Worldwide: Outbreaks of influenza A have been reported recently from Canada, Denmark, France, French Guiana, Hungary, Jamaica, Korea, Netherlands, Spain, Sweden, and Switzerland. With the exception of the Jamaican isolates, which were similar to A/England/864/75, all the further characterized isolates from these countries were similar to A/ Victoria/3/75. The United Kingdom has experienced a marked increase in influenza illness; the majority of recent isolates have been A/Victoria-like. Spain has experienced outbreaks of influenza B; sporadic cases of influenza B have also been reported from Denmark, Sweden, and Switzerland. (Reported by the World Health Organization in the Weekly Epidemiologic Record 51/6, 7, 81:51, 59, 65, Feb 6, 13, 20, 1976.)

United States: Influenza A continues to be widespread in the United States. Although the epidemic has peaked in the Northeast, increasing activity has been reported from the western states (Figure 1). In a telephone survey conducted on February 26, 24 states, the District of Columbia, and Puerto Rico reported widespread outbreaks, 16 states recorded regional outbreaks, and the remaining 10 states reported isolated cases.

Figure 1

REPORTED INFLUENZA ACTIVITY FEBRUARY 26, 1976, CDC TELEPHONE SURVEY

Figure 2

PNEUMONIA-INFLUENZA DEATHS IN 121 UNITED STATES CITIES

12 CITIES

2800

NO REPORTED CASES

ISOLATED CASES
REGIONAL OUTBREAKS

WIDESPREAD OUTBREAKS

Forty-one states, the District of Columbia, and Puerto Rico now have reported isolates of influenza A. All of the recently characterized isolates have been similar to A/Victoria/3/75. Isolates of influenza B from sporadic cases have been made in 6 western states and in New York.

Weekly pneumonia and influenza (P & I) deaths from 121 cities in the United States (Figure 2) have exceeded the level reached during recent influenza epidemics, but are much lower than the peak in the 1968-69 epidemic. All regions of the country have now reported P & I deaths in excess of the epidemic threshold, with the New England and Middle Atlantic states continuing to have the highest elevations.

Review of morbidity data collected from 532 reporting institutions in the United States indicated increased absenteeism in 30% of the schools and 29% of the industries, and increased emergency room visits in 43% of the hospitals. Morbidity appeared to be highest in the New England and Middle Atlantic areas, where 60% of schools, 46% of industries, and 43% of hospitals reported increases. A/Swine-like influenza

New Jersey: Investigation of the outbreak of A/Swinelike influenza at Fort Dix is continuing. One additional serologically confirmed case was reported, bringing the num

ber of confirmed cases to 12. Of 1,321 single sera collected at Fort Dix, 273 (21%) had positive HI titers to the A/Swine antigen. No new cases of A/Swine-like influenza at Fort Dix, nor suspect cases in the civilian New Jersey population, have been reported.

Mississippi: Of 33 family members and close contacts of the patient who had Hodgkin's disease and suspected swine influenza (MMWR 25[7]), only 1-a fellow-worker at the swine slaughterhouse-had an elevated HI titer. Sixteen of 34 other slaughterhouse employees were found to have elevated HI titers.

Virginia: Confirmatory serologic evidence of swine influenza infection in 2 patients with pneumonia in a university hospital has been reported. Preliminary investigation showed no evidence of spread of the illness to family members or close contacts of the 2 patients. (Reported by M Goldfield, MD, R Altman, MD, State Epidemiologist, New Jersey Dept of Health; J Bartley, Col, Health and Environment, USAMEDDAC, Ft Dix, NJ; T Nowosiwsky, Col, Div of Preventive Medicine, PK Russell, Col, Div of Communicable Disease and Immunology, FH Top, Jr, Col, Dept of Virology, Walter Reed Army Institute of Research, Washington, DC; DL Blakey, MD, State Epidemiologist, Mississippi Board of Health; R Webster, PhD, St Jude's Children's Hospital, Memphis; JM Gwaltney, Jr, MD, RP Wenzel, MD, University of Va School of Medicine; RS Jackson, MD, State Epidemiologist, Va Dept of Health; LJ Legters, Col, Health and Environment, Office of the Surgeon General Headquarters. Dept of the Army, Washington, DC; Virology Div, B Moratories, and Viral Diseases Div, Bur of Epidemiol