Norwegian Institute of Public Health WHO National Influenza Centre
Country:
Norway
Week No:
44
Date From:
10/26/2008
Date To:
11/1/2008
WCR:
One case of influenza A(H1N1) virus infection, patient returning from travel abroad (USA). No indication of indigenous circulation of influenza viruses.
EISS - Weekly Electronic Bulletin Week 45 : 03/11/2008-09/11/2008 - 14 November 2008, Issue N. 279 Continuing low levels of influenza activity in Europe - more countries reporting virus detections
§ Summary:
Levels of influenza activity were low in all European countries reporting data in week 45/2008.
Since week 40/2008, sporadic laboratory-confirmed cases of influenza have been reported from 15 countries across Europe.
§ Epidemiological situation - week 45/2008:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all the 26 countries providing data.
For the geographical spread indicator, sporadic influenza activity was reported in England, Ireland, Northern Ireland, Norway and Portugal and no activity in 21 countries.
§ Cumulative epidemiological situation - 2008-2009 season (weeks 40-45/2008):
So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (i.e. below the national baseline threshold).
§ Virological situation - week 45/2008:
The total number of respiratory specimens collected by sentinel physicians in week 45/2008 was 273, of which 17 (6.2%) were influenza virus positive; 16 type A (12 subtype H3, one subtype H1 and three not subtyped), and one type B.
In addition, 24 influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals); 22 type A (two subtype H1 and 20 not subtyped), and two type B.
Detection of influenza viruses was reported from ten countries across Europe, which, with two exceptions, were located along the western borders of Europe (England, Ireland, Northern Ireland, Norway, Portugal, Romania, Spain, Sweden, Switzerland, Wales).
§ Cumulative virological situation - 2008-2009 season (weeks 40-45/2008):
Of virus detections since week 40/2008, (N=125, sentinel and non-sentinel data), 111 were type A (39 subtype H3, 15 subtype H1 and 57 not subtyped), and 14 were type B.
Based on the antigenic and/or genetic characterisation of 23 influenza viruses, six were reported as A/Brisbane/59/2007 (H1N1)-like, 14 as A/Brisbane/10/2007 (H3N2)-like, one as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and two as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage).
Analyses of antiviral susceptibility by genetic or phenotypic methods have been reported for nine influenza viruses, five A(H1N1) and three A(H3N2) from the UK and one A(H1N1) from Norway.
Five of the six A(H1N1) viruses were shown to be resistant to oseltamivir (4 from the UK and 1 from Norway) and one to be sensitive; all those tested against zanamivir (4) and amantadine (2) were shown to be sensitive.
The two A(H3N2) viruses tested against amantadine were shown to be resistant; all three A(H3N2) viruses were shown to be sensitive to oseltamivir and zanamivir.
§ Comment:
An increasing number of countries reported sporadic influenza virus detection compared to previous weeks, although this was not accompanied by significant increases in consultation rates.
Most of the countries (11/15) in which influenza viruses have been detected since week 40/2008 are located along the western borders of Europe.
The majority (89%; 111/125) of virus detections have been type A and 72% (39/54) of those subtyped were shown to be H3. It is too soon, however, to conclude which virus type or subtype may become dominant in Europe this season.
Similarly, limited data are available on antiviral resistance and although most (5/6) of the A(H1N1) viruses analysed to date are oseltamivir-resistant it is too early to comment on the resistance pattern for Europe as a whole.
Whilst influenza activity in Europe is currently low, reports of RSV (respiratory syncytial virus), a respiratory virus with clinical symptoms similar to influenza, are increasing in several countries in Europe that report RSV detections to EISS, notably for the UK (e.g. England and Northern Ireland), Ireland and the the Netherlands. The increase in RSV detections at this time of the year is a normal phenomenon in these countries.
§ Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS.
In week 45/2008, 26 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 aegis 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)
- Norway
One case of influenza A detected by a laboratory in Northern Norway
- Spain
Sporadic AH3 isolates in the North of Spain
-
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
2008-2009 Influenza Season Week 45, ending November 8, 2008 (All data are preliminary and may change as more reports are received.) Synopsis:
During week 45 (November 2-8, 2008), a low level of influenza activity was reported in the United States.
Forty (1.7%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, and reported to CDC/Influenza Division, were positive for influenza.
The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
The proportion of outpatient visits for influenza-like illness (ILI) was below national and region-specific baseline levels.
One state reported local influenza activity; 15 states and Puerto Rico reported sporadic influenza activity; 34 states and the District of Columbia reported no influenza activity.
National and Regional Summary of Select Surveillance Components
Region
Data for current week
Data cumulative for the season
Out-patient ILI*
% positive for flu†
Number of jurisdictions reporting regional or widespread activity‡
A (H1)
A (H3)
A Unsub-typed
B
Pediatric Deaths
Nation
Normal
1.7 %
0 of 51
49
11
94
37
0
New England
Normal
0.3 %
0 of 6
0
1
0
1
0
Mid-Atlantic
Normal
0.3 %
0 of 3
1
0
2
0
0
East North Central
Normal
3.3 %
0 of 5
1
0
3
2
0
West North Central
Normal
0.3 %
0 of 7
0
0
2
0
South Atlantic
Normal
1.8 %
0 of 9
3
2
28
11
0
East South Central
Normal
0.0 %
0 of 4
0
0
0
0
0
West South Central
Normal
2.8 %
0 of 4
5
0
18
11
0
Mountain
Normal
0.6 %
0 of 8
0
6
5
3
0
Pacific
Normal
3.6 %
0 of 5
39
2
36
8
0
* Elevated means the % of visits for ILI is at or above the national or region-specific baseline
† National data is for current week; regional data is for the most recent three weeks.
‡ Includes all 50 states and the District of Columbia U.S. Virologic Surveillance:
During week 45, WHO and NREVSS laboratories located in all 50 states and Washington D.C. reported 2,332 specimens tested for influenza viruses, 40 of which were positive: eight influenza A (H1) viruses, two influenza A (H3) viruses, 23 influenza A viruses that were not subtyped, and seven influenza B viruses. Twenty-one states from eight of the nine surveillance regions have reported laboratory-confirmed influenza this season.
CDC has antigenically characterized one influenza virus collected by U.S. laboratories since October 1, 2008. The influenza B virus was characterized as B/Florida/04/2006-like, belonging to the B/Yamagata lineage. Influenza B viruses currently circulating can be divided into two antigenically distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. The recommended influenza B component for the 2008-09 influenza vaccine is a B/ Florida/04/2006-like viruses, belonging to the B/Yamagata lineage.
In addition, a small number of isolates from specimens collected during September were available for antigenic characterization: one influenza A (H1N1), two influenza A (H3N2), and four influenza B viruses. The influenza A (H1N1) specimen is antigenically close to A/Brisbane/59/2007, the influenza A (H1N1) component of the 2008-09 influenza vaccine. All six other viruses were antigenically similar to the components selected for the 2008-09 influenza vaccine (A/Brisbane/10/2007-like (H3N2) and B/Florida/04/2006-like).
It is too early in the influenza season to determine which influenza viruses will predominate or how well the vaccine and circulating strains will match. Antigenic Characterization:
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.
Neuraminidase Inhibitor Antiviral Drugs: Since October 1, 2008, one influenza A (H1N1), one influenza A (H3N2), and one influenza B virus have been tested for antiviral resistance. In addition, CDC performed antiviral resistance testing on one influenza A (H1N1), three influenza A (H3N2), and four influenza B viruses collected during September. All tested viruses are sensitive to both oseltamivir and zanamivir. Adamantane Antiviral Drugs: A small number of isolates from specimens collected during September were tested for adamantane resistance. The one influenza A (H1N1) virus tested and the two influenza A (H3N2) viruses tested were resistant to the adamantanes. The adamantanes are not effective against influenza B viruses.
Additional information on antiviral resistance can be found at: http://www.cdc.gov/flu/about/qa/antiviralresistance.htm
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/rr57e717a1.htm
During week 45, 6.3% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below the epidemic threshold of 6.8% for week 45.
No pediatric deaths have been reported for the 2008-09 season. One influenza-associated pediatric death was reported during week 45 from Washington. This death occurred during the 2007-08 season and brings the total number of reported pediatric deaths occurring during that season to 88.
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 45, 1.1% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) (formerly known as the U.S. 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 0.4% to 1.7%. All nine regions reported percentages of visits for ILI below their respective region-specific baselines.
During week 45 the following influenza activity was reported:
Local influenza activity was reported in one state (Hawaii).
Sporadic activity was reported in Puerto Rico and 15 states (Alaska, California, Colorado, Connecticut, Idaho, Illinois, Indiana, Massachusetts, Nevada, New York, Pennsylvania, Texas, Utah, Wisconsin, and Wyoming).
No influenza activity was reported in the District of Columbia and 34 states (Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, and West Virginia).
--------------------------------------------------------------------------------
A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
Most of the subtyped influenza A is H1N1, but most is in the Pacific (and most of the Pacific appears to be Hawaii). The Pacific is likely to have clade 2B (Brisbane) and clade 2C (Hong Kong), but it is not clear that the CDC is distinguishing between the two subclades. Reported Tamiflu resistance results is VERY limited.
Low levels of influenza activity continue to be reported in Canada; slight increases in lab detections and ILI consultation rates reported this week
During week 45, influenza activity in Canada remained low with the majority of the influenza surveillance regions reporting no activity and only six regions (in BC, AB, ON & QC ) reported sporadic influenza activity (see map). Seven specimens tested positive for influenza in Canada this week (percentage positive = 0.5%; 7/1,512) (see table). In week 45, the ILI consultation rate increased to 11 ILI consultations per 1,000 patient visits (see ILI graph), and is below the expected range for this week. The sentinel response rate remained low at 42%; however, sentinel participation is expected to increase as the influenza season progresses. 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 45.
Antigenic Characterization & Antiviral Resistance:
Since 1 September 2008, National Microbiology Laboratory (NML) has antigenically characterized five influenza viruses: one influenza A/Brisbane/10/2007(H3N2)-like (from BC), one influenza A/Brisbane/59/2007(H1N1)-like (from NS), two influenza B/Florida/4/2006-like (from ON and AB) and one B/Malaysia/2506/2004-like (from AB). A/Brisbane/10/2007(H3N2), A/Brisbane/59/2007(H1N1) and B/Florida/4/2006 are the influenza A and influenza B components recommended for the 2008-09 influenza vaccine. B/Malaysia/2506/2004 was the influenza B component for the 2007-2008 season vaccine (see pie chart). Antiviral Resistance:
Since the start of the season, the NML has tested 2 influenza A isolates (1 H1N1 and 1 H3N2) for amantadine resistance and found that the H3N2 isolate was resistant to amantadine and the H1N1 isolate was susceptible; resulting in 50% (1/2) resistance among all influenza A isolates tested.
The NML has also tested 5 influenza isolates (1 A/H1N1, 1 A/H3N2 & 3 B) for oseltamivir (Tamiflu) resistance and found that the H1N1 isolate tested was resistant to oseltamivir due to the H274Y mutation whereas the H3N2 and B isolates were susceptible; resulting in 20% (1/5) resistance among all influenza isolates tested. 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:
CDC: During week 44, a low level of influenza activity was reported in the United States with the majority of the states reporting no activity and several more states reporting sporadic activity compared to the previous week. Of the 1,780 specimens tested this week for influenza viruses, 11 (0.6%) were positive. Since 1 October 2008, the CDC has antigenically characterized one influenza virus: B/Florida/04/2006-like.
EISS: Levels of influenza activity were low in all European countries, however an increasing number of countries reported sporadic influenza virus detections compared to previous weeks. The majority (89%) of virus detections have been influenza A and 72% of those subtyped were shown to be A/H3. Limited data are available on antiviral resistance: 83% (5/6) of the influenza A(H1N1) viruses analysed to date are resistant to oseltamivir. Note that reports of RSV detections are increasing in several countries in Europe; however the increase in those countries is normal at this time of the year.
Total number of influenza tests performed and number of positive tests by province/territory of testing laboratory, Canada, 2008-2009
Province of
reporting
laboratories
Report Period:
November 2, 2008 to November 8, 2008
Season to Date:
August 24, 2008 to November 8, 2008
Total #
Influenza
Tests
# of Positive Tests
Total #
Influenza
Tests
# of Positive Tests
Influenza A
Influenza B
Total
Influenza A
Influenza B
Total
NL
7
0
0
0
57
0
0
0
PE
5
0
0
0
22
0
0
0
NS
13
0
0
0
113
1
0
1
NB
4
0
0
0
50
0
0
0
QC
419
4
0
4
2652
11
1
12
ON
441
0
0
0
3488
0
2
2
MB
45
0
0
0
434
0
0
0
SK
73
0
0
0
685
0
0
0
AB
469
0
2
2
3685
1
6
7
BC
36
1
0
1
279
1
0
1
Canada
1512
5
2
7
11465
14
9
23
Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Note: Cumulative data includes updates to previous weeks; due to reporting delays, the sum of weekly report totals do not add up to cumulative totals. Abbreviations: Newfoundland/Labrador (NL), Prince Edward Island (PE), New Brunswick (NB), Nova Scotia (NS), Quebec (QC), Ontario (ON), Manitoba (MB), Saskatchewan (SK), Alberta (AB), British Columbia (BC), Yukon (YT), Northwest Territories (NT), Nunavut (NU) Respiratory virus laboratory detections in Canada, by geographic regions, are available weekly on the following website:
<http://www.phac-aspc.gc.ca/bid-bmi/dsd-dsm/rvdi-divr/index-eng.php>
Number of influenza surveillance regions† reporting widespread or localized influenza activity, Canada, by report week, 2008-2009 (N=54)
† sub-regions within the province or territory as defined by the provincial/territorial epidemiologist. Graph may change as late returns come in.
Influenza Activity Level by Provincial and Territorial
Influenza Surveillance Regions, Canada,
November 2, 2008 to November 8, 2008 (Week 45)
Influenza tests reported and percentage of tests positive, Canada, by report week, 2008-2009
Percent positive influenza tests, compared to other respiratory viruses, Canada, by reporting week, 2008-2009
Influenza strain characterization, Canada, cumulative, 2008-2009 influenza season by the Respiratory Viruses Section at the National Microbiology Laboratory
[N=5]
{Strain characterization, number identified, per cent of total number} NACI recommends that the trivalent vaccine for the 2008-2009 season in Canada contain A/Brisbane/59/2007 (H1N1)-like virus; an A/Brisbane/10/2007 (H3N2)-like virus; and a B/Florida/4/2006-like virus.
Influenza-like illness (ILI) consultation rates, Canada, by report week,
2008-2009 compared to 1996/97 through to 2006/07 seasons
Note: No data available for mean rate in previous years for weeks 19 to 39 (1996-1997 through 2002-2003 seasons).
Number of New Outbreaks in Long Term Care Facilities, Canada, by Report Week, 2008-2009
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Re: Seasonal Flu 2008 - 2009
ITALY. First virus isolation for the season 2008/2009.
Ministry of Health press update of today Nov. 18, 2008 states that isolates from three patients (two children and an adult, unvaccinated) were subtyped as belonging to A/H3N2/Brisbane1007-like strain, reference virus for this season trivalent-inactivated influenza vaccine.
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
Early Dominance of H1N1 in the United States Recombinomics Commentary 19:53
November 18, 2008
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.
The above comments from the week 45 CDC report on influenza in the US are curious. The updated report indicates over 80% of the isolates are influenza A (154/191) and over 80% of the sub-typed influenza A is H1 (49/60). Although only one H1N1 sample has been reportedly tested for oseltamivir resistance, early data from the UK, Canada, and Norway indicates that H274Y in the Brisbane strain of H1N1 will be at or near 100% (and the resistant case in Norway had traveled to the US). Thus, the use of adamantines is discouraged because resistance is near 100% for H3N2, yet H3N2 is currently only a minor population in the reported flu cases in the US. The level of H1 is five fold higher, yet the US is withholding changes in recommendations for oseltamivir usage.
Worldwide data from last season demonstrated that many northern countries had high levels of H274Y in H1N1. Over the summer, these levels approached or reached 100% in multiple countries in the southern hemisphere.
These data put surveillance systems on high alert for resistance in the current season, and initial results have indicated the concerns were justified. Moreover, the highest number of reported H1 cases is in the US, yet resistance results have been released for only one of the 49 isolates that have been sub-typed as H1.
Release of resistance results and associated sequences 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
Delayed H1N1 Tamiflu Resistance Reports in the United States Recombinomics Commentary 03:05
November 19, 2008
The week 45 influenza report by the CDC this year is very similar to the same report last year. Most of the flu isolates are influenza A and the vast majority of the influenza A is H1N1. This season however, more of the influenza A isolates have been sub-typed, signaling a concern over the possibility that all or most H1N1 (especially clade 2B, Brisbane/59) will have H274Y (Tamiflu resistant). Once again most of the H1 is in the pacific region and the vast majority of the isolates from the Pacific region are H1N1 (39/41).
Last year most of the Hong Kong (clade 2C) were in the Pacific region, and none had H274Y. All of the resistance was in Brisbane/59 (clade 2B), but the resistance was almost exclusively in a sub-clade that was closely related to the dominant sub-clade in northern Europe. That dominant sub-clade became more dominant over the summer in the southern hemisphere, which led to frequencies at or near 100% in many countries. The initial data in the UK, Norway, and Canada support a similar high level this season in the northern hemisphere.
Somewhat surprisingly, the resistance of only one H1N1 isolate was reported. It was negative and was said to be Brisbane/59-like. However, the antigenic analysis is not informative, because it is likely that both clade 2B and clade 2C will be called “Brisbane/59-like” even though the two sub-clades are readily distinguished when appropriate anti-sera is used. Last year all clade 2B and clade 2C were called “Solomon Island-like” even though there was no Solomon Island in circulation and proper anti-sera readily distinguish between clade 2A, 2B, and 2C, which is why the vaccine this season targeted Brisbane/59 instead of Solomon Island/3, which was the H1N1 vaccine target last season.
Thus, it is unclear what is in circulation in the US (or anywhere else in the world), because the H1 isolates are all being called “Brisbane/59-like” which produces a “match” with the vaccine, regardless of whether the isolate is clade 2B or clade 2C. Phylogenetic classification would be much clearer and more useful, but the current vaccine approaches are largely base on technology that is over 50 years old and in need of a significant upgrade.
Moreover, the current status of clade 2B and clade 2C will be clear when sequences are released because the phylogenetic analysis is very straightforward and easily distinguishes clade 2B from clade 2C, as well as sub-clades within these larger sub-clades.
When the NA sequences are generated, the Tamiflu resistance frequencies will be clear, which will lead to an evaluation of the current recommendations, which includes use of oseltamivir for all influenza infections.
.
__________________
"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
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 HPA National Influenza Reports for 2008/09 season will be published fortnightly until activity begins to increase, when they will be published weekly. A short summary of activity will be made available in the weeks between the fortnightly reports. The next complete influenza report will be published on Wednesday 26 November 2008. Reporting period: Week 46 (10/11/08-16/11/08)
Influenza activity remained stable at low levels across all the countries of the United Kingdom during week 46/08. Some clinical indicators of influenza have slightly increased in England, Scotland and Wales but have slightly decreased in Northern Ireland in week 46/08, compared with week 45/08. Flu activity in countries with baseline activity thresholds are well below this level. Reports of influenza A and B from NHS and HPA laboratories are also at low levels, similar to week 45/08 and laboratory reports of RSV stayed at a similar level as week 45/08. Eighteen samples referred to the Centre for Infections' Respiratory Virus Unit (RVU) tested positive for influenza A (H3), which is an increase from seven in week 45/08 and three tested positive for RSV during week 46/08. There were no influenza A (H1) positive samples in week 46/08, compared to three in week 45/08. In Scotland three sentinel samples (15%) and one routine sample (3.1%) tested positive for influenza A.
Levels of influenza activity in Europe were low in week 45/08.
Neuraminidase inhibitor susceptibility testing on 18 out of 36 influenza A (H3) isolates since week 36/08 showed that all are sensitive to oseltamivir and zanamivir, but resistant to amantadine. Of the three influenza B isolates received since week 36/08, all are sensitive to oseltamivir and zanamivir. In the same time period, 13 influenza A (H1) isolates have been received and tested, of which twelve are resistant to oseltamivir but sensitive to zanamivir and amantadine. All of these 12 are from South West England and are being followed up in more detail.
Two outbreaks of respiratory illness have been reported from schools in week 47/08, one in East England and one in South England. Both outbreaks are still under investigation.
The weekly data on flu vaccination uptake in England continued to increase. The uptake rates for the over 65 years increased from 62.5% in week 45/08 to 66% in week 46/08. The uptake rates for the under 65 years at risk group increased from 35% in week 45/08 to 37.9% in week 46/08.
Influenza antiviral resistance during Northern Hemisphere season 2008-09 [page under development]
Since the start of the surveillance season (week 40-2008) analyses of antiviral susceptibility by genetic or phenotypic methods have been reported for 15 influenza viruses, eleven A(H1N1) and three A(H3N2) from the UK and one A(H1N1) from Norway.
Eleven of the twelve A(H1N1) viruses were shown to be resistant to oseltamivir (10 from the UK and 1 from Norway) and one to be sensitive; all those tested against zanamivir (4) and amantadine (2) were shown to be sensitive.
The two A(H3N2) viruses tested against amantadine were shown to be resistant; all three A(H3N2) viruses were shown to be sensitive to oseltamivir and zanamivir.
-
People come and go, but the creative force of great historical events, as well as important ideas and actions remain. (Aleksandr Romanovic Lurija, 1976)
-- A TIME'S MEMORY (Blog) ATTRAVERSO QUESTI GIORNI (Blog) tracciatore_traccia@libero.it
Influenza antiviral resistance during Northern Hemisphere season 2008-09 [page under development]
Since the start of the surveillance season (week 40-2008) analyses of antiviral susceptibility by genetic or phenotypic methods have been reported for 15 influenza viruses, eleven A(H1N1) and three A(H3N2) from the UK and one A(H1N1) from Norway.
Eleven of the twelve A(H1N1) viruses were shown to be resistant to oseltamivir (10 from the UK and 1 from Norway) and one to be sensitive; all those tested against zanamivir (4) and amantadine (2) were shown to be sensitive.
The two A(H3N2) viruses tested against amantadine were shown to be resistant; all three A(H3N2) viruses were shown to be sensitive to oseltamivir and zanamivir.
-
indicates they have now tested 13 H1N1 isolates and 12 are resistant (all from southwestern England), so the updated totals for Europe are 13/14 were resistant to oseltamivir (and I believe the positive in Norway had been infected in the US).
"13 influenza A (H1) isolates have been received and tested, of which twelve are resistant to oseltamivir but sensitive to zanamivir and amantadine. All of these 12 are from South West England and are being followed up in more detail."
EISS - Weekly Electronic Bulletin Week 46 : 10/11/2008-16/11/2008 - 21 November 2008, Issue N° 280 Influenza activity in Europe continues to be low – more countries report initial virus detections § Summary: The level of influenza activity was low in all countries reporting data in week 46/2008. Since week 40/2008, sporadic laboratory-confirmed cases of influenza have been reported from 18 countries across Europe.
§ Epidemiological situation - week 46/2008: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all the 25 countries providing data. However, marked increases in the consultation rates for ILI and/or ARI within the 0-4 age group were reported by Austria, Belgium, Bulgaria, England and Spain. For the geographical spread indicator, sporadic influenza activity was reported in 12 countries (Czech Republic, Denmark, England, Hungary, Ireland, Netherlands, Northern Ireland, Norway, Portugal, Spain, Sweden and Switzerland) and no activity in the other 13 countries.
§ Cumulative epidemiological situation – 2008-2009 season (weeks 40-46/2008): So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (i.e. below the national baseline threshold).Virological situation - week 46/2008: The total number of respiratory specimens collected by sentinel physicians in week 46/2008 was 451, of which 32 (7.1%) were positive for influenza virus: 29 type A (22 subtype H3 and seven not subtyped) and three type B. In addition, 30 influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals): 28 type A (six subtype H3 and 22 not subtyped) and two type B. Detection of influenza viruses was reported from 13 countries across Europe and included the first detections in Czech Republic, Hungary and Italy.
§ Cumulative virological situation – 2008-2009 season (weeks 40-46/2008): Of 192 virus detections (sentinel and non-sentinel) since week 40/2008, 171 were type A (73 subtype H3, 15 subtype H1 and 83 not subtyped) and 21 were type B. Based on the antigenic and/or genetic characterisation of 41 influenza viruses, three were reported as A/Brisbane/59/2007 (H1N1)-like, 35 as A/Brisbane/10/2007 (H3N2)-like, one as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and two as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage).
Analyses of antiviral susceptibility by genetic or phenotypic methods have been reported for 26 influenza viruses, 11 A(H1N1) and 15 A(H3N2) from England and one A(H1N1) from Norway. Eleven of the 12 A(H1N1) viruses were shown to be resistant to oseltamivir (10 from England and 1 from Norway) and one to be sensitive; all those tested against zanamivir (12) and amantadine (4) were shown to be sensitive. The six A(H3N2) viruses tested against amantadine were shown to be resistant; all 15 A(H3N2) viruses were shown to be sensitive to oseltamivir and zanamivir.
§ Comment:
An increasing number of countries reported sporadic influenza virus detection compared to previous weeks (12 versus five or less in previous weeks), although this was not accompanied by significant increases in overall consultation rates. The 18 countries that have detected influenza viruses since week 40/2008 are geographically distributed throughout Europe. The majority (89%; 171/192) of virus detections up to week 46 have been type A, a percentage unchanged since week 45. The proportion of type A viruses subtyped as H3 has increased from 72% up to week 45 to 83% (73/88) at week 46. Although this represents an apparent increase in prevalence of the H3 subtype, it is too soon to conclude which virus type or subtype may become dominant in Europe this season.
Similarly, limited data from only two countries (England and Norway) are available for antiviral resistance and although most (11/12) of the A(H1N1) viruses analysed to date are oseltamivir-resistant, these represent very early-season isolates. It is too early to comment on the antiviral-resistance pattern for Europe as a whole.
Whilst influenza activity in Europe is currently low, reports of RSV (Respiratory Syncytial Virus which induces clinical symptoms similar to influenza) from countries in Europe that report RSV detections to EISS showed continued increases in the Netherlands and Northern Ireland). Increase in RSV detections at this time of the year is a normal phenomenon in these countries.
§ Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. In week 46/2008, 25 countries reported clinical data and 26 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 aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (UK).
§ Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
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 inSouth-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).
§ Network comments (where available)
- Italy
Two A/H3N2 influenza viruses have been isolated during this week. One further A/H3N2 virus had been previously isolated from a sample collected in week 43/08.
- Netherlands
In week 46, a specimen from a sentinel boy patient of 10 years old with ILI was positive for infleunza virus A(H3N2). The patient has not visited foreign countries recently.
- Spain
Sporadic B and AH3 isolates with a dispersed geographic distribution
- Switzerland
Positive specimen were detected for the second consecutive week. 3 Influenza A viruses were detected during the week 46. However, clinical declarations remained below the epidemic threshold.
-
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
H1N1 Tamiflu Resistance in England Exceeds 92%
Recombinomics Commentary 18:05
November 20, 2008
13 influenza A (H1) isolates have been received and tested, of which twelve are resistant to oseltamivir but sensitive to zanamivir and amantadine. All of these 12 are from South West England and are being followed up in more detail.
The above quote from today’s UK report indicate the three most recent H1N1 isolates are oseltamivir resistant, so the frequency of H274Y in H1N1 in the UK now exceeds 92%. These high levels are not a surprise. Last season the have majority of H1N1 isolates with H274Y were due to a Brisbane/59 dominant sub-clade. That sub-clade emerged in South Africa over the summer and the H274Y frequency was 100% (215/215). Other countries in the southern hemisphere had similar high frequencies, which was firmly tied to the acquisition of D354G, which was present in all public clade 2A and clade 2C sequences from the past few years.
Thus, the all isolates in the dominant sub-clade had D354G in addition to H274Y which led to the dramatic spread of oseltamivir resistance last season in the northern hemisphere, which is likely to increase to levels close to 100% this year as evidenced by the detection of H274Y in 13/14 tested H1N1 isolates in Europe this season.
.
__________________
"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
2008-2009 Influenza Season Week 46, ending November 15, 2008 (All data are preliminary and may change as more reports are received.) Synopsis:
During week 46 (November 9-15, 2008), a low level of influenza activity was reported in the United States.
Sixteen (0.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, and reported to CDC/Influenza Division, were positive for influenza.
The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
The proportion of outpatient visits for influenza-like illness (ILI) was below national and region-specific baseline levels.
Twenty-one states, the District of Columbia, and Puerto Rico reported sporadic influenza activity and 29 states reported no influenza activity.
One human infection with a novel influenza A virus was reported.
National and Regional Summary of Select Surveillance Components
Region
Data for current week
Data cumulative for the season
Out-patient ILI*
% positive for flu†
Number of jurisdictions reporting regional or widespread activity‡
A (H1)
A (H3)
A Unsub-typed
B
Pediatric Deaths
Nation
Normal
0.9 %
0 of 51
62
12
101
43
0
New England
Normal
0.3 %
0 of 6
0
1
0
1
0
Mid-Atlantic
Normal
0.2 %
0 of 3
2
0
2
1
0
East North Central
Normal
3.6 %
0 of 5
3
0
2
4
0
West North Central
Normal
0.3 %
0 of 7
0
0
2
1
0
South Atlantic
Normal
1.1 %
0 of 9
6
2
28
13
0
East South Central
Normal
0.0 %
0 of 4
0
0
0
0
0
West South Central
Normal
2.3 %
0 of 4
6
0
21
12
0
Mountain
Normal
0.6 %
0 of 8
0
7
5
3
0
Pacific
Normal
2.9 %
0 of 5
45
2
41
8
0
* Elevated means the % of visits for ILI is at or above the national or region-specific baseline
† National data is for current week; regional data is for the most recent three weeks.
‡ Includes all 50 states and the District of Columbia U.S. Virologic Surveillance:
During week 46, WHO and NREVSS laboratories located in all 50 states and Washington D.C. reported 1,772 specimens tested for influenza viruses, 16 of which were positive: five influenza A (H1) viruses (Mid-Atlantic, South Atlantic, and West South Central regions), eight influenza A viruses that were not subtyped (East North Central, Mountain, Pacific, and West South Central regions), and three influenza B viruses (East North Central, South Atlantic, and West South Central regions). Twenty-three states from eight of the nine surveillance regions have reported laboratory-confirmed influenza this season.
CDC has antigenically characterized one influenza virus collected by U.S. laboratories since October 1, 2008. This influenza B virus was characterized as B/Florida/04/2006-like. The influenza B component of the 2008-09 influenza vaccine is a B/ Florida/04/2006-like virus.
In addition, a small number of isolates from specimens collected during September have been antigenically characterized: one influenza A (H1N1), three influenza A (H3N2), and four influenza B viruses. All seven viruses were antigenically related 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).
It is too early in the influenza season to determine which influenza viruses will predominate or how well the vaccine and circulating strains will match. Novel Influenza A Viruses:
One case of human infection with a novel influenza A virus was reported by the Texas Department of State Health Services during week 46. The person was infected with a swine influenza A (H1N1) virus, and reported several swine exposures including close contact with an ill pig. Although human infection with swine influenza is uncommon, sporadic cases have occurred in many years, usually among people in direct contact with ill pigs or who have been in places where pigs may have been present (e.g. agricultural fairs, farms, or petting zoos). The sporadic cases of human infections with swine influenza viruses identified in recent years have not resulted in sustained human-to-human transmission or community outbreaks. Nonetheless, when cases are identified, CDC recommends thorough investigations to evaluate the extent of the outbreak and possible human to human transmission, as transmission patterns may change with changes in swine influenza viruses. Antiviral Resistance:
In the United States, two groups of antiviral drugs have been approved by Food and Drug Administration for use in treating or preventing influenza virus infections. These two groups of antiviral drugs are the neuraminidase inhibitors (oseltamivir and zanamivir) and the adamantanes (amantadine and rimantadine). A description of these drugs can be found at: http://www.cdc.gov/flu/protect/antiviral/index.htm.
Neuraminidase Inhibitor Antiviral Drugs: Since October 1, 2008, two influenza A (H1N1) viruses, four influenza A (H3N2) viruses, and five influenza B viruses have been tested for antiviral resistance. One of the two influenza A (H1N1) viruses was found to be resistant to oseltamivir. All the influenza A (H3N2) viruses and influenza B viruses tested retain their sensitivity to oseltamivir. All tested viruses retain their sensitivity to zanamivir.
In addition, CDC performed antiviral resistance testing on one influenza A (H1N1), three influenza A (H3N2), and four influenza B viruses collected during September. All tested viruses are sensitive to both oseltamivir and zanamivir.
Additional information on antiviral resistance can be found at: http://www.cdc.gov/flu/about/qa/antiviralresistance.htm. Adamantane Antiviral Drugs: Three isolates from specimens collected during September were tested for adamantane resistance. The one influenza A (H1N1) virus tested and the two influenza A (H3N2) 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 in the United States. Use of amantadine or rimantadine is not recommended. Guidance on influenza antiviral use can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e717a1.htm
During week 46, 6.4% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below the epidemic threshold of 6.9% for week 46.
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 46, 1.1% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) (formerly known as the U.S. 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 0.4% to 1.8%. All nine regions reported percentages of visits for ILI below their respective region-specific baselines.
During week 46 the following influenza activity was reported:
Sporadic activity was reported in the District of Columbia, Puerto Rico and 21 states (Alaska, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Illinois, Indiana, Massachusetts, Maryland, Michigan, Nevada, New York, Pennsylvania, Rhode Island, Texas, Utah, Washington, Wisconsin, and Wyoming).
No influenza activity was reported in 29 states (Alabama, Arizona, Arkansas, Delaware, Georgia, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Vermont, Virginia, and West Virginia).
--------------------------------------------------------------------------------
A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
Doctors, epidemiologists predict the winter season 2008-2009 year growth in the incidence of influenza and acute infectious diseases of the respiratory tract. The greatest risk of falling ill influenza - children. To prevent these diseases and to avoid complications recommended vaccinations.
According to the National Center for Preventive Medicine (NTSPM) for the January-September 2008 in the republic were registered 2 thousand cases of influenza incidence was about 53 cases per 100 thousand people. Influenza place in light and medium clinical forms. Severe cases were reported. At the same time, recorded more than 164 thousand cases of acute infectious diseases, the incidence rate was about 4 thousand cases per 100 thousand population.
"At the current stage of world medicine has no effective means to prevent and treat influenza. It is therefore necessary to hold a series of measures to prevent the disease and mitigate its severity," - told the agency deputy director NTSPM Bartholomew Kalmyk. Specialists in this field are encouraged to include in your diet foods rich in vitamins, standing zakalivanie organism vaccinated against influenza, and avoid bad habits such as smoking, excessive consumption of alcohol and drug use.
Clinically influenza seen a sudden headache, temperature, weakness, cough, pain in the chest and joints. The results of testing conducted NTSPM, suggests that aetiologically cases of influenza caused by mutation of seasonal influenza virus A (H3N2) with increased virulence compared with previous influenza virus subtype.
Moscow, Nov. 24. Specialists Rospotrebnadzora predict that the flu epidemic in Russia will begin no earlier than next year.
«We expect an epidemic after the new year - January, February, March», - said today at a press conference then head of epidemiological surveillance Rospotrebnadzora Elena Ezhlova transmit «News».
She noted that in recent years, peak flu epidemic in Russia has shifted in the spring and falls on February-March.
The rise of the incidence of ARI in the Russian regions began in early October, said Elena Ezhlova. But in the last two weeks have seen some slowdown due to holidays and school vacations, when children do not talk so often and closely with each other, as during the study.
A week later, Rospotrebnadzor predicts a new increase in cases since the holiday was over. In some cities, according to Ezhlovoy, for example, Barnaul and Norilsk, registered a slight excess of the threshold incidence of ARI among all population groups. But talking about the epidemic at present it is too early, she said.
Doctors said that, at the end of November - early December have to rush vaccine campaign. In their view, when a mass vaccination only 2% of the population suffer from side effects. But if you do not give time, people may face serious complications, particularly pneumonia, treatment, which is 21 days. http://www.rosbalt.ru/2008/11/24/544297.html
In the Donetsk region today received a flu shot for more than 12 thousand people.
This was reported in the Donetsk regional sanitary-epidemiological station. According to doctors, given neepidemichesky the incidence of respiratory infection in October and November, now - the optimum time for immunization.
Protivogrippoznye measures in the field this fall are taken from September 30.
According to epidemiologists, weekly from September 15-17 in the recorded thousands of sick respiratory infections, which is 30-50% below the epidemic threshold. Over the last week of November (from 13 to 20 November) has already exceeded the epidemic threshold of 30% in the age group of 7 to 14 years.
During this period, with severe respiratory infections and complications hospitalized more than 300 residents of the area, 263 of them - children under 14 years old.
In the regional SES reminded that the projected Ukrainian Center of influenza in the autumn-winter period 2008-2009 influenza epidemic is expected to moderate-intensity caused by the turning of a new Ukraine strain of influenza A virus (H3N2) Brisbane (Uruguay). In future epidemics, according to experts, will participate and influenza A viruses (H1N1) influenza virus in Brisbane, Florida. These strains were recommended by the World Health Organization to vaccine manufacturers of drugs for influenza vaccine manufacturing at predepidemichesky season 2008-2009.
Currently, Ukraine registered and authorized for use 4 vaccines that contain a specified strains (Vaksigrip, Influvak, Infleksal, Flyuariks)
Summary of UK* surveillance of influenza and other seasonal respiratory illness
26 November 2008 (Week 48
)
Summary
Clinical indices of acute respiratory illness
(England, Wales, Scotland and Northern Ireland)
The overall influenza-like illness incidence rate**
remained below the baseline activity threshold (30 per
100, 000) at 10.4 per 100,000 in week 46/08 which then
increased to 12.6 per 100,000 in week 47/08 (Figure 1).
The rate in the northern region decreased from 9.2 per
100,000 in week 46/08 to 7.2 per 100,000 in week 47/08,
*Incorporating data from the Royal College of General Practitioners (RCGP) (England and Wales), The National
Public Health Service for Wales (NPHS), Health Protection Scotland (HPS), Communicable Disease Surveillance
Centre Northern Ireland (CDSC Northern Ireland), the Office for National Statistics (ONS) (England and Wales),
Medical Officers of Schools Association (MOSA) (England) and NHS Direct (England and Wales).
Figure 1
: RCGP consultation rate for influenza – like illness, 2007/08 and recent years, England and Wales
During weeks 46/08 and 47/08, influenza activity across the UK remained at low levels. Activity is still at baseline levels
in England, Scotland and Wales; thresholds have not yet been set for Northern Ireland. Some clinical indicators of
influenza have increased in England and Northern Ireland but have decreased slightly in Scotland and Wales. Of the
samples referred to the Centre for Infections’ Respiratory Virus Unit (RVU) during weeks 46/08 and 47/08, 45 were
positive for influenza A, three A (H1) and 42 A (H3) and one for influenza B. Other NHS and HPA laboratories in England
and Wales reported 27 influenza A and three influenza B positive specimens during these two weeks. Three influenza
A positive specimens were reported from Scotland in week 46/08 and three influenza A (H3) from Northern Ireland in
week 47/08. One outbreak of respiratory illness was reported from a school in Wales in week 47/08; one sample
tested positive for influenza A. The weekly vaccine uptake rates for the over 65 years increased from 62.5% in week 45/
08 to 66% in week 46/08 and in the under 65 years at risk group it increased from 35% to 37.9% in the same time
period. Vaccine uptake data is not currently available for week 47/08. Influenza activity was at low levels throughout
the rest of Europe.
England and Wales
Royal College of General Practitioners
(
http://www.rcgp.org.uk/bru/index.asp)
Covered in this report:
Data, except that from ONS, MOSA and non-UK sources: 10/11/08 - 23/11/08 (Weeks 46 and 47, 2008 )
Data from ONS, MOSA and non-UK sources: 03/11/08 - 16/11/08 (Weeks 45 and 46, 2008)
** RCGP incidence rates in this report only refer to first or new episodes of infection diagnosed by a GP.
Neuraminidase inhibitor susceptibility testing on 30 A (H3) isolates since week 36/08 showed that all are sensitive to
oseltamivir and zanamivir but resistant to amantadine. All of the four influenza B isolates received since week 36/08
are sensitive to oseltamivir and zanamivir
. Fourteen of fifteen A (H1) specimens tested in the same time frame are
resistant to oseltamivir but sensitive to zanamivir and amantadine. The majority of these resistant viruses come from
the south west of England with the remaining from Wales and northern England. Two influenza A (H1) isolates have
been found to be resistant to oseltamivir in Scotland this season.
Antiviral drug susceptibility test
an increase from 9 per 100,000 to 15.7 per 100,000 was
seen in the central region and the rate remained constant
in the south at 12.1 per 100,000 and 12.5 per 100,00 in
weeks 46 and 47/08 respectively. The rate was highest in
the 15-44 year age group at 17.1 per 100,000 in week 47/
08 (Figure 2).
The rate for acute bronchitis has been increasing steadily
over the season, it increased from 110.3 per 100,000 in
week 46/08 to 119.4 per 100,000 in week 47/08. The
episode incidence rate was highest in the 0-1 year age
group at 694.8 per 100 000 in week 47/08.
E n g l a n d ( R C G P )
S c o t l a n d ( H P S )
W a l e s ( N P H S )
N o r t h e r n I r e l a n d ( C D S C N I )
Figure 3
: GP Consultation rates for influenza/influenza-like illness in the U.K
QSurveillance
HPA and Nottingham University Division of Primary
Care.
(
http://www.qresearch.org)
Northern Ireland
CDSC Northern Ireland
(
http://www.cdscni.org.uk/)
The combined rate for influenza and influenza-like illness
nearly doubled from 26.5 per 100,000 (updated rate) in
week 46/08 to 44.7 per 100,000 in week 47/08 (Figure 3).
No threshold has been set for Northern Ireland.
This primary care surveillance system uses
QSurveillance, a database of general practice derived
data. During weeks 46/08 and 47/08, approximately
3200 practices reported from England, Wales, Scotland
and Northern Ireland covering a population of around 21
million. The rate of influenza-like illness increased from
9.8 per 100,000 in week 46/08 to 10.3 per 100,000 in
week 47/08. The highest rates have consistently been in
the 15-44 year age group. In weeks 46 and 47/08 the
rates were highest in London, Northern Ireland and the
West Midlands.
NHS Direct total call activity
England and Wales
(
http://www.nhsdirect.nhs.uk/)
Cold/flu and fever calls were low and within the baseline
levels during weeks 46/08 and 47/08. The proportion of
cold/flu calls remained the same at 0.6% in weeks 46
and 47/08 (the theshold is set at 1.2%). Fever calls in the
5-14 age group made up 6.3% of the total calls in week
47/08 which was similar to 6.4% in week 44/08, both are
lower than the threshold of 9%.
Wales
National Public Health Service
(
http://www.wales.nhs.uk/sites/home.cfm?OrgID=368)
GP consultation rates for influenza decreased from 4.2
per 100 000 in week 46/08 to 2.9 per 100,000 in week
47/08. Both figures are well below the baseline threshold
of 25 consultations per 100,000 (Figure 3).
Figure 2
: RCGP Episode incidence rates for influenza-like illness (ILI) by age group, England and Wales.
W e e k
Rate per 100 000 population
0 - 1
1 - 4
5 - 1 4
1 5 - 4 4
4 5 - 6 4
6 5 - 7 4
> 7 5
Medical Officers of Schools Association
(MOSA)
During weeks 45 and 46/08, 21 schools reported data.
There were no new episodes of influenza like illness
reported in week 45/08 and ten episodes in week 46/08
giving a rate of 4.8 per 1000. The rate of upper respiratory
tract infection in week 45/08 was 4.9 per 1000 population
(32 new episodes) which increased to 7.0 (42 new
episodes) in week 46/08.
Scotland
Health Protection Scotland
(
http://www.hps.scot.nhs.uk/)
GP consultation rates for influenza decreased from 13.0
per 100,000 in week 46/08 to 11.0 per 100,000 in week
47/08. Activity remains below the Scottish baseline
threshold of 50 consultations per 100,000 (Figure 3).
3
Respiratory Virus Unit (RVU) Influenza Reference
Laboratory, CfI
Forty-five specimens tested positive for influenza A viruses
in weeks 46/08 and 47/08 (Table 1). Since week 40/08 57
viruses have been characterised: nine A/Solomon Island/
3/2006 (H1)-like which is similar to the vaccine strain, two
A (H1) Brisbane/59/2007 (H1N1)-like (vaccine strain) and
46 A (H3) A/Brisbane/10/2007 (H3N2)-like (vaccine strain)
(Figure 4).
The majority of influenza A (H1) specimens
received to date come from Southern England (table
1).
Neuraminidase inhibitor susceptibility testing on 30 A
(H3) isolates since week 36/08 showed that all of them
are sensitive to oseltamivir and zanamivir but resistant to
amantadine. Of the 15 A (H1) specimens received and
tested, 14 are resistant to oseltamivir but sensitive to
zanamivir and amantadine. These specimens are from
Northern and Southern England and Wales (table 1). Four
* RSV detection is by PCR only
Other NHS and HPA laboratories (England and
Wales)
The number of specimens positive for influenza A has
decreased slightly from 16 in week 46/08 to 11 in week
47/08 and the number of RSV positives increased
slightly (from 320 to 351) in the same time period. To
date, a similar number of influenza A and B positive
specimens have come from each area of England with
fewer from Wales. (Table 2).
Please note that these data are provisional.
Laboratory indices of acute respiratory illness
*
Detections of RSV by isolation are not included.
Table 1 “Detections” (PCR and isolation) of influenza and
RSV made by RVU (CfI) Reference Laboratory.
Samples from community and hospital sources,
by week of report.
19 82 1 13
Influenza Detections by
PCR and Isolation
A (H1) A (H3) B RSV*
Cumulative to date
Northern England
Central England
Southern England
Wales
Scotland
Northern Ireland
Cumulative Total
Influenza type ( subtype)
Week 46/08
Week 47/08
(week 40/08 – 47/08)
356 336 3922
Table 2 ‘‘Detections” (isolation, PCR, direct
immunofluorescence and paired sera tests) of
influenza and RSV reported to CfI by NHS and
HPA microbiology laboratories. Data for England
and Wales by RCGP region, by week of report
Week 46/08
Week 47/08
Cumulative to Date
(week 40/08 - 47/08)
Northern England
Central England
Southern England
Wales
Cumulative Total
Detection (isolates, DIF and PCR)
Influenza A Influenza B RSV*
16 0 320
11 3 351
18 2 540
17 2 174
19 2 279
6 0 77
60 6 1070
1 23 0 3
2 19 1 0
Figure 4 : Total ( Community and Hospital) Influenza detections (PCR and Isolation) characterised by RVU,CfI, by week of
specimen
I n f l u e n z a A ( H 1 )
I n f l u e n z a A ( H 3 )
I n f l u e n z a B
further influenza A(H1) isolates are undergoing
resistance testing at the moment. Four influenza B
isolates have been received and tested and all are
sensitive to oseltamivir and zanamivir.
Please note that these data are provisional.
4
Avian Influenza
The WHO continues to monitor and report on new cases
of human infection with A(H5N1) avian influenza when
they occur.
There have been no new human cases since the last
cases reported from Indonesia on 10 September 2008.
According to WHO, the total number of confirmed human
infections worldwide with H5N1, since December 2003,
is 387 of which 245 (63%) have died.
The first three influenza A (H3) samples were reported
in week 47/08, two sentinel and one non-sentinel. In
week 46/08 21 non-sentinel samples were positive
for RSV and in week 47/08 this number was 29.
Flu Vaccination Campaign 2008/09 (England)
Data on influenza vaccination uptake is taken weekly from
a sample of GPs in England. Steady increasing trends
have been since since the start of the campaign in
September 2008.
The proportion vaccinated in the over 65 year age group
increased from 62.5% in week 45/08 to 66% in week 46/
08. In the under 65 years at risk group, the proportion
vaccinated increased from 35% in week 45/08 to 37.9%
in week 46/08. No data is currently available for week 47/
08.
It should be noted that all data is provisional.
This parallel GP sentinel scheme reported four out of
28 (14.3%) influenza A positive and one (3.6%)
influenza B positive specimens during weeks 46/08
and 47/08. To date, eight of the 14 oseltamavirresistant
A (H1) specimens have come from this
scheme. Two specimens were positive for RSV and
two for other respiratory viruses in the same time
period.
HPA CfI Virological Surveillance of Influenza
(England)
Outbreak Reports:
One outbreak was reported in week 47/08 from a school
in Wales. One specimen tested positive for influenza A.
CfI would welcome any reports of influenza outbreak
investigations. Please email any reports to
respdcsc@hpa.org.uk
).
Mortality Data
Office for National Statistics
(
http://www.statistics.gov.uk)
The number of deaths registered in England and Wales
decreased from 9900 in week 45/08 to 9869 in week 46/
08. The number of deaths due to all respiratory diseases
(as underlying cause) stayed constant at 1215 (12.3%)
in week 45/08 and 1207 (12.2%) in week 46/08. The
weekly all cause registered deaths are shown in Figure
5. No excess deaths were detected in either week.
Other Reports (UK)
Virological data from Scotland
(
http://www.show.scot.nhs.uk/scieh/)
During week 46/08, out of 20 sentinel samples, which
were received through SERVIS, three were positive for
influenza A and one for RSV. Thirty-two routine samples
reported from hospital and community sources were
tested in week 46/08, one was positive for influenza A
and 31 positive for RSV. In week 47/08 22 sentinel
samples were received, three were positive for
influenza A and three for RSV. Fifty-seven non-sentinel
samples were also tested of which five for positive for
influenza A and 52 for RSV.
Two influenza A (H1) isolates from Scotland this
season have been found to be resistant to oseltamivir.
Figure 5 : Weekly all cause registered deaths in England and Wales
4 0 4 2 4 4 4 6 4 8 5 0 5 2 2 4 6 8 1 0 1 2 1 4 1 6 1 8 2 0
W e e k N u m b e r
Number of Deaths
O b s e r v e d
E x p e c t e d
9 5 % U p p e r L i m i t
Data Source: The National Influenza Vaccine Uptake
Monitoring Programme (HPA/DH)
5
Data for this report were collated by the Influenza/
Respiratory Virus Team:
Estelle McLean, Joy Field, Hongxin Zhao and Richard
Pebody
Respiratory and Systemic Infections Department
HPA Centre for Infections, 61 Colindale Avenue
London NW9 5EQ, United Kingdom
Tel: (0)20 8327 7768; Fax: (0)20 8200 7868
E-mail:
respcdsc@hpa.org.uk
Maria Zambon, Joanna Ellis, Angie Lackenby, Alison
Bermingham and Praveen Sebastianpillai
Respiratory Virus Unit, Virus Reference Department
HPA Centre for Infections, 61 Colindale Avenue
London NW9 5HT, United Kingdom
Tel: (0)20 8327 6239; Fax: (0)20 8205 8195
E-mail:
ernvl@hpa.org.uk
If you wish to be included on our email notification list
please send your address to:
respcdsc@hpa.org.uk
Acknowledgements
Canada
Public Health Agency of Canada
(
http://www.phac-aspc.gc.ca/fluwatch/index.html)
During weeks 45 and 46/08, influenza activity remained
low with the majority of the influenza surveillance regions
reporting no activity and eight regions reporting sporadic
influenza activity in week 46/08. A slight increase in the
consultation rates and number of viruses detected has
been reported. Seven of 1512 (1.5%) specimens tested
positive for influenza in week 45/08 and 10/1479 (0.7%)
in week 46/08.
Since 1 September 2008, five influenza viruses have
been characterised: one influenza A/Brisbane/59/
2007(H1N1)-like, one A/Brisbane/10/2007 (H3N2)-like,
two influenza B/Florida/4/2006-like and one B/Malaysia/
2506/2004-like. The influenza A (H1N1) isolate has been
found to be resistant to oseltamivir.
Ireland
Health Protection Surveillance Centre (HPSC)
(
http://www.hpsc.ie/)
Influenza activity in Ireland during weeks 46 and 47/
08 were at low levels. In week 46/08 the ILI consultation
rate was 9.3 per 100,000 and increased to
10.8 per 100,000 in week 47/08 (21 consultations).
In week 46/08 two of six sentinel specimens tested
positive for influenza A (H3) and 20 of 82 nonsentinel
specimens tested were positive for RSV. In
week 47/08 one of eight sentinel samples was
positive for influenza B, which is the first of the
season in Ireland. Thirty-one of 81 non-sentinel
samples were positive for RSV in week 47/08.
Other country reports can be obtained from the World
Health Organisation:
In weeks 45 and 46/08, low levels of seasonal influenza
activity were seen across all 26 European countries
participating in the EISS. In week 46/08 sporadic activity
was reported in England, Ireland, Northern Ireland,
Norway, Portugal, Romania, Spain, Sweden, Switzerland
and Wales and no activity in the remaining 13 countries.
Out of the total 451 respiratory specimens collected by
sentinel physicians during week 46/08, 32 (7.1%)
specimens tested positive for influenza, seven type A (not
subtyped), 22 A(H3) and three type B. In addition, 30 nonsentinel
specimens tested positive including six A (H3),
22 influenza A (not subtyped) and one type B. These
positive specimens were reported from 13 countries with
the Czech Republic, Hungary and Italy reporting
detections for the first time in the 2008/09 season.
Since week 40/08, 41 viruses have been characterised;
39 of these seem to be a good match to the strains
recommended for the 2008-09 vaccine, the remaining
two were B/Malaysia/2506/2004-like.
Influenza activity outside the UK
In week 46/08 WHO and NREVSS laboratories reported
1772 specimens tested for influenza viruses, 16 (0.9%)
of which were positive: five influenza A (H1) and eight
influenza A (not subtyped). One human case of swine
influenza A (H1N1) was reported in week 46/08, the person
had been exposed to an ill pig.
Since week 40/08 one influenza virus has been
characterised as B/Florida/04/2006-like, which is
antigenically similar to one of the components
recommended for the 2008-09 vaccine. Of the two
influenza A (H1) viruses tested this season, one has been
2008-2009 Influenza Season Week 47, ending November 22, 2008 (All data are preliminary and may change as more reports are received.) Synopsis:
During week 47 (November 16-22, 2008), a low level of influenza activity was reported in the United States.
Fifty-two (2.5%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
The proportion of outpatient visits for influenza-like illness (ILI) was below national and region-specific baseline levels.
One state reported local influenza activity; the District of Columbia and 19 states reported sporadic influenza activity; 29 states reported no influenza activity; and one state did not report.
National and Regional Summary of Select Surveillance Components
Region
Data for current week
Data cumulative for the season
Out-patient ILI*
% positive for flu†
Number of jurisdictions reporting regional or widespread activity‡
A (H1)
A (H3)
A Unsub-typed
B
Pediatric Deaths
Nation
Normal
2.5 %
0 of 51
101
14
128
66
0
New England
Normal
0.5 %
0 of 6
0
1
2
1
0
Mid-Atlantic
Normal
0.1 %
0 of 3
2
0
2
1
0
East North Central
Normal
5.3 %
0 of 5
4
0
3
6
0
West North Central
Normal
0.3 %
0 of 7
0
0
2
1
0
South Atlantic
Normal
1.8 %
0 of 9
8
2
45
23
0
East South Central
Normal
0.0 %
0 of 4
0
0
0
0
0
West South Central
Normal
3.6 %
0 of 4
10
0
28
20
0
Mountain
Normal
1.2 %
0 of 8
2
7
7
4
0
Pacific
Normal
5.4 %
0 of 5
75
4
39
10
0
* Elevated means the % of visits for ILI is at or above the national or region-specific baseline
† National data is for current week; regional data is for the most recent three weeks.
‡ Includes all 50 states and the District of Columbia U.S. Virologic Surveillance:
During week 47, WHO and NREVSS laboratories located in all 50 states and Washington D.C. reported 2,080 specimens tested for influenza viruses, 52 of which were positive: ten influenza A (H1) viruses, 26 influenza A viruses that were not subtyped, and 16 influenza B viruses. Twenty-five states from eight of the nine surveillance regions have reported laboratory-confirmed influenza this season with three states accounting for 235 (76.1%) of the 309 reported influenza viruses.
CDC has antigenically characterized 21 influenza viruses [20 influenza A (H1) and one influenza B virus] collected by U.S. laboratories since October 1, 2008. All influenza A (H1) viruses were antigenically related to A/Brisbane/59/2007, the A (H1N1) component selected for the 2008-09 influenza vaccine. The influenza B virus was characterized as B/Florida/04/2006-like, the influenza B component of the 2008-09 influenza vaccine.
It is too early in the influenza season to determine which influenza viruses will predominate or how well the vaccine and circulating strains will match. Antiviral Resistance:
Since October 1, 2008, 21 influenza A (H1N1), five influenza A (H3N2), and eight influenza B viruses from eight states have been tested for antiviral resistance; however, 71% of the viruses tested were from only two states. Twenty of 21 influenza A (H1N1) viruses tested were resistant to oseltamivir; all 21 viruses were sensitive to zanamivir. All influenza A (H3N2) and B viruses tested were sensitive to oseltamivir and zanamivir.
Six influenza A (H1N1) and four influenza A (H3N2) viruses were tested for adamantane resistance. All influenza A (H1N1) viruses were sensitive to adamantanes and all influenza A (H3N2) viruses tested were resistant to adamantanes. The adamantanes are not effective against influenza B viruses.
Only one state has reported local influenza activity during the 2008-09 season in the United States to date, thus the number of virus specimens available for antiviral resistance testing is limited in both overall number tested and in the number of states that have submitted specimens. Currently, data on antiviral resistance, as well as the limited information on which influenza virus types or subtypes will circulate during the season, are insufficient to provide an indication of the prevalence of oseltamivir or adamantane (amantadine and rimantadine) resistance at a national or regional level. CDC has solicited a representative sample of viruses from WHO collaborating laboratories in the United States, and more specimens are expected as influenza activity increases. Pneumonia and Influenza (P&I) Mortality Surveillance
During week 47, 6.4% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below the epidemic threshold of 7.0% for week 47
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 47, 1.3% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) (formerly known as the U.S. 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 0.6% to 2.4%. All nine regions reported percentages of visits for ILI below their respective region-specific baselines.
During week 47 the following influenza activity was reported:
Local influenza activity was reported by one state (Hawaii)
Sporadic activity was reported in the District of Columbia and 19 states (Alaska, Arizona, California, Colorado, Connecticut, Florida, Idaho, Indiana, Massachusetts, Maryland, Michigan, Nevada, New York, Oregon, Pennsylvania, Texas, Utah, Wisconsin, and Wyoming).
No influenza activity was reported in 29 states (Alabama, Arkansas, Delaware, Georgia, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, and West Virginia).
--------------------------------------------------------------------------------
A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
Clicking on the map will, if available, take you through to the national web site. If 'regional' activity is reported, a pop-up text box will appear which describes the activity in greater detail.
Clicking on England and France will provide you with regional data.
A = Dominant virus A H1N1 = Dominant virus A(H1N1) H3N2 = Dominant virus A(H3N2) H1N2 = Dominant virus A(H1N2) B = Dominant virus B A & B = Dominant virus A & B
Low = no influenza activity or influenza at baseline levels Medium = usual levels of influenza activity High = higher than usual levels of influenza activity Very high = particularly severe levels of influenza activity
No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels) Sporadic = isolated cases of laboratory confirmed influenza infection Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,
or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed. Regional activity = influenza activity above baseline levels in one or more regions with
a population comprising less than 50% of the country's total population. Laboratory confirmed. Widespread = influenza activity above baseline levels in one or more regions with a population
comprising 50% or more of the country's population. Laboratory confirmed.
Finland : Where available, the epidemiological data are provided by a health-care district in
South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately one
percent of the Finnish population).
Network comments (where available)
Italy
Three further A/H3N2 influenza viruses have been isolated during this week. Latvia
In week 47,a specimen from non-sentinel girl of 13 years old ,patient with ARI ,was positive for influenza A.It was the first laboratory- confirmed influenza case in Latvia Switzerland
no influenza virus was detected during the week 47. One additional influenza A virus was detected during the week 46.
Intensity: Low = no influenza activity or influenza activity at baseline level; Medium= usual levels of influenza activity; High = higher than usual levels of influenza activity; Very high = particularly severe levels of influenza activity. Percentage positive: percentage of sentinel swabs that tested positive for influenza A or B Dominant type: this assessment is based on data from sentinel and non-sentinel sources ARI: acute respiratory infection ILI: influenza-like illness Population: per 100,000 population
The bulletin text was written by an editorial team at the European Centre for Disease Prevention and Control (ECDC) and the Community Network of Reference Laboratories for Human Influenza in Europe (CNRL). Team members are Flaviu Plata, Phillip Zucs and Bruno Ciancio from ECDC, and Adam, Meijer Rod Daniels Alan Hay and Maria Zambon from CNRL. The bulletin text was reviewed by Olav Hungnes (Norwegian Institute of Public Health, Oslo, Norway), and Anne Mazick (Statens Serum Institut, Copenhagen, Denmark) on behalf of the EISS members.
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Re: Seasonal Flu 2008 - 2009
Linear Mode
