Missouri Weekly Influenza Surveillance Report 2020-2021 Influenza Season

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by  Missouri Department of Health and Senior Services

Missouri Weekly Influenza Surveillance Report
Missouri 2020-2021 Influenza Season1
DHSS

Oeporilment ol Heolth
o nd s,m10, 5(:NJco$ Week 40: September 27, 2020 – October 3, 2020

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

Summary:
• The estimated influenza-like activity in Missouri is Sporadic2.

• During Week 40, a total of 14 laboratory-positive3 influenza cases (7 influenza A and 7 influenza B) were
reported. No laboratory-positive cases of influenza were reported by the Missouri State Public Health Laboratory
(MSPHL) during Week 40. The percentage of respiratory specimens testing positive for influenza in Missouri
laboratories reporting to the National Respiratory and Enteric Virus Surveillance System (NREVSS) remained
low during Week 40 (Figure 5)

• Influenza-like illness (ILI) activity was below baseline for the hospital emergency room visit chief complaint data
reported through ESSENCE. The reported percentage of visits for ILI through ESSENCE was 1.43% (Figure 6).4
The ILI data from a small number of sites located in the Northwest Region of the state is currently unavailable in
ESSENCE. Therefore, the ILI data for the Northwest Region should be interpreted with caution.

• No influenza-associated deaths have been reported in Missouri as of Week 40.5

• No influenza or ILI-associated outbreaks or school closures have been reported in Missouri as of Week 40.

• National influenza surveillance information is prepared by CDC and is included in the weekly FluView report,
which is available online at http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.

1The 2020- 2021 influenza season begins CDC Week 40 (week ending October 3, 2020) and ends CDC Week 39 (week ending September 25, 2021).

2Sporadic is defined as: Small numbers of laboratory-confirmed influenza cases or a single laboratory-confirmed influenza outbreak has been reported, but there is no
increase in cases of ILI.

3Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain reaction (RT-
PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.

4ILI is defined by ESSENCE as Emergency Department chief complaints for Influenza or (FeverPlus and (Cough or SoreThroat) and not NonILIFevers).

5All influenza-associated deaths became reportable in Missouri in 2016.

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Surveillance Data:

Interactive Maps

The jurisdiction-specific influenza data are provided though interactive maps available at
https://arcg.is/004CCr0. Click on the jurisdiction to view the influenza data specific to that jurisdiction.
• Reported Laboratory-positive Influenza Cases by Influenza Type by Jurisdiction, CDC Week 40
• Reported Week-specific Rate per 100,000 Population, CDC Week 40
• Reported Laboratory-positive Influenza Cases by Influenza Type by Jurisdiction, Season-to-Date
• Reported Rate per 100,000 Population, Season-to-Date

Data Figures

Figure 1. Number of Laboratory-positive† Influenza Cases by Influenza Type,
Missouri, CDC Week 40 (September 27, 2020 - October 3, 2020)*

2020-21*
Influenza Type Week 40
Season-to-Date
Influenza A
7 7
Influenza B
7 7
Influenza Unknown Or Untyped
0 0
Total
14 14
†
Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain
reaction (RT-PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.
*Influenza season begins week ending October 3, 2020 (CDC Week 40) Data Source: Missouri Health Information Surveillance System (WebSurv).

Figure 2. Number of Laboratory-positive† Influenza Cases and Case Rates by Age Group,
Missouri, CDC Week 40 (September 27, 2020 - October 3, 2020)*‡

Week 40 Week 40 2020-21* 2020-2021*
Age Group
Cases Rate‡ Season-to-Date Season-to-Date Rate‡
00-04 1 0.27 1 0.27
05-24 4 0.25 4 0.25
25-49 5 0.26 5 0.26
50-64 2 0.16 2 0.16
65+ 2 0.21 2 0.21
Total 14 0.23 14 0.23
†
Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain
reaction (RT-PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.
*Influenza season begins week ending October 3, 2020 (CDC Week 40) Data Source: Missouri Health Information Surveillance System (WebSurv)
‡
Incidence Rate per 100,000 population

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Figure 3. Number of Laboratory-positive† Influenza Cases and Case Rates by Region,
Missouri, CDC Week 40 (September 27, 2020 - October 3, 2020)*‡

Week 40 Week 40 2020-21* 2020-21*
Region
Cases Rate‡ Season-to-Date Season-to-Date Rate‡
Central 1 0.15 1 0.15
Eastern 12 0.53 12 0.53
Northwest 0 0.00 0 0.00
Southeast 0 0.00 0 0.00
Southwest 1 0.09 1 0.09
Total 14 0.23 14 0.23
†
Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain
reaction (RT-PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.
*Influenza season begins week ending October 3, 2020 (CDC Week 40) Data Source: Missouri Health Information Surveillance System (WebSurv)
‡
Incidence Rate per 100,000 population

Figure 4. Number of Laboratory-positive† Influenza Cases by CDC Week, Missouri, 2017-2020*
I-& 1
-e- -s-
2011-2018 2018-2019 2019-2020 ~ 2020-2021
16,000
14,000
12,000
10,000
C
0
u
8,000
n
t
6,000
4,000
2,000
0
4 4 4 4 4 4 4 4 4 4 5 5 5 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2
0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
Week

†
Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain reaction (RT-

PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.
*2020-2021 season-to-date through the week ending May 14, 2021 (Week 20).Data Source: Missouri Health Information Surveillance System (WebSurv).

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Figure 5. Season-to-Date PCR (+) Tests for Influenza in Missouri
1200 45.00%
40.00%
~ 1000
·.Eu, 35.00%
CL
~ 800 30.00%
->~
·;;;
.0. 25.00%
a..
600
.N, I
C: 20.00%
::i
;;:::
..!.: 400 15.00%
'o
.,
.c 10.00%
E
::i 200
2
5.00%
+-=;~...,......,,...,,,,,c_,-,,r~::,,.,■,,,,•=-.--J,..-,.~-,-l--,-,........,J....,_.,......,.......,. .............
0 ,...,.,:,_,...;;::;:::;,....;,.....,....-.;::::::;,....~~~~...,......,~...,......,~~~~~~.....+ 0.00%
40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40
2019-2020 CDC Week 2020-2021
- Influenza A (H1Nl)pdm09 - Influenza A (H3N2) Influenza A Untyped - Influenza B --Percent Positivity

Data Source: National Respiratory and Enteric Virus Surveillance System (NREVSS), Centers for Disease Control and Prevention (CDC).
2019-2020 season-to-date through the week ending May 14, 2021 (Week 20).

Figure 7. Percentage of Emergency Department (ED) Visits for Influenza-like Illness (ILI) in ESSENCE
Participating Hospitals, 2017-2020 Influenza Seasons*‡
9
~ 2017-2018
8
~ 2018-2019
7 ~ 2019-2020
~ 2020-2021
... 6
"'
>'iii •••••• ESSENCE ILi Baseline*
::::; 5
....
...
0
~ 4
..u.,..
a..
3
2
1
0
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
CDC week

*The ESSENCE ILI Baseline is the mean percent of ILI visits for each week during the previous three years (2017-19) when percentage of ILI
visits were less than 2% of total visits, plus two standard deviations. Data Source: Missouri Department of Health and Senior Services (DHSS),
Bureau of Reportable Disease Informatics, ESSENCE version 1.20.
‡
The ILI data from a small number of sites located in the Northwest Region of the state is temporarily unavailable in ESSENCE. Therefore, the
ILI data for the Northwest Region should be interpreted with caution.
*There are 53 weeks in 2020. The estimates for the previous 3 years’ values for the weeks 53 are the averages of weeks 52 and weeks 1.

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Figure 8. Percentage of Emergency Department (ED) Visits for Influenza-like Illness (ILI) in ESSENCE
Participating Hospitals, by Age Group, Region and Statewide, Week 40, 2021*
30
28
26
24
22
...
"' 20
·.;;
5 18 ■ 0-4 Yrs
C
.w... 16 ■ 5-24 Yrs
.0.. 14
C: ■ 25-49 Yrs
.Qu.. I 12
CQl.I 10 ■ 50-64 Yrs
8 ■ 65 Yrs+
6
4
2
0
CENTRAL EASTERN NORTHWEST SOUTHEAST SOUTHWEST STATEWIDE

Data Source: Missouri Department of Health and Senior Services (DHSS), Bureau of Reportable Disease Informatics, ESSENCE version 1.20.
*The ILI data from a small number of sites located in the Northwest Region of the state is temporarily unavailable in ESSENCE. Therefore, the ILI
data for the Northwest Region should be interpreted with caution.

Figure 9. Percentage of Emergency Department (ED) Visits for Influenza-like Illness (ILI) in ESSENCE
Participating Hospitals, by Region and Statewide, 2020-2021 Influenza Season*
14
13
11
11
10
...,.
9
"iii
5 8 - EASTERN
:::;
7 - NORTHWEST
0...
C: (i - SOUTHEAST
.Cu.l> .
5
OJ - SOUTHWEST
Q.
4
1-STATEWIDE
:l •
2
I
1
•
0
40 41 42 43 44 45 46 47 48 49 50 51 52 SJ 1 2 J 4 5 6 7 8 9 10 11 12 lJ 14 15 16 17 18 19 20
CDC Week

Data Source: Missouri Department of Health and Senior Services (DHSS), Bureau of Reportable Disease Informatics, ESSENCE version 1.20.
*The ILI data from a small number of sites located in the Northwest Region of the state is temporarily unavailable in ESSENCE. Therefore, the ILI
data for the Northwest Region should be interpreted with caution.

Page 5 of 7
Figure 10. Weekly Rate of Patients Hospitalized with Influenza and/or Pneumonia Syndromes in Missouri
Hospitals, 2017-2020 Influenza Seasons
22
20
18
C:
·0p 16
"'
[ 14
0
gQ. 12 ~ 2017-2018
g0 ~ 2018-2019
... 10
~ 2019-2020
cii 8
.C.. . ~ 2020-2021
Cl) 6
"'
a:
4
2
0
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 1112 13 14 15 16 17 18 19 20
CDC Week

Data Source: Missouri Department of Health and Senior Services (DHSS), Bureau of Reportable Disease Informatics, HL7 Messaging Portal.
Population data from Missouri Census Data Center 2017 (https://census.missouri.edu).

Figure 11. Number of Patients Hospitalized with Influenza and/or Pneumonia Syndromes in Participating
Missouri Hospitals, by Age Group, Week 40, 2020-2021 Influenza Season
1.~ll JI)
- 0-4 Yrs
"C:' 300 18 :;0C:: : - 5-14 Yrs
·.;0:: : 16 ""S'
,.!1.:1:.1! 250 14 C0 . - 1s 64Yrs
"15 Q,.
·o. 200 12 00 - b~+Yrs
0::."0i:. ': 150 81 0 .000. .~. --0R-a4le Y rs
ai --514Yrs
a.
..Cc1J 11Kl G l! Rate
E 4 "' - 1'>-h4Yr,
ct:
z:: i 50 Rate
2 --65+Yrs
0 0 Rale
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
CDC Week

Data Source: Missouri Department of Health and Senior Services (DHSS), Bureau of Reportable Disease Informatics, HL7 Messaging Portal.

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Additional Influenza Data Sources:

Centers for Disease Control and Prevention: National Influenza Surveillance (FluView):
http://www.cdc.gov/flu/weekly/fluactivitysurv.htm

The National Respiratory and Enteric Virus Surveillance System (NREVSS):
https://www.cdc.gov/surveillance/nrevss/

World Health Organization: International Influenza Surveillance:
http://www.who.int/influenza/surveillance_monitoring/en/
Page 7 of 7
Missouri Weekly Influenza Surveillance Report
Missouri 2020-2021 Influenza Season1
DHSS

Oeporlment ol Heolth
o nd s,m10, 5(:NJco$ Week 41: October 4, 2020 – October 10, 2020

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

Summary:
 The estimated influenza activity in Missouri is Sporadic2.

 During Week 41, a total of 20 laboratory-positive3 influenza cases (8 influenza A, 12 influenza B) were reported.
A season-to-date total of 35 laboratory-positive influenza cases (15 influenza A, 20 influenza B) have been
reported in Missouri. The influenza type for reported season-to-date cases includes 42.9% influenza A, 57.1%
influenza B. No laboratory-positive cases of influenza were reported by the Missouri State Public Health
Laboratory (MSPHL) during Week 41. The percentage of respiratory specimens testing positive for influenza in
Missouri laboratories reporting to the National Respiratory and Enteric Virus Surveillance System (NREVSS)
remained low during Week 41 (Figure 5).

 Influenza-like illness (ILI) activity was below baseline for the hospital emergency room visit chief complaint data
reported through ESSENCE. The reported percentage of visits for ILI was 1.44% (Figure 6) through ESSENCE.4
The ILI data from a small number of sites located in the Northwest Region of the state is currently unavailable in
ESSENCE. Therefore, the ILI data for the Northwest Region should be interpreted with caution.

 No influenza-associated deaths have been reported in Missouri as of Week 41.5

 No influenza or ILI-associated outbreaks or school closures have been reported in Missouri as of Week 41.

 Seasonal influenza activity remains low overall across the United States. National influenza surveillance
information is prepared by CDC and is included in the weekly FluView report, which is available online at
http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.

1The 2020-2021 influenza season begins CDC Week 40 (week ending October 3, 2020) and ends CDC Week 39 (week ending September 25, 2021).

2Sporadic is defined as: Small numbers of laboratory-confirmed influenza cases or a single laboratory-confirmed influenza outbreak has been reported, but there is no
increase in cases of ILI.

3Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain reaction (RT-
PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.

4Influenza-like illness (ILI) is defined by ILINet as fever (temperature of 100oF [37.8oC] or greater) and a cough and/or a sore throat without a known cause other than
influenza. ILI is defined by ESSENCE as Emergency Department chief complaints for Influenza or (FeverPlus and (Cough or SoreThroat) and not NonILIFevers).

5All influenza-associated deaths became reportable in Missouri in 2016.

Page 1 of 7
Surveillance Data:

Interactive Maps

The jurisdiction-specific influenza data are provided though interactive maps available at
https://arcg.is/004CCr0 Click on the jurisdiction to view the influenza data specific to that jurisdiction.
 Reported Laboratory-positive Influenza Cases by Influenza Type by Jurisdiction, CDC Week 41
 Reported Week-specific Rate per 100,000 Population, CDC Week 41
 Reported Laboratory-positive Influenza Cases by Influenza Type by Jurisdiction, Season-to-Date
 Reported Rate per 100,000 Population, Season-to-Date

Data Figures

Figure 1. Number of Laboratory-positive† Influenza Cases by Influenza Type,
Missouri, CDC Week 41 (October 4, 2020 - October 10, 2020)*

2019-2020*
Influenza Type Week 40 Week 41
Season-to-Date
Influenza A 7 8 15
Influenza B 8 12 20
Influenza Unknown Or Un-typed 0 0 0
Total 15 20 35
†
Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain
reaction (RT-PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.
*Influenza season begins week ending October 3, 2020 (CDC Week 40) Data Source: Missouri Health Information Surveillance System (WebSurv).

Figure 2. Number of Laboratory-positive† Influenza Cases and Case Rates by Age Group,
Missouri, CDC Week 41 (October 4, 2020 - October 10, 2020)*‡

Week 41 Week 41 2020-2021* 2020-2021*
Age Group
Cases Rate‡ Season-to-Date Season-to-Date Rate‡
00-04 2 0.53 3 0.80
05-24 4 0.25 8 0.50
25-49 5 0.26 11 0.57
50-64 1 0.08 3 0.24
65+ 8 0.84 10 1.05
Total 20 0.33 35 0.58
†
Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain
reaction (RT-PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.
*Influenza season begins week ending October 3, 2020 (CDC Week 40) Data Source: Missouri Health Information Surveillance System (WebSurv)
‡
Incidence Rate per 100,000 population

Page 2 of 7
Figure 3. Number of Laboratory-positive† Influenza Cases and Case Rates by Region,
Missouri, CDC Week 41 (October 4, 2020 - October 10, 2020)*‡

Week 41 Week 41 2020-2021* 2020-2021*
Region
Cases Rate‡ Season-to-Date Season-to-Date Rate‡
Central 1 0.15 2 0.30
Eastern 9 0.40 22 0.97
Northwest 2 0.13 2 0.13
Southeast 3 0.64 3 0.64
Southwest 5 0.47 6 0.56
Total 20 0.33 35 0.58
†
Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain
reaction (RT-PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.
*Influenza season begins week ending October 3, 2020 (CDC Week 40) Data Source: Missouri Health Information Surveillance System (WebSurv)
‡
Incidence Rate per 100,000 population

Figure 4. Number of Laboratory-positive† Influenza Cases by CDC Week, Missouri, 2017-2021*

1-s- + 1
-s-
2011-201a 2orn-2019 2019-2020 ~ 2120-2121
16,000
14,000
12,000
10,000
C
0
u 8,000
n
t
6,000
4,000
2,000
0
4 4 4 4 4 4 4 4 4 4 5 5 5 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2
0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
Week

†
Laboratory-positive influenza includes the following test methods: rapid influenza diagnostic tests (antigen), reverse transcriptase polymerase chain reaction (RT-

PCR) and other molecular assays, immunofluorescence antibody staining (Direct (DFA) or Indirect (IFA)), or viral culture.
*2020-2021 season-to-date through the week ending May 15, 2021 (Week 20).Data Source: Missouri Health Information Surveillance System (WebSurv).
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