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ECDC EXECUTIVE UPDATE 2009 pandemic influenza A(H1N1) Issue 27 Monday, 25 January 2010: 2452 deaths in EU and EFTA countries

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  • ECDC EXECUTIVE UPDATE 2009 pandemic influenza A(H1N1) Issue 27 Monday, 25 January 2010: 2452 deaths in EU and EFTA countries




    ECDC EXECUTIVE UPDATE 2009 pandemic influenza A(H1N1)

    Issue 27 Monday, 25 January 2010

    Weekly influenza surveillance overview (WISO) highlights
    ? During week 02/2010, only Bulgaria, Malta, Poland and Romania reported medium influenza like-illness/severe acute respiratory infection activity (ILI/ARI) in the EU and EEA.
    ? Of the 684 sentinel samples tested, 18.1% were positive for influenza of which more than 99% were 2009 pandemic influenza A(H1N1) virus.
    ? The number of cases of severe acute respiratory infection (SARI), measured by week of onset, continued to decline in week 02/2010.
    ? Of the 123 cases of severe acute respiratory infection, 44 (36%) were known to have required intensive care unit admission and 28 (23%) needed respiratory support.
    ? Detection of 2009 pandemic influenza A(H1N1) viruses resistant to oseltamivir remains sporadic; of 1260 viruses reported, 34 (2.7%) were resistant.

    The ECDC Weekly influenza surveillance overview is published on Friday afternoons on the 2009 pandemic influenza A(H1N1) web page (see ?latest publications?).

    ECDC Daily Updates
    Since the beginning of the 2009 influenza A(H1N1)pandemic, ECDC has been producing Daily Updates (situation reports), focusing on the spread of the pandemic in Europe and in the rest of the world and on the reported cumulative numbers of deaths due to the pandemic influenza. These updates have been posted on the ECDC web page by 09:00 every morning.
    Although the pandemic is far from over and the developments in the coming months are uncertain, as of 20 January 2010 the ECDC Daily Updates will no longer be published. This decision is based on the epidemiological pattern showing a declining incidence of morbidity and mortality in the EU which has led to a decrease of the information needs of our stakeholders. However, it is clear that influenza pandemics are unpredictable and the need to re-activate the Daily Updates will be reviewed if and when necessary.
    Developments in the pattern of infection and epidemiology in Europe will continue to be reported on Fridays in the Weekly Influenza Surveillance Overviews. A summary of other pandemic influenza developments reported by ECDC will also be published on a weekly basis, initially in the ECDC Executive Update on the 2009 Pandemic. Both are available on the ECDC pandemic web page.

    As of 25 January 2010, the cumulative number of reported deaths since the beginning of the pandemic in EU/EFTA Member States has totalled 2452

    Updates from Eurosurveillance
    In Eurosurveillance Volume 15, Issue 3, 21 January 2010, the following articles related to the 2009 influenza A(H1N1) pandemic were published:
    School absence data for influenza surveillance: a pilot study in the United Kingdom
    WP Schmidt, R Pebody, P Mangtani
    School-age children are at a high risk of acute respiratory virus infections including the 2009 pandemic influenza A(H1N1). School absence records have been suggested as a tool for influenza surveillance. We analysed absence records from six primary schools (children aged from around five to 11 years) in London during the years 2005 to 2007 in order to provide baseline epidemiological characteristics of illness-related school absence, and to correlate school absence with seasonal influenza. The daily average prevalence of absence due to illness was 2.9%. The incidence was 1.3% per person-day. The mean duration of absence was 1.8 days (SD 1.8). Over 60% of absence episodes lasted for one day. Absence prevalence did not differ by sex. Prevalence was highest in the youngest children and then declined slightly, but was again high again in the oldest. Absence was slightly higher on Mondays and Fridays. In general, peaks of absenteeism coincided with peaks of influenza A and B (laboratory reports) but several high peaks were not associated with influenza. There was a better correlation between absence and laboratory reports and prevalence compared to incidence. School absence data may be useful for the detection of localised school outbreaks and as an additional surveillance tool but are limited by lack of data on weekends and during holidays.

    Europe ? Greece: The vaccination campaign against 2009 pandemic influenza A(H1N1) and its continued importance in view of the uncertainty surrounding the risk associated with the pandemic
    S Tsiodras, V Sypsa, A Hatzakis

    Update: Follow-up study showing post-pandemic decline in hand sanitiser use, New Zealand, December 2009
    S Manning, T Barry, N Wilson, MG Baker
    This study aimed to measure rates of hand sanitiser use in a hospital entrance foyer four months after a baseline study during New Zealand's influenza pandemic. Of the 743 people observed over one (summer) day in December 2009, 8.2% used the hand sanitiser, which was significantly lower (p<0.0001) than the 18.0% reported in the August (winter) study. Health authorities may need to intensify promotion of hand hygiene to reduce the impact of future influenza pandemic waves. .


    Scientific advances
    A study has been published in the Lancet indicating that the levels of infection among children were ten times higher than suggested in clinical surveillance. In a commentary, ECDC emphasises how serological work needs to be undertaken by EU member states and coordinated across Europe if we are to understand what has happened with the pandemic so far and how the new pandemic virus is likely to behave in 2010.
    For link to the study and to the ECDC commentary

    Public health developments:
    On 14 January 2010 Dr Keiji Fukuda, Special Adviser to the Director-General on pandemic influenza, briefed the media on pandemic influenza activity and clarified some misconceptions in the news.
    Virtual press conference with Dr Keiji Fukuda, Special Adviser to the Director-General on Pandemic Influenza, WHO

    Past meetings and events
    18 January: ECDC convened a teleconference with its Advisory Forum on future planning assumptions of the pandemic.
    18 January: The European Medicines Agency visited ECDC, Stockholm, Sweden.

    Upcoming meetings and events
    26 January: ECDC will present its future look for pandemic and inter-seasonal influenza at a major meeting organised by the European Medicines Agency in London, UK.

    European epidemiology and key points
    During week 02/2010, only Bulgaria, Malta, Poland and Romania reported medium influenza like-illness or severe acute respiratory infection activity (ILI/ARI) in the EU and EEA.
    Of the 684 sentinel samples tested, 18.1% were positive for influenza of which more than 99% were 2009 pandemic influenza A(H1N1) virus.
    The number of cases of severe acute respiratory infection (SARI), measured by week of onset, continued to decline in week 02/2010.

    Figure 1: Deaths reported among 2009 pandemic influenza A(H1N1) cases in EU and EFTA countries (from week 25/2009 to week 03/2010)
    This figure shows a weekly number of deaths from mid-October onwards.
    Source: ECDC 2009 influenza A(H1N1) pandemic web page

    Map 1: Geographic spread distribution map week 02/2010
    This map shows how widespread influenza activity was in most European countries during week 02/2010.
    Source: ECDC Weekly influenza surveillance overview 22 January
    Table 1: Countries reporting community incidence in Week 02/2010

    Rising trend
    Austria
    Lithuania
    Slovakia


    Stable
    Belgium
    Bulgaria
    Cyprus
    Denmark
    Ireland
    Malta
    Netherlands
    Norway
    Spain
    Sweden
    UK-England


    Declining trend
    Czech Republic
    Germany
    Greece
    Hungary
    Latvia
    Poland
    Portugal
    Romania
    Slovenia
    UK-Northern Ireland, Scotland and Wales


    European surveillance

    Possible composition of the next influenza vaccines ? Looking ahead from the 2009 influenza A(H1N1) pandemic to the 2010?11 season

    It is still too early to talk about what the new influenza vaccines for next season should contain. However, given the predominance of the new 2009 A(H1N1) this autumn and winter, A(H3) viruses reported this season it is likely that the next season?s influenza vaccine will be recommended to include the 2009 pandemic influenza A(H1N1) strain as was recommended for by WHO for the Southern Hemisphere winter, which will start around June July.

    What now has to be done is to determine the characteristics of the upcoming seasonal influenza based first on the growing knowledge of the 2009 pandemic influenza, then on the experiences from the new influenza season first in the Southern Hemisphere and then in Europe. These characteristics should then be compared to those of the previous seasonal influenza to be able to determine a rational approach to mitigation, treatment and vaccination. An ECDC article on this was published in Eurosurveillance earlier this year. The responsibility for making recommendations on the precise antigen to be used for seasonal vaccines in the European Northern Hemisphere?s 2010?11 season will be decided during the annual influenza vaccine composition meeting taking place in February 2010. Following the recommendations issued by the WHO, the European Medicines Agency will issue its own recommendations during the spring.

    For further information on vaccines, please see the article ?Pandemic influenza A(H1N1) 2009 vaccines in the European Union? by K Johansen, A Nicoll, BC Ciancio and P Kramarz, published in Eurosurveillance on 15 October 2009.

    The ECDC Q&As on vaccines and vaccination for experts and for the general public can be found on the ECDC 2009 pandemic influenza A(H1N1) web page.

    Vaccination remains the most potent countermeasure for any human influenza. Given the significant risks to health from the pandemic, ECDC would strongly advise all Europeans who have been offered the vaccine to be vaccinated. By being vaccinated you protect not just your own health, but that of the people around you.

    A group especially singled out for attention and immunisation by the European Council are healthcare workers. The most important reason for healthcare workers to be immunised is to protect vulnerable patients who often belong to risk groups.

    Map 2: ECDC reported number deaths due to 2009 pandemic influenza A(H1N1) in Europe as of 25 January 2010
    This map shows how countries in Western Europe have been affected. Source: ECDC 2009 influenza A(H1N1) pandemic web page

    Other effective countermeasures: The usual hygiene and personal measures should continue to be promoted. These include regular hand washing, using tissues and staying at home if sick. There is very little resistance to the drugs used against seasonal influenza (oseltamivir and zanamivir) and treatment with antivirals is working, especially if given early; however, the seasonal influenza vaccine gives little protection against 2009 pandemic influenza A(H1N1) virus.
    Attached Files
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