Alabama Department of Public Health (ADPH)
Alabama Emergency Response Technology (ALERT)
Health Alert Network (HAN)
February 4, 2026 

Since early December, Alabama has experienced widespread influenza activity. Novel influenza A infection and influenza-associated pediatric deaths are mandatory reportable conditions in Alabama. 

• Novel influenza A infections must be reported within 24 hours of presumptive diagnosis.
• Influenza-associated pediatric deaths must be reported within 3 days of presumptive diagnosis.

Reports should be submitted via ADPH’s REPORT Card for Reportable Diseases/Conditions: https://redcap.link/REPORT2AL. 

For testing assistance, nasopharyngeal or nasal swabs may be submitted to the ADPH Bureau of Clinical Laboratories (BCL). Detailed collection and shipping instructions are available in the “Respiratory Surveillance Needs You” flyer. 

Novel Influenza A Infection

While there are currently no reported cases of novel influenza A infection in Alabama, ADPH encourages active testing to help maintain critical virologic surveillance. 

A novel influenza A virus causes human infection but differs from seasonal influenza A viruses (i.e., A/H1N1 or A/H3N2) that circulate among people each year. These viruses are of concern due to their pandemic potential.  

A case must be reported if a patient: 

• Tests positive for influenza A by molecular assay AND 
• Tests negative for all known seasonal influenza A subtypes (i.e., is unsubtypable)

Hospitalized patients with suspected or confirmed novel influenza A infection must be placed in an airborne infection isolation room (AIIR/negative pressure room). Caregivers should use standard, contact, and airborne precautions including eye protection (goggles or a face shield).

For accelerated subtyping in hospitalized patients, specimens for uninsured or underinsured patients may be sent to the BCL. Respiratory kits can be ordered directly from the BCL if needed.

To utilize the BCL courier service during business hours, healthcare providers should contact their nearest county health department. 

Influenza-Associated Pediatric Deaths

As of late January 2026, influenza activity in Alabama is “high”, with three pediatric deaths under investigation. Nationally, 44 pediatric deaths have been reported. 

Please report any death in a patient under 18 years of age with: 

• Clinically compatible illness AND 
• Laboratory-confirmed influenza (Type A or B) without a complete return to baseline health between the initial influenza illness and the time of death.

A death should not be reported as an influenza-associated pediatric death if:

1. There is no laboratory confirmation of influenza virus infection.
2. The patient fully recovered to baseline health prior to death.
3. The death occurred in a person 18 years or older.
4. There is a clear alternative, unrelated cause of death.

Laboratory confirmation using pre- or post-mortem clinical specimens may include:

• Reverse-transcriptase polymerase chain reaction (RT-PCR) testing of respiratory specimens
• Influenza virus isolation in tissue cell culture from respiratory specimens
• Immunohistochemical (IHC) staining for influenza viral antigens in respiratory tract tissue from autopsy specimens
• Immunofluorescent antibody staining (direct or indirect) of respiratory specimens
• Rapid influenza diagnostic testing of respiratory specimens
• Four-fold rise in influenza hemagglutination inhibition (HI) antibody titer in paired acute and convalescent sera