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{{Influenza}}
{{Influenza}}
'''For more information about non-human (variant) influenza viruses that may be transmitted to humans, see [[Zoonotic influenza]]'''<br><br>
{{CMG}}; {{AE}} {{AL}}


'''For patient information click [[Influenza (patient information)|here]]'''
==Overview==
The CDC estimates that 5 to 20 percent of Americans are affected by the flu during each flu season, which typically lasts from October to March. Children are 2 to 3 times more likely than adults to get sick with the flu, and children frequently spread the virus to others.  For elderly people, newborn babies, pregnant women, and people with certain chronic illnesses, the flu and its complications can be life-threatening.  Although most people recover from the illness, between 3,000 and 49,000 US citizens die from the flu and its complications every year.<ref>{{cite web| url=http://www.niaid.nih.gov/topics/Flu/understandingFlu/Pages/overview.aspx| title= National Institute of Allergy and Infectious Diseases - Flu Overview}} </ref>


{{CMG}}
==Epidemiology and Demographics==


==Overview==
===Prevalence===
'''Influenza''', commonly known as '''flu''', is an [[infectious disease]] of birds and [[mammal]]s caused by  [[RNA virus]]es of the biological family [[Orthomyxoviridae]] (the influenza viruses). In humans, common symptoms of influenza infection are [[fever]], [[pharyngitis|sore throat]], [[myalgia|muscle pains]], severe [[headache]], [[cough]]ing, [[fatigue (medical)|weakness]] and [[malaise|general discomfort]].
*Influenza affects approximately 5 to 10% of adults and 20 to 30% of children worldwide.
*WHO reports 3 to 5 million cases of severe influenza disease, with approximately 250 000 to 500 000 deaths.<ref> {{cite web|url=http://www.who.int/mediacentre/factsheets/fs211/en/| title=WHO Influenza Fact Sheets}}</ref>
 
===Gender===
*There is no gender predominance for influenza infection. However, pregnant women are at increased risk of having severe illness and possible complications.
 
===Age===
*Influenza viruses cause disease among persons in all age groups.  
*Rates of infection are highest among children, but the risks for complications, hospitalizations, and deaths from influenza are higher among persons aged 65 years and older, young children, and persons of any age who have medical conditions that place them at increased risk for complications from influenza (such as immunosuppression and pregnancy).
*During 1990--1999, estimated average rates of influenza-associated pulmonary and circulatory deaths per 100,000 persons were:<ref name=CDCACIP> {{cite web|url=http://www.cdc.gov/flu/professionals/acip/clinical.htm| title=CDC Hospitalizations and Deaths from Influenza}}</ref>
:* 0.4-0.6 among persons aged 0-49 years
:* 7.5 among persons aged 50-64 years
:* 98.3 among persons aged 65 years and older.


===Seasonal variations===
===Mortality===
{{further|[[Flu season]]}}
*Number of deaths: '''1,532''' <ref name="CDC Mortality"> {{cite web| url=http://www.cdc.gov/nchs/fastats/flu.htm| title=CDC FastStats Influenza}} </ref>
*Deaths per 100,000 population: '''0.5''' <ref name="CDC Mortality"> {{cite web| url=http://www.cdc.gov/nchs/fastats/flu.htm| title=CDC FastStats Influenza}} </ref>


[[Image:H5n1 spread with regression.png|thumb|right|300px|Cumulative Confirmed Human Cases of H5N1.<ref name=WHOH5N1data>[http://www.who.int/csr/disease/avian_influenza/country/en/ WHO Confirmed Human Cases of H5N1] Data published by WHO Epidemic and Pandemic Alert and Response (EPR). Accessed 24 Oct. 2006</ref> The regression curve for deaths is shown extended through the end of November 2006.]]
===Vaccination===
The following data represents the percentage of individuals who received influenza vaccine in the United States:<ref name="CDC Mortality"> {{cite web| url=http://www.cdc.gov/nchs/fastats/flu.htm| title=CDC FastStats Influenza}}</ref>
* '''45.2%''' of children from 6 months to 17 years old received an influenza vaccination during the past 12 months.
* '''26.3%''' of adults aged 18 to 49 years received an influenza vaccination during the past 12 months.
*'''42.7%''' of adults aged 50 to 64 years received an influenza vaccination during the past 12 months.
*'''66.5%''' of adults aged 65 years and over received an influenza vaccination during the past 12 months.
{|
|[[File:Percentage of adults aged 18 and over who received an influenza vaccination during the past 12 months, by age group and quarter US, 1997–2012.png|thumb|350px|Percentage of adults aged 18 and over who received an influenza vaccination during the past 12 months, by age group and quarter: United States, 1997–2012<br> Image obtained from CDC[http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201306_04.pdf]]]
|[[File:Percentage of persons who received an influenza vaccination during the past 12 months, by age group and sex US, 2012.png|thumb|350px| Percentage of persons who received an influenza vaccination during the past 12 months, by age group and sex: United States, 2012 <br> Image obtained from CDC[http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201306_04.pdf]]]
|}


Influenza reaches peak prevalence in winter, and because the Northern and Southern Hemisphere have winter at different times of the year, there are actually two different flu seasons each year. This is why the [[World Health Organization]] (assisted by the [[National Influenza Centers]]) makes recommendations for two different vaccine formulations every year; one for the Northern, and one for the Southern Hemisphere.<ref name= WHOrecommendation>[http://www.who.int/csr/disease/influenza/2007northreport.pdf  Recommended composition of influenza virus vaccines for use in the 2006–2007 influenza season] WHO report 2006-02-14. Accessed [[19 October]] [[2006]].</ref>
==Influenza in the United States==
===National and Regional Summary of Select Surveillance Components===
*The proportion of outpatient visits for influenza-like illness (ILI) was 1.4%, which is below the national baseline of 2.0%. One region reported ILI above their region-specific baseline level.
*Puerto Rico experienced high ILI activity; one state experienced low ILI activity; New York City and 49 states experienced minimal ILI activity and the District of Columbia had insufficient data.
*The geographic spread of influenza in Guam was reported as widespread; Puerto Rico and five states reported local activity; the U.S. Virgin Islands and 36 states reported sporadic activity; and the District of Columbia and nine states reported no influenza activity.


It remains unclear why outbreaks of the flu occur seasonally rather than uniformly throughout the year. One possible explanation is that, because people are indoors more often during the winter, they are in close contact more often, and this promotes transmission from person to person. Another is that cold temperatures lead to drier air, which may dehydrate mucus, preventing the body from effectively expelling virus particles. The virus may also survive longer on exposed surfaces (doorknobs, countertops, etc.) in colder temperatures.  Increased travel and visitation due to the Northern Hemisphere winter holiday season may also play a role.<ref name = "NPR2003-12-17">[http://www.npr.org/templates/story/story.php?storyId=1551913 Weather and the Flu Season] NPR Day to Day, [[December 17]] [[2003]]. Accessed, [[19 October]] [[2006]]</ref> However, seasonal changes in infection rates are also seen in tropical regions and these peaks of infection are seen mainly during the rainy season.<ref>Shek LP, Lee BW. "Epidemiology and seasonality of respiratory tract virus infections in the tropics." ''Paediatr Respir Rev.'' 2003 Jun;4(2):105–11. PMID 12758047</ref> Seasonal changes in contact rates from school-terms, which are a major factor in other childhood diseases such as [[measles]] and [[pertussis]], may also play a role in flu. A combination of these small seasonal effects may be amplified by "dynamical resonance" with the endogenous disease cycles.<ref>Dushoff J, Plotkin JB, Levin SA, Earn DJ. "Dynamical resonance can account for seasonality of influenza epidemics." ''Proc Natl Acad Sci U S A.'' [[30 November]][[2004]];101(48):16915–6. PMID 15557003</ref> [[H5N1]] exhibits seasonality in both humans and birds.<ref name=WHOH5N1data/>
{{#widget:BlueTable}}
{| class="BlueTable" style="font-size:95%; width:82%"
|+ '''''Data cumulative since September 28, 2014 (week 40) <ref name="CDC Epi"> {{cite web|url=http://www.cdc.gov/flu/weekly/ | title=CDC Weekly U.S. Influenza Surveillance Report}} </ref>'''''
|-
!style="width: 100px"|HHS Surveillance Regions
!style="width: 70px"|Out-patient ILI<sup>†</sup>
!style="width: 70px"|Percentage positive for flu<sup>‡</sup>
!style="width: 100px"|Number of jurisdictions reporting regional or widespread activity<sup>§</sup>
!style="width: 70px"|2009 H1N1
!style="width: 70px"|Type A (H3)
!style="width: 70px"|Type A <br><Small>(Subtyping not performed)</small>
!style="width: 70px"|Type B
!style="width: 70px"|Pediatric Deaths
|-
| Nation||Normal||4.8%||1 of 54||7||267||405||392||1
|-
| Region 1||Normal||1.6%||0 of 6||0||8||8||4||0
|-
| Region 2||Elevated||1.1%||0 of 4||1||17||17||11||0
|-
| Region 3||Normal||1.7%||0 of 6||0||16||16||69||0
|-
| Region 4||Normal||8.0%||0 of 8||0||56||290||246||1
|-
| Region 5||Normal||2.1%||0 of 6||3||28||15||12||0
|-
| Region 6||Normal||4.3%||0 of 5||2||32||26||69||0
|-
| Region 7||Normal||1.9%||0 of 4||0||12||15||9||0
|-
| Region 8||Normal||1.2%||0 of 6||0||15||5||6||0
|-
| Region 9||Normal||3.2%||1 of 5||1||27||27||19||0
|-
| Region 10||Normal||5.5%||0 of 4||0||56||4||7||0
|-
|colspan=9|
<small>*HHS regions (Region 1 CT, ME, MA, NH, RI, VT; Region 2: NJ, NY, Puerto Rico, US Virgin Islands; Region 3: DE, DC, MD, PA, VA, WV; Region 4: AL, FL, GA, KY, MS, NC, SC, TN; Region 5: IL, IN, MI, MN, OH, WI; Region 6: AR, LA, NM, OK, TX; Region 7: IA, KS, MO, NE; Region 8: CO, MT, ND, SD, UT, WY; Region 9: AZ, CA, Guam, HI, NV; and Region 10: AK, ID, OR, WA). <br>
† Elevated means the % of visits for Influenza-like illness (ILI) is at or above the national or region-specific baseline. <br>
‡ National data are for current week; regional data are for the most recent three weeks. <br>
§ Includes all 50 states, the District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands </small>
|}
{|
|[[File:Number of Influenza-Associated Pediatric Deaths by Week of Death.png|thumb|480px| Number of Influenza-Associated Pediatric Deaths by Week of Death: 2011-2012 season to present <br> Image obtained from CDC [http://www.cdc.gov/flu/weekly/] ]]
|[[File:Weekly Influenza Activity Estimates Reported by State.png|thumb|480px|Weekly Influenza Activity Estimates Reported by State (Oct 2014)<br> Image obtained from CDC [http://www.cdc.gov/flu/weekly/] ]]
|}


An alternative hypothesis to explain seasonality in influenza infections is an effect of [[vitamin D]] levels on immunity to the virus.<ref>{{cite journal | last = Cannell | first = J | coauthors = Vieth R, Umhau J, Holick M, Grant W, Madronich S, Garland C, Giovannucci E | title = Epidemic influenza and vitamin D | journal = Epidemiol Infect | volume = 134 | issue = 6 | pages = 1129–40 | year = 2006 | id = PMID 16959053}}</ref> This idea was first proposed by Robert Edgar Hope-Simpson in 1965.<ref>{{cite journal | last = HOPE-SIMPSON | first = R | title = The nature of herpes zoster: a long-term study and a new hypothesis | journal = Proc R Soc Med | volume = 58 | issue = | pages = 9–20 | year = | id = PMID 14267505}}</ref> He proposed that the cause of influenza epidemics during winter may be connected to seasonal fluctuations of vitamin D, which is produced in the skin under the influence of solar (or artificial) [[ultraviolet|UV radiation]]. This could explain why influenza occurs mostly in winter and during the tropical rainy season, when people stay indoors, away from the sun, and their vitamin D levels fall. Furthermore, some studies have suggested that administering [[cod liver oil]], which contains large amounts of vitamin D, can reduce the incidence of respiratory tract infections.<ref name = "Linday2004">{{cite journal | last = Linday | first = L | coauthors = Shindledecker R, Tapia-Mendoza J, Dolitsky J | title = Effect of daily cod liver oil and a multivitamin-mineral supplement with selenium on upper respiratory tract pediatric visits by young, inner-city, Latino children: randomized pediatric sites | journal = Ann Otol Rhinol Laryngol | volume = 113 | issue = 11 | pages = 891–901 | year = 2004 | id = PMID 15562899}}</ref>
==Worldwide Influenza==
*During May 18–September 20, typical seasonal patterns of influenza activity occurred in temperate climate Southern Hemisphere countries.


===Epidemic and pandemic spread===
====South and Central America====
{{further|[[Flu pandemic]]}}
*In temperate countries of South America, influenza activity began to increase in June, remained elevated through July and mid-August, and decreased in September. Influenza A viruses were reported more frequently than influenza B viruses, and influenza A (H3N2) viruses were predominant in Chile, Argentina, Uruguay, and Paraguay.
*In tropical South America, influenza A viruses were most commonly reported. Influenza A (H3N2) viruses predominated in Brazil and Colombia, whereas influenza B viruses were more frequently reported in Ecuador. In Peru, influenza A (H3N2) and pH1N1 viruses cocirculated, but influenza B viruses also were identified.
*In the Caribbean and Central America, an increase in the number of influenza B viruses was reported in July and August, particularly in Honduras, Jamaica, and Nicaragua, with influenza A viruses cocirculating in Guatemala and Panama.


[[Image:Antigenic drift versus shift.png|thumb|right|400px|[[Antigenic drift]] creates influenza viruses with slightly-modified antigens, while [[antigenic shift]] generates viruses with entirely novel antigens.]]
====Europe and North America====
*In Europe and North America, influenza activity was low, and small numbers of pH1N1, influenza A (H3N2), and influenza B viruses were identified.


[[Image:Influenza geneticshift.jpg|thumb|right|300px|How antigenic shift, or reassortment, can result in novel and highly pathogenic strains of human influenza]]
====Asia====
*In South Asia and Southeast Asia, a decrease in influenza activity was observed during August and September, and influenza A (H3N2) predominated in Cambodia, India, China, and Vietnam, with smaller numbers of influenza B viruses reported.
*In Thailand, influenza B viruses were more frequently reported in July and August, but influenza A (H3N2) and pH1N1 viruses also were identified.


As influenza is caused by a variety of species and strains of [[virus]]es, in any given year some strains can die out while others create [[epidemic]]s while yet another strain can cause a [[pandemic]]. Typically, in a year's normal two [[flu season]]s (one per hemisphere) there are between three and five million cases of severe illness and up to 500,000 deaths worldwide, which by some definitions is a yearly influenza epidemic.<ref>[http://www.who.int/mediacentre/factsheets/fs211/en/ Influenza] WHO Fact sheet N°211 revised March 2003. Accessed [[22 October]] [[2006]]</ref>  Although the incidence of influenza can vary widely between years, approximately 36,000 deaths and more than 200,000 hospitalizations are directly associated with influenza every year in America.<ref>{{cite journal | last = Thompson | first = W | coauthors = Shay D, Weintraub E, Brammer L, Cox N, Anderson L, Fukuda K | title = Mortality associated with influenza and respiratory syncytial virus in the United States | url=http://jama.ama-assn.org/cgi/content/full/289/2/179 | journal = JAMA | volume = 289 | issue = 2 | pages = 179–86 | year = 2003 | id = PMID 12517228}}</ref><ref>{{cite journal | last = Thompson | first = W | coauthors = Shay D, Weintraub E, Brammer L, Bridges C, Cox N, Fukuda K | title = Influenza-associated hospitalizations in the United States | url= http://jama.ama-assn.org/cgi/content/full/292/11/1333 | journal = JAMA | volume = 292 | issue = 11 | pages = 1333–40 | year = 2004 | id = PMID 15367555}}</ref><ref>[http://www.niaid.nih.gov/factsheets/flu.htm Flu factsheet] National Institute of Allergy and Infectious Diseases Accessed 22 Dec 2006</ref> Every ten to twenty years a pandemic occurs, which infects a large proportion of the world's population, and can kill tens of millions of people (see history section).
====South Africa====
*In South Africa, influenza activity began to increase in late May and decreased in early August. Influenza A (H3N2) viruses predominated in that country, but pH1N1 and influenza B viruses also were reported.  


New influenza viruses are constantly being produced by [[mutation]] or by [[reassortment]].<ref name= hay/> Mutations can cause small changes in the hemagglutinin and neuraminidase [[antigen]]s on the surface of the virus. This is called [[antigenic drift]], which creates an increasing variety of strains over time until one of the variants eventually achieves higher [[fitness (biology)|fitness]], becomes dominant, and rapidly sweeps through the human population &ndash; often causing an epidemic.<ref>{{cite journal | author = | title = Long intervals of stasis punctuated by bursts of positive selection in the seasonal evolution of influenza A virus | journal = Biol Direct | volume = 1 | issue = 1 | pages = 34 | year = 2006 | id = PMID 17067369}}</ref>  In contrast, when influenza viruses re-assort, they may acquire new antigens — for example by reassortment between avian strains and human strains; this is called antigenic shift.  If a human influenza virus is produced with entirely novel antigens, everybody will be susceptible and the novel influenza will spread uncontrollably, causing a pandemic.<ref>{{cite journal | last = Parrish | first = C | coauthors = Kawaoka Y | title = The origins of new pandemic viruses: the acquisition of new host ranges by canine parvovirus and influenza A viruses | journal = Annual Rev Microbiol | volume = 59 | issue = | pages = 553–86 | year = | id = PMID 16153179}}</ref> In contrast to this model of pandemics based on antigenic drift and shift, an alternative approach has been proposed where the periodic pandemics are produced by interactions of a fixed set of viral strains with a human population with a constantly-changing set of immunities to different viral strains.<ref>{{cite journal |author=Recker M, Pybus OG, Nee S, Gupta S |title=The generation of influenza outbreaks by a network of host immune responses against a limited set of antigenic types |url=http://www.pnas.org/cgi/content/full/104/18/7711 |journal=Proc Natl Acad Sci U S A. |volume=104 |issue=18 |pages=7711–7716 |year=2007 |pmid=17460037}}</ref>
====Australia and New Zealand====
*In Australia and New Zealand, influenza activity began to increase in late July and remained elevated through mid-September. Influenza A viruses predominated in both countries.


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Disease]]
[[Category:Mature chapter]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Influenza| ]]
[[Category:Influenza| ]]
[[Category:Infectious disease]]
{{WH}}
{{WS}}

Latest revision as of 22:24, 29 July 2020

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For more information about non-human (variant) influenza viruses that may be transmitted to humans, see Zoonotic influenza

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [6]

Overview

The CDC estimates that 5 to 20 percent of Americans are affected by the flu during each flu season, which typically lasts from October to March. Children are 2 to 3 times more likely than adults to get sick with the flu, and children frequently spread the virus to others. For elderly people, newborn babies, pregnant women, and people with certain chronic illnesses, the flu and its complications can be life-threatening. Although most people recover from the illness, between 3,000 and 49,000 US citizens die from the flu and its complications every year.[1]

Epidemiology and Demographics

Prevalence

  • Influenza affects approximately 5 to 10% of adults and 20 to 30% of children worldwide.
  • WHO reports 3 to 5 million cases of severe influenza disease, with approximately 250 000 to 500 000 deaths.[2]

Gender

  • There is no gender predominance for influenza infection. However, pregnant women are at increased risk of having severe illness and possible complications.

Age

  • Influenza viruses cause disease among persons in all age groups.
  • Rates of infection are highest among children, but the risks for complications, hospitalizations, and deaths from influenza are higher among persons aged 65 years and older, young children, and persons of any age who have medical conditions that place them at increased risk for complications from influenza (such as immunosuppression and pregnancy).
  • During 1990--1999, estimated average rates of influenza-associated pulmonary and circulatory deaths per 100,000 persons were:[3]
  • 0.4-0.6 among persons aged 0-49 years
  • 7.5 among persons aged 50-64 years
  • 98.3 among persons aged 65 years and older.

Mortality

  • Number of deaths: 1,532 [4]
  • Deaths per 100,000 population: 0.5 [4]

Vaccination

The following data represents the percentage of individuals who received influenza vaccine in the United States:[4]

  • 45.2% of children from 6 months to 17 years old received an influenza vaccination during the past 12 months.
  • 26.3% of adults aged 18 to 49 years received an influenza vaccination during the past 12 months.
  • 42.7% of adults aged 50 to 64 years received an influenza vaccination during the past 12 months.
  • 66.5% of adults aged 65 years and over received an influenza vaccination during the past 12 months.
Percentage of adults aged 18 and over who received an influenza vaccination during the past 12 months, by age group and quarter: United States, 1997–2012
Image obtained from CDC[1]
Percentage of persons who received an influenza vaccination during the past 12 months, by age group and sex: United States, 2012
Image obtained from CDC[2]

Influenza in the United States

National and Regional Summary of Select Surveillance Components

  • The proportion of outpatient visits for influenza-like illness (ILI) was 1.4%, which is below the national baseline of 2.0%. One region reported ILI above their region-specific baseline level.
  • Puerto Rico experienced high ILI activity; one state experienced low ILI activity; New York City and 49 states experienced minimal ILI activity and the District of Columbia had insufficient data.
  • The geographic spread of influenza in Guam was reported as widespread; Puerto Rico and five states reported local activity; the U.S. Virgin Islands and 36 states reported sporadic activity; and the District of Columbia and nine states reported no influenza activity.

Data cumulative since September 28, 2014 (week 40) [5]
HHS Surveillance Regions Out-patient ILI Percentage positive for flu Number of jurisdictions reporting regional or widespread activity§ 2009 H1N1 Type A (H3) Type A
(Subtyping not performed)
Type B Pediatric Deaths
Nation Normal 4.8% 1 of 54 7 267 405 392 1
Region 1 Normal 1.6% 0 of 6 0 8 8 4 0
Region 2 Elevated 1.1% 0 of 4 1 17 17 11 0
Region 3 Normal 1.7% 0 of 6 0 16 16 69 0
Region 4 Normal 8.0% 0 of 8 0 56 290 246 1
Region 5 Normal 2.1% 0 of 6 3 28 15 12 0
Region 6 Normal 4.3% 0 of 5 2 32 26 69 0
Region 7 Normal 1.9% 0 of 4 0 12 15 9 0
Region 8 Normal 1.2% 0 of 6 0 15 5 6 0
Region 9 Normal 3.2% 1 of 5 1 27 27 19 0
Region 10 Normal 5.5% 0 of 4 0 56 4 7 0

*HHS regions (Region 1 CT, ME, MA, NH, RI, VT; Region 2: NJ, NY, Puerto Rico, US Virgin Islands; Region 3: DE, DC, MD, PA, VA, WV; Region 4: AL, FL, GA, KY, MS, NC, SC, TN; Region 5: IL, IN, MI, MN, OH, WI; Region 6: AR, LA, NM, OK, TX; Region 7: IA, KS, MO, NE; Region 8: CO, MT, ND, SD, UT, WY; Region 9: AZ, CA, Guam, HI, NV; and Region 10: AK, ID, OR, WA).
† Elevated means the % of visits for Influenza-like illness (ILI) is at or above the national or region-specific baseline.
‡ National data are for current week; regional data are for the most recent three weeks.
§ Includes all 50 states, the District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands

Number of Influenza-Associated Pediatric Deaths by Week of Death: 2011-2012 season to present
Image obtained from CDC [3]
Weekly Influenza Activity Estimates Reported by State (Oct 2014)
Image obtained from CDC [4]

Worldwide Influenza

  • During May 18–September 20, typical seasonal patterns of influenza activity occurred in temperate climate Southern Hemisphere countries.

South and Central America

  • In temperate countries of South America, influenza activity began to increase in June, remained elevated through July and mid-August, and decreased in September. Influenza A viruses were reported more frequently than influenza B viruses, and influenza A (H3N2) viruses were predominant in Chile, Argentina, Uruguay, and Paraguay.
  • In tropical South America, influenza A viruses were most commonly reported. Influenza A (H3N2) viruses predominated in Brazil and Colombia, whereas influenza B viruses were more frequently reported in Ecuador. In Peru, influenza A (H3N2) and pH1N1 viruses cocirculated, but influenza B viruses also were identified.
  • In the Caribbean and Central America, an increase in the number of influenza B viruses was reported in July and August, particularly in Honduras, Jamaica, and Nicaragua, with influenza A viruses cocirculating in Guatemala and Panama.

Europe and North America

  • In Europe and North America, influenza activity was low, and small numbers of pH1N1, influenza A (H3N2), and influenza B viruses were identified.

Asia

  • In South Asia and Southeast Asia, a decrease in influenza activity was observed during August and September, and influenza A (H3N2) predominated in Cambodia, India, China, and Vietnam, with smaller numbers of influenza B viruses reported.
  • In Thailand, influenza B viruses were more frequently reported in July and August, but influenza A (H3N2) and pH1N1 viruses also were identified.

South Africa

  • In South Africa, influenza activity began to increase in late May and decreased in early August. Influenza A (H3N2) viruses predominated in that country, but pH1N1 and influenza B viruses also were reported.

Australia and New Zealand

  • In Australia and New Zealand, influenza activity began to increase in late July and remained elevated through mid-September. Influenza A viruses predominated in both countries.

References

  1. "National Institute of Allergy and Infectious Diseases - Flu Overview".
  2. "WHO Influenza Fact Sheets".
  3. "CDC Hospitalizations and Deaths from Influenza".
  4. 4.0 4.1 4.2 "CDC FastStats Influenza".
  5. "CDC Weekly U.S. Influenza Surveillance Report".

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