I'm Commander Ibad Khan, and I'm representing the Clinical

Outreach Communication Activity, COCA,

with the Emergency Risk Communication Branch

at the Centers for Disease Control and Prevention.

I'd like to welcome you to today's COCA call:

2019 to 2020 Influenza Season Update

and Recommendations for Clinicians.

Please stay tuned until the end of this COCA call

for more information about two upcoming COCA calls

on HHS guidance on opioid dosage reduction or discontinuation,

as well as another one on the novel Coronavirus outbreak.

Both calls will take place later this week.

You may participate in today's presentation via webinar,

or you may download the slides if you're unable

to access the webinar.

The PowerPoint slides and the webinar link can be found on our

COCA webpage at emergency.cdc.gov/COCA.

Again, that web address is emergency.cdc.gov/COCA.

Once you reach the webinar page,

the PowerPoint slides can be found

under the call materials tab.

Free continuing education is offered for this webinar.

Instructions on how to earn continuing education will be

provided at the end of the call.

In compliance with continuing education requirements, CDC,

our planners, our presenters, and their spouses/partners wish

to disclose they have no financial interests

or other relationships with the manufacturers

of commercial products,

suppliers of commercial services,

or commercial supporters.

Planners have reviewed content to ensure there is no bias.

The presentation will not include any discussion

of the unlabeled use of a product or a product

under investigational use, expect Dr. Angela Campbell would

like to disclose that she will discuss the off-label use

of antiviral medications for treatment of influenza.

CDC did not accept commercial support

for this continuing education activity.

After the presentation, there will be a Q and A session.

You may submit questions at any time during the presentation

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If you are a patient, please refer your questions

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At the conclusion of today's webinar,

participants will be able to accomplish the following.

Describe the current status

of influenza activity in the United States.

Describe the circulating influenza viruses detected this

season, and explain the implications for clinicians.

And describe antiviral testing and treatment recommendations

for patients with suspected and confirmed influenza.

Now I would like to introduce our presenters

for today's webinar.

Our first presenter is Miss Alicia Budd.

Miss Budd is an epidemiologist in CDC's Influenza Division.

Miss Budd has been at CDC for more than 13 years,

and has worked on national influenza surveillance

for most of that time.

She also has experience in infection control,

having spent 6 years at the Johns Hopkins hospital,

in the Hospital Epidemiology and Infection Control department.

Our second presenter is Dr. Angela Campbell.

Dr. Campbell is a medical officer

in CDC's Influenza Division.

Her projects focus on studies of influenza

and antiviral treatment, and antiviral effectiveness,

vaccine effectiveness, pandemic preparedness, and development

of CDC clinical guidance related to treatment and prevention

of seasonal and novel influenza viruses.

She is an adjunct associate professor of pediatrics

at Emory University School of Medicine,

and has a professional staff appointment

at Children's Healthcare of Atlanta.

I will now turn it over to Miss Alicia Budd.

Miss Budd, you may proceed.

>> Thank you.

So today I'll be giving an update

on the current influenza season, based on activity

that we've received-- or data we've received, rather,

about activity occurring through January 18 of this year.

Next.

So before I launch-- oops.

Next slide.

Before I launch into an actual update on activity,

I just wanted to briefly explain how we get all this information

in that I will be talking about.

So flu surveillance

on the national level is really a collaborative effort

between those of us at CDC, and also our public health partners

at the state and local level and territories,

and also numerous other data providers, many of whom are

at the clinical level.

And our role at CDC is really to coordinate the system

that all those various partners make possible.

So we get data from five categories of flu activity

from eight different sources.

Three of those have to do with the virus tracking itself.

Two have to do with flu-related mortality,

and then we have one each that focus on outpatient visits,

hospitalizations and the geographic spread

of flu activity in general.

And every week we analyze that information,

and we make it available to the public in the form of FluView

which is a static report, and FluView Interactive,

which is a system online that really lets you dive deeper

into the data on different geographic levels,

different time frames, and things like that.

And those are both available on the internet,

and in the resource slide at the end,

you'll have those web pages.

Next.

So the goals with the flu surveillance really haven't

changed, even though the system has been in place

over many, many years.

Some of the systems have changed.

Some of the data we get in have changed, but really all along,

we're focused on identifying and characterizing the viruses

that are circulating, with a special eye towards making sure

that any viruses with pandemic potential would be

recognized early.

We also are doing flu surveillance

to provide situational awareness about the onset of the season,

where we are in the season in terms of activity increasing

or decreasing, and where in the country activity is occurring.

We're also of course looking at the severity of the flu season,

and whether it looks like things are what we would expect,

or maybe a bit higher or lower.

And then, we're looking of course

to describe the clinical infections,

and those at most risk, and all of this really

with the eye towards how we can guide decisions

about interventions.

Next.

So now I'm going to move into where we are with this season.

So this slide shows what we're seeing in terms

of influenza virus circulation, based on the data

that have been reported to us from clinical labs

and public health labs across the country.

So clinical labs test specimens primarily

for diagnostic purposes, and we use the data from these labs

to calculate the percent of specimens that they're testing

that are positive for influenza.

And with this data, we can track the timing of the season,

and the intensity of flu activity.

So this season, activity was low in October,

and began to increase in November,

but then really took off in December.

We had a slight decrease in activity the first two weeks

of January, and we're starting to see an increase again now

in the third week of January.

And there's a number of reasons that this might be occurring.

That decrease could be related to a slight decrease

in transmission that occurred because kids were out of school

for a couple of weeks around the holidays.

It could be that that highest peak there is somewhat impacted

by changes in healthcare-seeking behavior over the holidays,

and it was sort of an auto-data correction bit

that we saw there with the decline.

Or it could be, and I'll talk

about this a little bit more later,

it could be that we're switching over from seeing sort

of an increase in B activity, and now we're seeing more

of an increase in A activity.

But things haven't quite evened out yet.

So regardless, we are definitely seeing high levels of activity,

and you can see with this increase

in the most recent week, we're just about back up to

where we were at the highest point this season.

So we don't know yet at this point where things are going

to go from here, but it's definitely something

to continue to monitor.

From the public health labs, that bottom panel there,

you can see the information about the--

what types of flu viruses are circulating.

So this season, we've seen, for the season as a whole,

predominantly B/Victoria lineage virus season.

So that's the most common virus reported

for the season as a whole.

But in the most recent weeks, we've seen nearly equal numbers

of B/Victoria viruses and Influenza A/H1N1 viruses.

Very little B/Yamagata virus circulation,

and not much H3 virus circulation, either.

Next slide.

So this slide is a little busy, but I wanted to put

into perspective how unusual it is that we are seeing

so much Influenza B activity.

So each individual pie chart here represents the distribution

of influenza viruses by Influenza A subtype

and B lineage where we have it,

going back to the 1976-77 season.

And then, on the bottom right there, in the red box,

is this season's data to date.

The red represents H3 viruses.

The blue is the pre-pandemic H1 viruses.

The yellow or orange color is H1pdm09 virus,

our current H1 virus since the last pandemic.

And then the greens are the Influenza B viruses.

Next slide.

So now, that blue circle there is the 1992-'93 season.

And that is the last time

that we have had a B-predominant season here in the U.S.

And it was a B/Yamagata virus.

And it accounted for almost 75% of the viruses that season.

Next.

More recently, there circled, are the 2000-2001

and 2002-2003 seasons.

These seasons were not B-predominant,

but they were the last time that we saw such a significant amount

of Influenza B activity.

And in both seasons,

it was actually H1 that was predominant.

It was the pre-pandemic H1, but it was H1,

just like we're seeing as our other sort

of co-circulating virus this season.

The 2000-2001 B's were of the Yamagata lineage,

and the 2002-2003 B's were the Victoria lineage.

Next slide.

So I think in general people tend

to be a little bit less aware of some of this Influenza B history

than we are of the Influenza A sub-type.

So I just wanted to spend a quick minute talking about that.

So it was the early to mid-1980s

when the two separate B lineages, the Yamagata

and Victoria, were identified.

In 1988, rather, it was the B/Yamagata/16/88 strain was

identified in Japan.

Looking back earlier, it looks like maybe as far

as the early '80s, it was also in some other countries in Asia.

And it's similar to a 1983 virus from Russia.

So the specific date of when it emerged isn't known,

but sometime in the early to mid-'80s.

Despite that, it's still in the U.S. for the '88-'89 season.

Our B viruses were antigenically

like the B/Victoria lineage viruses.

It wasn't until the 1990-'91 season

that we first saw B/Yamagata lineage viruses in the U.S.

And the Yamagata viruses dominated the B circulation

in the U.S. throughout the 1990s.