Commentary
Spreading H1N1 Tamiflu Resistance in Australia? Recombinomics Commentary 19:25
September 5, 2008
AN unexpected influenza strain has swept through Geelong and blown out waiting times at the hospital emergency department, Barwon Health says.
Barwon Health said reports of 20-hour waits in the hospital's ED were due to a "strain of influenza not covered by this year's vaccine".
"Consequently, the Geelong Hospital is experiencing a period of high demand and high acuity," the Barwon Health statement said.
Barwon Health could not confirm the strain's identity late yesterday, but said it caused respiratory problems, particularly among older people.
The above comments describe a flu outbreak in Australia. Since the influenza is said to not be covered by the current vaccine, it is likely an outbreak of H1N1. The vaccine for 2007/2008 northern hemisphere flu season mismatched all three targets. However, poor reference anti-sera failed to detect significant differences between Solomon Island/3, the H1N1 vaccine target, and Brisbane/59, the dominant H1N1 sub-clade outside of Asia. Consequently, the 2008 vaccine for the southern hemisphere had new targets for H3N2 and Influenza B, but the mismatched Solomon Island/3 target was used, extending the mismatch to another season.
As was easily seen by phylogenetic analysis, Solomon Island/3 (clade 2A) was not circulating in 2007/2008, and had been replaced by Brisbane/59 (clade 2B), which also had H274Y. The first 10 sequenced H1N1 isolates in Australia had H274Y, suggesting the Tamiflu resistance was widespread and likely to be present in the patients experiencing respiratory problems.
Similar respiratory problems were reported in Honduras recently, and H1N1 HA sequences recently released suggests that those isolates, as well as isolates from Guatemala, which were virtually identical, had H274Y in the NA sequence.
As was seen in the recent fatal case from the Netherlands, treatment of H274Y positive H1N1 with Tamiflu fails to reduce the viral load, which could create problems for immuno-compromised patients, leading to death.
More information on the recent outbreak in Australia would be useful.
.
__________________
"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
(1a) Decline in influenza-associated mortality among Dutch elderly following the introduction of a nationwide vaccination program.
Jansen A, et al - Vaccine - August 20, 2008
Description: This article describes a retrospective nationwide cohort study in the Netherlands over 1992–2003, using mortality and viral surveillance data showing how routine influenza vaccination among Dutch elderly was statistically associated with a significant decrease in influenza-associated mortality, notably in those aged 65–69 years.
The aim of the work was to assess the influenza-associated mortality in the elderly before and after the introduction of a nationwide influenza vaccination program in 1996 (vaccination coverage raised from below 50% to 80% in the elderly population).
The average annual influenza-associated mortality declined in the years after the vaccination programme from 131 to 105 per 100,000 persons (relative risk 0.80). The decline was largest in the age group 65–69 years (relative risk 0.54) but less in those aged 75 years and older. Validation by undertaking different Serfling-type regression analysis revealed similar results.
ECDC Comment (11/09/08): This is another in the series of ecological studies looking for temporal associations between levels of immunisation and respiratory or all cause deaths in the elderly. While it is not controversial that influenza epidemics are associated with excesses of deaths in the elderly(1) it seems harder to demonstrate that immunisation reduces the association.
Notable studies on data in the US and Italy have failed to find associations.(2,3) Why is this?
Firstly the protective effect on mortality in the elderly is considerably less than the 70-90% protection seen in trials measuring laboratory confirmed outputs. One of the best cohort studies found only a 12% protection in immunised versus unimmunised elderly.(4)
Secondly mortality data does not allow discrimination between respiratory deaths due to influenza and non-influenza causes and so the effect is much diluted.
Thirdly as we move further away from the last pandemic the circulating viruses adapt more and more to humans and are less lethal as a consequence. In the light of these considerations any study such as this that finds an effect should probably be given more weight than studies that fail to demonstrate any effect.
1. Tillett HE, Smith JWG, Clifford RE. Excess morbidity and mortality associated with influenza in England and Wales. Lancet 1980; i: 793-5.
2. Rizzo C, Viboud C, Montomoli E, Simonsen L, Miller MA. Influenza-related mortality in the Italian elderly: no decline associated with increasing vaccination coverage. Vaccine 2006; 24: 6468-75
3. Simonsen L, Reichart TA, Viboud C, Blackwelder WC, Taylor RJ, Miller MA. Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med 2005; 165:265-72
4. Mangtani J Cumberland P. Hodgson CR, Roberts JA, Cutts FT, Hall AJ.A cohort study of the effectiveness of influenza vaccine in older people, performed using the UK General Practice Research Database J I Inf Dis 2004: 190: 1-10.
(1b) Report of fatal oseltamivir-resistant A(HIN1) influenza virus infection in a man with leukaemia
Fatal oseltamivir resistant influenza virus infection - Van der Vries E, Van den Berg B, Schutten M. - NEJM 2008; 359:1074-5.
Description:
This letter reports on a man with known chronic lymphocytic leukaemia and on immunosupressant drugs who died in the Netherlands seemingly from infection with oseltamivir resistant A(H1N1) infection.
The patient initially presented with respiratory symptoms and was started on antibiotics. Later influenza A(H1N1) was detected and he was started on oseltamivir. Oseltamivir treatment was discontinued a week later when it was determined that the A(H1N1) was oseltamivir resistant.
Amantadine was then started though it then turned out that the virus was also resistant to that. The patient recovered somewhat and this was thought to be due to recovery of his immune system. However later his condition deteriorated and he subsequently died.
ECDC Comment (11/09/08): This case illustrates that at present there is no clinical guidelines on the management of immune-incompetent patients in the presence of significant levels of ‘fit’ (transmitting) but oseltamivir resistant viruses. Producing such clinical guidelines where there is no clear public health benefit is not within ECDC’s mandate.
(1c) Guidance for Dentists issued by the UK Department of Health
Description:
The UK Department of Health has published two guidance documents dealing with pandemic preparedness in primary care dentistry. The first “Guidance for Dental Practices” provides recommendations for reducing the risk of pandemic influenza in the setting of a dental practices.
The recommendations include: educating staff, patients and visitors about the symptoms, transmission and prevention to influenza, time and space separations between influenza and non-influenza patients, implementing appropriate infection control precautions, environmental cleaning and disinfection, vaccination and PPE for staff and the use of antiviral drugs for staff and patients.
Procedural aspects to mitigate infection during a pandemic are based on existing classical infection control and precautionary hygiene measures, but also include patients screening for influenza symptoms, visit limitations to pain relief or emergency treatment and collaboration with primary care trusts to retain dental care facilities to infected patients.
The second document “Guidance on the delivery of and contract arrangements for primary care dentistry” provides specific advice to the NHS on the delivery and contract arrangements for primary care dentistry in the event of a pandemic.
ECDC Comment (11/09/08):
This seems to be the pandemic-specific guidance documents produced in Europe for dentists. Focusing on primary care dentistry in influenza pandemic preparedness is important due to the ease of spread of the disease in dental setting and high number of people who visit dentist.
The “Guidance for Dental Practices” gives useful guidelines how to contain the infection, provide dental care during pandemic, control infection, and recover symptomatic patients which could be implemented by the other EU countries.
The second document “Guidance on the delivery of and contract arrangements for primary care dentistry” illustrates organisational aspects of primary care dentistry during a pandemic. This is perhaps more focused for UK audiences with less broad application elsewhere, although the principles are universal.
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
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
DOI: 10.3201/eid1410.080646
Suggested citation for this article: Cowling BJ, Lau EHY, Lam CLH, Cheng CKY, Kovar J, Chan KH, et al. Effects of school closures, 2008 winter influenza season, Hong Kong. Emerg Infect Dis. 2008 Oct; [Epub ahead of print]
Effects of School Closures, 2008 Winter Influenza Season, Hong Kong
Benjamin J. Cowling, Eric H.Y. Lau, Conrad L.H. Lam, Calvin K.Y. Cheng, Jana Kovar, Kwok Hung Chan, J.S. Malik Peiris, and Gabriel M. Leung
Author affiliations: University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China (B.J. Cowling, E.H.Y. Lau, C.L.H. Lam, C.K.Y. Cheng, K.H. Chan, J.S.M. Peiris, G.M. Leung); and University College London, London, UK (J. Kovar)
In winter 2008, kindergartens and primary schools in Hong Kong were closed for 2 weeks after media coverage indicated that 3 children had died, apparently from influenza.
We examined prospective influenza surveillance data before, during, and after the closure.
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
Published: Sunday, September 14, 2008 at 1:00 a.m.
Last Modified: Sunday, September 14, 2008 at 12:29 a.m.
Health authorities have detected the emergence of a rare but deadly "lung-eating" form of pneumonia sparked by the combination of a skin infection and the common flu.
The national Centers for Disease Control and Prevention reported 22 deaths among children in 2007 from the dual infection. Numbers from the 2007-to-2008 flu season won't be released until October, but officials say that deaths have increased. The CDC has just begun tracking cases among all age groups.
The number of fatalities, while low, is a sharp increase from previous years, and infectious disease experts worry that an ongoing epidemic of skin infections could drive the numbers higher. The double infection was the leading cause of bacterial pneumonia deaths during the 1957-1958 flu pandemic. Health authorities are putting out a call for people to get a simple annual flu vaccine.
"Since so many of these pneumonias are associated with influenza, the best prevention is to prevent influenza," said Jeffrey C. Hageman, a CDC epidemiologist.
Health officials watching whether flu viruses are becoming resistant to drug
TORONTO — As flu season approaches, public health authorities will be keeping an anxious eye on one family of flu viruses to see if an unwelcome phenomenon that cropped up last winter will stage a repeat performance.
To the surprise and dismay of scientists and governments, H1N1 viruses that were resistant to Tamiflu suddenly appeared in high numbers in Northern Europe.
Testing elsewhere has since shown viruses resistant to the key drug - whose generic name is oseltamivir - have spread to North and South America, the Caribbean, Africa, parts of Asia, Australia and New Zealand.
North American officials say they will quickly test for resistance once the northern hemisphere flu season begins and H1N1 viruses start to spread. And in the U.S. at least, authorities are entertaining the possibility they may have to tweak the advice they give doctors on which flu drugs to use should - as most expect - the problem recur.
"We are thinking about the various sorts of scenarios that might occur," says Dr. Tony Fiori, who develops antiviral drug and vaccine policy in the influenza division of the U.S. Centers for Disease Control in Atlanta, Ga.
"It's hard to imagine we'd be at a point of telling people not to use oseltamivir. We might look at possibilities like pushing people towards using zanamivir when they can, since there hasn't been resistance seen to that."
Zanamivir is the generic name for GlaxoSmithKline's Relenza, which, like Tamiflu, belongs to a class of drugs called neuraminidase inhibitors.
Both drugs block the ability of flu viruses to spread from infected cells to healthy ones, making symptoms less severe and speeding recovery.
Tamiflu producer Hoffman-La Roche intends to get into the surveillance effort, mounting a multi-country study to figure out how much resistance is out there, whether the resistant viruses cause milder disease and what happens clinically to people infected with the resistant viruses who take Tamiflu.
"So in a very short space of time we hope to get a picture on the frequency, if the strain does re-emerge in the northern hemisphere," says Dr. David Reddy, Roche's pandemic influenza task force leader.
"We don't know what the northern hemisphere will bring," he said, expressing an optimism not supported by the resistance pattern seen in H1N1 viruses during the southern hemisphere flu season.
Canada too will be testing early so it can inform the medical community of which kinds of flu viruses are causing the most disease and whether they are resistant to Tamiflu.
But the Public Health Agency of Canada is unlikely to issue across-the-board recommendations, because the drug still works against two other types of flu viruses - the other influenza A subtype, H3N2 as well as influenza B viruses - and because it's unlikely there will be one single pattern of illness across the entire country.
"This season's going to be a little bit more complicated than previous seasons. And I think one is going to have to . . . at the local and provincial level take more of a risk-assessment, risk-management approach based on what strains of flu are circulating," says Dr. John Spika, acting director general of the centre for immunization and respiratory infectious diseases.
"Are they H1N1 predominantly or are they H3N2? And, based on the available information, then decide whether or not it is appropriate to use the oseltamivir or potentially adamantane drugs. And how zanamivir fits in with that as well."
The adamantane drugs are older flu drugs that have their own resistance problem. In early 2006 both the CDC and the Public Health Agency told doctors not to use the drugs when it was found over 90 per cent of H3N2 viruses were resistant to them.
As for Tamiflu and Relenza, neither drug has done remarkably well in the seasonal flu market except in Japan, where Tamiflu is widely used.
So in some ways, the resistance problem isn't likely to have a huge impact on how doctors treat their patients who contract influenza - so long as resistance doesn't also emerge in either or both of H3N2 and influenza B viruses, experts say.
"That's what everybody's holding their breath on," says Dr. Allison McGeer, an influenza expert at Toronto's Mount Sinai Hospital.
"If we see H3N2 resistance at significant levels, that's the catastrophic bridge."
But Roche has sold vast quantities of Tamiflu to governments and corporations for pandemic influenza stockpiles. Discovering the vulnerability of the main drug weapon in pandemic arsenals has unsettled governments, public health officials and flu researchers.
"The bigger issue is loss of confidence overall and how it will shape the stockpiling," says McGeer, who says governments may be less willing to lay in stockpiles when the next generation of flu drugs hit the market for fear the Tamiflu phenomenon will repeat itself.
It is a fact of nature that bacteria and viruses will eventually evolve to become resistant to drugs. But research had suggested that the changes flu viruses would have to undergo to become resistant to Tamiflu would so weaken them that they would lose the capacity to spread from person to person.
Last winter nature delivered a double whammy: Not only had resistance emerged - and emerged in places where it was clear misuse wasn't responsible - but the resistant viruses spread easily.
That demolished the theory that resistant viruses were less biologically fit viruses, at least so far as H1N1 viruses are concerned.
"I am really staggered that this H1N1 virus has been able to spread as it has," says Jennifer McKimm-Breschkin, a flu antiviral expert at Australia's Commonwealth Scientific and Industrial Research Organization and a member of the team that developed Relenza.
McKimm-Breschkin, who receives no royalties from sales of the drug, thinks in light of the resistance problem, public health agencies should be telling doctors to use Relenza this flu season.
"The drugs are expensive. So if you have one drug that you know is effective against all (flu) strains, surely the logical prescribing pattern is to prescribe that drug."
But she thinks officials would be reluctant to issue that kind of recommendation, because of the lion's share position Tamiflu holds in most pandemic drug stockpiles.
"It is a politically sensitive issue because of the stockpiling. And governments don't want to alarm people that the stockpiles may not be useful because the bird flu still remains sensitive," McKimm-Breschkin says, referring to the dangerous H5N1 strain killing poultry and occasionally people in parts of Asia and Africa.
Other experts say the Tamiflu situation doesn't merit the same response as the adamantane drug resistance problem did. For one thing, at least in North America, the Tamiflu resistance rates were lower last winter - 26 per cent in Canada, and 11 per cent in the U.S. And for another thing, H1N1 viruses generally cause milder flu than H3N2 viruses.
Fiori says there is another important distinction between the two situations.
"I think what makes it somewhat different from the adamantane situation of a couple of years ago is that we had a good drug - perhaps even a better drug - in reserve at that point," he says, referring to Tamiflu.
"And we don't at this point. We don't really have that sort of option here."
EISS - Inter-season Electronic Bulletin Week 37 : 08/09/2008-14/09/2008 - 19 September 2008, Issue N° 272 - VERY SPORADIC INFLUENZA ACTIVITY IN EUROPE
Summary: Influenza virus detections occur very sporadically in Europe.
In week 36/2008, there was no detection and in week 37 there was only one detection reported.
Out of 11 countries reporting the geographical spread indicator in week 36-37/2008, 10 countries reported no influenza activity and England reported sporadic activity.
In week 36-37/2008, Out of a total of 137 investigated specimens in Europe only one influenza virus (type A not subtyped) was detected in England from a non-sentinel specimen.
There have been no reports of unusual influenza activity in Europe at a community level (i.e. in a region or local area such as a city, county or district) since week 16/2008.
Background:
The Inter-season Electronic Bulletin presents and comments influenza activity based on virological data reported to EISS.
In weeks 36/2008 and 37/2008, a total of 14 countries reported virological data to EISS.
The Inter-season Electronic Bulletin will be published between week 21/2008 and week 39/2008.
The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS in collaboration with the WHO Collaborating Centre in London (United Kingdom) and the European Centre for Disease Prevention and Control in Stockholm (Sweden).
Graph
The graph presents the total number of specimens positive for influenza A and B viruses in Europe during the inter-season period.
Map
The map presents the geographical spread as assessed by each of the networks in EISS.
A = Dominant virus
AH1N1 = Dominant virus A(H1N1)
H3N2 = Dominant virus A(H3N2)
H1N2 = Dominant virus A(H1N2)
B = Dominant virus B
A & B = Dominant virus A & B
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 populationcomprising 50% or more of the country's population. Laboratory confirmed.
--
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
NZ: SC hit by the flu
South Canterbury | Tuesday, 23 September 2008
SOUTH CANTERBURY has had the highest flu rate in the country according to latest statistics from the Ministry of Health.
For the second week in September, South Canterbury had the highest doctor consultation rate for influenza type symptoms, with 99 people per 50,000 of the population being seen by their doctor.
The second highest was Northland with 97 per 50,000.
The national average for the week was 24 per 50,000.
Overall, Ministry of Health statistics show flu rates were tracking down with the peak an average of 50 per 50,000 recorded in mid August and this had dropped to 24 per 50,000.
Russia may have cold and flu epidemic month earlier than planned – expert
23.09.2008, 20.17
ST. PETERSBURG, September 23 (Itar-Tass) -- A cold and flu epidemic in Russia may start in November because of early frosts, head of the World Health Organization (WHO) National Flu Center Academician Oleg Kiselyov told Itar-Tass on Tuesday.
“The Federal Consumer Rights and Human Well Being Service has forecasted the beginning of the cold and flu epidemic a month later, in December. Everything will depend on the weather,” the expert said. “It is still hard to predict a flu type, but one can be sure we will have no H5N1 avian influenza virus.”
He urged regional medical authorities to intensify cold and flu diagnostic at laboratories and to tighten sanitary control at industrial enterprises and children’s institutions.
The National Flu Center conducts round-the-year epidemiological monitoring in 54 largest cities of Russia and exchanges information with the WHO Geneva headquarters.
In the middle of Week 38 were observed in the micro-biologist, Karolinska University Hospital, Solna the first influenza A case of the season. The sample came from a middle-aged man in the Stockholm region, which has not been abroad in the past month. He had flu-like symptoms. This test is now characterized. There is a similar to the H3N2 strains that have circulated in Sweden during the last two seasons (see Figure 1). Strain similar to that contained in this year's vaccine, H3/Brisbane/190/2007. It is sensitive to neuraminidase inhibitors Tamiflu and Relenza ® ®, however, resistant to amantadine license preparation. Amantadine is not used in Sweden and the resistant H3N2 strains circulating in the world since 2002-2003.
What will this mean for this year's flu season? Since last season (2007-2008) was dominated by influenza B and influenza A/H1N1, it is likely that a larger number of people are naive to H3N2, however, is similar to the strain of the influenza A/H3N2 strains that have circulated the past seasons. On ESWI (European Scientific Working Group on Influenza) conference in Portugal (14-17 September) presented C. Ringholz from NIH, Bethesda that three out of five times that H3N2 has changed more than usual have been after a season dominated by A/H1N1 or B. They had studied the circulating H3N2 strains from 1990. We see no tendency that has caused a significant change. On 22 September, WHO decided that the vaccine strains to be included in the southern hemisphere influenza vaccine for 2009 are included in the vaccine that we use before this season. While this suggests that no new variants of H3N2 has begun to circulate.
/ Maria Break Ting (SMI), Maria Rotzén Östlund (Karolinska, Solna)
Timeline for the emergence of oseltamivir resistant influenza A(H1N1) 2007-8
With the help of its partners (1) ECDC is constructing a time-line of the more significant events and publications surrounding the emergence and dissemination of these viruses. This is very much a work in progress and ECDC welcomes comments and additions which should be sent to influenza@ecdc.europa.eu The Time line which will be update periodically.
Information and data in the time line were provided by the European Influenza Surveillance Scheme http://www.eiss.org/index.cgi and the VIRGIL Project http://www.virgil-net.org/ ECDC would like to thank all countries, virologists, clinicians and others for contributing data.
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
Coming to Britain - the Australian flu virus that has already killed hundreds
By Daniel Martin
Last updated at 10:53 PM on 28th September 2008
A flu virus more deadly than any seen in two decades is threatening Britain.
The strain originates in Australia where it has claimed hundreds of lives, including those of children.
Called Brisbane H3N2, it is so virulent that health chiefs have had to change the make-up of flu vaccines to deal with it.
It affects three times the number of victims hit by other strains, with many deaths resulting from pneumonia.
Viruses from the southern hemisphere strike in their winter months - our summer - and tend to travel north for our winter.
And although that did not happen after Brisbane H3N2 ravaged Australia last year, experts fear Europe will not escape it this winter.
Hugh Pennington, professor of bacteriology at Aberdeen University, said: 'If this flu has been busy in Australia, it is reasonable to suppose that we may get a similar situation in the UK. Viruses travel round the world very quickly now.
We have had some very quiet flu years recently and every year we have to assume that it will be busier than last year.
'Sooner or later we will have a big outbreak, and the more cases there are, the more deaths there will be.
'There is no doubt that elderly people are more at risk. It can tear through an old folk's home and cause a lot of harm.'
The last major outbreak in England and Wales came in 1989-90, when 23,046 people died, compared with a seasonal average of around 4,000. The elderly are those most at risk because they have weaker immune systems.
The Australian flu outbreak affected even fit young adults, and New South Wales saw more than 800 deaths from pneumonia in just five weeks in June and July 2007. Many children died.
Experts speculated that several winters of mild flu had left the population with little immunity. Last year the Australian inventor of the flu vaccine, Dr Graeme Laver, said the outbreak in his country meant Britain was also in danger. 'If the seasonal flu is as bad as it was in Australia, you are in for a pretty bad time,' he said.
'You could have a really severe epidemic. Thousands will be ill and many will die.'
The World Health Organisation and Sanofi Pasteur, a vaccine manufacturer, have combined the Brisbane strain with two others, one also named after the city, in their latest flu vaccine.
This summary provides an updated report of seasonal influenza activity for weeks 37-38.
It does not include reports of avian influenza in humans, which are available at the avian influenza page.
Seasonal influenza activity in the world, weeks 37-38 (as of 29 September 2008)
During the weeks 37-38, overall influenza activity in the southern hemisphere declined, except for New Zealand, where a widespread outbreak was reported.
Activity was low in the rest of the world.
* China, Hong Kong Special Administrative Region.
A decline in the activity of influenza A(H3) and A(H1) viruses was observed, with influenza A(H3) still predominating. Both B/Yamagata and B/Victoria lineage viruses were detected.
* New Zealand.
Influenza activity remained widespread with influenza B viruses predominating and A(H3) co-circulating.
Between weeks 37 to 38, sporadic influenza activity was detected in Argentina (A,B), Canada (B), Chile (B) and the United Kingdom (A).
Belgium, Cameroon, Germany, the Islamic Republic of Iran, Kyrgyzstan, Mongolia, Oman, Paraguay, Poland, Slovenia, Sri Lanka and Switzerland reported no influenza activity.
--
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
[Some excerpts from this week ECDC Influenza News. See bottom of the post for link to the ECDC website page.]
* Seasonal influenza vaccination for health care workers
Facing the challenges of influenza in healthcare settings: The ethical rationale for mandatory seasonal influenza vaccination and its implications for future pandemics.
Tilburt J.C. at alVaccine, Volume 26, Supplement 4, 12 September 2008
Description: This article whose lead author is a well-respected ethicist considers the ethical issues around encouraging or requiring health care workers (HCWs) to be immunised pointing out how despite the reality of nosocomial transmission of influenza both to and from HCWs most efforts at voluntary vaccination, healthcare institutions have failed to achieve sustained high-level annual vaccination rates.
The article considers the basic principles of biomedical ethics in which welfare concerns outweigh concerns about autonomy. After considering the ‘pros’ and ‘cons’ it argues that healthcare institutions have an obligation to achieve adequate vaccination rates including, if necessary, even mandatory or conditional vaccination. It also discusses the practical implications of these arguments and mentions the potential that such policies have for future pandemic preparedness.
ECDC Comment: (02/10/08)
It is interesting considering this article in the light of the effort and experience in Germany mentioned below . Health care workers are at risk of acquiring influenza infection or passing it onto their patients and there is good evidence from a randomised trial at least that in the residential setting immunisation of staff saves lives.(1,2)
At a recent discussion on this topic with Prof Tilburt at the ESWI meeting in Portugal the situation for flu was contrasted with that for Tb and Hepatitis B. A majority of that audience (admittedly all people interested in influenza) considered that annual influenza immunisation should be made conditional (not mandatory) for HCWs – that is they should be expected to be immunised by their employers unless they came up with a reason by not.
1) Hayward, A.C., et al., Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ, 2006. 333(7581): p. 1241
2) Carman, W.F., et al., Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet, 2000. 355(9198): p. 93-7.
* Public Health Developments - P.H. DEVELOPMENTS – SEASONAL INFLUENZA - VACCINES
Start of influenza surveillance season – How Severe will the Coming Season be? Questions and Answers
In ‘temperate climates’ – like Europe while there is a low level of influenza transmission all the time the epidemics occur in the winter. The exact timing varies from year to year. In recent years the epidemics have started later than in earlier decades.
Last season for example did not start until just about the time of the New Year (see Eurosurveillance Article) .
This week is the start of the Influenza Surveillance Season which runs each year from Week 40 of one season to Week 20 of the next. This is a time when the EISS network is reporting weekly on the EISS web-site and in summary in ECDC’s Influenza News
This year there has been some unfounded rumours that the coming season will be especially severe. ECDC can find no basis for this rumour apart from the truism that you never know what the coming season will be like.
However some Q & As have been constructed to respond to the questions we and national authorities are being asked
Comment to influenza@ecdc.europa.eu
National campaign on immunization against influenza “A step ahead of the flu” in Germany – Targeting health care workers
Description:
The Robert Koch-Institute (RKI) in cooperation with the Federal Centre for Health Education (BZgA) has organised an on-going influenza immunization campaign “Ich komme der Grippe zuvor.” (“A step ahead of the flu.”).
The campaign is financed by the German Federal Ministry of Health.
The Starting in autumn 2006 using a ‘multiplier approach’ and supported by the German Medical Association, posters and flyers for patients were sent to all doctors giving vaccines in Germany (approximately 55,000 doctors).
Additionally in 2007/8 particular material for Health Care Workers was developed and sent to all hospitals (~2000) and Long Term Care Facilities (LTCFs~7300) in Germany in season 2007/08. After the 2007/8 influenza season telephone interviews of a representative sample of the target groups: doctors in practice, hospitals and LTCF were conducted to evaluate the campaign.
The evaluation showed good acceptance and use of the distributed materials and further need for support of local activities of physicians in practice. For evaluation of the activities in institutions, the persons in charge of medical services of the hospitals (n=200) and LTCF (n=500) were interviewed.
The interviews suggested only a moderate and non statistically significant increase of the average immunization rate of eligible staff in hospitals from 17.5% to 22.2% after the intervention in 2007/08.
To boost these low immunizations rates in hospitals the campaign has put a special focus on HCWs in season 2008/09. International experience, the evaluation of the campaign and a workshop conducted in 2007 with occupational physicians suggested the importance of multifaceted approaches to increase vaccination coverage in the hospital setting. Free and easy availability of immunization, extensive education and promotion combined with incentives along with the involvement and dedication of local actors seem to be the keys for successful interventions.
The national campaign of RKI and BZgA supports local activities by providing tailored posters and booklets, a CD with flash animation on influenza, a presentation for in-house education, text modules for local media work and a ‘good practice’ example of a successful intervention. Cups with the slogan of the campaign and a raffle with book gift vouchers for HCW are used as incentives to increase the motivation to get a flu shot.
Additionally a ‘good practice’ contest of successful interventions in participating hospitals will be conducted in cooperation with eleven Federal States and the German Hospital Association. The winning interventions will be considered as potential models for successful approaches in the following years. To increase the vaccination coverage of HCW and other influenza risk groups, it is important to secure the sustainability of the campaign.
To profit from the experiences of other European countries it is important to exchange materials and lessons learned from other successful campaigns on influenza prevention and immunization. The used material of the campaign in German can be ordered and downloaded from the website of the BZgA(www.bzga.de/:influenza).
International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.
This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007). The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union. The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009. A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting.
* European Scientific Conference on Applied Infectious Disease Epidemiology, Berlin 19-21 November 2008.
The second annual European Scientific Conference on Applied Infectious Disease Epidemiology – ESCAIDE – is fast approaching. The event is being held in Berlin from 19-21 November, and over 500 health experts from across Europe and beyond are expected to come together to share scientific knowledge and experience on all areas related to infectious disease epidemiology.It is possible to register for the conference for a reduced fee of 100 Euros- the deadline for early registration is 1st October. It is also still possible to submit a ‘late breaker abstract’ to the conference- the deadline for submission is 29th September.
Details of the full conference programme, participant registration, and abstract submission can be found on the ESCAIDE website
--
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
EISS - Inter-season Electronic Bulletin - Week 39 : 22/09/2008-28/09/2008 - 03 October 2008, Issue N. 273 - SPORADIC INFLUENZA ACTIVITY IN EUROPE
Summary:
Influenza virus detections occur very sporadically in Europe.
In week 38/2008, there were two detections and in week 39 there were nine detections reported.
Out of nine countries reporting the geographical spread indicator in week 38-39/2008, all reported no influenza activityIn weeks 38-39/2008, 11 influenza viruses were detected in Europe out of a total of 244 investigated specimens: one influenza A not subtyped virus each in Poland, Spain, Switzerland and Sweden, respectively, and four in England.
One type A(H3) in Germany, one type A(H3N2) and one type B in Sweden.
All detections were from non-sentinel specimens.
As usual for this time of the year, a number of the influenza cases are travellers who have been abroad.
There have been no reports of unusual influenza activity in Europe at community level (i.e. in a region or local area such as a city, county or district) since week 16/2008.
Background:
The Inter-season Electronic Bulletin presents and comments influenza activity based on virological data reported to EISS.
In weeks 38/2008 and 39/2008, a total of 16 countries reported virological data to EISS.
The Inter-season Electronic Bulletin will be published between week 21/2008 and week 39/2008.
The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS in collaboration with the WHO Collaborating Centre in London (United Kingdom) and the European Centre for Disease Prevention and Control in Stockholm (Sweden).
Graph
The graph presents the total number of specimens positive for influenza A and B viruses in Europe during the inter-season period.
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
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 populationcomprising 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) * Sweden - The patient with Influenza A has been in London, the Influenza B patient in Senegal.
--
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
BAHRAIN is coughing and sneezing its way out of the summer, with an outbreak of flu and cold bugs as the weather changes. More people are reporting flu and cold symptoms at health centres, says health education director Dr Amal Al Jowder.
"There is a drastic increase in the number of cases being reported. This is mainly because people are exposed to the 'different' weather conditions during the day and at night.
"It is still hot during the day, with dusty winds, as we experience the last few days of summer," she said.
The "unstable" weather leads people to being exposed to sudden heat and cold.
The weather, which varies several times during the day, is "ideal" for the viruses to thrive, said Dr Al Jowder.
"Under such weather conditions it is important to maintain personal hygiene to avoid viral infection.
"People should also maintain a healthy lifestyle, particularly now, to boost immunity because those with even slightly weak immune systems fall prey to a cold or even flu."
Dr Al Jowder said that victims in only a few cases of flu caused by viral infections, suffered from complications and needed prolonged treatment with antibiotics.
"In some cases, patients have to be referred to Salmaniya Medical Complex," she said.
"Proper rest, steam inhalation, drinking lots of water and other fluids and a cold water sponge are highly recommended."
Dr Al Jowder said that the most common complaint at the moment was sore throat and the onset of symptoms was mostly sudden.
"The common symptoms are headache, sore throat, fatigue, fever, sneezing and a running nose.
"But if the person is suffering from uncontrollable coughing and his or her sputum is green, yellow or black, earache, difficulty in breathing and muscle rigidness, they need immediate consultation.
"The infection is easily passed from one person to another by coughing and sneezing. It attacks the respiratory tract - nose, throat, and lungs."
It is usually "very unpleasant", but in most cases, symptoms get better after seven to 10 days.
"The infection rate is highest amongst children, but the rate of serious illness and sometimes death are highest among people aged 65 years and above."
Success and problems with live (non-injected) nasal vaccines for seasonal vaccines in young children
Safety and efficacy of live attenuated influenza vaccine in children 2-7 years of age. R.B. Belshe, C.S Ambrose and T.Yi
Description:
This publication summarises the results of three trials of the new live attenuated influenza vaccines (LAIV) given nasally to young children. Two are controlled studies versus placebo and one is a trial comparing LAIV against conventional injected trivalent inactivated influenza vaccine (TIV). The publication pays particular attention to analyses the safety and efficacy of LAIV in the children of 2 years of age and older as this the age group for which LAIVs have been licensed.
In the two placebo trials there was good efficacy demonstrated compared with placebo in children aged 2–7 years in seasons with matched strains, (69.2% [95% CI: 52.7, 80.4] and 94.6% [95% CI: 88.6, 97.5]).
When compared with TIV recipients, children who had LAIV recipients and aged 2–5 years had about 50% fewer cases of confirmed influenza illness and this difference was statistically significant. In the children of two years and older the only adverse reactions noted were minor runny nose, nasal congestion and some low-grade fever.
However the trials also involved children under age 2 and here problems arose.
In the trial against injectable vaccines the LAIVs were associated with an excess of hospitalizations (for a variety of reasons) and medically significant wheezing were increased in children 6–11 and 6–23 months of age who received LAIV, respectively (compared to those receiving the injected vaccine). No such effect was seen in the older children.
ECDC Comment: (09/10/08)
Children have many immunisations by injection in their first two years of life. Injecting a baby may not be a pleasant experience for baby, parent or the injector. Therefore the live nasal vaccines have been considered a very attractive prospect by those recommending influenza vaccination in children. The unexpected finding of an increase in hospitalisations for non-specific reasons has therefore been a considerable disappointment.
The finding of significant wheezing following an oral live vaccine is not so unexpected.
The set-back is especially unfortunate in that it’s the youngest children under age 3 (and those with other chronic diseases) that seem to be those most needing influenza immunisation as they are the age group in children at highest risk of experiencing severe disease in at least one European country(1) and in North America.(2)
1. Heikkinen T, Silvennoinen H, Peltola V et al Burden of influenza in children in the community. JID 2004; 190: 1369-1973.
2. Glezen WP, Taber LH, Frank AL, Gruber WC, Piedra PA. Influenza virus infections in infants. Pediatr Inf Dis J, 1997; 16: 1065-8.
3. Fiore, AE, Shay DK, Haber P, Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR Recomm Rep, 2007. 56(RR-6): p. 1-54.
* Recent trends in vaccine coverage in the elderly in France, Germany, Italy, Spain and the UK 2001/2 to 2006/7
Influenza vaccination coverage rates in five European countries during season 2006/07 and trends over six consecutive seasons. Blank P.R. Schwenkglenks M, Szucs TD. BMC Public Health. 2008 Aug 1;8:272. http://www.biomedcentral.com/1471-2458/8/272
Description:
This article from the group that has been undertaking consumer surveys in EU countries since 2001/2 describes their experience over the six year period in the five countries where the work has been longest running. The work is supported by industry but is undertaken by a highly regarded University group and appears in peer-reviewed publications. The surveys were undertaken by applying a standard questionnaire telephoning the public (apart from in France where questionnaires are mailed).
Unlike systems using administrative methods (returns from health services) this approach allows the investigators to also ask about attitudes to immunisation and the main sources of advice. Looking at overall coverage in the population the surveys found that in 2006/7 the coverage was between 22% and 25% with a slight overall upward trend from 2001/2 onwards.
However in the most numerous ‘risk group’ – older people - there were no significant trends – uptake seems to have plateaued in these countries above the World Health Assembly target of 50% by 2006 but below that of 75% by 2010.(1)
Rates of immunisation among those with chronic illness (which only started to be measured in 2003/4) were lower than for the elderly with the highest rates in 2006/7 in the UK and the lowest in Germany.
Being both elderly and having a chronic illness increased the likelihood of being immunised in all four countries.
The most commonly cited reason for getting immunised was the recommendation of the health care provider. Immunisation uptake among health care workers was also investigated and found to be low and not increasing except in France. In 2006/7 it ranged from 12% in Italy to 22% in Germany.
ECDC Comment: (09/10/08)
There is a wealth of data in these surveys and the results are most interesting. For example the finding that being older and having a chronic illness boosts the likelihood of being immunised must have implications for interpretation of observational studies of vaccine effectiveness in the older people. It means people being immunised already have an expectation of ill-heath and so vaccine effectiveness in preventing severe illness in these countries at least will tend to be immunised. Also there is notable peak in the proportion of the population immunised in season 2005/6 across all countries, perhaps associated with the concern that season over ‘bird flu’ in the media and hence the general population (the effect is hardly there in older people).
It is also ironic that though health workers are cited as the most powerful source of positive advice and encouragement by those being immunised many of these health workers seem to lack enthusiasm themselves in being vaccinated.
However a difficulty is the validity of the values for vaccine coverage. Some are at variance with national figures. For example the cited figure from this work for the UK coverage in older people (over age 64 years) in 2006/7 season is around 65% while the official figures from that country reported by the national authorities to the VENICE survey and using administrative returns was 74%.(2) The confidence intervals overlap, but only just. There have been one publication comparing the results of the two systems in the UK and finding they correlated well but that does not look the case here.(3) Also would the results be put forward for publication if they did not agree.
Probably more attention should be paid to the trends rather than the absolute values but it is useful to have another figure apart from the official returns as when the two agree we have greater confidence in the official findings and when they differ it is a trigger to looking at both systems. It is therefore saddening to learn that these valuable surveys may have to cease because of funding coming to an end.
1. Resolution of the World Health Assembly 56th Assembly WHA 56.19 Agenda Item 14.14 Prevention and Control of Influenza Pandemics and Annual Epidemics May 28th 2003 http://www.who.int/gb/ebwha/pdf_files/WHA56/ea56r19.pdf
2. VENICE & ECDC Project National seasonal influenza vaccination survey in Europe 2007. (in press will be posted on VENICE web site http://venice.cineca.org/
2. Muller D, Nguyen-Van-Tam JS, Szucs TD: Influenza vaccination coverage rates in the UK: a comparison of two monitoring methods during the 2002–2003 and 2003–2004 seasons. Public health 2006, 120(11):1074-1080
* Public Health Developments - P.H. DEVELOPMENTS – PANDEMIC INFLUENZA - PREPAREDNESS
The UK Health Department, Scientific Pandemic Influenza Sub-Group on Modelling update to their Modelling Summary document.
Description:
The UK Department of Health in London convenes a group of modellers chaired by Dr Peter Grove that have a particular interest in influenza and these come to an evidence-based agreement on how they would expect a pandemic would behave.
This is the source of the UK’s pandemic planning assumptions. The group’s advice is based on both the available evidence from prior pandemics and modelling work. For some time the Department of Health has been publishing at intervals summary papers which not only contains statements of what might happen but also the group’s view of the policy implications. This takes the form of notes on ‘What we can do now’ and ‘Policy questions’.
The factors such as practicality, proportionality and questions of value for money are outside the remit of the sub-group and that is not cover in the particular document. The Department of Health has recently issued their most recent modelling Summary document and that can be found on the DH website.
Topics covered in the document include how the pandemic is likely to spread in the UK, the national and local pandemic profile, and its more likely impact on the population, as well as the expected effectiveness of pharmaceutical and non-pharmaceutical countermeasures.
ECDC would be interested to learn of other similar initiatives by authorities in Europe, especially if they are in the public domain.
* P.H. DEVELOPMENTS – INFLUENZA
Influenza Vaccination - new section on the ECDC web-site and Publication of VENICE project results on Seasonal Influenza Coverage in the Elderly for the EU/EEA member States
The area dealing with influenza on the ECDC web-site has up to now been divided into three Avian Influenza, Pandemic Influenza and Seasonal Influenza each leading onto ECDC publications, Questions and Answers, Fact Sheets. From this week there will be a fourth section Influenza Vaccination through which it is possible to find ECDC’s scientific opinion on seasonal influenza risk groups, its guidance on human avian influenza ‘pre-pandemic’ vaccines and lists of all the scientific and public health developments relating to influenza vaccination featured in influenza news.
This development coincides with publication of the results of the VENICE Project’s 2007-8 survey on coverage of seasonal influenza vaccine coverage in older people in Europe as a Rapid Communication in Eurosurveillance and a publication of a press release from ECDC emphasising the importance of seasonal influenza immunisation programmes which are underway at present in most Member States and announcing the start of weekly surveillance through the EISS system.
* P.H. DEVELOPMENTS –AVIAN INFLUENZA-INNOVATIONS
One Health – an initiative which designed to unite human and veterinary medicine concerning Zoonoses
Description:
With the beginning of October new “One Health” website was launched. One Health is a concept mostly from the veterinary world with particular relevance to zoonoses (animal infections that can infect and affect humans) including avian influenza. The developers envision this website as a method of providing worldwide ‘One Health’ Initiative information for the general public, political and governmental leaders, news media and all ‘One Health’ professionals, advocates and supporters. The 'One Health Newsletter' and its links will be prominently featured on the site as a major 'One Health' international educational publication. In addition, there will be links to the American Veterinary Medical Association 'One Health' task force recommendations published in the Journal of the AVMA (JAVMA) and other pertinent 'One Health' publications. The website is a first part of One Health concept which is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans and animals.
ECDC comment:
The development and launch of this site is associated with the forthcoming International Ministerial Conference on Avian and Pandemic Influenza in Sharm el-Sheikh, Egypt. Avian influenza is the most eye-catching zoonosis at present but of course there are many others such as rabies, some of the viral haemorrhagic fevers and many food borne infections (salmonella, campylobacter spp etc.) Cooperation has been especially strong over avian influenza and it will be interesting to see how this is captured in the One Health concept. To date most of the support for this has come from the veterinary world and it now needs to be picked up also by the medical specialists if it is to have enduring value. To visit the One health Website click here: http://www.onehealthinitiative.com
* Meetings and workshops
International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.
This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007). The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008. The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union. The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009. A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting. Its last report is available at http://www.undg.org/docs/8097/12-18-...port-final.doc A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/
Retroscreen Virology Conference - Medical, Scientific and Historical Lessons from the Great Avian (H1N1) "Spanish" Influenza Pandemic of 1918:
The 90th Anniversary 10th November 2008 at The Imperial War Museum - London
This conference specifically considers the first World War and the start of the Spanish Influenza pandemic. Specifically did the war itself engender the emergence of this avian influenza A(H1N1)? Are there serious lessons from that pandemic to help today as we prepare for 21st century pandemics?Details are at http://www.retroscreen.com/rv/news/r...08/2008-09-08/
--
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
EISS - Weekly Electronic Bulletin Week 40 : 29/09/2008-05/10/2008 10 October 2008, Issue N° 274 Low levels of influenza activity in Europe as influenza surveillance season starts
Summary:
Levels of influenza activity in Europe are currently low, and all countries reporting no or only sporadic influenza activity this week.
There have been sporadic laboratory confirmed cases of influenza across Europe in the past four weeks.
Epidemiological situation - week 40/2008:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all of the 21 countries providing these data.
For the geographical spread indicator, sporadic influenza activity was reported in Norway and Sweden and no activity in 20 countries.
Virological situation - week 40/2008:
The total number of respiratory specimens collected by sentinel physicians in week 40/2008 was 105, of which one was influenza virus positive (type A not subtyped in Spain).
Comment:
There have only been sporadic laboratory confirmed cases of influenza reported to EISS in the last month. A number of these cases were reported to be infections acquired outside of Europe (e.g. a person returning from holiday in Africa). Therefore it is currently too early to say which virus type or subtype will become dominant in Europe this season.
Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. In week 40/2008, 22 countries reported clinical data and 24 countries reported virological data to EISS. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the coordination of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (United Kingdom).
Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
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 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 populationcomprising 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 onepercent of the Finnish population).
Network comments (where available) * Latvia
No influenza activity in Latvia. Local outbreaks of ARI due to parainfluenza 3 virus circulation * Switzerland
No influenza activity was observed
--
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 Centers for Disease Control and Prevention’s (CDC) Influenza Division collects and analyzes surveillance data year-round and produces a weekly report on U.S. influenza activity from October through May. The U.S. influenza surveillance system consists of information in five different categories collected from nine different data sources.
The five categories of influenza surveillance consist of:
Viral Surveillance: U.S. World Health Organization (WHO) collaborating laboratories, the National Respiratory and Enteric Virus Surveillance System (NREVSS), and novel influenza A virus case reporting;
Outpatient Illness Surveillance: US Outpatient Influenza-like Illness Surveillance Network;
Mortality: 122-Cities Mortality Reporting System and influenza-associated pediatric mortality;
Hospitalizations: Emerging Infections Program and the New Vaccine Surveillance Network; and,
Summary of geographic spread of influenza: state and territorial epidemiologists’ reports.
From week 21 through week 39 (weeks ending May 18 – September 27), WHO and NREVSS laboratories located in all 50 states and Washington DC tested 25,031 specimens for influenza and 179 (0.7%) were positive. Influenza positive tests were reported from all nine public health surveillance regions during the summer. Of the positive results, 6 (3.4%) were influenza A (H1) viruses, 21 (11.7%) were influenza A (H3) viruses, 80 (44.7%) were influenza A viruses that were not subtyped, and 72 (40.2%) were influenza B viruses. More than half (63%) of these isolates were tested from mid-May through late July. Of the 40 influenza viruses reported during September (weeks 36-39), one (2.5%) was an influenza A (H1) virus, four (10.0%) were influenza A (H3) viruses, 29 (72.5%) were influenza A viruses that were not subtyped, and six (15.0%) were influenza B viruses.
Since September 30, 2007, WHO and NREVSS laboratories have tested a total of 218,493 specimens for influenza viruses and 39,407 (18.0%) were positive. Among the 39,407 influenza viruses, 28,091 (71.3%) were influenza A viruses and 11,316 (28.7%) were influenza B viruses. Eight thousand two hundred seventy-two (29.4%) of the 28,091 influenza A viruses have been subtyped: 2,173 (26.3%) were influenza A (H1) viruses and 6,099 (73.7%) were influenza A (H3) viruses.
During week 40, WHO and NREVSS laboratories reported 1,123 specimens tested for influenza viruses, eight of which were positive: five influenza A viruses that were not subtyped (Mountain, Pacific, South Atlantic and West South Central regions) and three influenza B virus (Mountain and South Atlantic regions).
A small number of isolates were available for antigenic characterization during the summer. CDC antigenically characterized six isolates collected from May 18 – September 27, including four influenza A (H1), one influenza A (H3), and one influenza B viruses. All six viruses are antigenically similar to the components selected for the 2008-09 influenza vaccine (A/Brisbane/59/2007-like (H1N1), A/Brisbane/10/2007-like (H3N2), and B/Florida/04/2006-like). Novel Influenza A Viruses:
No novel influenza A virus infections were reported during the summer of 2008 or for week 40. Antiviral Resistance:
In the United States, two groups of antiviral drugs have been approved by FDA for use in treating or preventing influenza virus infections. These two groups of antiviral drugs are: neuraminidase inhibitors (oseltamivir and zanamivir) and adamantanes (amantadine and rimantadine). A description of these drugs can be found at: http://www.cdc.gov/flu/protect/antiviral/index.htm.
A small number of isolates collected since May 18 were sent to CDC for antiviral resistance testing during the summer.
Neuraminidase Inhibitor Antiviral Drugs: CDC performed antiviral resistance testing on 10 influenza A and B viruses collected since May 18. Two of the six influenza A (H1N1) viruses tested were found to be resistant to oseltamivir. No oseltamivir resistance has been detected in influenza A (H3N2) or influenza B viruses, and all tested viruses retain their sensitivity to zanamivir. Additional information on antiviral resistance can be found at: http://www.cdc.gov/flu/about/qa/antiviralresistance.htm Adamantane Antiviral Drugs:Six influenza A viruses collected since May 18 have been tested for adamantane resistance. The one influenza A (H3N2) virus tested and one of the five influenza A (H1N1) viruses tested were resistant to the adamantanes. The adamantanes are not effective against influenza B viruses.
Based on the level of oseltamivir resistance observed in only one influenza subtype, H1N1, and the persisting high levels of resistance to the adamantanes in H3N2 viruses, CDC continues to recommend the use of oseltamivir and zanamivir for the treatment or prevention of influenza. Use of amantadine or rimantadine is not recommended. Guidance on influenza antiviral use can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm
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). EIP and NVSN estimated rates of hospitalization for influenza will be reported every two weeks starting later this season. Outpatient Illness Surveillance:
During week 40, 0.8% of patient visits reported through the US Outpatient Influenza-like Illness Surveillance Network (ILINet), formally known as the US Influenza Sentinel Provider Surveillance Network, 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 0.3% to 1.6%. All nine regions reported percentages of visits for ILI below their respective region-specific baselines.
During week 40 the following influenza activity was reported:
Sporadic activity was reported in seven states (California, Connecticut, Florida, Hawaii, Idaho, New York, and Wyoming).
No influenza activity was reported in 41states (Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Wisconsin, and West Virginia) and the District of Columbia.
Two states (Montana and Washington) did not report.
--------------------------------------------------------------------------------
A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
>>>Six influenza A viruses collected since May 18 have been tested for adamantane resistance. The one influenza A (H3N2) virus tested and one of the five influenza A (H1N1) viruses tested were resistant to the adamantanes. <<<
The presence of anamtadine resistance (S31N) in one of the H1N1 isolates suggest clade 2C is also present in the isolates from the summer, which is not reflected in the antigenic analysis, which only found clade 2B.
Guam: GMH notes increase in admissions of flu-related ailments
By Beau Hodai • Pacific Daily News • October 15, 2008
Last week, GMH Nursing Supervisor Julietta Quinene said she has seen a marked increase in recent weeks of admissions to the hospital for respiratory problems and other symptoms linked to the flu.
Yesterday, she said she has seen the trend continue.
"We had a lot of kids, not just adults," said Quinene. "Over the weekend, we didn't have enough pediatric beds -- parents were getting angry."
Quinene said that about 80 percent of admissions she's seen over the past week have been for respiratory ailments, such as bronchitis, pneumonia and fever -- all of which she said could be attributed to the flu.
She said in the 24 hours that elapsed between last Tuesday and Wednesday, the hospital took in 33 pediatric patients suffering from respiratory ailments, one of which had to be placed on life support.
During the same period, the hospital admitted eight adults for respiratory ailments, four of whom had to be placed on life support.
Quinene said the flu season usually sets in about the time kids return to school in early August. Quinene said that she has definitely seen an increase in respiratory hospital admissions this year over last year.
Information provided in the Guam Epidemiology Newsletter, provided by the Department of Public Health and Social Services' Office of Epidemiology and Research, shows cases of acute respiratory infections increase around mid-August and level off in late October.
Linda Unpingco,[/] health services administrator at the Public Health's northern and southern clinics, said she has seen a recent increase in patients with flu-related symptoms coming into the clinics, most of whom are children.[/b]
The clinic hasn't yet received any flu vaccines, Unpingco said, though she said she expects them sometime this month.
Unpingco suggested that people use preventive measures to ensure that they do not catch the flu.
"When you sneeze or cough, cover your mouth -- basic cough etiquette," said Unpingco. "Also, wash your hands and dispose of your tissues properly."
Several people are in isolation in Shepparton's public hospital because of an outbreak of gastroenteritis.
Fifteen people have been treated at the hospital for vomiting and diarrhoea in the past 24 hours.
Another six people at the Ave Maria nursing home are also sick.
Goulburn Valley Health CEO Greg Pullen says they are trying to prevent the virus from spreading.
"There are some patients that are kept in isolation on the medical ward, some on the rehabilitation ward," he said.
"We have to limit access to them unfortunately. We try and ensure that the chance of it spreading is completely reduced, but we can't always do that of course, it's a quite spreadable sort of disease."
-- Glycan microarray technologies – a tool which can facilitate mapping of the coarse and fine specificity of previous, current and emerging influenza viruses.
- Recent avian H5N1 viruses exhibit increased propensity for acquiring human receptor specificity. J. Stevens et al - Journal of Molecular Biology 2008 Sep 19;381(5) [URL: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WK7-4S85DTV-3&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=7b4dea057afc07d0f2103783e9e35c82 ] - Glycan microarray technologies: tools to survey host specificity of influenza viruses. J. Stevens, O. Blixt at al - Nature Reviews Microbiology 4, 857-864 (November 2006) [URL: http://www.nature.com/nrmicro/journal/v4/n11/abs/nrmicro1530.html ]
Description:
These two articles between them describe the theory and application of a set of laboratory techniques, Glycan Microarray Technologies, that has been developed to objectively measure the specificity of influenza viruses to bind to host surface receptors in the human respiratory tract.
The technique is described in the 2006 article and then applied in the 2008 article to avian influenza A(H5N1) viruses of clade 2.2 when the mutations that seemed to make the 1957 and 1968 pandemics gain human receptor specificity are inserted into them.
The authors suggest that this makes the widely spread A(H5N1) – clade 2.2 influenza strains at higher risk of acquiring an affinity for human receptors than other avian influenza viruses.
ECDC Comment: (16/10/08)
With novel avian influenza viruses, viruses that are essentially transmitting among birds, it is difficult to decide whether or not they are likely to be able to adapt to humans. With A(H5N1) in its current form plainly it has not yet reached that stage in that despite much exposure to humans it has failed to infect them often and transmission from human to humans is even rarer.1
However the difficulty is that one has to have good surveillance to detect a change towards better adaptation to humans and that after the change has happened it is essentially too late to intervene. This technique is one that give an important objective laboratory information as to whether any new avian influenza viruses has moved or (if previous strains are available) is moving closer to being adapted to humans.
However like all laboratory based test it is only a demonstration of human adaptation, not the entire step.
1. ECDC The public health risk from highly pathogenic avian influenza viruses emerging in Europe with specific reference to influenza type A/H5N1 June 1st 2006.
* Public Health Developments - P.H. DEVELOPMENTS – PANDEMIC INFLUENZA- PREPAREDNESS
-- Draft WHO Guidance on Pandemic Influenza Preparedness and Response – Core Document - Opportunity for Comment October 15th to November 3rd
For nearly the past 12 months WHO has being reviewing and revising its guidance on planning essentially updating its 2005 pandemic planning guidance.
They have now made available for comment through the internet what is to be regarded as the core document to be published later this year.
This draft guidance is available through the WHO web-site through with a rather cumbersome procedure as those wishing to see the guidance have to fist register and make a declaration before getting access to the document.
The deadline for comment is also tight as all comments have to be in before the end of November 3rd.
There are good reasons for updating the guidance since the last planning document and its accompanying Check List were published.
* Extensive experience has been gained from the pandemic planning process in Europe and elsewhere.
* There has also been much practice in responding to avian influenza outbreaks, some involving human cases in many countries.
* Influenza science has moved on including use of vaccines and antivirals which were hardly mentioned in 2005.
* Pandemic planning has moved out from the health care sector to embrace many other sectors.
Finally the 2005 International Health Regulations have come into force in 2007 providing a major step forward in efforts by the international community to address international public health concerns.
The process of revision has been rapid but detailed and comprehensive with strong involvement of European experts though this is the first consultation open to all countries and the public.
The process and progress was described by WHO in July 2008 through its web-site. It is important to appreciate that the document available now is only the core document and after it will be published a folio of supporting technical document and ‘tools’ on issues like outbreak communication, on-health sector preparedness, a revised check-list and sample preparedness plans etc.
-- WHO guidelines for emergency health interventions in community settings
Description:
In response to demand from humanitarian agencies for guidance on reducing excess mortality from common illnesses during an influenza pandemic, the WHO in collaboration with external partners has developed practical and simplified recommendations on measures that can be implemented by community-based responders to complement national Pandemic Preparedness Plans.
The two main objectives of document are:
* To provide strategies for prevention and treatment, at the community and household levels, of the most likely contributors to mortality from common illnesses during an influenza pandemic.
* To provide recommendations to support a minimum level of continuity for priority public health programmes during a pandemic.
These WHO guidelines “Reducing excess mortality from common illnesses during an influenza pandemic “ can be found at:http://www.who.int/diseasecontrol_emergencies/common_illnesses2008_6.pdf
-- Simulation Exercises on Influenza Pandemic Responses in the Asia Pacific Region
Description:
The UN System Influenza Coordination (UNSIC) Asia-Pacific Regional Hub has released a compilation of simulation exercises conducted by countries to prepare for a human influenza pandemic. It has done so in collaboration with Asian Disaster Preparedness Center and the Kenan Institute Asia with contributions of more than 50 writing team members.
This booklet is a compendium of a number of simulation exercises that have been used to test pandemic preparedness and response plans in different countries and by various organizations in the Asia-Pacifi*c region.
Moreover the document provides a brief discussion on the rationale for conducting simulation exercises, different types of exercises that may be pursued, and factors that may influence the selection of types of simulation exercises.
ECDC Comment:
The last two significant pandemics have emerged from the Asia-Pacific Region as has avian influenza A(H5N1) and the most recent A(H3N2) variants. Therefore this part of the world is the most likely area for the emergence of the next pandemic and the place where WHO’s rapid containment strategy.
-- An attempt to stifle and capture a putative influenza virus
The booklet can be downloaded at:http://www.un-influenza.org/files/asia_pacific/temp/unsic_pandemic_complete.pdf
* Meetings and workshops
-- International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.
This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007). The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.
The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union.
The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009.
A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting. Its last report is available at http://www.undg.org/docs/8097/12-18-07-UN-WB-AHI-Progress-Report-final.doc
A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/
--
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
EISS - Weekly Electronic Bulletin Week 41 : 06/10/2008-12/10/2008 - 17 October 2008, Issue N. 275 - Continuing low levels of influenza activity in Europe
§ Summary:
Levels of influenza activity in Europe are low, with all countries reporting no or only sporadic influenza activity in week 41/2008.
There have been sporadic laboratory confirmed cases of influenza in weeks 40-41/2008: 12 cases of influenza A and one case of influenza B.
§ Epidemiological situation - week 41/2008:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all of the 26 countries providing these data. For the geographical spread indicator, sporadic influenza activity was reported in two countries (England and Sweden) and no activity in 24 countries.
§ Cumulative epidemiological situation - 2008-2009 season (since week 40/2008):
So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (e.g. below the national baseline threshold).
§ Virological situation - week 41/2008:
The total number of respiratory specimens collected by sentinel physicians in week 41/2008 was 159, of which two (1.3%) were influenza virus positive [types A (H1) and A (H3), respectively].
In addition, five influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals), of which four were type A not subtyped and one was type B.
§ Cumulative virological situation - 2008-2009 season (since week 40/2008):
In the first two weeks of the current season, 13 influenza viruses were detected in three countries: eight in England, three in Spain and two in Sweden. Of the detected viruses, eight were type A not subtyped, two type A subtype H1, two type A subtype H3 and one type B.
§ Comment: There have only been a few sporadic laboratory confirmed cases of influenza reported to EISS in this surveillance season (the past two weeks). Hence, it is currently too early to comment on which virus type or subtype may become dominant in Europe this season.
§ Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS.
In week 41/2008, 26 countries reported clinical data and 25 countries reported virological data to EISS.
The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the responsibility of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (United Kingdom).
§ Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
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 populationcomprising 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 onepercent of the Finnish population).
§ Network comments (where available) -- Switzerland: No activity detected last week.
-
----
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
October 21, 2008 CDC reports the first influenza death this year
TAIPEI, Taiwan –– The Centers for Disease Control (CDC) said yesterday that the first death from influenza this year was reported last week in southern Taiwan, and it urged people at high risk to get free flu vaccines before the end of November.
According to CDC Deputy Minister Lin Ting, the patient was a 75-year-old woman who fell ill on Oct. 13and died three days later of influenza with the complication of pneumonia.
“It is a pity that the woman did not get a free flu shot,” said Lin, noting that the first influenza death occurred this year much earlier than in previous years.
October 5, 2008 to October 11, 2008 (Week 41) FluWatch Low levels of influenza activity continue to be reported in Canada; no new laboratory detections reported this week
During week 41, influenza activity in Canada remained low with the majority of the influenza surveillance regions
reporting no activity and only six regions (in NS, QC, ON & AB) reported sporadic influenza activity (see map).
No specimens tested positive for influenza in Canada this week (percentage positive = 0%; 0/1,167) (see table).
In week 41, the ILI consultation rate was 18 ILI consultations per 1,000 patient visits (see ILI graph), and is
within the expected range for this week. The sentinel response rate has been slowly increasing over the last
several weeks but remained low at 47% for this week. Fluctuations in ILI consultation rates are expected during
periods of low influenza activity and low sentinel participation. No new influenza outbreaks were reported in
week 41. Antigenic Characterization:
Since 1 September 2008, National Microbiology Laboratory (NML) has antigenically characterized three
influenza viruses: one influenza A/Brisbane/59/2007(H1N1)-like and two influenza B/Florida/4/2006 viruses,
which are the influenza A(H1N1) and influenza B components recommended for the 2008-09 influenza vaccine.
(see pie chart) Antiviral Resistance:
The testing results showed that the influenza A(H1N1) isolate was sensitive to amantadine, however, it was
resistant to oseltamivir due to the H274Y mutation. Both of the influenza B viruses tested were found to be
sensitive to oseltamivir. Influenza-associated Paediatric Hospitalizations:
No laboratory-confirmed influenza-associated paediatric hospitalizations have been reported through the
Immunization Monitoring Program Active (IMPACT) network for the 2008-09 season. International:
WHO:
During the weeks 39 and 40, overall influenza activity in the southern hemisphere continued to decline. Activity was
low in the rest of the world.
www.who.int />
CDC:
During week 40, overall influenza activity was low with the majority of the states reporting no activity and only 7
states reported sporadic activity. Of the 1,123 specimens tested for influenza viruses in week 40, 8 (0.7%) were positive.
From May 18 - September 27, 2008, the CDC antigenically characterized 6 influenza viruses: 4 influenza A(H1), 1
influenza A(H3), and 1 influenza B. All six viruses are antigenically similar to the components selected for the 2008-09
influenza vaccine. CDC performed oseltamivir and zanamivir resistance testing on 10 influenza A and B viruses collected
since May 18. Two of the 6 influenza A(H1N1) viruses tested were found to be resistant to oseltamivir and the influenza
A(H3N2) and influenza B viruses tested were sensitive to oseltamivir. All tested viruses retain their sensitivity to zanamivir.
Of the 6 influenza A viruses collected since May 18 that were tested for adamantane resistance, 1 influenza A(H3N2)
virus and 1 of the 5 influenza A (H1N1) viruses tested were resistant.
www.cdc.gov />
EISS:
In week 41, levels of influenza activity in Europe were low, with all countries reporting no or only sporadic influenza
activity. Since week 40, 13 influenza viruses were detected of which 8 were influenza A not subtyped, 2 were influenza
A(H1), 2 were influenza A(H3) and 1 was influenza B. It is currently too early to determine which virus type or subtype may
become dominant in Europe this season. <
http://www.eiss.org/cgi-files/bulletin_v2.cgi>
Human Avian Influenza:
No new cases of human H5N1 avian influenza infection have been reported by the WHO since
10 September 2008.
www.who.int index.html avian_influenza>
Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza season:
It is recommended that vaccines for use in the 2009 influenza season (southern hemisphere winter) contain the following:
– an A/Brisbane/59/2007 (H1N1)-like virus
– an A/Brisbane/10/2007 (H3N2)-like virus
– a B/Florida/4/2006-like virus
-- Influenza vaccine safety monitoring – the US experience.
Iskander J, Broder K.
- Monitoring the safety of annual and pandemic influenza vaccines: lessons from the US experience Expert review of vaccines. 2008 Feb; 7(1):75-82
Description:
In this paper authors from the U.S. Centers for Disease Control and Prevention (CDC) discuss the issues concerning how broad and focused vaccine safety surveillance and research will be undertaken both for seasonal and for pandemic vaccines when deployed on a large scale in a pandemic.
They point out the experience from 1976-77 in the USA when severe adverse events Guillain-Barre syndrome were associated with deployment of an influenza vaccine and how this then halted an emergency vaccination campaign.(1)
They argue that the role of public health officials is to monitor unexpected and rare events during a national vaccination program, because recent experience suggests that detection of common nonserious adverse event following immunization occurs quite frequently, but can be planned for.
They argue that existing United States vaccine safety surveillance infrastructure (Vaccine Adverse Event Reporting System VAERS, Vaccine Safety Datalink VSD) may need to be enhanced in order to be able to provide large amounts of safety data in a timely manner, as may be needed during a prepandemic or pandemic vaccine campaign.
ECDC Comment: (23/10/08)
The circumstances and challenge described by CDC for the United States would apply also in Europe either with seasonal influenza vaccines or more especially human avian influenza (‘per-pandemic’) vaccines (HAIVs) and specific pandemic vaccines (SPVs).
With seasonal influenza vaccines adverse events, seemingly associated with immunisation, occur on occasion and always need careful investigation.(2)
Though its rare to find a causative relationship these events are disruptive to vaccination programmes both where they occur and in other countries through media reporting. In the event of a pandemic SPVs and HAIVs would be offered to large numbers of people rapidly. While there would be some safety experience with the HAIVs this would be for a limited number of people and by definition there would be hardly any experience with the SPVs which would be being prepared rapidly and mass distributed.
By chance alone there would be adverse events taking place in association with these immunisations. It is easy to imagine that these could be perceived as having a causative relationship with vaccination and of course there would always be the possibility that this was a real relationship.(1)
The challenge for Europe would be as for the United States, namely to quickly assess reported associations and investigate and analyse those that have epidemiological and biological plausibility.
This will only be possible with pre-planning and investigations could probably not be left to vaccine producers alone if the results are to have credibility.
1. Schonberger LB, Bergman DJ, Sullivan-Bolyai JZ, et al. Guillain-Barré syndrome following vaccination in the National Influenza Immunization Program, United States, 1976-1977. Am J Epidemiol. 1979;110:105-123.
2. ECDC Risk Assessment October 2006 – Four sudden deaths in elderly patients associated with use of influenza vaccine in Israel.
* Public Health Developments
-- An International Pandemic Influenza Preparedness Strategy published by the UK Government
Ahead of the International Ministerial Conference on Avian and Pandemic Influenza in Egypt 24-26 October (see next item) the UK Government has this week published an international strategy on pandemic preparedness demonstrating a cross government approach for the next three to five years. »
* Meetings and workshops
-- International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.
This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007).
The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.
The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union.
The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009.
A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting.
-- Retroscreen Virology Conference - Medical, Scientific and Historical Lessons from the Great Avian (H1N1) "Spanish" Influenza Pandemic of 1918: The 90th Anniversary 10th November 2008 at The Imperial War Museum - London
This conference specifically considers the first World War and the start of the Spanish Influenza pandemic.
Specifically did the war itself engender the emergence of this avian influenza A(H1N1)?
Are there serious lessons from that pandemic to help today as we prepare for 21st century pandemics?
-- European Scientific Conference on Applied Infectious Disease Epidemiology, Berlin 19-21 November 2008.
The second annual European Scientific Conference on Applied Infectious Disease Epidemiology – ESCAIDE – is fast approaching.
The event is being held in Berlin from 19-21 November, and over 500 health experts from across Europe and beyond are expected to come together to share scientific knowledge and experience on all areas related to infectious disease epidemiology.
It is possible to register for the conference for a reduced fee of 100 Euros- the deadline for early registration is 1st October. It is also still possible to submit a ‘late breaker abstract’ to the conference- the deadline for submission is 29th September.
Details of the full conference programme, participant registration, and abstract submission can be found on the ESCAIDE website
-
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 reader is responsible for discerning the validity, factuality or implications of information posted here, be it fictional or based on real events. Moderators on this forum make every effort to review the material posted on this site however, it is not realistically possible for our staff to manually review each post.
The content of posts on this site, including but not limited to links to other web sites, are the expressed opinion of the original authors or posters and are not endorsed by, or representative of the opinions of, the owners or administration of this website. The posts on this website are the opinion of the specific author or poster and should not be construed as statements of advice or factual information.
Not all posts on this website are intended as truthful or factual assertion by their authors. NO posts on this website should be considered factual information on face value alone. Users are encouraged to USE DISCERNMENT and do their own follow up research while reading and posting on this website. FluTrackers.com Inc. reserves the right to make changes to, corrections and/or remove entirely at any time posts made on this website without notice. In addition, FluTrackers.com Inc. disclaims any and all liability for damages incurred directly or indirectly as a result of a post on this website.
This site is provided "as is" without warranty of any kind, either expressed or implied. You should not assume that this site is error-free or that it will be suitable for the particular purpose which you have in mind when using it. In no event shall FluTrackers.com Inc. be liable for any special, incidental, indirect or consequential damages of any kind, or any damages whatsoever, including, without limitation, those resulting from loss of use, data or profits, whether or not advised of the possibility of damage, and on any theory of liability, arising out of or in connection with the use or performance of this site or other documents which are referenced by or linked to this site.
Finally, FluTrackers.com Inc. reserves the right to delete, correct, or make changes to any post on this website without notice at any time for any reason.
Fair Use Notice:
This site may contain copyrighted material the use of which has not always been specifically authorized by the copyright owner. Users may make such material available in an effort to advance awareness and understanding of issues relating to public health, civil rights, economics, individual rights, international affairs, liberty, science & technology, etc. We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C.Section 107, the material on this site is distributed to those who have expressed a prior interest in receiving the included information for research and educational purposes.
In accordance with industry accepted best practices we ask that users limit their copy / paste of copyrighted material to the relevant portions of the article you wish to discuss and no more than 50% of the source material, provide a link back to the original article and provide your original comments / criticism in your post with the article. Please remember you are responsible for what you post on the internet and you could be sued by the original copyright holder if you do not honor these rules.
If you are a legal copyright holder or a designated agent for such and you believe a post on this website falls outside the boundaries of "Fair Use" and legitimately infringes on yours or your clients copyright
we may be contacted concerning copyright matters at:
FluTrackers.com Inc.
c/o Sharon Sanders
1676 Hibiscus Avenue
Winter Park, Florida 32789
Phone: 407-406-3037
E-Mail: flutrackers@earthlink.net
In accordance with section 512 of the U.S. Copyright Act our contact information has been registered with the United States Copyright Office. "Safe Harbor" noticing procedures as outlined in the DMCA apply to this website concerning all 3rd party posts published herein.
If notice is given of an alleged copyright violation we will act expeditiously to remove or disable access to the material(s) in question.
All 3rd party material posted on this website is the copyright of the respective owners / authors. FluTrackers.com Inc. makes no claim of copyright on such material.
For more information please visit:
http://www.law.cornell.edu/uscode/17/107.shtml
Please be aware any communications sent complaining about a post on this website may be posted publicly at the discretion of the administration.
FluTrackers Does Not Provide Any Medical Advice:
FluTrackers, Inc. does not provide medical advice. Information on this web site is collected from various internet resources, and the FluTrackers board of directors makes no warranty to the safety, efficacy, correctness or completeness of the information posted on this site by any author or poster.
The information collated here is for instructional and/or discussion purposes only and is NOT intended to diagnose or treat any disease, illness, or other medical condition. Every individual reader or poster should seek advice from their personal physician/healthcare practitioner before considering or using any interventions that are discussed on this website.
By continuing to access this website you agree to consult your personal physican before using any interventions posted on this website, and you agree to hold harmless FluTrackers.com Inc., the board of directors, the members, and all authors and posters for any effects from use of any medication, supplement, vitamin or other substance, device, intervention, etc. mentioned in posts on this website, or other internet venues referenced in posts on this website.
By using and/or accessing this site, either passively or actively, you are agreeing to all of the above conditions. Also, by using and/or accessing this site, either passively or actively, you agree to conduct all business and legal affairs related to this website in the jurisdiction of Flutrackers.com Inc. which is registered in Central Florida, USA.
These Disclaimers are subject to change at anytime.
Email the Webmaster with questions or comments about this site at flutrackers@earthlink.net
Re: Seasonal Flu 2008 - 2009
Linear Mode
