Influenza-associated intensive-care unit admissions and deaths - California, September 29, 2013-January 18, 2014

Abstract

The California Department of Public Health (CDPH) conducts surveillance on severe influenza illness among California residents aged <65 years. Severe cases are defined as those resulting in admission to an intensive care unit (ICU) or death; reporting of ICU cases is voluntary, and reporting of fatal cases is mandatory. This report describes the epidemiologic, laboratory, and clinical characteristics of ICU and fatal influenza cases with symptom onset on or after September 29, 2013, and reported by January 18, 2014 of the 2013-14 influenza season. At the time of this report, local health jurisdictions (LHJs) in California had reported 94 deaths and 311 ICU admissions of patients with a positive influenza test result. The 405 reports of severe cases (i.e., fatal and ICU cases combined) were more than in any season since the 2009 pandemic caused by the influenza A (H1N1)pdm09 (pH1N1) virus. The pH1N1 virus is the predominant circulating influenza virus this season. Of 405 ICU and fatal influenza cases, 266 (66%) occurred among patients aged 41-64 years; 39 (10%) severe influenza illnesses occurred among children aged <18 years. Only six (21%) of 28 patients with fatal illness whose vaccination status was known had received 2013-14 seasonal influenza vaccine ≥2 weeks before symptom onset. Of 80 patients who died for whom sufficient information was available, 74 (93%) had underlying medical conditions known to increase the risk for severe influenza, as defined by the Advisory Committee on Immunization Practices (ACIP). Of 47 hospitalized patients with fatal illness and known symptom onset and antiviral therapy dates, only eight (17%) received neuraminidase inhibitors within 48 hours of symptom onset. This report supports previous recommendations that vaccination is important to prevent influenza virus infections that can result in ICU admission or death, particularly in high-risk populations, and that empiric antiviral treatment should be promptly initiated when influenza virus infection is suspected in hospitalized patients, despite negative results from rapid diagnostic tests.

FIGURE 1

Number of cases of severe influenza,* by week of symptom onset — California, April 26, 2009–January 11, 2014^† * Severe cases of influenza are defined as influenza infections resulting in intensive care unit (ICU) admission or death. ^† ICU cases from three large local health jurisdictions have not been fully reported yet for the 2013–14 influenza season; for comparability, their ICU data are excluded from all years in this figure. Only cases occurring through January 11, 2014, are included because reporting for the cases with onset in the week ending January 18, 2014 was incomplete at the time of this report.

FIGURE 2

Percentage of severe* influenza cases, by age group, across influenza seasons — California, 2009–January 18, 2014 * Severe cases of influenza are defined as influenza infections resulting in intensive-care unit admission or death.