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EISS - Bulletin Review: Issue N? 305 - Seasonal influenza activity low but human infections with the new influenza A(H1N1) virus have been reported (Edited)
EISS - Weekly Electronic Bulletin Week 19 : 04/05/2009-10/05/2009 - 15 May 2009, Issue N? 305 - Seasonal influenza activity low but human infections with the new influenza A(H1N1) virus have been reported
-- Summary:
In week 19/2009, influenza activity remained at baseline levels, with sentinel virus detections being low, in almost all of Europe. While the Northern Hemisphere influenza season is coming to an end, more than 200 cases of new influenza A(H1N1) virus infections have been reported in European region countries.
-- Epidemiological situation - week 19/2009:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in almost all countries that reported this indicator. Only Albania and two of seven regions (Siberian and Urals) of the Russian Federation reported medium intensity. For the geographical spread indicator, the Russian Federation reported local activity whereas all other countries reported sporadic or no activity. Definitions for the epidemiological indicators can be found here.
-- Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-19/2009):
Consultation rates for ILI and/or ARI rose above baseline levels as of week 49/2008 in most western and central European countries following a general west to east progression. High influenza intensity, with peak activity following a general west to east progression, has been reported in 15 countries since week 51/2008. Generally, the highest consultation rates have been in the 0-4 and 5-14 age groups, but Ireland, UK, Norway and Romania have reported their highest ILI consultation rates in the 15-64 age group. In most countries the seasonal epidemic appears to be over, with consultation rates for ILI and/or ARI having returned to baseline levels.
-- Virological situation - week 19/2009:
The total number of respiratory specimens collected by sentinel physicians in week 19/2009 was 630, of which 36 (5.7%) were positive for influenza virus: 20 type A (one subtype H3, three subtype H3N2, one subtype H1, two subtype H1N1, two subtype new H1, two subtype new H1N1 and nine not subtyped) and 16 type B. In addition, 130 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 82 type A (20 subtype H3, seven subtype H3N2, three subtype H1, one subtype H1N1, one subtype novel H1, six subtype novel H1N1 and 44 not subtyped) and 48 type B.
-- Cumulative virological situation - 2008-2009 season (weeks 40/2008-19/2009):
Of 30924 virus detections (sentinel and non-sentinel) since week 40/2008, 25815 (83%) were type A (11630 subtype H3, 1407 subtype H1 and 12778 not subtyped) and 5109 (17%) were type B. Based on the antigenic and/or genetic characterisation of 3696 influenza viruses reported to EISS up to week 19/2009, 2564 (69%) were reported as A/Brisbane/10/2007 (H3N2)-like, 166 (4%) as A/Brisbane/59/2007 (H1N1)-like, 30 (1%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage), 935 (25%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) and one as A/California/4/2009 (H1N1)-like (click here). More detailed antigenic and genetic analyses have shown that B/Victoria/2/87 lineage viruses resembled either B/Malaysia/2506/2004-like or B/Brisbane/60/2008-like, the prototype vaccine strain recommended by WHO for inclusion in the 2009-10 vaccine (WER 2009; 84(9): 65-76 (click here)).
Influenza isolates from 20 countries were assessed for antiviral drug susceptibility.
All influenza A(H3N2) viruses tested were sensitive to oseltamivir and zanamivir, but resistant to M2 inhibitors.
Ninety-eight percent of influenza A(H1N1) viruses analysed were resistant to oseltamivir while all those tested against zanamivir were sensitive. One A(H1N1) virus was M2 inhibitor resistant, but sensitive to the neuraminidase inhibitors.
The small number of influenza B viruses tested were sensitive to oseltamivir and zanamivir.
By genetic analysis, the new A(H1N1) viruses have been assessed as being sensitive to oseltamivir and zanamivir (click here).
-- Comment:
Seasonal influenza activity in Europe is coming to an end, with most influenza virus detections having occurred between weeks 48/2008 and 15/2009 (a 20-week period) (click here ). However, a new A(H1N1) subtype influenza virus strain with pandemic potential has emerged in North America and spread to many countries. The World Health Organisation has raised the pandemic alert level to phase five. For further details please see the WHO website (click here).
As of 14 May, 229 confirmed cases have been reported in 17 European region countries (222 in EU/EFTA countries and 7 in non-EU/EFTA countries). Outside of the United States and Mexico, no sustained community transmission has been recorded so far. For more information please go to the dedicated web pages of ECDC (click here) or WHO (click here).
European Member States have been requested to continue to perform seasonal influenza surveillance until further notice. As of week 18/2009, countries are able to report detections of the new virus to the EISS platform.
Influenza A has been the dominant virus type circulating in Europe, mostly characterised antigenically and/or genetically as A(H3N2). Of the influenza B viruses that were characterised, the majority were B/Victoria lineage. With the exception of these B/Victoria lineage viruses, the viruses circulating are similar to the three components - A(H1N1), A(H3N2) and B/Yamagata lineage - included in the 2008/2009 Northern Hemisphere influenza vaccine. The mismatch of these B/Victoria/2/87 lineage viruses with the current vaccine is unlikely to be of public health significance because of limited circulation of influenza B viruses and the dominant circulation of influenza A(H3N2) viruses which matched the strain included in the vaccine.
From a public health perspective, the vaccine used this season is therefore expected to have been effective.
-- Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS. Of these countries, 26 reported both clinical and virological data, eight reported virological data only and three reported clinical data only to EISS in week 19/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by the network under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) and the WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
-- Other bulletins:
The EISS bulletin is prepared using reports from GP consultations and other sources, depending on individual country arrangements. It is important to recognise that different health care systems and types of measurement should also be considered when assessing the impact of influenza. To view national/regional bulletins in Europe and other bulletins from around the world, please click here.
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-- Network comments (where available)
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<cite cite="http://www.eiss.org/cgi-files/bulletin_v2.cgi">EISS - Bulletin Review</cite>
-- Summary:
In week 19/2009, influenza activity remained at baseline levels, with sentinel virus detections being low, in almost all of Europe. While the Northern Hemisphere influenza season is coming to an end, more than 200 cases of new influenza A(H1N1) virus infections have been reported in European region countries.
-- Epidemiological situation - week 19/2009:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in almost all countries that reported this indicator. Only Albania and two of seven regions (Siberian and Urals) of the Russian Federation reported medium intensity. For the geographical spread indicator, the Russian Federation reported local activity whereas all other countries reported sporadic or no activity. Definitions for the epidemiological indicators can be found here.
-- Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-19/2009):
Consultation rates for ILI and/or ARI rose above baseline levels as of week 49/2008 in most western and central European countries following a general west to east progression. High influenza intensity, with peak activity following a general west to east progression, has been reported in 15 countries since week 51/2008. Generally, the highest consultation rates have been in the 0-4 and 5-14 age groups, but Ireland, UK, Norway and Romania have reported their highest ILI consultation rates in the 15-64 age group. In most countries the seasonal epidemic appears to be over, with consultation rates for ILI and/or ARI having returned to baseline levels.
-- Virological situation - week 19/2009:
The total number of respiratory specimens collected by sentinel physicians in week 19/2009 was 630, of which 36 (5.7%) were positive for influenza virus: 20 type A (one subtype H3, three subtype H3N2, one subtype H1, two subtype H1N1, two subtype new H1, two subtype new H1N1 and nine not subtyped) and 16 type B. In addition, 130 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 82 type A (20 subtype H3, seven subtype H3N2, three subtype H1, one subtype H1N1, one subtype novel H1, six subtype novel H1N1 and 44 not subtyped) and 48 type B.
-- Cumulative virological situation - 2008-2009 season (weeks 40/2008-19/2009):
Of 30924 virus detections (sentinel and non-sentinel) since week 40/2008, 25815 (83%) were type A (11630 subtype H3, 1407 subtype H1 and 12778 not subtyped) and 5109 (17%) were type B. Based on the antigenic and/or genetic characterisation of 3696 influenza viruses reported to EISS up to week 19/2009, 2564 (69%) were reported as A/Brisbane/10/2007 (H3N2)-like, 166 (4%) as A/Brisbane/59/2007 (H1N1)-like, 30 (1%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage), 935 (25%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) and one as A/California/4/2009 (H1N1)-like (click here). More detailed antigenic and genetic analyses have shown that B/Victoria/2/87 lineage viruses resembled either B/Malaysia/2506/2004-like or B/Brisbane/60/2008-like, the prototype vaccine strain recommended by WHO for inclusion in the 2009-10 vaccine (WER 2009; 84(9): 65-76 (click here)).
Influenza isolates from 20 countries were assessed for antiviral drug susceptibility.
All influenza A(H3N2) viruses tested were sensitive to oseltamivir and zanamivir, but resistant to M2 inhibitors.
Ninety-eight percent of influenza A(H1N1) viruses analysed were resistant to oseltamivir while all those tested against zanamivir were sensitive. One A(H1N1) virus was M2 inhibitor resistant, but sensitive to the neuraminidase inhibitors.
The small number of influenza B viruses tested were sensitive to oseltamivir and zanamivir.
By genetic analysis, the new A(H1N1) viruses have been assessed as being sensitive to oseltamivir and zanamivir (click here).
-- Comment:
Seasonal influenza activity in Europe is coming to an end, with most influenza virus detections having occurred between weeks 48/2008 and 15/2009 (a 20-week period) (click here ). However, a new A(H1N1) subtype influenza virus strain with pandemic potential has emerged in North America and spread to many countries. The World Health Organisation has raised the pandemic alert level to phase five. For further details please see the WHO website (click here).
As of 14 May, 229 confirmed cases have been reported in 17 European region countries (222 in EU/EFTA countries and 7 in non-EU/EFTA countries). Outside of the United States and Mexico, no sustained community transmission has been recorded so far. For more information please go to the dedicated web pages of ECDC (click here) or WHO (click here).
European Member States have been requested to continue to perform seasonal influenza surveillance until further notice. As of week 18/2009, countries are able to report detections of the new virus to the EISS platform.
Influenza A has been the dominant virus type circulating in Europe, mostly characterised antigenically and/or genetically as A(H3N2). Of the influenza B viruses that were characterised, the majority were B/Victoria lineage. With the exception of these B/Victoria lineage viruses, the viruses circulating are similar to the three components - A(H1N1), A(H3N2) and B/Yamagata lineage - included in the 2008/2009 Northern Hemisphere influenza vaccine. The mismatch of these B/Victoria/2/87 lineage viruses with the current vaccine is unlikely to be of public health significance because of limited circulation of influenza B viruses and the dominant circulation of influenza A(H3N2) viruses which matched the strain included in the vaccine.
From a public health perspective, the vaccine used this season is therefore expected to have been effective.
-- Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS. Of these countries, 26 reported both clinical and virological data, eight reported virological data only and three reported clinical data only to EISS in week 19/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by the network under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) and the WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
-- Other bulletins:
The EISS bulletin is prepared using reports from GP consultations and other sources, depending on individual country arrangements. It is important to recognise that different health care systems and types of measurement should also be considered when assessing the impact of influenza. To view national/regional bulletins in Europe and other bulletins from around the world, please click here.
(...)
-- Network comments (where available)
- Georgia: 10 specimens from regional sentinel stations were received and tested as well. week 16 - 3 samples (all negative) week 17 - 5 samples (2 posiive for influenza B) week 18 - 2 samples (2 positive for influenza B)
- Italy: Four further novel A/H1N1 viruses have been detected during this week.
- Slovenia: In week 19 in the Laboratory for Virology, NIPH of The Republic of Slovenia, 12 specimens from patients suspected to be infected with the new Influenza virus were analysed. All specimens were negative in the analysis for presence of Influenza A and Influenza B.
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