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Re: Seasonal Flu 2008 - 2009
EISS - Bulletin Review: Influenza activity in Europe remains low but steadily rising ? more countries report initial virus detections (12/12/2008)
EISS - Weekly Electronic Bulletin Week 49 : 01/12/2008-07/12/2008 - 12 December 2008, Issue N? 283 - Influenza activity in Europe remains low but steadily rising ? more countries report initial virus detections
? Summary:
A total of 23 countries reported influenza activity in week 49/2008. This activity was low in all but three countries where medium activity was recorded. Since week 40/2008, sporadic laboratory-confirmed cases of influenza have been reported from 23 countries across Europe. Two of these countries, neighbouring, are now reporting local outbreaks (Spain) and widespread increased influenza activity above baseline levels (Portugal).
? Epidemiological situation - week 49/2008:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in 20 of the 23 countries providing data, with Ireland, Northern Ireland and Portugal reporting medium intensity.
Eight countries, however, reported increasing clinical activity (England, Ireland, Latvia, Netherlands, Northern Ireland, Portugal, Spain, Wales), but only for England, Ireland, Netherlands, Northern Ireland and Portugal was this elevated compared to the 2007-8 season.
For the geographical spread indicator, sporadic influenza activity was reported in 11 countries (Bulgaria, Denmark, England, Germany, Hungary, Ireland, Luxembourg, Northern Ireland, Slovenia, Sweden and Switzerland) whereas Spain reported local outbreaks and Portugal widespread increased influenza activity above baseline levels.
The other ten countries reported no activity.
? Cumulative epidemiological situation ? 2008-2009 season (weeks 40-49/2008):
So far this season, the consultation rates for ILI and/or ARI are generally at levels usually seen outside the winter period (i.e. below the national baseline threshold).
? Virological situation - week 49/2008:
The total number of respiratory specimens collected by sentinel physicians in week 49/2008 was 615, of which 118 (19.2%) were positive for influenza virus: 114 type A (85 subtype H3, one H1 and 28 not subtyped) and four type B.
In addition, from 665 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) 96 (14.4%) influenza virus detections were reported: 92 type A (11 subtype H3, three subtype H1 and 78 not subtyped) and four type B.
Detection of influenza viruses was reported from 15 countries across Europe and included the first influenza detections from Bulgaria, Luxembourg and Slovenia.
? Cumulative virological situation ? 2008-2009 season (weeks 40-49/2008):
Of 668 virus detections (sentinel and non-sentinel) since week 40/2008, 621 were type A (317 subtype H3, 26 subtype H1 and 278 not subtyped) and 47 were type B.
Based on the antigenic and/or genetic characterisation of 106 influenza viruses, 100 were reported as A/Brisbane/10/2007 (H3N2)-like, two as A/Brisbane/59/2007 (H1N1)-like, two as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) and two as B/Florida/4/2006-like (B/Yamagata/16/88 lineage).
No additional antiviral resistance data has been uploaded in the last week so the situation is as reported in week 48/2008.
Data from Austria, England and Norway shows most (18/19) of the A (H1N1) viruses analysed to be oseltamivir-resistant with all 19 remaining sensitive to zanamivir.
Of 27 A (H3N2) viruses analysed for neuraminidase inhibitor susceptibility, all are sensitive to both oseltamivir and zanamivir.
Of 26 A (H3N2) viruses analysed for adamantane susceptibility, all are resistant.
Most circulating influenza A at present is H3N2 that remains fully sensitive to oseltamivir and zanamivir.
? Comment:
Many countries reporting influenza virus detection continue to classify this as sporadic with only Spain (local) and Portugal (widespread) changing their classifications, although this has not been accompanied by significant increases in overall consultation rates.
Of the eight countries that reported increasing clinical activity during week 49/2008, six (England, Ireland, Northern Ireland, Portugal, Spain and Wales) also reported influenza virus detections.
The 23 countries that have detected influenza viruses since week 40/2008 are geographically distributed throughout Europe.
The majority (93%; 621/668) of virus detections up to week 49 have been type A.
The cumulative proportion of type A viruses subtyped as H3 has increased from 90% (205/228) at week 48 to 92.4% (317/343) at week 49.
Virological subtype analysis indicates that whilst there is mixed circulation of H1 and H3 in countries reporting isolates, the H1 detections have been made at a stable rate of one to five per week since week 40 whereas H3 detections have been rising consistently since week 41 to reach 96 in week 49.
This is an early indication of the 2008-9 influenza season in Europe being dominated by H3.
Whilst influenza activity in Europe remains low currently, Respiratory Syncytial Virus (RSV) infections induce clinical symptoms similar to influenza. Earlier weekly reports of RSV detections from countries in Europe that report RSV detections to EISS, showed increased detections in a number of countries which have now stabilised or declined in all but the Netherlands.
Increase in RSV detections at this time of the year is a normal phenomenon in these countries.
? Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. Of these countries, 23 reported clinical data, 26 virological data and 22 both data sets to EISS in week 49/2008.
The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (UK).
? Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
<table style="width: auto;"><tbody><tr><td>
</td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From MAPS</td></tr></tbody></table>
<table style="width: auto;"><tbody><tr><td>
</td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From MAPS</td></tr></tbody></table>
Europe Year 2008 / Week 49
A = Dominant virus A
H1N1 = Dominant virus A(H1N1)
H3N2 = Dominant virus A(H3N2)
H1N2 = Dominant virus A(H1N2)
B = Dominant virus B
A & B = Dominant virus A & B
= : stable clinical activity
+ : increasing clinical activity
- : decreasing clinical activity
Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza activity
No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels)
Sporadic = isolated cases of laboratory confirmed influenza infection
Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed.
Regional activity = influenza activity above baseline levels in one or more regions witha population comprising less than 50% of the country's total population. Laboratory confirmed.
Widespread = influenza activity above baseline levels in one or more regions with a population comprising 50% or more of the country's population. Laboratory confirmed.
Finland : Where available, the epidemiological data are provided by a health-care district inSouth-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).
? Network comments (where available)
-- Italy: Only one A/H3N2 influenza viruses have been isolated during this week.
-- Switzerland: Influenza activity is very low. An influenza B virus has been detected last week.
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EISS - Bulletin Review: Influenza activity in Europe remains low but steadily rising ? more countries report initial virus detections (12/12/2008)
EISS - Weekly Electronic Bulletin Week 49 : 01/12/2008-07/12/2008 - 12 December 2008, Issue N? 283 - Influenza activity in Europe remains low but steadily rising ? more countries report initial virus detections
? Summary:
A total of 23 countries reported influenza activity in week 49/2008. This activity was low in all but three countries where medium activity was recorded. Since week 40/2008, sporadic laboratory-confirmed cases of influenza have been reported from 23 countries across Europe. Two of these countries, neighbouring, are now reporting local outbreaks (Spain) and widespread increased influenza activity above baseline levels (Portugal).
? Epidemiological situation - week 49/2008:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in 20 of the 23 countries providing data, with Ireland, Northern Ireland and Portugal reporting medium intensity.
Eight countries, however, reported increasing clinical activity (England, Ireland, Latvia, Netherlands, Northern Ireland, Portugal, Spain, Wales), but only for England, Ireland, Netherlands, Northern Ireland and Portugal was this elevated compared to the 2007-8 season.
For the geographical spread indicator, sporadic influenza activity was reported in 11 countries (Bulgaria, Denmark, England, Germany, Hungary, Ireland, Luxembourg, Northern Ireland, Slovenia, Sweden and Switzerland) whereas Spain reported local outbreaks and Portugal widespread increased influenza activity above baseline levels.
The other ten countries reported no activity.
? Cumulative epidemiological situation ? 2008-2009 season (weeks 40-49/2008):
So far this season, the consultation rates for ILI and/or ARI are generally at levels usually seen outside the winter period (i.e. below the national baseline threshold).
? Virological situation - week 49/2008:
The total number of respiratory specimens collected by sentinel physicians in week 49/2008 was 615, of which 118 (19.2%) were positive for influenza virus: 114 type A (85 subtype H3, one H1 and 28 not subtyped) and four type B.
In addition, from 665 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) 96 (14.4%) influenza virus detections were reported: 92 type A (11 subtype H3, three subtype H1 and 78 not subtyped) and four type B.
Detection of influenza viruses was reported from 15 countries across Europe and included the first influenza detections from Bulgaria, Luxembourg and Slovenia.
? Cumulative virological situation ? 2008-2009 season (weeks 40-49/2008):
Of 668 virus detections (sentinel and non-sentinel) since week 40/2008, 621 were type A (317 subtype H3, 26 subtype H1 and 278 not subtyped) and 47 were type B.
Based on the antigenic and/or genetic characterisation of 106 influenza viruses, 100 were reported as A/Brisbane/10/2007 (H3N2)-like, two as A/Brisbane/59/2007 (H1N1)-like, two as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) and two as B/Florida/4/2006-like (B/Yamagata/16/88 lineage).
No additional antiviral resistance data has been uploaded in the last week so the situation is as reported in week 48/2008.
Data from Austria, England and Norway shows most (18/19) of the A (H1N1) viruses analysed to be oseltamivir-resistant with all 19 remaining sensitive to zanamivir.
Of 27 A (H3N2) viruses analysed for neuraminidase inhibitor susceptibility, all are sensitive to both oseltamivir and zanamivir.
Of 26 A (H3N2) viruses analysed for adamantane susceptibility, all are resistant.
Most circulating influenza A at present is H3N2 that remains fully sensitive to oseltamivir and zanamivir.
? Comment:
Many countries reporting influenza virus detection continue to classify this as sporadic with only Spain (local) and Portugal (widespread) changing their classifications, although this has not been accompanied by significant increases in overall consultation rates.
Of the eight countries that reported increasing clinical activity during week 49/2008, six (England, Ireland, Northern Ireland, Portugal, Spain and Wales) also reported influenza virus detections.
The 23 countries that have detected influenza viruses since week 40/2008 are geographically distributed throughout Europe.
The majority (93%; 621/668) of virus detections up to week 49 have been type A.
The cumulative proportion of type A viruses subtyped as H3 has increased from 90% (205/228) at week 48 to 92.4% (317/343) at week 49.
Virological subtype analysis indicates that whilst there is mixed circulation of H1 and H3 in countries reporting isolates, the H1 detections have been made at a stable rate of one to five per week since week 40 whereas H3 detections have been rising consistently since week 41 to reach 96 in week 49.
This is an early indication of the 2008-9 influenza season in Europe being dominated by H3.
Whilst influenza activity in Europe remains low currently, Respiratory Syncytial Virus (RSV) infections induce clinical symptoms similar to influenza. Earlier weekly reports of RSV detections from countries in Europe that report RSV detections to EISS, showed increased detections in a number of countries which have now stabilised or declined in all but the Netherlands.
Increase in RSV detections at this time of the year is a normal phenomenon in these countries.
? Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. Of these countries, 23 reported clinical data, 26 virological data and 22 both data sets to EISS in week 49/2008.
The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (UK).
? Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
<table style="width: auto;"><tbody><tr><td>
</td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From MAPS</td></tr></tbody></table><table style="width: auto;"><tbody><tr><td>
</td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From MAPS</td></tr></tbody></table>Europe Year 2008 / Week 49
A = Dominant virus A
H1N1 = Dominant virus A(H1N1)
H3N2 = Dominant virus A(H3N2)
H1N2 = Dominant virus A(H1N2)
B = Dominant virus B
A & B = Dominant virus A & B
= : stable clinical activity
+ : increasing clinical activity
- : decreasing clinical activity
Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza activity
No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels)
Sporadic = isolated cases of laboratory confirmed influenza infection
Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed.
Regional activity = influenza activity above baseline levels in one or more regions witha population comprising less than 50% of the country's total population. Laboratory confirmed.
Widespread = influenza activity above baseline levels in one or more regions with a population comprising 50% or more of the country's population. Laboratory confirmed.
Finland : Where available, the epidemiological data are provided by a health-care district inSouth-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).
? Network comments (where available)
-- Italy: Only one A/H3N2 influenza viruses have been isolated during this week.
-- Switzerland: Influenza activity is very low. An influenza B virus has been detected last week.
-
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27CDB6E-AE6D-11cf-96B8-444553540000>
News Editor
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were influenza positive. 
Comment