Flunearyou.org to get information on what is participatory surveillance and how you can participate.
Virology
Virology surveillance makes it possible to track and monitor the type and subtype of circulating viruses. Seasonal influenza is not reportable in Texas.
Public Health Laboratory Results
Influenza: Public health labs test respiratory specimens for seasonal and novel influenza types and subtypes that are circulating. Weekly percent of flu positives by subtype are reported.
Non influenza viruses: The Bureau of Laboratory Services tests respiratory specimens with culture or respiratory virus panel to determine the occurrence of non-influenza respiratory viruses. Weekly count of respiratory viruses are reported.
Only specimens collected through active surveillance from participating sentinel providers are tested by the Bureau of Laboratory Services at Houston Health Department. The respiratory specimens are collected, tested and results reported on a weekly basis by the Houston Health Department.
To learn more about how to become a sentinel provider see the announcements section on the last page.
Clinical Laboratory Results
Electonic Lab Results: Houston Health Department receives electronic lab reports (ELR) from clinical laboratories to determine the type (Flu A or Flu B) of flu circulating. The type of clinical lab usually consist of hospital labs. The number of clinical laboratories that transmit ELR flu positives varies from week to week. Flu positives are transmitted to HHD on a daily basis. Flu positives from clinical lab are reported as number of flu positives by type per week.
Non Electronic Lab Results: Houston Health Department receives non-electronic lab reports of flu positive results from clinical laboratories via paper reports to determine the type of flu circulating among individuals that obtained care in outpatient settings. The number of clinical laboratories that send in paper reports of flu positives varies from week to week. Flu positives are reported to HHD on a daily basis. Flu positives from clinical lab are reported as number of flu positives by type per week.
Pediatric Mortalities
Influenza associated pediatric mortality is a reportable condition in Texas. Reports of confirmed pediatric mortalities are received from the Harris County Forensic Institute. Reports of suspected influenza associated pediatric mortalities should be immediately reported to the Houston Health Department.
##Contact information The Houston Influenza Surveillance Weekly Report is available on the Houston Health Department web site at: http://www.houstontx.gov/health/Epidemiology/index.html
Twitter @HoustonHealth
Houston Health Department
Office of Surveillance and Public Health Preparedness
Program of Public Health Informatics
8000 N. Stadium Dr, 4th Floor
Houston, TX 77054
Main Phone Number: (832) 393-5080
Disease Reporting Fax Number: (832) 393-5232
24-Hour Disease Reporting Number: (832) 393-5080
Announcements
Healthcare providers can become ILInet Providers. An ILINet provider conducts surveillance for influenza-like illness (ILi) in collaboration with the Texas Department of State Health Services and the Centers for Disease Control and Prevention (CDC). Data reported by ILINet providers are combined with other surveillance data to provide a national picture of influenza virus and ILI activity in the U.S.
ILINet providers receive feedback on the data submitted, summaries of regional and national influenza data, and preliminary information via email and letters.
For more information about the ILINet Program visit http://www.dshs.state.tx.us/idcu/disease/influenza/surveillance/ILINet/
Flu Near You Flu Near You is a participatory surveillance (crowd sourcing) tool which complements traditional disease surveillance activities. Registered users can obtain real-time information on flu activity and influenza vaccines in the Greater Houston Metropolitan Area. Flu Near You features include:
- Report symptoms
- Find vaccines
- Map flu cases in the Greater Houston Metropolitan area
- Get flu news
- Share on social media
This season HHD invites you to register for Flu Near You at https://flunearyou.org
Flu Near You has several ways to register. Users can register on the website, obtain the mobile application or join via Facebook. In order to register, individuals must be 13 years of age or older. During the registration process users are asked to provide their email, gender, birthdate, and ZIP code. Once registered, users receive a weekly email or push notification to report symptoms. They also get real-time information on flu activity.
