First Confirmed Case of Influenza 2013-2014: Alert for New Hampshire Clinicians

|September 20, 2013

The New Hampshire Division of Public Health Services (NH DPHS) has confirmed the first respiratory sample positive for seasonal influenza virus (influenza 2009 H1N1) in the New Hampshire Public Health Laboratories (NH PHL) for this 2013-2014 season. The case was confirmed in an adult with influenza-like illness (ILI) in Grafton County. Nationwide, there is very little circulating influenza at this point.

The NH DPHS recommends:

  1. Awareness of the first confirmed influenza virus infection in New Hampshire for the 2013-2014 influenza season.

  2. Awareness of the availability and composition of the 2013-2014 seasonal influenza vaccine.

  3. Encouraging influenza vaccination for everyone over six months of age (without medical contraindication).


The 2012-2013 influenza season was moderately severe on the national level, with a higher percentage of outpatient visits for ILI, higher rates of hospitalization, and more reported deaths attributed to pneumonia and influenza compared with recent years. In New Hampshire, there were a total of 44 influenza-associated deaths for 2012-2013, which is the highest number recorded during a flu season since 1997. New Hampshire also reported three pediatric influenza-associated deaths.


Both trivalent and quadrivalent influenza vaccine preparations are available in the United States for 2013-2014. Most available influenza vaccine will be trivalent; all live attenuated influenza vaccines (nasal spray) are expected to be quadrivalent.

The 2013-2014 trivalent influenza vaccine is made from the following three viruses: A/California/7/2009 (H1N1)pdm09-like virus, A(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011, and B/Massachusetts/2/2012-like virus. It is recommended that the quadrivalent vaccine containing two influenza B viruses include the above three viruses and a B/Brisbane/60/2008-like virus.

All persons aged six months or older should be vaccinated annually, especially those who are at increased risk for severe complications from influenza. Continued emphasis should be placed on vaccination of persons who live with or care for persons at higher risk for influenza-related complications. Persons with a history of influenza or vaccination last year should be encouraged to get the vaccine again this year, due to the natural waning of the antibody response over 7-12 months. It is not too early to begin vaccinating patients now, since it takes about 14 days for antibodies to form and the flu season has already begun in our state.

All children aged 6 months to 8 years old who are recommended for 2 doses should receive their first dose as soon as possible after the vaccine becomes available; these children should receive the second dose 4 weeks or more later.

Guidance on which children should receive 2 doses is available on the CDC website.

Guidance for vaccinating persons with reported egg allergies is available on the CDC website.

NH DPHS will continue to update you throughout this influenza season when we have new data to share about circulating strains of influenza in New Hampshire, antiviral susceptibilities, or increased rates of illness. Please contact us directly with any questions about influenza or if we can help with your response during this current season.

For additional information on the 2013-2014 influenza season from the CDC, refer to their website.

For additional information on influenza diagnostic testing, please refer to the NH DHHS website for archived Health Alert Network messages.

For any questions regarding the contents of this message, please contact NH DHHS, DPHS, Bureau of Infectious Disease Control, at 1-603-271-4496 (after hours, 1-800-852-3345, ext. 5300).

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