Weekly US Influenza Surveillance Report: Key Updates for Week 36, ending September 7, 2024

What to know

Seasonal influenza activity remains low nationally.

Summary

Viruses

Illness

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

Directional arrows indicate changes between the current week and the previous week. Additional information on the arrows can be found at the bottom of this page.

A description of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component is available on the surveillance methods page.1

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.

Key Points‎

• Seasonal influenza activity remains low nationally.



• One human infection with an influenza A(H5) virus was reported by the Missouri Department of Health and Senior Services.



• CDC estimates that there have been at least 35 million illnesses, 400,000 hospitalizations, and 25,000 deaths from flu so far this season.



•There are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.1


•Seasonal flu viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and RSV activity on a weekly basis.

U.S. virologic surveillance

Nationally, the percentage of respiratory specimens testing positive for influenza in clinical laboratories remained stable (change of ≤0.5 percentage points) compared to the previous week. Nationally, influenza A(H1N1)pdm09, A(H3N2), and B/Victoria viruses are all co-circulating. However, the distribution of circulating viruses varies by region. For regional and state level data and age group distribution, please visit FluView Interactive.

Clinical Laboratories

The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza virus) are used to monitor whether influenza activity is increasing or decreasing.

Results of tests from Clinical Laboratories
Week 36 Data Cumulative since
October 1, 2023
(Week 40)
No. of specimens tested 42,081 3,979,467
No. of positive specimens (%) 179 (0.4%) 351,928 (8.8%)
Positive specimens by type
Influenza A 154 (86.0%) 243,405 (69.2%)
Influenza B 25 (14.0%) 108,512 (30.8%)
Influenza Positive Tests Reported to CDC by Clinical Laboratories, National Summary, 2023-24 Season, week ending Sep 7, 2024
Influenza Positive Tests Reported to CDC by Clinical Laboratories, National Summary, 2023-24 Season, week ending Sep 7, 2024

View Chart Data

Public Health Laboratories

The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating influenza viruses that belong to each influenza subtype/lineage.

Results of tests from Public Health Laboratories
Week 36
Data Cumulative since
October 1, 2023
(Week 40)
No. of specimens tested 926 131,076
No. of positive specimens 58 40,099
Positive specimens by type/subtype    
         Influenza A 57 (98.3%) 30,882 (77.0%)
Subtyping Performed 50 (87.7%) 26,086 (84.5%)
            (H1N1)pdm09 23 (46.0%) 16,968 (65.0%)
             H3N2 27 (54.0%) 9,104 (34.9%)
             H3N2v 0 (0.0%) 1 (<0.1%)
             H5* 0 (0.0%) 13* (<0.1%)
Subtyping not performed 7 (12.3%) 4,796 (15.5%)
        Influenza B 1 (1.7%) 9,217 (23.0%)
Lineage testing performed 1 (100.0%) 8,013 (86.9%)
            Yamagata lineage 0 (0.0%) 0 (0.0%)
            Victoria lineage 1 (100.0%) 8,013 (100.0%)
Lineage not performed 0 (0.0%) 1,204 (13.1%)

*This data reflects specimens tested and the number determined to be positive for influenza viruses at the public health labs (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. The guidance for influenza A/H5 testing recommends testing both a conjunctival and respiratory swab for people with conjunctivitis which has resulted in more specimens testing positive for influenza A/H5 than the number of human H5 cases. For more information on the number of people infected with A/H5, please visit the "How CDC is monitoring influenza data among people to better understand the current avian influenza A (H5N1) situation"

This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.
This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.

View Chart Data

This graph reflects the number of specimens tested and the number determined to be positive for influenza viruses at the public health lab (specimens tested is not the same as cases). It does not reflect specimens tested only at CDC and could include more than one specimen tested per person. Specimens tested as part of routine influenza surveillance as well as those tested as part of targeted testing for people exposed to influenza A(H5) are included.

Additional virologic surveillance information for current and past seasons:‎

Novel Influenza A Virus

One new human infection with a novel influenza A virus was reported by the Missouri Department of Health and Senior Services. The patient was infected with an influenza A(H5) virus.

The patient is >18 years and has multiple underlying medical conditions. The patient developed symptoms during the week ending August 24, 2024, was hospitalized, and has since recovered. A respiratory specimen collected from the patient tested positive for influenza A at the hospital. The specimen was then forwarded to the Missouri State Public Health Laboratory (MSPHL) with the Department of Health and Senior Services as part of routine influenza surveillance. CDC confirmed the infection was caused by an influenza A (H5) virus. A subsequent investigation by state and local public health officials did not find any known direct or indirect contact with wild birds, domestic poultry, cattle (including no consumption of raw dairy products), or other wildlife prior to the patient's illness onset. One close contact of the patient was also ill at the same time, was not tested, and has since recovered.

During the 2023-2024 influenza season, a total of 14 cases of human infection with influenza A (H5) virus have been reported in the United States. Four of these occurred in individuals working with dairy cows, nine in individuals associated with poultry depopulation and disposal, and one in an individual with an unknown source of exposure. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional human cases is ongoing.

Seven variant influenza virus cases were also reported during the 2023-2024 season (four A(H1N2)v, two A(H3N2)v, and one A(H1N1)v virus), for a total of 20 novel influenza A virus cases reported this season.

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at Swine Flu.

Additional information regarding human infections with novel influenza A viruses:‎

Influenza Virus Characterization

CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local public health laboratories according to the Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses representing viruses contained in the current influenza vaccines. The data are also used to monitor evolutionary changes that continually occur in influenza viruses circulating in humans. CDC also tests susceptibility of circulating influenza viruses to antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir.

CDC has genetically characterized 5,348 influenza viruses collected since October 1, 2023.

Influenza Virus Characterization from viruses collected in the U.S. from September 29, 2019
Virus Subtype or Lineage Genetic Characterization
Total No. of
Subtype/Lineage
Tested
HA
Clade
Number (% of
subtype/lineage
tested)
HA
Subclade
Number (% of
subtype/lineage
tested)
A/H1 2,004
6B.1A.5a 2,004 (100%) 2a 504 (25%)
2a.1 1,500 (75%)
A/H3 1,775
3C.2a1b.2a 1,935 (100%) 2a.1b 1 (0.1%)
2a.3a 1 (0.1%)
2a.3a.1 1,932 (99.8%)
2b 1 (0.1%)
B/Victoria 1,462
V1A 1,486 (100%) 3a.2 1,486 (100%)
B/Yamagata 0
Y3 0 Y3 0 (0%)

CDC antigenically characterizes influenza viruses by hemagglutination inhibition (HI) (H1N1pdm09, H3N2, B/Victoria, and B/Yamagata viruses) or neutralization-based HINT (H3N2 viruses) using antisera that ferrets make after being infected with reference viruses representing the 2023-2024 Northern Hemisphere recommended cell or recombinant-based vaccine viruses. Antigenic differences between viruses are determined by comparing how well the antibodies made against the vaccine reference viruses recognize the circulating viruses that have been grown in cell culture. Ferret antisera are useful because antibodies raised against a particular virus can often recognize small changes in the surface proteins of other viruses. In HI assays, viruses with similar antigenic properties have antibody titer differences of less than or equal to 4-fold when compared to the reference (vaccine) virus. In HINT, viruses with similar antigenic properties have antibody neutralization titer differences of less than or equal to 8-fold. Viruses selected for antigenic characterization are a subset representing the genetic changes in the surface proteins seen in genetically characterized viruses.

Influenza A Viruses

  • A (H1N1)pdm09: 582 A(H1N1)pdm09 viruses were antigenically characterized by HI, and 581 (99.8%) were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown A/Wisconsin/67/2022-like reference viruses representing the A(H1N1)pdm09 component for the cell- and recombinant-based influenza vaccines.
  • A (H3N2): 665 A(H3N2) viruses were antigenically characterized by HI or HINT, and 629 (95%) were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer in HI or reacting at titers that were less than or equal to 8-fold of the homologous virus in HINT) by ferret antisera to cell-grown A/Darwin/6/2021-like reference viruses representing the A(H3N2) component for the cell- and recombinant-based influenza vaccines.

Influenza B Viruses

  • B/Victoria: 447 influenza B/Victoria-lineage virus were antigenically characterized by HI, and all were well-recognized (reacting at titers that were within 4-fold of the homologous virus titer) by ferret antisera to cell-grown B/Austria/1359417/2021-like reference viruses representing the B/Victoria component for the cell- and recombinant-based influenza vaccines.
  • B/Yamagata: No influenza B/Yamagata-lineage viruses were available for antigenic characterization.

Assessment of Virus Susceptibility to Antiviral Medications

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Information about antiviral susceptibility test methods can be found at U.S. Influenza Surveillance: Purpose and Methods.

Viruses collected in the U.S. since October 1, 2023, were tested for antiviral susceptibility as follows:

Viruses collected in the U.S. tested for antiviral susceptibility
Antiviral Medication Total Viruses A/H1 A/H3 B/Victoria
Neuraminidase Inhibitors Oseltamivir Viruses Tested 5,330 1,976 1,901 1,453
Reduced Inhibition 1 (0.02%) 1 (0.1%) 0 (0%) 0 (0%)
Highly Reduced Inhibition 6 (0.1%) 6 (0.3%) 0 (0%) 0 (0%)
Peramivir Viruses Tested 5,330 1,976 1,901 1,453
Reduced Inhibition 3 (0.1%) 0 (0%) 0 (0%) 3 (0.2%)
Highly Reduced Inhibition 7 (0.1%) 6 (0.3%) 0 (0%) 1 (0.1%)
Zanamivir Viruses Tested 5,330 1,976 1,901 1,453
Reduced Inhibition 1 (0.02%) 0 (0%) 0 (0%) 1 (0.1%)
Highly Reduced Inhibition 0 (0%) 0 (0%) 0 (0%) 0 (0%)
PA Cap-Dependent Endonuclease Inhibitor Baloxavir Viruses Tested 5,239 1,925 1,873 1,441
Decreased Susceptibility 1 (0.02%) 0 (0%) 1 (0.1%) 0 (0%)

Five A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution and one A(H1N1)pdm09 virus had NA-H275Y/H, conferring highly reduced inhibition by oseltamivir and peramivir. One (H1N1)pdm09 virus had NA-I223V and NA-S247N amino acid substitutions and showed reduced inhibition by oseltamivir. Two B viruses had NA-A245G amino acid substitution and showed reduced inhibition by peramivir. One B virus had NA-D197N amino acid substitution and showed reduced inhibition by zanamivir and peramivir. One B virus had NA-H273Y amino acid substitution and showed highly reduced inhibition by peramivir. One A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to baloxavir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented.

Outpatient respiratory illness surveillance

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for respiratory illness referred to as influenza-like illness [ILI (fever plus cough or sore throat)], not laboratory-confirmed influenza and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including influenza viruses, SARS-CoV-2, and RSV. It is important to evaluate syndromic surveillance data, including that from ILINet, in the context of other sources of surveillance data to obtain a more complete and accurate picture of influenza, SARS-CoV-2, and other respiratory virus activity. CDC is providing integrated information about COVID-19, influenza, and RSV activity on a website that is updated weekly. Information about other respiratory virus activity can be found on CDC's National Respiratory and Enteric Virus Surveillance System (NREVSS) website.

Outpatient respiratory illness visits

Nationally, the percentage of visits for respiratory illness that were reported through ILINet remained stable (change of ≤ 0.1 percentage points) compared to the previous week and remains below the national baseline. All 10 regions are below their region-specific baselines. Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Percentage of Outpatient Visits for Respiratory Illness Reported by. The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet)
Percentage of Outpatient Visits for Respiratory Illness Reported by. The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet)

View Chart Data

Outpatient respiratory illness visits by age group

About 70% of ILINet participants provide both the number of patient visits for respiratory illness and the total number of patient visits for the week broken out by age group. Data from this subset of providers are used to calculate the percentages of patient visits for respiratory illness by age group.

The percentage of visits for respiratory illness reported in ILINet remained stable in all age groups in Week 36 compared to Week 35.

Percent of Outpatient Visits for Respiratory Illness by Age Group. Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet)
Percent of Outpatient Visits for Respiratory Illness by Age Group. Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet)

View Chart Data

Outpatient respiratory illness activity map

Data collected in ILINet are used to produce a measure of ILI activity* by state/jurisdiction and Core Based Statistical Areas (CBSA).

ILI Activity by State/Jurisdiction and Core Based Statistical Area
Activity Level Number of Jurisdictions Number of CBSAs
Week 36
(Week ending
Sep. 7, 2024)
Week 35
(Week ending
Aug. 31, 2024)
Week 36
(Week ending
Sep. 7, 2024)
Week 35
(Week ending
Aug. 31, 2024)
Very High 0 0 0 1
High 0 0 2 4
Moderate 1 0 8 7
Low 0 3 36 42
Minimal 54 51 681 620
Insufficient Data 0 1 265 255

*Data collected in ILINet may disproportionally represent certain populations within a jurisdiction or CBSA, and therefore, may not accurately depict the full picture of influenza activity for the entire jurisdiction or CBSA. Differences in the data presented here by CDC and independently by some health departments likely represent differing levels of data completeness with data presented by the health department likely being the more complete.

Additional information about medically attended visits for ILI for current and past seasons:‎

Hospitalization surveillance

FluSurv-Net

The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. FluSurv-NET hospitalization data are preliminary. As data are received each week, prior case counts and rates are updated accordingly.

A total of 25,423 laboratory-confirmed influenza-associated hospitalizations were reported by FluSurv-NET sites between October 1, 2023, and September 7, 2024. The weekly hospitalization rate observed in week 36 was 0.1 per 100,000 population. The peak weekly hospitalization rate observed this season was 8.9 per 100,000 population and occurred during week 52.

Among 25,423 hospitalizations, 21,506 (84.6%) were associated with influenza A virus, 3,768 (14.8%) with influenza B virus, 56 (0.2%) with influenza A virus and influenza B virus co-infection, and 93 (0.4%) with influenza virus for which the type was not determined. Among those with influenza A subtype information, 4431 (67.6%) were A(H1N1) pdm09 and 2,119 (32.3%) were A(H3N2).

Weekly Rates of Laboratory-Confirmed Influenza Hospitalization among all ages for 2014-25 to 2023-24 seasons
Weekly Rates of Laboratory-Confirmed Influenza Hospitalization among all ages for 2014-25 to 2023-24 seasons

**In this figure, weekly rates for all seasons prior to the 2023-2024 season reflect end-of-season rates. For the 2023-2024 season, rates for recent hospital admissions are subject to reporting delays and are shown as a dashed line for the current season. As hospitalization data are received each week, prior case counts and rates are updated accordingly.

Additional FluSurv-NET hospitalization surveillance information for current and past seasons and additional age groups:‎

National healthcare safety network (NHSN) hospitalization surveillance

Effective May 1, 2024, hospitals are no longer required to report hospital admissions, hospital capacity, or hospital occupancy data to HHS through NHSN. Voluntarily reported NHSN hospital data can found at Weekly United States Hospitalization Metrics by Jurisdiction.

Additional NHSN Hospitalization Surveillance information:‎

Mortality surveillance

National Center for Health Statistics (NCHS) Mortality Surveillance

Based on NCHS mortality surveillance data available on September 12, 2024, the percentage of deaths that were due to influenza remained stable (<0.1 percentage point change) compared to the previous week. The data presented are preliminary and may change as more data are received and processed.

Pneumonia and Influenza Mortality from the National Center for Health Statistics Mortality Surveillance System
Pneumonia and Influenza Mortality from the National Center for Health Statistics Mortality Surveillance System

Download Data

Additional pneumonia, influenza and COVID-19 mortality surveillance information for current and past seasons:‎

Influenza-Associated Pediatric Mortality

Three influenza-associated pediatric deaths were reported to CDC during Week 36.

Two deaths occurred during the 2023-2024 season, bringing the total pediatric deaths for this season to 199. One of the deaths was associated with an influenza B virus with no lineage determined and occurred during week 13 (the week ending March 30, 2024). The other death was associated with an influenza A(H1N1) virus and occurred during week 33 (the week ending August 17, 2024).

One death occurring during the 2022-2023 season was also reported, which brings the total number of pediatric deaths for last season to 187. The death was associated with an influenza A virus for which subtyping was not performed and occurred during week 27 of 2023 (the week ending July 8, 2023).

Influenza-Associated Pediatric Deaths by Week of Death, 2020-21 season to 2023-24 season
Influenza-Associated Pediatric Deaths by Week of Death, 2020-21 season to 2023-24 season

Additional pediatric mortality surveillance information for current and past seasons:‎

Additional National and International Influenza Surveillance Information

IncreasingIncreasing
DecreasingDecreasing
StableStable

Clinical Labs: Up or down arrows indicate a change of greater than or equal to 0.5 percentage points in the percent of specimens positive for influenza compared to the previous week.
Outpatient Respiratory Illness (ILINet): Up or down arrows indicate a change of greater than 0.1 percentage points in the percent of visits due to respiratory illness (ILI) compared to the previous week.
NHSN Hospitalizations: Up or down arrows indicate change of greater than or equal to 5% of the number of patients admitted with laboratory-confirmed influenza compared to the previous week.
NCHS Mortality: Up or down arrows indicate change of greater than 0.1 percentage points of the percent of deaths due to influenza compared to the previous week.

FluView Interactive: FluView includes enhanced web-based interactive applications that can provide dynamic visuals of the influenza data collected and analyzed by CDC. These FluView Interactive applications allow people to create customized, visual interpretations of influenza data, as well as make comparisons across flu seasons, regions, age groups and a variety of other demographics.

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH.

U.S. State and local influenza surveillance: Select a jurisdiction below to access the latest local influenza information.

World Health Organization:
Additional influenza surveillance information from participating WHO member nations is available through FluNet and the Global Epidemiology Reports.

WHO Collaborating Centers for Influenza:
Australia, China, Japan, the United Kingdom, and the United States (CDC in Atlanta, Georgia)

Europe:
The most up-to-date influenza information from Europe is available from WHO/Europe and the European Centre for Disease Prevention and Control.

Public Health Agency of Canada:
The most up-to-date influenza information from Canada is available in Canada's weekly FluWatch report.

Public Health England:
The most up-to-date influenza information from the United Kingdom is available from Public Health England.

Any links provided to non-Federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization web pages found at these links.

A description of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component is available on the surveillance methods page.

  1. U.S. Influenza Surveillance: Purpose and Methods (2023 Oct). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/weekly/overview.htm#ILINet.