title: Seasonal synchronization of influenza in the United States older adult population.
abstract: BACKGROUND
  In temperate regions, influenza epidemics occur annually with the highest activity occurring during the winter months. While seasonal dynamics of the influenza virus, such as time of onset and circulating strains, are well documented by the Centers for Disease Control and Prevention Influenza Surveillance System, an accurate prediction of timing, magnitude, and composition of circulating strains of seasonal influenza remains elusive. To facilitate public health preparedness for seasonal influenza and to obtain better insights into the spatiotemporal behavior of emerging strains, it is important to develop measurable characteristics of seasonal oscillation and to quantify the relationships between those parameters on a spatial scale. The objectives of our research were to examine the seasonality of influenza on a national and state level as well as the relationship between peak timing and intensity of influenza in the United States older adult population.
  
  
  RESULTS
  A total of 248,889 hospitalization records were extracted from the Centers for Medicare and Medicaid Services for the influenza seasons 1991-2004. Harmonic regression models were used to quantify the peak timing and absolute intensity for each of the 48 contiguous states and Washington, DC. We found that individual influenza seasons showed spatial synchrony with consistent late or early timing occurring across all 48 states during each influenza season in comparison to the overall average. On a national level, seasons that had an earlier peak also had higher rates of influenza (r(s) = -0.5). We demonstrated a spatial trend in peak timing of influenza; western states such as Nevada, Utah, and California peaked earlier and New England States such as Rhode Island, Maine, and New Hampshire peaked later.
  
  
  CONCLUSIONS
  Our findings suggest that a systematic description of influenza seasonal patterns is a valuable tool for disease surveillance and can facilitate strategies for prevention of severe disease in the vulnerable, older adult population.
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America.
authors.forename: Julia B
authors.initials: JB
authors.lastname: Wenger
authors.forename: Elena N
authors.initials: EN
authors.lastname: Naumova
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D003625:Data Collection; D058872:Epidemics; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology*; D006278:Medicare; D044382:Population Groups; D011159:Population Surveillance; D012621:Seasons; D014481:United States / Q000453:epidemiology