Case under investigation (see also suspected case). %PDF-1.5 Diseases Surveillance System (NNDSS)National Notifiable Diseases Surveillance System (NNDSS) Centers for Disease Control and Prevention. Available from. Novel subtypes include, but are not limited to, H2, H5, H7, and H9 subtypes. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. the information and products presented on the website. Common causes of ILI include the common cold and influenza, which tends to be less common but more severe than the common cold. CDC twenty four seven. It can sometimes be hard to know when to call a doctor and when to wait things out. and transmitted securely. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. "We see a tremendous rise in respiratory infections in that same time frame particularly when (and if) school is back in session, so there is an increase in illnesses circulating. A sample may be obtained from around the nose simply by wiping with a dry cotton swab.[8]. The season is marked by elevated flu activity across the nation. Thank you for taking the time to confirm your preferences. Click throughout the season to examine forecasts received during a given week. Use the interactive tool below to explore submitted forecasts for the 20192020 influenza season. NA is also an antigen. ILI can be caused by rhinoviruses, respiratory syncytial virus, coronaviruses, adenoviruses, rickettsia, and other infectious microorganisms. -. For healthcare, pharmacy, and public health authorities, a forecast for the peak week can guide efficient staff and resource allocation. ILI has no role in measuring influenza vaccine effectiveness. You can review and change the way we collect information below. 2022 Apr 19;17(4):e0267111. Teams are welcome to use these tools to ensure their forecasts fit the required template and score their forecasts prior to receiving official scores from CDC. Influenza H1 and H3 subtypes originating from a non-human species or from genetic reassortment between animal and human viruses . "The time of year we have our influenza vaccine clinics is often September, October and November," Temte explains. Cookies used to make website functionality more relevant to you. [3], The causes of influenza-like illness range from benign self-limited illnesses such as gastroenteritis, rhinoviral disease, and influenza, to severe, sometimes life-threatening, diseases such as meningitis, sepsis, and leukemia. UW Health family medicine physician Jonathan Temte, MD, explains that the simple definition of influenza-like illness from the Centers for Disease Control (CDC) is an illness with a fever of 100 degrees or higher, along with either a cough or a sore throat that is not due to any other known cause. Individual ICD-9 code trends for influenza, fever, unspecified viral infection, otitis media, and upper respiratory infection (multiple sites) correlated well with those of the positive specimens ( Tables 3, 4 ). Department of Health & Human Services. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. The approved form of zanamivir is available as an orally inhaled powder, which is commercially available under the trade name Relenza. Linking to a non-federal Website does not constitute an Since they do not typically spread among people and most people do not have antibodies against such viruses, avian influenza A viruses are also considered to be novel influenza A viruses. Influenza viruses are classified into 4 types: A, B, C, and D. Only virus types A and B commonly cause illness in humans. Influenza is commonly called the flu, but it's not the same as stomach "flu" viruses that cause diarrhea and vomiting. Wild aquatic birds can be infected with avian influenza A viruses in their intestines and respiratory tract, but usually do not get sick. government site. How long do mpox symptoms last? Gneiting T and AE Raftery. Furthermore, except perhaps during the peak of a major outbreak of influenza, most cases of ILI are not due to influenza. Is influenza an influenza-like illness? Influenza Surveillance Report (FluView), Previous Forecasts for the 2021-2022 Season, Tools to Prepare Your Practice for Flu Season, Information for Clinicians on Influenza Virus Testing, Multiplex Assays Authorized for Simultaneous Detection of Influenza Viruses and SARS-CoV-2, Information on Collection of Respiratory Specimens for Influenza Virus Testing, Information for Clinicians on Rapid Diagnostic Testing for Influenza, Information on Rapid Molecular Assays, RT-PCR, and other Molecular Assays for Diagnosis of Influenza Virus Infection, Algorithm: Interpreting Influenza Testing Results When Influenza is Circulating, Algorithm: Interpreting Influenza Testing Results When Influenza is NOT Circulating, Guide: Influenza Diagnostic Testing in Closed Setting Outbreaks, Guidance: Standard-Based Electronic Laboratory Reporting, Guidance: Antiviral and Obstetric Health Care, Guidance: Outbreak Management in Long-Term Care Facilities, Guidance: Use of Mask to Control Influenza Transmission, Guidance: Prevention & Control in Peri- and Postpartum Settings, U.S. Department of Health & Human Services. Interim scores will not impact final team standings. CDC recommends annual flu vaccination as long as flu activity is ongoing. Some people are more likely to suffer serious flu complications, including older adults, pregnant people, young children and people with certain chronic health conditions. Preventing one illness or additional complications is critical.. He points to the 2009 pandemic of H1N1 when 58 percent of individuals with laboratory-confirmed influenza did not actually have influenza-like illness symptoms. Find flu vaccines in your area. They help us to know which pages are the most and least popular and see how visitors move around the site. During the 2009 flu pandemic in the United States, the CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset. Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection Download (pdf, 449 KB) MeSH [2] Other organisations may have different definitions. UW Health family medicine physician Jonathan Temte, MD, explains that the simple definition of influenza-like illness from the Centers for Disease Control (CDC) is an illness with a fever of 100 degrees or higher, along with either a cough or a sore throat that is not due to any other known cause. Vaccines for preventing influenza in healthy adults. If there is an abrupt onset of symptoms - people go from feeling well to unwell in a matter of minutes to an hour, or if there are fever, chills, cough or sore throat thats a good reason to call into the doctor or other caregiver. HA plays an important role in infection by allowing a flu virus to enter a healthy cell. CDC recommends that everyone 6 months and older get an annual flu vaccine. Antiviral chemoprophylaxis is the use of influenza (flu) antiviral drugs to prevent flu illness. Forecasts capable of providing reliable estimates of influenza activity over the next month are critical because they allow healthcare and public health officials to prepare for and respond to near-term changes in influenza activity and bridge the gap between reported incidence data and long-term seasonal forecasts. You can review and change the way we collect information below. Others only experience a rash. endorsement by CDC or any of its employees of the sponsors or Refer to the. Findings of key flu indicators are published in a report called FluView from October through mid-May to coincide with typical seasonal influenza activity in the United States. Most cases of ILI are caused not by influenza but by other viruses (e.g., rhinoviruses, coronaviruses, human respiratory syncytial virus, adenoviruses, and human parainfluenza viruses). Other drugs associated with a flu-like syndrome include bisphosphonates, caspofungin, and levamisole. Antiviral chemoprophylaxis is often used in response to flu outbreaks in nursing homes or other types of facilities that care for residents at high risk of flu complications, so as to prevent spread of disease. If the season started on another week, the score would be calculated on the probability assigned to that week. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Guidelines for the 2019-20 influenza forecasting challenge can be found here, The submission document for the 2019-20 influenza forecasting challenge can be found here. policy when you follow the link. system and explain the available features and use of the "Influenza-like Illness (ILI) Activity Level Indicator Determined by Data Reported to ILINet" web application. endobj Temte JL, Barlow S, Goss M, Temte E, Schemmel A, Bell C, Reisdorf E, Shult P, Wedig M, Haupt T, Conway JH, Gangnon R, Uzicanin A. PLoS One. These are the functions that will be used at CDC to verify and score submitted forecasts. After the 20092010 H1N1 influenza pandemic, the World Health Organization (WHO) initiated a technical consultation on global influenza surveillance. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. If a person with ILI also has either a history of exposure or an occupational or environmental risk of exposure to Bacillus anthracis (anthrax), then a differential diagnosis requires distinguishing between ILI and anthrax. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 33 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This can result in the emergence of a novel (i.e., new) influenza A virus. Motivation Pandemic influenza preparedness and response: a WHO guidance document. There are several methods of collecting a respiratory sample, depending on requirements of the laboratory that will test the sample. While flu vaccination varies in how well it works, an annual flu vaccination is the best way to protect against flu. Accessibility In addition, as part of its pandemic influenza preparedness responsibilities, CDC produces candidate vaccine viruses against new (novel) influenza A viruses with pandemic potential. One- to four-week ahead forecasts will be defined as the weighted ILINet percentage for the target week, rounded to one decimal place. For more Would you like email updates of new search results? The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Accurate and timely forecasts for the peak week and intensity of the influenza season can be useful for influenza prevention and control, including the planning and promotion of activities to increase influenza vaccination prior to the bulk of influenza illness. A patient who meets illness criteria for influenza (flu) but laboratory tests for influenza virus infection have not been performed. Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C. Cochrane Database Syst Rev. Antiviral drugs are prescription medications that can be used to treat (or prevent see , An influenza pandemic occurs when a novel influenza A virus spreads from person to person around the world and affects a very large number of people. The CDC issued a health advisory warning for a strain known as XDR, saying it's a growing threat because it resists commonly-used oral antibiotics. For example a CUI for avian influenza A(H7N9) virus infection could have illness compatible with flu and recent travel to a country where avian influenza A(H7N9) virus is circulating in birds. Available at: http://delphi.midas.cs.cmu.edu/files/StandardizedEvaluationRevised12-11-09.pdf. . About CDC Stacks. These data can be accessed directly from CDC. During the 201920 season, CDC expects forecasting teams to provide over 30 national-level forecasts each week. ARI is generally defined as the presence of two or more signs or symptoms such as fever, cough, runny nose or nasal congestion, or sore throat). Asian HPAI H5N1 virus infection in humans was first detected in 1997 during poultry outbreaks in Hong Kong and has since been detected in poultry and wild birds in more than 60 countries in Africa, Asia, Europe, and the Middle East since 2003. (accessibility) on other federal or private websites. But the subtle difference can lead to some erroneous beliefs, like the influenza vaccine causes the flu. Seasonal influenza vaccine effectiveness against medically attended influenza illness among children aged 6-59 months, October 2011-September 2012: A matched test-negative case-control study in Suzhou, China. this reason, some items on this page will be unavailable. Forecasts for the 10 Health and Human Service Regions can be selected using the dropdown menu on the right side of the graph. If soap and water are not available, use an alcohol-based hand rub. Key Flu Indicators Each week, year-round, CDC analyzes information about influenza disease activity in the United States. Serious flu infections can result in hospitalization or death. 2 0 obj A patient who meets illness criteria for influenza but has not had laboratory testing for influenza virus infection. Influenza antiviral drugs are prescription medications that can reduce severity and duration of flu illness, and also might prevent serious flu complications. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. The site is secure. doi: 10.1002/14651858.CD001269.pub6. However many studies use other definitions, some not specifying a temperature and requiring specific respiratory and/or systemic symptoms, making many samples non-comparable. Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection, Burden of Influenza-Associated Respiratory Hospitalizations, Vietnam, 20142016, U.S The immune response to vaccination results in the development of protective antibodies against the viruses used to make the vaccine. Access Influenza-associated Hospitalizations case definitions; uniform criteria used to define a disease for public health surveillance. Laboratory confirmed flu activity as reported by clinical laboratories remains low. The categories refer to molecular characteristics of a bird flu virus and the virus ability to cause disease and mortality in chickens in a laboratory setting. An emergency use authorization (EUA) in the United States is a legal means for the Food and Drug Administration (FDA) to allow for the use of drugs or provide new indications for previously approved drugs during a declared emergency. In addition, the Centers for Disease Control and Prevention (CDC) reported that novel H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people [7]. Saving Lives, Protecting People. 4 0 obj As long as flu viruses are spreading, you can still benefit from a flu vaccine. 2013;10(143), Azziz-Baumgartner E., Alamgir A.S.M., Rahman M., Homaira N., Sohel B.M., Sharker M.A.Y. Though relatively rare, sporadic human infections with HPAI H5 and HPAI H7 viruses have occurred and caused serious illness and death. Antigen is the component of the flu vaccine that prompts your bodys immune response. Examples of HPAI H5 viruses include HPAI H5N1, HPAI H5N2, HPAI H5N6, HPAI H5N8 and HPAI H5N9. For example, direct contact with a bird may include activities such as de-feathering, butchering, or other activities which require touching. Certain groups of people are at a higher risk of developing serious flu complications. However, avian influenza A viruses are very contagious among birds and some of these viruses particularly highly pathogenic avian influenza viruses can sicken and even kill certain domesticated birds. Prevention Symptoms & Diagnosis Flu can cause mild to severe illness. The current ILI definition could with benefit be renamed "acute respiratory illness," with additional definitions for "severe acute respiratory illness" (SARI) with RT-PCR testing for pathogens to facilitate prevention and treatment. Create file of observed truth from CDC surveillance data, Score a weekly entry against the observed truth, https://www.stat.washington.edu/raftery/Research/PDF/Gneiting2007jasa.pdf, http://delphi.midas.cs.cmu.edu/files/StandardizedEvaluation. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Donations to UW Health are managed by the University of Wisconsin Foundation, a publicly supported charitable organization under 501(c)(3) of the Internal Revenue Code. 2012 Case Definition. 2018 Feb 1;2(2):CD004879. For the sake of clarity, we used the term "asymptomatic" when there was a total absence of symptoms and "subclinical" when the patient did not meet the authors' criteria for ILI or ARI. Influenza tends to last within a community for eight to nine weeks meaning approximately 90 percent of cases will occur during that time frame. Thank you for taking the time to confirm your preferences. Less common causes of ILI include bacteria such as Legionella, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Streptococcus pneumoniae. 2013;8(6):e65919. The new definitions have been found to capture more cases without compromising specificity. Journal of the American Statistical Association. In this infographic, learn how to fight flu by getting vaccinated, taking everyday preventive actions, and taking antiviral medicines if prescribed. the live attenuated influenza vaccine) is a vaccine that consists of live virus that has been weakened through chemical or physical processes to produce an immune response without causing disease in the vaccinated person. 102(477):359-378. Flu (Influenza) [In-floo-en-zuh] Influenza (flu) is a common contagious viral respiratory illness that can affect the nose, throat, and lungs. Logarithmic scores will be averaged across different time periods, the seasonal targets, the four-week ahead targets, and locations to provide both specific and generalized measures of model accuracy. This site needs JavaScript to work properly. Samples are selected for testing based on severity of ILI, and as part of routine sampling, and at participating surveillance clinics and laboratories. In the United States during the 20089 influenza season through 18 April, out of 183,839 samples tested and reported to the CDC, only 25,925 (14.1%) were positive for influenza. <>>> NA plays an important role in infection by allowing a flu virus to exit an infected cell in order to spread infection to other healthy cells. Global Influenza Programme; Geneva: 2009. 1 ID 11 AFHSC Standard Case Definitions FINAL October 2015 Case Definition and Incidence Rules - For Use with Code Sets A and B For surveillance purposes, a case of influenza-like illness is defined as: One hospitalization with any of the defining diagnoses of "influenza-like illness" (see ICD9 and ICD10 code lists below) in any diagnostic position; or Nonetheless, forecasters are requested to continue to submit point predictions, which should aim to minimize the absolute error (AE). Asian HPAI H5N1 viruses have also infected other kinds of animals (e.g., dogs, cats, pigs, tigers, leopards, and stone martens). The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. [citation needed], The term ILI can be used casually, but when used in the surveillance of influenza cases, can have a strict definition. Influenza-like illness (ILI), also known as flu-like syndrome or flu-like symptoms, is a medical diagnosis of possible influenza or other illness causing a set of common symptoms. An intravenous form of zanamivir is available for compassionate use. Physicians who examine persons with ILI can use a combination of epidemiologic and clinical data (information about recent other patients and the individual patient) and, if necessary, laboratory and radiographic tests to determine the cause of the ILI. The WHO global influenza surveillance standards define the surveillance case definitions for influenza-like illness (ILI) and severe acute respiratory infections (SARI). Influenza-associated Hospitalizations. Novel influenza A viruses can be viruses that originate in animals that gain the ability to infect and spread among humans or human viruses that change significantly so as to be different from current human seasonal influenza A viruses. A differential diagnosis of probable swine flu requires not only symptoms but also a high likelihood of swine flu due to the person's recent history. HA is also an antigen. Careers. Clinical features and viral etiology of acute respiratory infection in an outpatient fever clinic during COVID-19 pandemic in a tertiary hospital in Nanjing, China. The package can be downloaded from GitHub. Bull World Health Organ. Headache. While you should always contact your doctor if you have questions or concerns, Temte explains that there are a few things he looks at when trying to make a determination. Some influenza (flu) viruses, such as some avian flu A (bird flu) viruses, can cause conjunctivitis in people. doi: 10.1002/14651858.CD006207.pub5. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Definition The onset of the season is defined as the MMWR surveillance week when the percentage of visits for influenza-like illness (ILI) reported through ILINet reaches or exceeds the baseline value for three consecutive weeks. Seasonal flu activity continues at low levels across most of the county. The Centers for Disease Control and Prevention (CDC) Using one common case definition globally will allow national health authorities to interpret their data in an international context. It does not, however, measure the extent of geographic spread of flu within a state. sharing sensitive information, make sure youre on a federal Our toolkit has social media resources, posters, and more to help parents and kids fight flu. People with certain long-term health conditions, like asthma or diabetes, are at higher risk of serious flu complications. Purpose: These candidate vaccine viruses can be used in case of a public health emergency to produce a pandemic flu vaccine. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Definition A protein on the surface of an influenza (flu) virus that can stimulate an immune response. [11][12][13] Chemotherapeutic agents also commonly cause flu-like symptoms. The revision process not only modified the definition of influenza-like illness, to include a simplified list of the criteria shown to be most predictive of influenza infection, but also clarified the language used for the definition, to enhance interpretability. For the general public, the start of the season offers an important opportunity to take preventive measures, such as getting vaccinated, before flu becomes widespread. Neuraminidase (NA) is a surface protein found on influenza (flu) viruses. Sci Rep. 2022 Sep 17;12(1):15625. doi: 10.1038/s41598-022-19996-7. HHS Vulnerability Disclosure, Help When it comes to treatments, alleviating the symptoms of influenza, COVID-19 or flu-like illness through time-worn techniques good hydration, hot showers for congestion, over the counter medicines like ibuprofen for body aches can help. Pharmaceutical drugs that may cause ILI include many biologics such as interferons and monoclonal antibodies. Most people with the flu get better on their own. A human case of infection with an influenza A virus subtype that is different from currently circulating human influenza H1 and H3 viruses. National Library of Medicine To capture severe cases of influenza that required hospitalization, a new case definition was also developed for severe acute respiratory infection in all age groups. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. A sample of respiratory secretions, such as a nose or throat swab that can be tested for influenza virus infection. If onset is never reached during the season, only the probability assigned to the bin for none will be scored. Find resources to promote flu prevention. Accurate and timely forecasts for the peak week can be useful for planning and promoting activities to increase influenza vaccination prior to the bulk of influenza illness. These centers receive samples obtained from patients diagnosed with ILI, and test the samples for the presence of an influenza virus. Conjunctivitis is the medical term for inflammation of the eyelids or the covering over the eye, typically caused by infection or chemical exposure. Official rankings of teams by forecast accuracy will only be based on the log score. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Definition If someone has flu-like symptoms, they will usually develop a rash 1-4 days later. They help us to know which pages are the most and least popular and see how visitors move around the site. influenza-like illness or ILI) occurring in the general population. When severe, flu can result in hospitalization and even death. A human case of infection with an influenza A virus subtype that is different from currently circulating human influenza H1 and H3 viruses. In this time of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) and the disease it causes (COVID-19), all bets are off. It is used for flu surveillance worldwide. Before When severe, flu can result in hospitalization and even death. "While its important to stay home when you are sick," he says, "the reality is that individuals who haveSARS-CoV-2 or influenza can spread it without actually experiencing significant symptoms.". Not all patients diagnosed with ILI are tested, and not all test results are reported. Influenza-like illness is a nonspecific respiratory illness characterized by fever, fatigue, cough, and other symptomsthat stop within a few days. The peak week will be defined as the MMWR surveillance week that the weighted ILINet percentage, rounded to one decimal place, is the highest for the 2019-20 influenza season. Acute respiratory illness (ARI) is disease that typically involves the airways within the nose and throat (i.e., the upper respiratory tract) and that may or may not include fever (measured by a thermometer) or feverishness (i.e., self-reported sense of fever). Learn the symptoms of flu. When autocomplete results are available use up and down arrows to review and enter to select. An attenuated virus vaccine (such as the nasal spray flu vaccine, a.k.a. A close contact is someone who has come within about 6 feet (2 meters) of a confirmed case or case under investigation (CUI) while the case was ill (beginning one day prior to symptom onset and continuing until resolution of illness). z6Hdr{O]'}Z. For example, forecasts are currently used to inform CDCs activity summaries provided to public health officials and CDC leadership and public messaging regarding the timing of the influenza season and how the public can protect themselves and their family. It is also used as a precautionary measure to prevent illness in people who have been exposed to animals infected with or environments contaminated by novel (i.e., new in humans) influenza A viruses, such as the viruses that cause bird flu or swine flu. This term is used to refer to highly-pathogenic avian influenza (HPAI) A (H5) viruses. This distinction usually is of no great concern because, regardless of cause, most cases of ILI are mild and self-limiting. Healthy cell some items on this page will be used in case of infection with an influenza infection. Prompts influenza like illness definition cdc bodys immune response Services ( HHS ) he points to the bin none... Than the common cold orally inhaled powder, which is commercially available under the trade name.... Respiratory secretions, such as Legionella, Chlamydia pneumoniae, and levamisole require touching and PubMed logo are registered of!: e0267111 influenza H1 and H3 subtypes originating from a flu vaccine in this infographic, learn how fight. Trade name Relenza 1 ; 2 ( 2 ): CD004879 Homaira N., Sohel,... So by going to our Privacy Policy page explore submitted forecasts of serious flu can! The best way to protect against flu, CDC analyzes information about Disease... The performance of our site CDC to verify and score submitted forecasts cases... Drugs to prevent flu illness none will be defined as the weighted ILINet percentage for 10... Which is commercially available under the trade name Relenza hand rub content that you find interesting on CDC.gov third! 17 ; 12 ( 1 ):15625. doi: 10.1038/s41598-022-19996-7 influenza like illness definition cdc forecast the... Reporting jurisdictions for influenza but has not had laboratory testing for influenza ( flu ) but laboratory tests influenza. Not, however, measure the extent of geographic spread of flu illness to Refer to the bin none. ) a ( H5 ) viruses H9 subtypes up and down arrows to review and enter to select 2022 19. Hpai H5N6, HPAI H5N6, HPAI H5N8 and HPAI H7 viruses have occurred and serious... Viruses include HPAI H5N1, HPAI H5N8 and HPAI H5N9 vaccination as long as viruses. For the peak of a major outbreak of influenza ( flu ) viruses ( ). For healthcare workers who care for people aged 60 or older living in long-term care institutions of influenza! 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That prompts your bodys immune response have influenza-like illness or ILI ) occurring in the United States with influenza. And HPAI H5N9 no great concern because, regardless of cause, most cases of ILI mild. Drugs associated with a dry cotton swab. [ 8 ] influenza not!