The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
Clicking on the map will, if available, take you through to the national web site. If 'regional' activity is reported, a pop-up text box will appear which describes the activity in greater detail.
Clicking on England and France will provide you with regional data.
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
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 with
a 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 in
South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately one
percent of the Finnish population).
Network comments (where available)
Greece
In Southern Greece, the total number of sentinel swabs collected by sentinel physicians in week 04/2009 was 30, of which 11 (36.7%) were positive for influenza virus: 3 type A (subtype H3N2) and 8 type B. In addition, 13 non-sentinel source swabs were collected by children's Hospital, none of which were positive for influenza virus. So far type A(H3) has been the dominant influenza virus circulating. Interestingly in week 4/2009, type B is the dominant influenza virus. Based on the antigenic characterisation all 3 flu A isolates were A/Brisbane/10/2007 (H3N2)-like. Their HA sequences were found A/Brisbane/10/2007 (H3N2)-like, characterized by the amino acid changes G50E and K140I and differed from the vaccine strain by 2 amino acids. Based on the genetic characterisation all flu B isolates were B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage). Italy
Further 19 type A influenza viruses (18 H3 and 1 H1) were isolated together with 1 influenza type B. Latvia
Influenza activity continued to increase last week.Influenza A/H3 are mainly detected.Firsts cases of influenza B and A/H1 have been detected . Sweden
The virological laboratory in the south of Sweden had a substantial increase of laboratory confirmed influenza A cases. The data has beeen therefore updated. Switzerland
Epidemic activity increased highly these two last week. Influenza A (H3N2) are mainly detected. Influenza A viruses are antigenically related to influenza A/Brisbane/10/07 (H3N2) viruses.
Intensity: Low = no influenza activity or influenza activity at baseline level; Medium= usual levels of influenza activity; High = higher than usual levels of influenza activity; Very high = particularly severe levels of influenza activity. Percentage positive: percentage of sentinel swabs that tested positive for influenza A or B Dominant type: this assessment is based on data from sentinel and non-sentinel sources ARI: acute respiratory infection ILI: influenza-like illness Population: per 100,000 population
The bulletin text was written by an editorial team at the European Centre for Disease Prevention and Control (ECDC) and the Community Network of Reference Laboratories for Human Influenza in Europe (CNRL). Team members are Flaviu Plata, Phillip Zucs and Bruno Ciancio from ECDC, and Adam, Meijer Rod Daniels Alan Hay and Maria Zambon from CNRL. The bulletin text was reviewed by Olav Hungnes (Norwegian Institute of Public Health, Oslo, Norway), and Anne Mazick (Statens Serum Institut, Copenhagen, Denmark) on behalf of the EISS members.
Neither the European Centre for Disease Prevention and Control (ECDC), nor any person acting on his behalf is liable for the use that may be made of the information contained in this bulletin. Maps and commentary used in this Bulletin do not imply any opinions whatsoever of ECDC or its partners on the legal status of the countries and territories shown or concerning their borders.
Vaccine and Tamiflu Resistant H1N1 in Italy Recombinomics Commentary 23:52
January 29, 2009
During last surveillance week, Parma's University detected first FIVE A/(H1N1) influenza virus isolations for this season in Italy.
From the analysis performed by NIC, ALL OF THEM WERE OSELTAMIVIR RESISTANT (IC50 value very high); while resistant to oseltamivir, these viruses remained susceptible to Zanamivir.
Corresponding clinical samples were collected at Parma, during week 03/2009, from three children and two adults respectively.
Among these patients, three received this season influenza vaccine, while none of them were treated with oseltamivir.
The above comments are from the week 4 report from Italy. In week 3 the collection of the first five H1N1 isolates in Italy was reported. The finding that all five were oseltamivir resistant was not a surprise, nor was the absence of oseltamivir usage in the infected patients. However, it is worth noting that three of the five patients had been vaccinated. This season the H1N1 component of the trivalent vaccine is A/Brisbane/59/2007, which is considered a “match” for the osletamivir resistant clade 2B which has become dominant throughout the northern hemisphere.
However, the sequences of H1N1 in the United States have evolved away from the 2007 isolate that is the vaccine target. All clade 2B isolates in the United States had acquired A193T on HA. The polymorphism was also in the dominant sub-clade in South Africa over the summer, and was also in two large sub-clades in Japan this season. Thus, it is likely that A193T is also in the H274Y positive H1N1 in Europe, which may contribute to the failure to protect the patients in Italy.
The emergence of A193T was evident in isolates in the United States and England which were collected in 2007, two months prior to the selection of the vaccine target for this season. Moreover, A193T has not been in any of the H1N1 vaccine targets, although it was widespread in H1N2 isolates in 2003 and was also present in clade 2C in the 2006/2007 and 2007/2008 seasons in Asia.
The failure of H1N1 “matches” to protect against infection by oseltamivir resistant H1N1 is problematic for at risk individuals.
Moreover, the fixing of H274Y in H1N1 seasonal flu discounts the utility of Tamiflu stockpiled to control H5N1 through treatment or prophylaxis.
.
__________________
"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
"three of the five patients had been vaccinated. This season the H1N1 component of the trivalent vaccine is A/Brisbane/59/2007, which is considered a “match” for the osletamivir resistant clade 2B which has become dominant throughout the northern hemisphere.
However, the sequences of H1N1 in the United States have evolved away from the 2007 isolate that is the vaccine target. All clade 2B isolates in the United States had acquired A193T on HA."
"Thus, it is likely that A193T is also in the H274Y positive H1N1 in Europe, which may contribute to the failure to protect the patients in Italy." ___
"Moreover, the fixing of H274Y in H1N1 seasonal fludiscounts the utility of Tamiflu stockpiled to control H5N1 through treatment or prophylaxis."
The above last sentence is something new(?)
Wasn't there sci. statements that Tamiflu is further o.k. to treat b.f. because the AH5N1 didn't aquired the new resistence to Tamiflu now present in seasonal AH1N1?
"three of the five patients had been vaccinated. This season the H1N1 component of the trivalent vaccine is A/Brisbane/59/2007, which is considered a “match” for the osletamivir resistant clade 2B which has become dominant throughout the northern hemisphere.
However, the sequences of H1N1 in the United States have evolved away from the 2007 isolate that is the vaccine target. All clade 2B isolates in the United States had acquired A193T on HA."
"Thus, it is likely that A193T is also in the H274Y positive H1N1 in Europe, which may contribute to the failure to protect the patients in Italy." ___
"Moreover, the fixing of H274Y in H1N1 seasonal fludiscounts the utility of Tamiflu stockpiled to control H5N1 through treatment or prophylaxis."
The above last sentence is something new(?)
Wasn't there sci. statements that Tamiflu is further o.k. to treat b.f. because the AH5N1 didn't aquired the new resistence to Tamiflu now present in seasonal AH1N1?
You may be confusing "sci statements" with Roche press releases.
You may be confusing "sci statements" with Roche press releases.
Quite not.
The inspiration to my words: "Wasn't there sci. statements that Tamiflu is further o.k. to treat b.f. because the AH5N1 didn't aquired the new resistence to Tamiflu now present in seasonal AH1N1?"
#20: (Recomb.comm.) None of these three changes is represented in the current H1N1 vaccine and the increased reservoir of H274Y in seasonal fluraises concerns of recombination between the N1 on H1N1 and the N1 of H5N1to produce Tamiflu resistant H5N1."
From the: "raises concerns" AND "to produce", I assumed that this fact have not yet been happened, that it is only one of the concerning possibilities yet to be confirmed or negated.
And from the above, that AH5N1 did not aquired the Tamiflu resistance yet.
If after the above clarification cames up that the situation is worst, feel free to correct me, and further I'm suggesting to create an new FT thread which name must be:
"AH5N1 became resistant to Tamiflu"
___
About the Roche.
The Roche question was pertinent to us all, no matter that many now tends to minimize it or acredit it as advocacing (which is not my case).
The fact is that in "old times" (2005.) when all the world was scared about avian flu humanization because of the recent SARS episode, only Roche had something which seems to work onto the few human avian flu infections.
And it worked in part, if early somministrated.
No one that time had any better solutions to gave which was already at hand on the Market.
No vaccines, no meds.
Because of that WHO suggest it as the only probably working "bullet" in the guideliness.
Was at the time an business play about?
Maybe, but what can be changed because of that?
Maybe the depots could not be stocked with Tam. at the time and remained empty, but nobody knows for shure what would happens after.
Out there, in that time or now, were there other silver bullets deep down into the spec. labs, or in the corp's vaults ,conceived from the rest of us?
Maybe, but nobody mention anything about.
Anyway, if existing, they will not reach the masses.
Have "we" now better solutions - SuperRelenza?
Maybe.
Could the rest of us 99.9% people got at hand this SRelenza now?
No we could not.
Additionaly, the same Tamiflu resistance fate would surely became the other new SR/antivirals fate after few years.
So, my wrotings had never to do with Roche Market business.
Week 4 : 19/01/2009-25/01/2009 30 January 2009, Issue N° 290
Influenza activity increasing across Europe but activity is now decreasing in some countries
Summary: In week 04/2009, influenza activity continued to intensify and progress across Europe with most countries now reporting medium to high intensity. However, influenza activity has peaked and declined in Ireland, Portugal and the UK (England). Influenza A (H3) continues to be the predominant circulating virus and all the A(H3N2) viruses tested for antiviral resistance were susceptible to neuraminidase inhibitors but resistant to M2 inhibitors. Although low numbers of A(H1N1) viruses are circulating, over 97% of those tested are resistant to oseltamivir, but sensitive to zanamivir.
Epidemiological situation - week 04/2009: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were high in Germany, Luxembourg, Poland, Sweden and Switzerland, medium in 16 countries and the UK (Northern Ireland and Scotland), and low in the other five countries and two parts of the UK (England and Wales) that reported this indicator. Of the 22 countries that reported medium to high influenza activity this week, two (Estonia and Hungary) did so for the first time during the current season.
The majority of countries reported increasing or stable trends for intensity in week 04/2009 compared to the previous week, but four countries (Denmark, Ireland, Portugal and Spain) and the UK (England, Northern Ireland and Wales) reported decreasing intensity. For the geographical spread indicator, widespread influenza activity was reported in 13 countries and the UK (Northern Ireland), regional activity in three countries, local activity in four countries and sporadic or no activity in the remaining six countries and the UK (England, Scotland and Wales). Definitions for the epidemiological indicators can be found here.
Cumulative epidemiological situation – 2008-2009 season (weeks 40/2008-04/2009): Consultation rates for ILI and/or ARI above baseline levels, corresponding to influenza activity of medium intensity, were first reported in Portugal, Ireland and the UK (England and Northern Ireland) in week 49/2008, which peaked in weeks 52/2008 to 1/2009, and have declined since. Subsequent to week 49/2008 consultation rates rose above baseline levels in most European countries following a general west to east progression. Of the countries reporting in week 4/2009, Latvia, Lithuania, Serbia and Slovakia continue to report low intensity. High influenza intensity has been reported in Portugal (week 51/2008), Ireland (week 01/2009), Switzerland (week 02/2009), Austria, Denmark and Luxembourg (week 3/2009), Germany, Poland and Sweden (week 4/2009), but this status has now declined for Portugal and Ireland. Generally, the highest consultation rates have been in the 0-4 age group, but Ireland, UK and Norway have reported their highest ILI consultation rates in the 15-64 age group.
Virological situation - week 04/2009: The total number of respiratory specimens collected by sentinel physicians in week 04/2009 was 2874, of which 999 (34.8%) were positive for influenza virus: 939 type A (586 subtype H3, 53 subtype H1 and 300 not subtyped) and 60 type B. In addition, 905 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 885 type A (217 subtype H3, six subtype H1 and 662 not subtyped) and 20 type B.
Cumulative virological situation – 2008-2009 season (weeks 40/2008-04/2009): Of 11028 virus detections (sentinel and non-sentinel) since week 40/2008, 10643 were type A (4518 subtype H3, 268 subtype H1 and 5857 not subtyped) and 385 were type B. Based on the antigenic and/or genetic characterisation of 1040 influenza viruses, 944 (90.7%) were reported as A/Brisbane/10/2007 (H3N2)-like, 58 (5.6%) as A/Brisbane/59/2007 (H1N1)-like, 12 (1.2%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 26 (2.5%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) (click here).
Eight countries have reported antiviral susceptibility data. Ninety-seven percent of influenza A(H1N1) viruses analysed were resistant to oseltamivir , but all those tested against zanamivir and M2 inhibitors were sensitive. All influenza A(H3N2) viruses tested were sensitive to oseltamivir and zanamivir, but resistant to M2 inhibitors. The few influenza B viruses analysed were sensitive to oseltamivir and zanamivir (click here).
Comment: Influenza activity has continued to rise in Europe, following a west-to-east trend, with three additional countries reporting high intensity. The four countries still reporting low activity are all based in eastern Europe. In some western countries influenza activity has already peaked and declined. In week 4/2009 34.8% of sentinel specimens tested positive for influenza showing a decrease from 42.3% in week 3/2009.
Whereas type A (H3N2) continues to be the clearly dominant influenza virus circulating in Europe, type B, following a rising trend in recent weeks and a reduction in type A detection in week 4/2009, were the majority of viruses identified in sentinel specimens from Greece in week 4/2009. Antigenic and/or genetic characterisation indicates that, with the exception of the few B/Victoria lineage viruses, the viruses circulating are similar to the three components (A(H1N1), A(H3N2) and B/Yamagata lineage) included in the current influenza vaccine.
Background: The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. Of these countries, 27 reported both clinical and virological data, one reported virological data only and one reported clinical data only to EISS in week 04/2009. 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).
The inspiration to my words: "Wasn't there sci. statements that Tamiflu is further o.k. to treat b.f. because the AH5N1 didn't aquired the new resistence to Tamiflu now present in seasonal AH1N1?"
#20: (Recomb.comm.) None of these three changes is represented in the current H1N1 vaccine and the increased reservoir of H274Y in seasonal fluraises concerns of recombination between the N1 on H1N1 and the N1 of H5N1to produce Tamiflu resistant H5N1."
From the: "raises concerns" AND "to produce", I assumed that this fact have not yet been happened, that it is only one of the concerning possibilities yet to be confirmed or negated.
And from the above, that AH5N1 did not aquired the Tamiflu resistance yet.
If after the above clarification cames up that the situation is worst, feel free to correct me, and further I'm suggesting to create an new FT thread which name must be:
"AH5N1 became resistant to Tamiflu"
___
About the Roche.
The Roche question was pertinent to us all, no matter that many now tends to minimize it or acredit it as advocacing (which is not my case).
The fact is that in "old times" (2005.) when all the world was scared about avian flu humanization because of the recent SARS episode, only Roche had something which seems to work onto the few human avian flu infections.
And it worked in part, if early somministrated.
No one that time had any better solutions to gave which was already at hand on the Market.
No vaccines, no meds.
Because of that WHO suggest it as the only probably working "bullet" in the guideliness.
Was at the time an business play about?
Maybe, but what can be changed because of that?
Maybe the depots could not be stocked with Tam. at the time and remained empty, but nobody knows for shure what would happens after.
Out there, in that time or now, were there other silver bullets deep down into the spec. labs, or in the corp's vaults ,conceived from the rest of us?
Maybe, but nobody mention anything about.
Anyway, if existing, they will not reach the masses.
Have "we" now better solutions - SuperRelenza?
Maybe.
Could the rest of us 99.9% people got at hand this SRelenza now?
No we could not.
Additionaly, the same Tamiflu resistance fate would surely became the other new SR/antivirals fate after few years.
So, my wrotings had never to do with Roche Market business.
Roche has put out recent press releases noting that H3N2, is dominant in Europe (and H3N2 is Tamiflu sensitive) and H5N1 remains Tamiflu sensitive.
The Recombinomics commentary noted that the fixing of H274Y in seasonal flu discounted the utility of Tamiflu stockpiled for H5N1.
It is discounted because H274Y is now at or near 100% in H1N1, and H1N1 is widespread in areas where H5N1 is in humans (largely in Asia). Last season H274Y was rare in Asia, so the change this year changes the liklihood of H274Y jumping to H5N1.
H274Y has been reported in H5N1 in wild birds in Astrakhan (in 2005), but has not become dominant in reported sequences. However, no recent H5N1 sequences have been released and in China, H5N1 in poultry isn't even reported (other than the Jiangsu outbreak and those sequences haven't been released).
Thus, both widespread H274Y in H1N1 and vaccine resistance increase the discounting of the utility of Tamiflu for treating H5N1. If H274Y was widespread in H5N1, the discount would approach 100%.
Roche has put out recent press releases noting that H3N2, is dominant in Europe (and H3N2 is Tamiflu sensitive) and H5N1 remains Tamiflu sensitive.
The Recombinomics commentary noted that the fixing of H274Y in seasonal flu discounted the utility of Tamiflu stockpiled for H5N1.
It is discounted because H274Y is now at or near 100% in H1N1, and H1N1 is widespread in areas where H5N1 is in humans (largely in Asia). Last season H274Y was rare in Asia, so the change this year changes the liklihood of H274Y jumping to H5N1.
H274Y has been reported in H5N1 in wild birds in Astrakhan (in 2005), but has not become dominant in reported sequences. However, no recent H5N1 sequences have been released and in China, H5N1 in poultry isn't even reported (other than the Jiangsu outbreak and those sequences haven't been released).
Thus, both widespread H274Y in H1N1 and vaccine resistance increase the discounting of the utility of Tamiflu for treating H5N1. If H274Y was widespread in H5N1, the discount would approach 100%.
I understand better now.
So, H5N1 didn't became resistant, but because of both above cited reasons and the enaugh real probability that the AH5N1 resistence jump was occured or it is near to in the hot zones, the treatment of bf patients by Tamiflu probably loosed or would in short terms it's previous eficacy.
Thank you Dr. Niman for your clarification about the bf resistance question.
2008-2009 Influenza Season Week 3 ending January 24, 2009 (All data are preliminary and may change as more reports are received.) Synopsis:
During week 3 (January 18-24, 2009), influenza activity continued to slowly increase in the United States.
Five hundred eighty-eight (15.8%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
The proportion of outpatient visits for influenza-like illness (ILI) was below the national baseline. The New England region reported ILI above its’ region-specific baseline.
Two states reported widespread influenza activity, 14 states reported regional activity; 12 states reported local influenza activity; and the District of Columbia, Puerto Rico and 22 states reported sporadic influenza activity.
One human infection with a novel influenza A virus was reported.
National and Regional Summary of Select Surveillance Components
Region
Data for current week
Data cumulative for the season
Out-patient ILI*
% positive for flu†
Number of jurisdictions reporting regional or widespread activity‡
A (H1)
A (H3)
A Unsub-typed
B
Pediatric Deaths
Nation
Normal
15.8 %
16 of 51
801
126
1,753
508
2
New England
Normal
7.8 %
5 of 6
24
6
84
14
0
Mid-Atlantic
Normal
7.0 %
3 of 3
84
13
129
31
0
East North Central
Normal
17.6 %
1 of 5
85
25
22
24
0
West North Central
Normal
5.8 %
0 of 7
55
7
70
17
0
South Atlantic
Normal
7.9 %
2 of 9
86
13
254
132
0
East South Central
Normal
5.7 %
1 of 4
9
3
0
8
0
West South Central
Normal
16.9 %
1 of 4
101
2
894
237
1
Mountain
Normal
16.5 %
3 of 8
57
43
187
16
1
Pacific
Normal
6.1 %
0 of 5
300
14
113
29
0
* Elevated means the % of visits for ILI is at or above the national or region-specific baseline
† National data is for current week; regional data is for the most recent three weeks.
‡ Includes all 50 states and the District of Columbia U.S. Virologic Surveillance:
WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C. report to CDC the number of respiratory specimens tested for influenza each week. The results of tests performed during the current week and cumulative totals for the season are summarized in the table below.
Week 2
Cumulative for the Season
No. of specimens tested
3,711
74,208
No. of positive specimens (%)
588 (15.8%)
3,188 (4.3%)
Positive specimens by type/subtype
Influenza A
508 (86.4%)
2,680(84.1%)
A (H1)
74 (14.6%)
801 (29.9%)
A (H3)
14 (2.8%)
126 (4.7%)
A (unsubtyped)
420 (82.7%)
1,753 (65.4%)
Influenza B
80 (13.6%)
508 (15.9%)
The District of Columbia and 45 states from all nine surveillance regions have reported laboratory-confirmed influenza this season.
One case of human infection with a novel influenza A virus was reported by the South Dakota Department of Health during week 3. The person was infected with a swine influenza A (H1N1) virus, and an investigation is currently underway to determine the source of illness. Although human infection with swine influenza is uncommon, sporadic cases have occurred in many years, usually among people in direct contact with ill pigs or who have been in places where pigs may have been present (e.g. agricultural fairs or farms). The sporadic cases of human infections with swine influenza viruses identified in recent years have not resulted in sustained human-to-human transmission or community outbreaks. Nonetheless, when cases are identified, CDC recommends thorough investigations to evaluate the extent of the outbreak and possible human to human transmission, as transmission patterns may change with changes in swine influenza viruses. Antigenic Characterization:
CDC has antigenically characterized 229 influenza viruses [142 influenza A (H1), 35 influenza A (H3) and 52 influenza B viruses] collected by U.S. laboratories since October 1, 2008.
All 142 influenza A (H1) viruses are related to the influenza A (H1N1) component of the 2008-09 influenza vaccine (A/Brisbane/59/2007). All 35 influenza A (H3N2) viruses are related to the A (H3N2) vaccine component (A/Brisbane/10/2007).
Influenza B viruses currently circulating can be divided into two distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. Seventeen influenza B viruses tested belong to the B/Yamagata lineage and are related to the vaccine strain (B/Florida/04/2006). The remaining 35 viruses belong to the B/Victoria lineage and are not related to the vaccine strain. Thirty of the 35 viruses belonging to the B/Victoria lineage were from two states.
Data on antigenic characterization should be interpreted with caution given that antigenic characterization data is based on hemagglutination inhibition (HI) testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination.
Annual influenza vaccination is expected to provide the best protection against those virus strains that are related to the vaccine strains, but limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages, as is seen with the two lineages of influenza B viruses. Antiviral Resistance:
Since October 1, 2008, 165 influenza A (H1N1), 37 influenza A (H3N2), and 67 influenza B viruses have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). One hundred sixty-five influenza A (H1N1) and 37 influenza A (H3N2) viruses have been tested for resistance to the adamantanes (amantadine and rimantadine). The results of antiviral resistance testing performed on these viruses are summarized in the table below.
Isolates tested (n)
Resistant Viruses,
Number (%)
Isolates tested (n)
Resistant Viruses, Number (%)
Oseltamivir
Zanamivir
Adamantanes
Influenza A (H1N1)
165
162 (98.2%)
0 (0)
165
2 (1.2%)
Influenza A (H3N2)
37
0 (0)
0 (0)
37
37 (100%)
Influenza B
67
0 (0)
0 (0)
N/A*
N/A*
*The adamantanes (amantadine and rimantadine) are not effective against influenza B viruses.
Influenza A (H1N1) viruses from 26 states have been tested for antiviral resistance to oseltamivir so far this season. In all 26 states, at least one oseltamivir-resistant influenza A (H1N1) virus has been identified. To date, all influenza A (H3N2) viruses tested are resistant to the adamantanes. Influenza activity in the United States, although increasing, remains relatively low with influenza A (H1N1) viruses predominating overall. However, the level of activity and the relative proportion of circulating virus type or subtype has varied by region and may vary over the course of the season. This presents challenges for the selection of antiviral medications for the treatment and chemoprophylaxis of influenza and highlights the importance of testing patients for influenza and consulting local surveillance data when evaluating patients with acute respiratory infections during the influenza season. CDC issued interim recommendations for the use of influenza antiviral medications in the setting of oseltamivir resistance among circulating influenza A (H1N1) viruses on December 19, 2008. These interim recommendations are available at http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00279 Pneumonia and Influenza (P&I) Mortality Surveillance
During week 3, 7.3% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below the epidemic threshold of 7.8% for week 3.
No influenza-associated pediatric deaths were reported during week 3. Since September 28, 2008, CDC has received a total of two reports of influenza-associated pediatric deaths that occurred during the current season.
Laboratory-confirmed influenza-associated hospitalizations are monitored in two population-based surveillance networks: the Emerging Infections Program (EIP) and the New Vaccine Surveillance Network (NVSN).
No influenza-associated hospitalizations have been reported from the New Vaccine Surveillance Network this season.
During October 1, 2008 – January 17, 2009, preliminary laboratory-confirmed influenza-associated hospitalization rates reported by the EIP for children aged 0-4 years and 5-17 years were 0.6 per 10,000 and 0.02 per 10,000, respectively. For adults aged 18-49 years, 50-64 years, and = 65 years, the rates were 0.05 per 10,000, 0.08 per 10,000, and 0.2 per 10,000, respectively.
During week 3, 2.0% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is less than the national baseline of 2.4%. On a regional level, the percentage of visits for ILI ranged from 1.1% to 3.8%. One region (New England) reported 1.9% of outpatient visits for ILI, which is above its’ region-specific baseline of 1.5%, while the remaining eight regions reported percentages of visits for ILI below region-specific baseline levels.
During week 3, the following influenza activity was reported:
Widespread influenza activity was reported by two states (New Jersey and Virginia).
Regional influenza activity was reported by 14 states (Arizona, Colorado, Connecticut, Indiana, Maine, Massachusetts, Montana, New Hampshire, New York, North Carolina, Pennsylvania, Rhode Island, Tennessee, and Texas).
Local influenza activity was reported by 12 states (Alabama, California, Florida, Hawaii, Illinois, Maryland, Michigan, Minnesota, Nevada, Oklahoma, South Carolina, and Vermont).
Sporadic activity was reported in the District of Columbia, Puerto Rico, and 22 states (Alaska, Arkansas, Delaware, Georgia, Idaho, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, New Mexico, North Dakota, Ohio, Oregon, South Dakota, Utah, Washington, West Virginia, Wisconsin, and Wyoming).
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A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
Influenza activity in Canada continues to increase; ILI consultation rate remains below expected levels
During week 03, influenza activity in Canada continued to increase with more regions reporting localized (n=7; in ON, AB, BC & NT) and sporadic activity (n=22) (see map). The proportion of tests that were positive for influenza continued to increase steadily with a percentage positive of 7.3% (251/3,423) this week (see table). The majority of influenza virus detections to date this season were influenza A viruses (58% or 487/835). In week 03, the ILI consultation rate was 13 ILI consultations per 1,000 patient visits (see ILI graph), which is below the expected range for this week. The sentinel response rate was 62%. In week 03, 4 new influenza outbreaks were reported: 1 in a LTCF and 3 in schools (all from BC). Antigenic Characterization:
Since 1 September 2008, the NML has antigenically characterized 134 influenza viruses: 30 influenza A/Brisbane/59/2007(H1N1)-like (from BC, AB, ON, NS & PEI), 8 influenza A/Brisbane/10/2007(H3N2)-like (from BC, SK & ON), 5 influenza B/Florida/4/2006-like (from AB & ON) and 91 B/Malaysia/2506/2004-like (from AB, MB, ON, QC & PEI). A/Brisbane/59/2007(H1N1), A/Brisbane/10/2007(H3N2) and B/Florida/4/2006 are the influenza A and influenza B components recommended for the 2008-09 influenza vaccine. B/Malaysia/2506/2004 was the influenza B component for the 2007-2008 season vaccine (see pie chart). Antiviral Resistance: Results from the NML:
Since the start of the season, the NML has tested 50 influenza A isolates (28 H1N1 and 22 H3N2) for amantadine resistance. All of the H1N1 isolates were susceptible; however all of the H3N2 isolates were resistant to amantadine (resistance = 100% or 22/22). The resistant isolates were from BC, AB, SK, ON & QC.
The NML has also tested 122 influenza isolates (25 A/H1N1, 11 A/H3N2 & 86 B) for oseltamivir (Tamiflu) resistance. All of the A/H3N2 and B isolates were sensitive; however all of the A/H1N1 isolates were resistant to oseltamivir due to the H274Y mutation (resistance = 100% or 25/25). The resistant isolates were from BC, AB, ON and NS.
All 126 influenza isolates (29 A/H1N1, 11 A/H3N2 & 86 B) tested for zanamivir resistance to date were sensitive to zanamivir. Oseltamivir resistance findings from Provincial laboratories:
To date this season, 59 influenza isolates in BC have been sub-typed as A/H1 and were assessed genotypically for oseltamivir resistance using an SNP assay. Fifty-four isolates tested positive for the H274Y mutation (resistance = 100% or 54/54), with the other 5 specimens still pending confirmatory testing. Influenza-associated Paediatric Hospitalizations:
In week 03, 4 laboratory-confirmed influenza-associated paediatric hospitalizations were reported through the Immunization Monitoring Program Active (IMPACT) network. All 4 cases were from Ontario and half were due to influenza A. To date, 31 hospitalizations have been reported of which 68% (21/31) have been due to influenza A. The proportion of cases to date by age group are as follows: 13% were 0-5 month olds; 23% were 6-23 month olds; 10% were 2-4 year-olds; 16% were 5-9 year-olds; and 39% were 10-16 year-olds. The distribution of cases to date by province are as follows: 81% from ON, 10% from AB, 6% from QC and 3% from BC.
*** Over the next several weeks, more retrospective reports of cases may be reported due to technical difficulties with IMPACT's electronic reporting system. International:
WHO: During the weeks 1-2, the level of overall influenza activity in the world increased, particularly in Europe. In North America and Hong Kong Special Administrative Region of China overall influenza activity remained relatively low.
CDC: During week 02, influenza activity continued to slowly increase in the United States. Of the 3,554 specimens tested this week for influenza viruses, 409 (11.5%) were positive. Since 1 October 2008, the CDC has antigenically characterized 207 influenza viruses: 142 influenza A(H1) (all A/Brisbane/59/2007-like), 13 A(H3) (all A/Brisbane/10/2007-like) and 52 influenza B (17 were B/Florida/04/2006-like belonging to the B/Yamagata lineage and the other 35 belonged to the B/Victoria lineage). Since 1 October, 2008, 187 influenza viruses (103 A(H1N1), 23 A (H3N2), and 61 B) have been tested for resistance to neuraminidase inhibitors. Of the A(H1N1) viruses tested, 98% (101/103) were resistant to oseltamivir however all were sensitive to zanamivir. All of the A(H3N2) and B viruses tested were sensitive to both oseltamivir and zanamivir. The CDC tested 126 influenza A viruses (103 H1, 23 H3) for amantadine resistance: only one of the H1N1 viruses was resistant to amantadine (1%, 1/103) however all the H3N2 viruses (100%) were resistant. In week 02, 2 influenza-associated pediatric deaths were reported to CDC (the first cases reported this season to date) .
EISS: Influenza activity continued to intensify and progress across Europe with most countries now reporting medium to high intensity. In some western countries influenza activity has already peaked and declined. Influenza A(H3) viruses continue to predominate. With the exception of the few B/Victoria lineage viruses, the viruses circulating in Europe are similar to the strains included in the current influenza vaccine. Of the 115 A(H3N2) isolates that were tested for adamantanes susceptibility, 115 (100%) were resistant. Of the 75 A(H1N1) virus isolates tested for resistance against neuraminidase inhibitors, 73 (97%) were resistant to oseltamivir, but all were sensitive to zanamivir.
Human Avian Influenza: Since 24 January 2009, the WHO has reported 4 new cases of human H5N1 avian influenza infection: 3 from China (2 deaths) and 1 from Egypt.
Total number of influenza tests performed and number of positive tests by province/territory of testing laboratory, Canada, 2008-2009
Province of
reporting
laboratories
Report Period:
January 18, 2009 to January 24, 2009
Season to Date:
August 24, 2008 to January 24, 2009
Total #
Influenza
Tests
# of Positive Tests
Total #
Influenza
Tests
# of Positive Tests
Influenza A
Influenza B
Total
Influenza A
Influenza B
Total
NL
31
1
0
1
249
1
0
1
PE
6
1
1
2
76
1
2
3
NS
28
0
0
0
351
2
0
2
NB
52
1
8
9
333
6
8
14
QC
1083
60
6
66
10001
151
13
164
ON
1086
36
67
103
12406
103
236
339
MB
48
0
0
0
1046
0
2
2
SK
199
5
0
5
1978
10
0
10
AB
758
22
11
33
10168
114
77
191
BC
132
26
6
32
971
99
10
109
Canada
3423
152
99
251
37579
487
348
835
Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Note: Cumulative data includes updates to previous weeks; due to reporting delays, the sum of weekly report totals do not add up to cumulative totals. Abbreviations: Newfoundland/Labrador (NL), Prince Edward Island (PE), New Brunswick (NB), Nova Scotia (NS), Quebec (QC), Ontario (ON), Manitoba (MB), Saskatchewan (SK), Alberta (AB), British Columbia (BC), Yukon (YT), Northwest Territories (NT), Nunavut (NU) Respiratory virus laboratory detections in Canada, by geographic regions, are available weekly on the following website:
<http://www.phac-aspc.gc.ca/bid-bmi/dsd-dsm/rvdi-divr/index-eng.php>
Number of influenza surveillance regions† reporting widespread or localized influenza activity, Canada, by report week, 2008-2009 (N=54)
† sub-regions within the province or territory as defined by the provincial/territorial epidemiologist. Graph may change as late returns come in.
Influenza Activity Level by Provincial and Territorial
Influenza Surveillance Regions, Canada,
January 18, 2009 to January 24, 2009 (Week 03)
Influenza tests reported and percentage of tests positive, Canada, by report week, 2008-2009
Percent positive influenza tests, compared to other respiratory viruses, Canada, by reporting week, 2008-2009
Influenza strain characterization, Canada, cumulative, 2008-2009 influenza season by the Respiratory Viruses Section at the National Microbiology Laboratory
[N=134]
{Strain characterization, number identified, per cent of total number} NACI recommends that the trivalent vaccine for the 2008-2009 season in Canada contain
A/Brisbane/59/2007 (H1N1)-like virus; an A/Brisbane/10/2007 (H3N2)-like virus; and a B/Florida/4/2006-like virus.
Influenza-like illness (ILI) consultation rates, Canada, by report week,
2008-2009 compared to 1996/97 through to 2007/08 seasons
Note: No data available for mean rate in previous years for weeks 19 to 39 (1996-1997 through 2002-2003 seasons).
Number of New Outbreaks in Long Term Care Facilities, Canada, by Report Week, 2008-2009
Flu Season Is Off to Slow Start, But for Va.
State Is the First With Widespread Reports of Illness
By Ashley Halsey III
Washington Post Staff Writer
Monday, February 2, 2009; B01
Virginia is the first state in the nation to report a widespread outbreak of the flu, and the federal Centers for Disease Control and Prevention says the chronic winter illness might spread rapidly after a relatively slow start this season.
"We could really get slammed in two weeks," Anthony Fiore, a CDC epidemiologist, responded when asked whether much of the nation might be spared this year. "Oh, no, it'll get here."
The weekly survey conducted by the CDC during flu season found localized outbreaks of the illness in Maryland and sporadic cases in the District, but Virginia was the only state so far where the flu was widespread.
"We can expect to see high incidence for the next six to eight weeks," said Laura Ann Nicolai, an epidemiologist for the Virginia Department of Health. "You can see the illness into March, April, even May."
Although the flu season generally begins with the onset of colder weather in October and November, in some years it peaks later. People who get sick during that period often mistake one of the scores of other winter viruses for the flu, whose symptoms include fever, aching muscles, headache, a dry cough, sore throat and lack of energy.
Although it doesn't keep track of the others as meticulously, the federal government carefully monitors influenza because severe strains can result in death. The 1918 worldwide flu epidemic killed an estimated 20 million to 40 million people, including 675,000 Americans.
Flu vaccination grew out of that pandemic, when desperate doctors discovered that blood transfusions from recovered flu patients to new patients had a positive effect. The first vaccines were approved for use by the military in the 1940s, and a decade later researchers developed the current production methods, which grow the virus in chicken embryos.
The illness presents itself in a mix of strains, some more powerful than others, so, as they formulate the vaccine each year, researchers make an educated guess as to which strains the vaccine should protect against.
"The years when we tend to have more illness tend to be the years when there's not a good match," said David Blythe, an epidemiologist with the Maryland Department of Health. "This year, there's a good match with the two A strains, and some of the B strains don't match quite as well."
The fact that the vaccine matches up well with this year's version of the flu is one explanation for the somewhat slow advance of the illness outside Virginia.
"It's out there, but no question, it's breaking late," said Susan Fay, coordinator of the communicable disease program in Fairfax County. "That's happened the last few seasons."
The fact that the District and Maryland are next door to Virginia doesn't necessarily mean that they will be next to cross the threshold into the "widespread" flu designation that every state in the nation achieved last year.
"The flu has 100 different entry points to a given area," Fiore said. "For example, if West Virginia has high reports next week, that doesn't necessarily mean it comes from Virginia."
A designation of widespread means the illness is affecting wide areas of the state. Health officials do not know the exact number of cases in Virginia.
Fiore said that, particularly in jurisdictions where the illness has not become widespread, it's important for people to get flu vaccinations. The vaccine begins to provide effective protection two weeks after it's received.
In Montgomery County, senior epidemiologist Jamaal Russell said there have been no significant outbreaks.
"That's not to say you don't need to get a flu shot," Russell said. "It usually picks up from now until March. Last year, we had a spike in March."
In years when flu vaccine has been in short supply, young children and people 50 or older were given preference, but this year plenty of vaccine is available, and health officials are encouraging people of all ages to receive shots.
"Every year, there are otherwise healthy young people who are hospitalized or die of the flu," said Loudoun County Health Director David Goodfriend. "The more people who get the flu shot, the fewer people you come in contact with will have the flu."
Flu vaccines not as effective this year as in the past: DOH
Central News Agency
2009-02-03 10:59 PM
Taipei, Feb. 3 (CNA)
Influenza vaccines that proved to be effective late last year have failed to live up to expectations early this year, the Department of Health (DOH) said Tuesday.
Chou Jih-haw, deputy director general of DOH's Centers for Disease Control, said more than 3.2 million free flu shots were given to the public in autumn and winter last year.
"Judging from the number of influenza cases in the fourth quarter of 2008, it was significantly lower than in the same period the previous year," Chou said.
"But this year, tests of flu viruses on the patients showed that the results have not been as good as expected," he continued.
Chou said influenza vaccines given in autumn 2008 and this winter should be effective against the H1N1 and H3N2 viruses, and tests taken from patients who were inoculated last year proved their effectiveness.
But in January, tests found the vaccines did not work on 70 percent of those with H1N1 viruses and 40 percent of those with the H3N2 virus.
A vaccine is considered effective if it controls the virus in 80 percent to 90 percent of those inoculated.
Chou would not categorize the vaccines as ineffective, however, because influenza viruses are "prone to mutation, " meaning that the virus formula for producing vaccines must be changed on a yearly basis.
A former CDC director suggested Tuesday that part of the problem may be that flu viruses tend to strike Taiwan between six months and two years earlier than European countries and the United States.
Su Ih-jen, director of the Division of Clinical Research of the National Health Research Institutes, said that because of the time lag, influenza vaccines produced by European and American pharmaceutical makers based on data provided by the World Health Organization could not keep up with the outbreak of flu in Asia.
Su noted that with close exchanges between Taiwan and China, Taiwan has become an outpost of influenza outbreaks.
The World Health Organization began to address the issue of different prevalent viruses in Asia and Europe last April.
Currently, two out of five major vaccine manufacturers have made inroads into China, and the production of Asian influenza vaccines "has become a trend," he said.
Su suggested that the virus in every influenza outbreak is slightly different, and that "it can show major changes about every five years, so the effectiveness of vaccines can diminish." (By Lilian Wu)
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People come and go, but the creative force of great historical events, as well as important ideas and actions remain. (Aleksandr Romanovic Lurija, 1976)
-- A TIME'S MEMORY (Blog) ATTRAVERSO QUESTI GIORNI (Blog) tracciatore_traccia@libero.it
Vaccine Resistant H1N1 in Taiwan Increases Concerns Recombinomics Commentary 23:44
February 3, 2009
But in January, tests found the vaccines did not work on 70 percent of those with H1N1 viruses.
The above comments on H1N1 in Taiwan supports data released yesterday by the NIH in Japan, which showed significant titer reductions in reference anti-sera activity against H1N1 isolates from recent patients at two medical centers in Japan. The titers were 4-8 fold lower than the Brisbane/59 isolate used in the current trivalent vaccine. In some cases the titer was 16-32 fold lower, indicating vaccine failure for many of the patients. The data from Taiwan reports similar results.
Moreover, the data from Japan showed that anti-sera directed against last year's vaccine target, Solomon Island/3, failed to produce detectable activity with the 2009 H1N1 isolates.
Japan has released a considerable amount of data on H1N1 isolates there. In the fall an outbreak in Sendai identified isolates which matched the major sub-clade circulating in the United States. These isolates had three characteristic HA polymorphisms, G189V, A193T, and H196R. A more comprehensive analysis was done on 33 H1N1 isolates, which again matched sequences in the United States, all of which had A193T. These changes around the receptor binding domain were likely responsible for the lower titers and vaccine failures.
Although A193T was present in the United States and Europe in late 2007 / early 2008, the vaccine target for this season does not have A193T. Moreover, the vaccine for the southern hemisphere also does not have A193T even though Tamiflu resistance last season was at 100% in South Africa and the dominant H1N1 also had A193T, suggesting that H1N1 with H274Y spread will continue to be facilitated by mismatch H1N1 vaccines in the upcoming flu season in the southern hemisphere.
These vaccine mismatches are cause for concern. Last season the H1N1 target was changed from New Caledonia (clade 1) to Solomon Islands (clade 2A). However, last season there was little Solomon Islands in circulation, because it had been replaced by Brisbane (clade 2B) and Hong Kong (clade 2C), although agencies in the US and Europe initially called all clade 2 sub-clades "Solomon Island -like." Later they began calling Brisbane "Brisbane-like", but the vaccine was a clear mismatch, which was demonstrated when appropriate reference anti-sera was used.
However, last season clade 2B acquired A193T from clade 2C, which created a new sub-clade which subsequently emerged in the southern and northern hemisphere, along with H274Y which was hitch-hiking with the dominant sub-clade, which is now not only Tamifu resistant because of H274Y on the NA, but also vaccine resistant because of the receptor binding domain changes on the HA.
The vaccine resistant H1N1 has exploded in Korea and Japan, resulting in school closing across Japan (see updated map) and a dramatic jump in doctor's visits in both countries. These jumps raise concerns of similar increases in countries where H1N1 is dominant, such as the United States and China. China spread creates additional concerns because of the increase in H5N1 human cases and reporting failures of H5N1 poultry cases. The human cases can lead to dual infections with Tamiflu resistant H1N1, leading to Tamiflu resistant H5N1 through recombination.
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__________________
"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Tables and graphs indicates the Influenza-like Illness incidence among population, as elaborated by CIRI (Centro Interuniversitario per lo Studio dell'Influenza) from data collected by the network of sentinel family doctors participant to influenza epidemiological surveillance.
Values indicate the incidence of ILI as per 1,000 inhabitants, and have been tabulated according epidemic season, surveillance week and classes of age.
This week there is a decrease in overall incidence value (from 6.03 to 5.5 x 1,000). However, the incidence in 0-4 class-age population continues to rise (from 1668 to 1705 x 100,000). Other classes of age report a decrease in incidence value.
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__________________
GIMI69 (IRONOREHOPPER)
--
People come and go, but the creative force of great historical events, as well as important ideas and actions remain. (Aleksandr Romanovic Lurija, 1976)
-- A TIME'S MEMORY (Blog) ATTRAVERSO QUESTI GIORNI (Blog) tracciatore_traccia@libero.it
Influenza activity is decreasing across the UK.
In week 05/09 GP consultation rates decreased and remained below baseline levels in England and Scotland. In Wales the rate has increased slightly but remains below baseline. In Northern Ireland the consultation rate has decreased but thresholds have not yet been set. The proportions of cold/flu and fever calls to NHS direct in England and Wales have decreased, and remain below baseline levels.
In week 05/09, 21 specimens tested positive for influenza virus (three A (H1), 14 A (H3) and four B) at the Centre for Infections' Respiratory Virus Unit (RVU). Other NHS and HPA laboratories in England and Wales reported 66 influenza A, and 16 influenza B positive specimens in week 04/09. Nineteen Scottish and four Northern Irish influenza-positive specimens were reported in week 05/09. No respiratory disease outbreaks have been reported recently. The proportion of people over 65 years who have received this season's influenza vaccine was 74.1% in week 05/09, and 47.2% in those aged under 65 years in risk groups. Characterisation of 539 influenza viruses since week 40/08 by RVU have shown that the majority of circulating strains are well-matched to the current influenza vaccine.
Influenza activity continued to intensify and spread across Europe, with most countries reporting medium to high intensity in week 04/09.
Full reports will now be published fortnightly, with a summary in alternate weeks, unless activity increases again.
Since week 40/08 all of the influenza A (H3) isolates that have been tested for drug sensitivity have been found to be sensitive to oseltamivir and zanamivir, but resistant to amantadine. Forty-three influenza A (H1) specimens have been tested for anti-viral drug resistance, 42 of these were resistant to oseltamivir and all were sensitive to zanamivir and amantadine. Twelve influenza B specimens have been tested and all were sensitive to oseltamivir and zanamivir.
Eurosurveillance, Volume 14, Issue 5, 05 February 2009
Research articles
Use of oseltamivir in 12 European countries between 2002 and 2007 – lack of association with the appearance of oseltamivir-resistant influenza A(H1N1) viruses
P Kramarz 1, Dominique Monnet1, A Nicoll1, C Yilmaz2, B Ciancio1
1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
2. Ministry of Health of the Republic of Turkey, Ankara, Turkey
Citation style for this article: Kramarz P, Monnet D, Nicoll A, Yilmaz C, Ciancio B. Use of oseltamivir in 12 European countries between 2002 and 2007 – lack of association with the appearance of oseltamivir-resistant influenza A(H1N1) viruses . Euro Surveill. 2009;14(5):pii=19112. Available online: http://www.eurosurveillance.org/View...rticleId=19112
Date of submission: 04 November 2008
Variable levels of oseltamivir resistance among seasonal influenza A(H1N1) isolates have been reported in Europe during the 2007-8 northern Hemisphere influenza season. It has been questioned whether oseltamivir use could have driven the emergence and predominance of resistant viruses. This study aimed at describing the levels of use of oseltamivir in 12 European Union (EU) Member States and European Economic Area (EEA)/European Free Trade Area (EFTA) countries. The data were converted into prescription rates and compared with the national proportions of resistant influenza A(H1N1) viruses through regression analysis. Overall use of oseltamivir in European countries between 2002 and 2007 was low compared to e.g. the use in Japan. High variability between the countries and over time was observed. In eight of the 12 countries, there was a peak of prescriptions in 2005, coinciding with concerns about a perceived threat from an influenza pandemic which might have lead to personal stockpiling. Ecological comparison between national levels of use of oseltamivir in 2007 and the proportions of A(H1N1) viruses that were resistant to oseltamivir showed no statistical association. In conclusion, our results do not support the hypothesis that the emergence and persistence of these viruses in 2007-8 was related to the levels of use of oseltamivir in Europe. Further investigation is needed to elucidate the reasons for different level of use between the countries.
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__________________
GIMI69 (IRONOREHOPPER)
--
People come and go, but the creative force of great historical events, as well as important ideas and actions remain. (Aleksandr Romanovic Lurija, 1976)
-- A TIME'S MEMORY (Blog) ATTRAVERSO QUESTI GIORNI (Blog) tracciatore_traccia@libero.it
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
Clicking on the map will, if available, take you through to the national web site. If 'regional' activity is reported, a pop-up text box will appear which describes the activity in greater detail.
Clicking on England and France will provide you with regional data.
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
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 with
a 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 in
South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately one
percent of the Finnish population).
Network comments (where available)
Italy
Further 19 type A influenza viruses (12 H3) were isolated together with 2 influenza type B. Since the start of this season H3 strains have been always prevalent ( 81%) among the A viruses. Switzerland
Influenza activity reached a peak during the week 4 and started to decrease during the week 5.
Intensity: Low = no influenza activity or influenza activity at baseline level; Medium= usual levels of influenza activity; High = higher than usual levels of influenza activity; Very high = particularly severe levels of influenza activity. Percentage positive: percentage of sentinel swabs that tested positive for influenza A or B Dominant type: this assessment is based on data from sentinel and non-sentinel sources ARI: acute respiratory infection ILI: influenza-like illness Population: per 100,000 population
The bulletin text was written by an editorial team at the European Centre for Disease Prevention and Control (ECDC) and the Community Network of Reference Laboratories for Human Influenza in Europe (CNRL). Team members are Flaviu Plata, Phillip Zucs and Bruno Ciancio from ECDC, and Adam, Meijer Rod Daniels Alan Hay and Maria Zambon from CNRL. The bulletin text was reviewed by Olav Hungnes (Norwegian Institute of Public Health, Oslo, Norway), and Anne Mazick (Statens Serum Institut, Copenhagen, Denmark) on behalf of the EISS members.
Neither the European Centre for Disease Prevention and Control (ECDC), nor any person acting on his behalf is liable for the use that may be made of the information contained in this bulletin. Maps and commentary used in this Bulletin do not imply any opinions whatsoever of ECDC or its partners on the legal status of the countries and territories shown or concerning their borders.
Membro del Comitato Consultivo, Editore e Direttore del Forum Italiano di FluTrackers
Join Date: Dec 2007
Location: PADUA
Posts: 12,355
Re: Seasonal Flu 2008 - 2009 --
Phylogenetic tree for relation between A/(H3N2) HA1 portions in Italian isolations during 2008/2009 epidemic season compared with previous season isolates.
Current season H3N2 isolates evidently derived from A/Brisbane/10/2007 vaccine reference strain lineage, with the two amino acids changes (G50E e K140I) that differentiate from previous reference strain A/Wisconsin/67/2005. However, Italian isolates showed also to possess another important substitution (K173Q) at E antigenic site, reported also in the most recent reference strain A/Wisconsin/5/2008.
People come and go, but the creative force of great historical events, as well as important ideas and actions remain. (Aleksandr Romanovic Lurija, 1976)
-- A TIME'S MEMORY (Blog) ATTRAVERSO QUESTI GIORNI (Blog) tracciatore_traccia@libero.it
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Re: Seasonal Flu 2008 - 2009
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