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Introduction Previous FluSurv-NET studies found that adult females had a higher incidence of influenza-associated hospitalizations than males. To identify groups of women at higher risk than men, we analyzed data from 14 FluSurv-NET sites that conducted population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among residents of 78 US counties. Methods We analyzed 6292 laboratory-confirmed, geocodable (96%) adult cases collected by FluSurv-NET during the 2010-12 influenza seasons. We used 2010 US Census and 2008-2012 American Community Survey data to calculate overall age-adjusted and age group-specific female:male incidence rate ratios (IRR) by race/ethnicity and census tract-level poverty. We used national 2010 pregnancy rates to estimate denominators for pregnant women aged 18-49. We calculated male:female IRRs excluding them and IRRs for pregnant:non-pregnant women. Results Overall, 55% of laboratory-confirmed influenza cases were female. Female:male IRRs were highest for females aged 18-49 of high neighborhood poverty (IRR 1.50, 95% CI 1.30-1.74) and of Hispanic ethnicity (IRR 1.70, 95% CI 1.34-2.17). These differences disappeared after excluding pregnant women. Overall, 26% of 1083 hospitalized females aged 18-49 were pregnant. Pregnant adult females were more likely to have influenza-associated hospitalizations than their non-pregnant counterparts (relative risk [RR] 5.86, 95% CI 5.12-6.71), but vaccination levels were similar (25.5% vs 27.8%). Conclusions Overall rates of influenza-associated hospitalization were not significantly different for men and women after excluding pregnant women. Among women aged 18-49, pregnancy increased the risk of influenza-associated hospitalization sixfold but did not increase the likelihood of vaccination. Improving vaccination rates in pregnant women should be an influenza vaccination priority.

During 2017, CDC received 1,521 reports of acute hepatitis A virus (HAV) infections from California, Kentucky, Michigan, and Utah; the majority of infections were among persons reporting injection or noninjection drug use or homelessness. Investigations conducted by local and state health departments indicated that direct person-to-person transmission of HAV infections was occurring, differing from other recent, large HAV outbreaks attributed to consumption of contaminated commercial food products. Outbreaks with direct HAV transmission among persons reporting drug use or homelessness signals a shift in HAV infection epidemiology in the United States, and vaccination of these populations at high risk can prevent future outbreaks.

Background We investigated the effect of influenza vaccination on disease severity in adults hospitalized with laboratory-confirmed influenza during 2013-14, a season in which vaccine viruses were antigenically similar to those circulating. Methods We analyzed data from the 2013-14 influenza season and used propensity score matching to account for the probability of vaccination within age strata (18-49, 50-64, and ≥65 years). Death, intensive care unit (ICU) admission, and hospital and ICU lengths of stay (LOS) were outcome measures for severity. Multivariable logistic regression and competing risk models were used to compare disease severity between vaccinated and unvaccinated patients, adjusting for timing of antiviral treatment and time from illness onset to hospitalization. Results Influenza vaccination was associated with a reduction in the odds of in-hospital death among patients aged 18-49 years (adjusted odds ratios [aOR] = 0.21; 95% confidence interval [CI], 0.05 to 0.97), 50-64 years (aOR = 0.48; 95% CI, 0.24 to 0.97), and ≥65 years (aOR = 0.39; 95% CI, 0.17 to 0.66). Vaccination also reduced ICU admission among patients aged 18-49 years (aOR = 0.63; 95% CI, 0.42 to 0.93) and ≥65 years (aOR = 0.63; 95% CI, 0.48 to 0.81), and shortened ICU LOS among those 50-64 years (adjusted relative hazards [aRH] = 1.36; 95% CI, 1.06 to 1.74) and ≥65 years (aRH = 1.34; 95% CI, 1.06 to 1.73), and hospital LOS among 50-64 years (aRH = 1.13; 95% CI, 1.02 to 1.26) and ≥65 years (aRH = 1.24; 95% CI, 1.13 to 1.37). Conclusions Influenza vaccination during 2013-14 influenza season attenuated adverse outcome among adults that were hospitalized with laboratory-confirmed influenza.

Background Invasive aspergillosis primarily affects immunosuppressed persons, but it has also been observed in immunocompetent patients with severe influenza. Several case series suggest that severe influenza infection might be an under-recognized risk factor for aspergillosis. We examined the frequency of aspergillosis-related hospital discharge codes in a national surveillance database of influenza hospitalizations. Methods We analyzed laboratory-confirmed influenza-associated hospitalizations reported during 2005–2017 to Centers for Disease Control and Prevention (CDC)’s Influenza Hospitalization Surveillance Network (FluSurv-NET), which includes children and adults in 13 states. We obtained data on underlying conditions and clinical course through medical chart abstraction. We defined invasive aspergillosis cases as influenza hospitalizations with ≥1 of the following the International Classification of Diseases (ICD) 9th or 10th Clinical Modification discharge diagnosis codes: 117.3 (aspergillosis), 484.6 (pneumonia in aspergillosis), B44.0 (invasive pulmonary aspergillosis), B44.2 (tonsillar aspergillosis), and B44.7 (disseminated aspergillosis). Results Among 92,671 influenza hospitalizations, we identified 94 cases (0.1%) that had invasive aspergillosis codes. Characteristics of patients were: 60% male (56/94), 72% white race (60/83), and median age 58 years [interquartile range (IQR) 41–67]. Influenza A accounted for 80% (75/94) of cases. Seventy-nine percent (74/94) received antiviral therapy. Underlying conditions included 63% (59/94) immunocompromising condition, 51% (48/94) chronic lung disease, 22% (21/94) renal disease, and 15% (14/94) asthma. Forty-eight percent of patients (45/94) required intensive care. At the time of discharge, 60% (56/94) were diagnosed with pneumonia and 14% (13/94) died. Conclusion Over one-third of patients with invasive aspergillosis did not have a documented immunosuppressive condition. ICD codes are likely an imperfect way to identify invasive aspergillosis, and further studies are needed to characterize risk factors and verify diagnoses for aspergillosis among patients with severe influenza. Disclosures E. J. Anderson, NovaVax: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. AbbVie: Consultant, Consulting fee. MedImmune: Investigator, Research support. PaxVax: Investigator, Research support. Micron: Investigator, Research support. K. Talbot, sanofi pasteur: Investigator, Research support. Gilead: Investigator, Research support. MedImmune: Investigator, Research support. Seqirus: Scientific Advisor, Consulting fee. MedImmune: Scientific Advisor, Consulting fee.

Background. Some studies suggest that influenza vaccination might be protective against severe influenza outcomes in vaccinated persons who become infected. We used data from a large surveillance network to further investigate the effect of influenza vaccination on influenza severity in adults aged ≥50 years who were hospitalized with laboratory-confirmed influenza. Methods. We analyzed influenza vaccination and influenza severity using Influenza Hospitalization Surveillance Network (FluSurv-NET) data for the 2012−2013 influenza season. Intensive care unit (ICU) admission, death, diagnosis of pneumonia, and hospital and ICU lengths of stay served as measures of disease severity. Data were analyzed by multivariable logistic regression, parametric survival models, and propensity score matching (PSM). Results. Overall, no differences in severity were observed in the multivariable logistic regression model. Using PSM, adults aged 50−64 years (but not other age groups) who were vaccinated against influenza had a shorter length of ICU stay than those who were unvaccinated (hazard ratio for discharge, 1.84; 95% confidence interval, 1.12−3.01). Conclusions. Our findings show a modest effect of influenza vaccination on disease severity. Analysis of data from seasons with different predominant strains and higher estimates of vaccine effectiveness are needed.

Background Influenza results in an estimated 12,000–56,000 deaths annually in the USA. While in-hospital deaths are well characterized, less is known about deaths that occur after discharge among those hospitalized with influenza. Methods We identified patients hospitalized with laboratory-confirmed influenza who died during hospitalization or within 30 days after discharge during the 2014–2015 influenza season for 11 Influenza Hospitalization Surveillance Network sites. We matched cases to the National Center for Health Statistics Electronic Death Registration System and abstracted cause and location of death from death certificates. We compared clinical characteristics between those who died during hospitalization and those who died after hospital discharge using χ2 tests. Results Among 795 patients with laboratory-confirmed influenza who died, 370 (47%) died during hospitalization, and 425 (53%) died within 30 days after discharge. Eighteen (2%) were 0–17 years and 652 (82%) were ≥65 years. Common causes of death listed in any position on the death certificate included influenza (35%), other respiratory causes (50%), cardiovascular disease (37%), and sepsis (15%). Among those who died after discharge, 207 (49%) died within 7 days, 86 (20%) within 8–14 days, and 132 (31%) within 15–30 days post discharge. Patients who died after discharge were more likely to be ≥65 years (88 vs. 74%) or admitted from a nursing home (48 vs. 36%), but were less likely to be admitted to an intensive care unit (30 vs. 68%) or receive a pneumonia diagnosis (46 vs. 62%) than patients who died during hospitalization (all P Conclusion Over half of deaths among patients hospitalized with laboratory-confirmed influenza occurred after discharge. Patients who died after discharge were older and less likely to have influenza listed as a cause of death. Deaths that occur after an influenza-related hospitalization represent an important and under-characterized contribution to the burden of seasonal influenza. Disclosures E. J. Anderson, AbbVie: Consultant, Consulting fee; NovaVax: Research Contractor, Research support; Regeneron: Research Contractor, Research grant; MedImmune: Research Contractor, Research grant and Research support. W. Schaffner, Pfizer: Scientific Advisor, Consulting fee; Merck: Scientific Advisor, Consulting fee; Novavax: Consultant, Consulting fee; Dynavax: Consultant, Consulting fee; Sanofi-pasteur: Consultant, Consulting fee; GSK: Consultant, Consulting fee; Seqirus: Consultant, Consulting fee

Cholera caused by toxigenic Vibrio cholerae, serogroup O1, serotype Ogawa, biotype El Tor, was confirmed on October 21, 2010, in Haiti and on October 31, 2010, in the Dominican Republic. These countries are on the island of Hispaniola. During October 21, 2010–April 4, 2011, >275,000 cholera cases and >4,700 deaths were reported from Hispaniola. Of these cases, 840 culture-confirmed cases and 10 deaths were reported from the Dominican Republic. Illness caused by toxigenic V. cholerae O1 has been documented in the United States since 1832. During 1965–1991, an average of 5 cases per year were reported. During the Latin American cholera epidemic that started in 1991, the number of cholera cases in the United States increased because of importation of cases related to the epidemic to an average of 53 cases per year during 1992–1994 (1,2). As the Latin American epidemic waned, during 1995–2000, the average annual case count decreased to 10 (3). During 2000–2010, the average number of cases was 6, and 57% of case-patients had traveled internationally (4). This experience raised concern that a dramatic increase in US cholera cases could result from the Hispaniola epidemic. In the United States, cholera is confirmed by identification of toxigenic V. cholerae serogroup O1 or O139 or by serologic evidence of infection in a patient with diarrhea and an epidemiologic link to a culture-confirmed case. Since 2000, suspected V. cholerae isolates have been sent by state public health laboratories to the Centers for Disease Control and Prevention (CDC) for confirmation and characterization. We summarize characteristics of confirmed US cases associated with the Hispaniola epidemic that were reported to the CDC Cholera and Other Vibrio Illness Surveillance System, a national database of all laboratory-confirmed cholera and vibriosis cases. For each case of cholera, state and local health officials submit a Cholera and Other Vibrio Illness Surveillance System report form that contains demographic, clinical, and epidemiologic information, including selected food and water exposures associated with cholera, travel history, and vaccination status.