Neuraminidase inhibitor susceptibility testing was not carried out during this Christmas - New Year holiday period.
Canada:
Since 1 September 2008, 20 influenza viruses have been
characterised: three influenza A/Brisbane/59/
2007(H1N1)-like, two A/Brisbane/10/2007 (H3N2)-like,
three influenza B/Florida/4/2006-like and 12 B/Malaysia/
2506/2004-like, the latter was a component of the 2007/
08 vaccine. Six influenza A (H1N1) isolates have been
Gradually increasing level of influenza activity, especially in El Paso County, based on the number of hospitalizations and increasing sentinel laboratory positivity.
Local activity was reported to CDC for the first time this season.
INFLUENZA-LIKE ILLNESS SURVEILLANCE FROM KAISER PERMANENTE
(DENVER METRO REGION)
0.9% - week ending 12/13/08
0.8% - week ending 12/20/08
0.9% - week ending 12/27/08
NOTE: The inter-season range from June through September was 0.4% - 0.8%.
REPORTED INFLUENZA-ASSOCIATED HOSPITALIZATIONS
1 - week ending 12/13/08
1 - week ending 12/20/08
3 - week ending 12/27/08
7 (Cumulative 10/04/08 – 12/27/08)
TYPE AND STRAIN INFORMATION
(CUMULATIVE 12/02/08 – 12/27/08)
Type A Influenza = 20
• Subtype H3 = 11
• Subtype H1 = 7
Type B Influenza = 1
NOTE: Type and strain information is based on direct fluorescent antibody (DFA), RT-PCR and viral culture results. Results included in strain surveillance do not necessarily represent hospitalizations and should not be regarded as cases.
SENTINEL LABORATORY SURVEILLANCE
Based on 15 reporting labs, 386 specimens were tested for influenza of which 21 (5.4%) were positive for A.
REPORTS OF OUTBREAKS OF INFLUENZA
There were no influenza outbreaks reported in the past week.
Week 52 (Dec 21-27, ’08) Report
This Week"s Activity Level is:
“Local”
Reports from Sentinel Providers indicate an elevated level of influenza-like illness in one surveillance region the State AND there are now lab-confirmed cases of influenza.)
Reports of visits for influenza-like illness (ILI) to sentinel providers. This week, a total of 59 visits for ILI were reported by 7 providers. The median percent of ILI visits in Maryland was 1.5%. This is below the state baseline of 3.6%.
Sentinel providers are health care providers who report to us the proportion of patient visits for influenza like illness. Because of the great variability in reported ILI proportions among providers each week, the median ILI is used instead of the average. Half of the ILI reports were below the median and half were above.
If you are interested in becoming a sentinel provider, please feel free to contact us at flu@dhmh.state.md or by phone at 410-767-6700.
Click on graph to enlarge
Reports of rapid influenza tests from clinical laboratories. During week 52, a total of 255 rapid influenza tests were reported by 9 reporting clinical laboratories. Of these, 18 tests (7.1%) were positive.
Because the sensitivity and specificity of rapid flu tests vary with the prevalence of influenza in the population*, rapid flu tests performed before the first DHMH lab-confirmed case are not counted as confirmed cases for the purpose of surveillance. Now that the DHMH laboratory has confirmed a case by reference methods, all rapid influenza tests will be counted as confirmed cases.
Click on graph to enlarge
Reports of reference testing on submitted specimens from the Public Health Laboratory. During week 52, a total of 19 specimens were submitted for testing at the DHMH laboratory. One (5.3%) of these were positive for influenza. This season, a total of 130 specimens have been submitted for testing at the DHMH laboratory. Of these, 7 (5.4%) have been positive by PCR. Four specimens (3.1%) were positive for influenza Type A, and three specimens (2.3%) were positive for influenza Type B.
For the purpose of influenza surveillance, cases are counted as “confirmed” when they are based on more reliable reference test methods (PCR or culture) performed by the DHMH lab, or are based on other techniques such as rapid test for the detection of influenza antigen AFTER the DHMH lab has confirmed its first case of the season.
This is done because the sensitivity and specificity of rapid flu tests vary with the prevalence of influenza in the population*, and are less reliable when prevalence is low. This season, all positive clinical laboratory results from week 46 onward (45) are counted as confirmed cases, and of course, all the positive DHMH lab results (3).
The seven positive specimens identified by the DHMH lab have been typed as influenza A (4, 57%) and influenza B (3, 43%). To date, the CDC laboratory has identified two as type A (H1N1) Brisbane-like and another as type B Florida-like. Both strains are components of this season’s influenza vaccine. The type A (H1N1) isolate was found to be resistant to Oseltamivir (Tamiflu ®) but sensitive to Adamantanes and Zanamivir. Interim guidelines on the use of antivirals for influenza can be found athttp://tinyurl.com/cdcinterim.
Click on graph to enlarge
Reports of outbreaks of influenza in schools and other institutions. One outbreak of pneumonia was reported to the Division of Outbreak Investigations this week.
Although influenza is not a reportable condition in Maryland, outbreaks of influenza in institutional settings are reportable. Please contact your local health department to report an outbreak.
For more information about outbreak investigations in Maryland, please visit: http://edcp.org/html/otbkhmpg.html.
Click on graph to enlarge
Reports of hospitalizations due to influenza. No reports were filed this week due to the Holidays.
To date, there have been 84 (47, 56% adult, and 37, 44% pediatric) hospitalizations for influenza reported to DHMH. Last season, 715 (516, 72% adult, and 199, 28% pediatric) hospitalizations were reported.
The Emerging Infections Program collects information on a weekly basis from several hospitals in the Baltimore Metro Region on the number of hospitalizations associated with influenza.
Click on graph to enlarge
Reports from Maryland residents. A total of 444 participants signed up at http://tinyurl.com/flu-enroll by the end of week 52. Of the 444 residents who received the weekly survey, 224 (50%) responded to it. Among the respondents, 3 (1.3%) reported flu-like symptoms. One of the respondents reported getting his or her flu vaccine this week.
Because there is no baseline to compare these results, and the sample size is small (compared to the population), caution must be taken when interpreting the results.
We continue to recruit participants. Please enroll at the link above or pass on the link to anyone interested. If you would like to participate in the resident flu tracking survey, please visit THIS SITE [https://www.surveymonkey.com/s.aspx?sm=eIGPl_2bIZTs3qV90lureTog_3d_3d]or email us at flu@dhmh.state.md.us.
Laboratories report positive influenza tests to ADHS. Of the lab-confirmed influenza reported this season, 18 are influenza A, 7 are influenza B and 2 are unknown.
Laboratory Data
Two WHO/NREVSS collaborating laboratories in Washington reported data for week 50. Three of the 183 (1.6%) specimens tested were positive for influenza. One was influenza A(H3N2) and two were influenza A(unknown subtype). To date, eight specimens tested by collaborating laboratories in Washington have been positive for influenza (two A-H1, one A-H3, four A-unknown subtype, and one B) since the start of the influenza surveillance season. In the Pacific Region, six WHO/NREVSS collaborating laboratories reported testing 317 specimens during week 50. Twelve (3.8%) were positive (8 A-H1, 1 A-H3, and 3 A-unknown subtype). Last week 2.6% of specimens tested were positive for influenza. Since the beginning of influenza surveillance season, 3.5% of all specimens tested have been positive for influenza. The table and chart below show cumulative influenza isolates from the Pacific Region reported by WHO/NREVSS collaborating laboratories.
what are the chances of brisbane flu,i think that was what is was called,the one they have had in australia.that hit people quite hard,is it still around and what are the chances of it reaching the uk if it is.......?.
one more question if anyone can answer it please there has been a chesty cough virus going around the uk,with no other symptoms just those,any idea what it is.people get it and i thought if you had,had it your body would have a defence against you getting it again but it doesnt i have family and friends who have had this more than once.thanks for any advice.
what are the chances of brisbane flu,i think that was what is was called,the one they have had in australia.that hit people quite hard,is it still around and what are the chances of it reaching the uk if it is.......?.
one more question if anyone can answer it please there has been a chesty cough virus going around the uk,with no other symptoms just those,any idea what it is.people get it and i thought if you had,had it your body would have a defence against you getting it again but it doesnt i have family and friends who have had this more than once.thanks for any advice.
Both influenza sub-types are from Brisbane. H1N1 is Brisbane/59 while H3N2 is Brisbane/10. UK has both but 90% of infleunza A is H3N2.
However, UK also has the norovirus, which isn't flu and produces GI symtoms. There are also other respiratory viruses like RSV, which also are not flu.
Of the 608 specimens tested since the beginning of the 2008-09 flu season, 179 (29.4%) influenza isolates
have been detected by SLD. Of these, 4 (2%) were influenza A (subtype unknown), 166 (93%) were
influenza A(H1) and 5 (3%) were influenza A(H3). There have been 4 (2%) influenza B cases. Select
isolates were sent to CDC for strain characterization.
CDC has reported antigenic characterization results from 21 influenza isolates [11 influenza A/H1, 0 influenza A/H3, and 10 influenza B viruses] received from the Texas Department of State Health Services (DSHS) Laboratory since the beginning of the 2008-09 flu season.
Influenza A/H1 [11]
Eleven (100%) of the eleven viruses were characterized as A/Brisbane/59/2007, the influenza A/H1 component of the 2008-09 influenza vaccine for the Northern Hemisphere.
Influenza A/H3 [0]
The DSHS lab has not isolated influenza A/H3 from any specimens yet this season.
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 A/H3N2 influenza isolates have been reported during this week. Latvia
Influenza activity is still very low .Second influenza A virus in this season , has been detected in last week from patient getting ill on the day of returning from England. Netherlands
First week this season that a substantial proportion of specimens from sentinel ILI patients contained influenza virus: in 5 of 11 specimens A(H3N2) was detected. So far this season all influenza viruses detected in specimens from sentinel ILI patients were A(H3N2). Switzerland
Influenza A, and exclusively influenza A (H3N2) are detected in Switzerland. Medical consultations remained below threshold last week.
Intensity: Low = no influenza activity or influenza activity at baseline level; Medium= usual levels of influenza activity; High = higher than usual levels of influenza activity; Very high = particularly severe levels of influenza activity. Percentage positive: percentage of sentinel swabs that tested positive for influenza A or B Dominant type: this assessment is based on data from sentinel and non-sentinel sources ARI: acute respiratory infection ILI: influenza-like illness Population: per 100,000 population
The bulletin text was written by an editorial team at the European Centre for Disease Prevention and Control (ECDC) and the Community Network of Reference Laboratories for Human Influenza in Europe (CNRL). Team members are Flaviu Plata, Phillip Zucs and Bruno Ciancio from ECDC, and Adam, Meijer Rod Daniels Alan Hay and Maria Zambon from CNRL. The bulletin text was reviewed by Olav Hungnes (Norwegian Institute of Public Health, Oslo, Norway), and Anne Mazick (Statens Serum Institut, Copenhagen, Denmark) on behalf of the EISS members.
Neither the European Centre for Disease Prevention and Control (ECDC), nor any person acting on his behalf is liable for the use that may be made of the information contained in this bulletin. Maps and commentary used in this Bulletin do not imply any opinions whatsoever of ECDC or its partners on the legal status of the countries and territories shown or concerning their borders.
EISS - Weekly Electronic Bulletin Week 52 : 22/12/2008-28/12/2008 - 01 January 2009, Issue N° 286. Influenza season started in seven countries of Western/Southern Europe.
-- Summary:
In week 52/2008, influenza activity of high intensity in Portugal and medium intensity in Ireland, Spain and the UK (England and Northern Ireland) was maintained, whilst activity reached medium intensity in France and Italy.
Most of the viruses isolated so far are type A of which the majority are of the H3 subtype.
Given the current epidemiological and virological situation, and despite lowered reporting over the Christmas holiday period, it is anticipated that in the coming weeks seasonal influenza will continue to spread and become more intense in a number of Eastern-Northern European countries.
Vaccination of those still at risk should be expedited.
-- Epidemiological situation - week 52/2008:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were high in Portugal and medium in France, Ireland, Italy, Spain and the UK (England and Northern Ireland).
The remaining 17 countries providing data reported low intensity with increasing trends, compared to week 51/2008, in Ireland, Italy, Luxembourg, Portugal, Spain and Wales.
For the geographical spread indicator, widespread influenza activity occurred in France, Portugal and the UK (England and Northern Ireland), while regional activity was reported in Netherlands, Spain and the UK (Wales) and local activity in Italy.
Sporadic activity was observed in five countries (Belgium, Luxembourg, Slovakia, Slovenia and Switzerland) while no activity was apparent in the other 11 countries reporting for week 52/2008.
-- Cumulative epidemiological situation – 2008-2009 season (weeks 40-52/2008):
The majority of countries participating in European influenza surveillance continue to report low intensity of influenza activity with sporadic/regional cases at most.
Seven Western/Southern European countries are currently experiencing medium to high intensity which is also reported to be widespread in France, Portugal and the UK (England and Northern Ireland).
The first countries in Europe to report medium intensity of influenza activity (i.e. consultation rates being above the national baseline thresholds that are set at levels usually seen outside the winter period) were Ireland, Northern Ireland and Portugal (in week 49/2008) and England (in week 50/2008).
Subsequently, Spain (since week 51/2008), France and Italy (in week 52/2008) have reported influenza activities greater than baseline levels.
Portugal has reported high activity since week 51/2008.
Generally, the highest consultation rates have been reported for the 0-4 age group, but England, Ireland, Northern Ireland, Portugal, Switzerland and Wales have been reporting high ILI consultation rates in the 15-64 age group compared to the other age groups.
-- Virological situation - week 52/2008:
The total number of respiratory specimens collected by sentinel physicians in week 52/2008 was 435, of which 224 (51.5%) were positive for influenza virus: 218 type A (140 subtype H3, seven H1 and 71 not subtyped) and six type B.
In addition, 223 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 211 type A (14 subtype H3, one subtype H1 and 196 not subtyped) and 12 type B.
Overall, across Europe detection of influenza viruses was reported from 16 of 21 countries providing virological data for week 52/2008 and included the first 2008-2009 seasonal-influenza detections for Greece and Malta.
-- Cumulative virological situation – 2008-2009 season (weeks 40-52/2008):
Of 2650 virus detections (sentinel and non-sentinel) since week 40/2008, 2534 were type A (1030 subtype H3, 71 subtype H1 and 1433 not subtyped) and 116 were type B.
Based on the antigenic and/or genetic characterisation of 262 influenza viruses, 233 were reported as A/Brisbane/10/2007 (H3N2)-like, 19 as A/Brisbane/59/2007 (H1N1)-like, six as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) and four as B/Florida/4/2006-like (B/Yamagata/16/88 lineage).
These characterisations match the current WHO recommendations for H1N1, H3N2 and B/Yamagata lineage virus components for the Northern Hemisphere vaccine.
Three countries (Norway, Sweden and UK) have reported sequence-based antiviral testing with the majority of those viruses analysed from the UK also being assessed phenotypically for neuraminidase inhibitor susceptibility.
Fifty-eight A(H3N2) viruses have been tested for antiviral susceptibility so far this season; all those tested were sensitive to neuraminidase inhibitors (58 for oseltamivir, 56 for zanamivir) and resistant to the M2 inhibitors (56).
Of 30 A(H1N1) viruses analysed, all were sensitive to zanamivir and 29 were resistant to oseltamivir, whilst all of the 19 tested were M2 inhibitor sensitive.
Both B viruses tested were sensitive to neuraminidase inhibitors (one was tested against both zanamivir and oseltamivir and one against oseltamivir only).
But for oseltamivir resistant A(H1N1) viruses from Norway (two) and Sweden (one), all other viruses tested have been from the UK.
-- Comment:
Six countries are now reporting medium influenza intensity and Portugal has reported maintained widespread high intensity in week 52/2008.
Six of these seven countries are on the western seaboard of Europe, whilst Italy has a Mediterranean coastline.
Whilst some of the neighbouring Central and Northern European countries continued to show rising ILI/ARI consultation rates in week 52/2008 the majority, together with most Eastern European countries, continued to report low influenza intensity.
However, consultation rates for week 52/2008 should be interpreted with caution since this week spans the Christmas holiday period when access to primary care and patient swabbing procedures is likely to have been sub-optimal.
This is reflected in the overall number of sentinel specimens collected for virological testing decreasing from 1062 in week 51 to 435 (a 59% reduction) in week 52/2008.
Despite lower sentinel sampling, the proportion of specimens testing positive for influenza virus detection rose from 32.6% in week 51 to 51.5% in week 52/2008.
With this rising trend, the number of countries, especially in the Eastern-Northern parts of Europe, with levels of influenza activity above their baseline thresholds is expected to grow over the coming weeks.
So far this season, the majority (93.6%) of H-subtyped type A viruses have been H3.
These observations consolidate earlier indications that the 2008-2009 influenza season in Europe will probably be dominated by H3 viruses.
-- Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS.
Of these countries, 24 reported clinical data, 21 reported virological data and 18 reported both clinical and virological data to EISS in week 52/2008.
The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (UK).
-- Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
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 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 A/H3N2 influenza isolates have been reported during this week. * Latvia: Influenza activity is still very low. Second influenza A virus in this season , has been detected in last week from patient getting ill on the day of returning from England. * Netherlands: First week this season that a substantial proportion of specimens from sentinel ILI patients contained influenza virus: in 5 of 11 specimens A(H3N2) was detected. So far this season all influenza viruses detected in specimens from sentinel ILI patients were A(H3N2). * Switzerland: Influenza A, and exclusively influenza A (H3N2) are detected in Switzerland. Medical consultations remained below threshold 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
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Travis Hottes, Naveed Janjua, & Danuta Skowronski Number 5: Weeks 51 and 52
BCCDC Influenza & Emerging Respiratory Pathogens Team Dec 14 – 27, 2008
Influenza Activity Continues to be Sporadic in BC
Highlights
During weeks 51 and 52 (Dec 14 – 27, 2008),
BC laboratories reported 11 positive
respiratory specimens for influenza A and 2
positive specimens for influenza B. Of the
influenza A isolates that have been sub-typed
to date this season, 89% (24 / 27) were A/H1.
Oseltamivir resistance has been reported in a
high proportion of A/H1N1 viruses to date this
season. Forty-three percent of respiratory
specimens tested at BC Children’s and
Women’s Health Centre were positive for RSV
with only 2 influenza A and 2 influenza B
detections by that Centre. No influenza
outbreaks were reported in weeks 51 and 52,
and the rate of ILI visits to physicians remains
lower than average for this time of year.
Please remember to notify BCCDC if an
outbreak of ILI occurs in your region, by
emailing
ilioutbreak@bccdc.ca and attaching
the outbreak report form (a copy is found at the
end of this report).
Sentinel Physicians
Based on the historic range for this time of
year, the rate of ILI visits to sentinel physicians
was lower than expected. In week 51, the
percentage of all patient visits due to ILI was
0.25%; final sentinel ILI rates for week 52 are
still pending. (See graph and table on page 4.)
ILI Outbreaks
Since the start of the season (Sept 28),
specimens have been submitted to BCCDC
Laboratory Services in relation to 24 ILI
outbreak investigations. Rhino/enterovirus was
identified in 9/24 (38%) of the investigations,
RSV was identified in 1 (4%) investigation,
and no pathogen was identified in the other 14
investigations. (See graph on page 5.)
Laboratory Reports
During weeks 51 and 52 (Dec 14 – 27, 2008),
BCCDC Laboratory Services tested 102
respiratory specimens. Influenza A was
identified in 9 specimens. Of these, 5 were
sub-typed as H1, 1 was sub-typed as H3, and
the other 3 have yet to be sub-typed. Ten
specimens tested positive for
rhino/enterovirus, 9 for RSV, 3 for
parainfluenza, and 2 for adenovirus.
During weeks 51 and 52 (Dec 14 – 27, 2008),
Children’s and Women’s Health Centre
Laboratory tested 192 respiratory specimens.
Influenza was identified in 4 specimens (2
influenza A and 2 influenza B). Eighty-three
(43%) specimens tested positive for RSV, 2
for adenovirus, and 2 for parainfluenza. (See
graphs on page 6.)
Oseltamivir Resistance
During the 2007-08 season, oseltamivir
resistance was identified among circulating
A/H1N1 viruses worldwide. Testing in Canada
Contents:
Overview
Page 1
Sentinel Physicians
Page 1
ILI Outbreaks
Page 1
Laboratory Reports
Page 1
Oseltamivir Resistance
Page 1
Canadian Data
Page 2
International Data
Page 2
Avian Influenza
Page 2
Vaccine Composition
Page 3
Activity Level Definitions
Page 3
List of Acronyms
Page 3
Web Sites
Page 3
Weekly ILI Graph
Page 4
ILI by Health Authority
Page 4
ILI Outbreaks Graph
Page 5
Lab Summary Graphs
Page 6
ILI Outbreak Form
Page 7
B
RITISH COLUMBIA (BC)
I
NFLUENZA SURVEILLANCE
2008-2009
UPDATE
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indicated that 26% of last season’s A/H1N1
isolates were resistant to oseltamivir. Influenza
activity remains low, and only a small sample
of viruses is yet available for assessment for
the current season. To date (Dec 31), BCCDC
has assessed 19 A/H1N1 isolates for
oseltamivir resistance; 14 show genotypic
evidence of oseltamivir resistance, and the
other 5 are indeterminate and undergoing
further assessment through sequencing of the
neuraminidase gene. These specimens were
from community-based cases of ILI; none was
associated with an outbreak.
Health care providers considering use of
antivirals are advised to consult public
health and surveillance updates and to
stay informed about influenza activity and
resistance patterns throughout the season.
The BCCDC has shared interim guidelines
for antiviral options in the context of
evolving resistance patterns with local
health authorities. Local health authorities
may be consulted for more information.
CANADA
Flu Watch
During week 51, sporadic activity was reported
in BC, Alberta, and Quebec. No outbreaks in
LTCFs have been reported in Canada since
week 36 of last season (Aug 31 – Sept 6).
Since August 24, 2008 provincial/territorial
laboratories have detected 162 cases of
influenza, 99 influenza A and 63 influenza B.
The national rate of ILI visits to sentinel
physicians (19 cases per 1,000 visits during
week 51) is within the expected range for this
time of the season.
Since Sept 1, 20 influenza isolates from
provincial and hospital labs have been
characterized at the National Microbiology
Laboratory (NML):
3 A/Brisbane/59/07(H1N1)-like* from NS and ON,
2 A/Brisbane/10/07(H3N2)-like* from BC and ON,
3 B/Florida/04/06(Yamagata)-like* from AB and
ON,
and 12 B/Malaysia/2506/04(Victoria)-like from NS,
ON, AB, and BC.
* indicates a strain match to the vaccine component.
Antiviral Resistance
Drug susceptibility testing at the NML showed
that all (n=5) H1N1 isolates tested to date
were resistant to oseltamivir, while all H3N2
(n=2) and influenza B (n=15) isolates tested
were sensitive to oseltamivir. Of those isolates
tested for amantadine resistance, all (n=6)
H1N1 isolates were found to be sensitive, and
all (n=5) H3N2 isolates were found to be
resistant. All 18 (1 H1N1, 2 H3N2, and 15
influenza B) isolates that have been tested for
zanamivir resistance were sensitive.
INTERNATIONAL
A low level of Influenza activity was reported
during week 51 (Dec 14 – 20) in the United
States. Localized activity was reported in eight
states (none bordering BC), and sporadic
activity was reported in most other states. The
rate of ILI visits to sentinel physicians
remained below national baseline levels. To
date this season, US laboratories have typed
846 influenza-positive specimens: 680 (80%)
influenza A and 166 (20%) influenza B. Of the
influenza A isolates, 303 have been subtyped,
of which 92% were A/H1. Sixty-four of
65 (99%) A/H1 viruses tested were found to
be resistant to oseltamivir. For information
about influenza surveillance indicators in the
United States, please visit:
.
Two European countries (Portugal and the
UK) reported widespread influenza activity and
two (Spain and Switzerland) reported localized
activity during week 51. Of the 2026 influenza
virus detections in Europe since the start of
the season (week 40), 1929 (95%) were
influenza A, and of those subtyped, 94% were
A/H3. For more information, please visit:
No additional cases of human H5N1 AI have
been reported by the WHO in the past two
weeks. Since 2003, the WHO has confirmed
391 human AI cases and 247 deaths. For
more information on human avian influenza
cases please visit:
This year’s (2008-09) influenza vaccine contains
the following virus antigens:
A/Brisbane/59/2007(H1N1)-like
A/Brisbane/10/2007(H3N2)-like
Note: A/Uruguay/716/2007(H3N2) is
antigenically equivalent to
A/Brisbane/10/2007(H3N2) and may be
included by vaccine producers.
B/Florida/04/2006(Yamagata lineage)-like
Activity Level Definitions
Sporadic influenza activity:
sporadically occurring
ILI and laboratory-confirmed influenza during
previous 4 weeks, with no outbreaks.
Localized influenza activity:
as for sporadic activity,
but with ILI outbreaks in schools and worksites, or
laboratory-confirmed influenza outbreaks in
residential institutions occurring in less than 50% of
the influenza surveillance regions during the week
of reporting.
Widespread influenza activity:
as for localized
activity, but with outbreaks occurring in greater
than or equal to 50% of the influenza surveillance
regions during the week of reporting.
th Ave, Vancouver BC V5Z 4R4
Tel: (604) 660-6061 / Fax: (604) 660-0197
InfluenzaFieldEpi@bccdc.ca
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W
EEKLY ILI
Percentage of Patient Visits due to Influenza Like Illness (ILI) per Week
Compared to Average Percentage of ILI Visits for the Past 19 Seasons
Sentinel Physicians, British Columbia, 2008-2009
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
2008/2009 season 1989/90 to 2007/08 seasons (Average +/- (2 standard units))
I
NFLUENZA-LIKE ILLNESS BY HEALTH AUTHORITY
Week 51
HEALTH
Dec 14 – 20
AUTHORITY
ILI
Visits
Total
Visits
% ILI
Fraser 1 2,383 0.04%
Interior 6 595 1.01%
Northern 0 278 0.00%
Vancouver Coastal 5 1,526 0.33%
Vancouver Island 2 851 0.24%
BC Total 12 5,633 0.25%
- 5 -
ILI O
UTBREAKS
Number of Influenza-Like Illness (ILI) Outbreaks Investigated or Reported,
Compared to Current ILI Rate and Average ILI Rate for past 19 years, per Week
British Columbia, 2008-2009
# Influ LTCF*
# Other LTCF*
# ILI (No Pathogen) LTCF*
# ILI Acute Hospitals
# ILI Schools
Avg ILI Rate
Current ILI Rate
* Influ LTCF = Long-term care facility, influenza identified
* Other LTCF = Long-term care facility, other pathogen identified (including RSV, parainfluenza, adenovirus, and rhino/enterovirus)
* ILI (No Pathogen) LTCF = Long-term care facility, no pathogen identified
- 6 -
L
ABORATORY SUMMARY
Virus Isolates and Percentage of Respiratory Specimens Submitted to
BC Provincial Laboratory Diagnosed Positive for a Virus, per Week
British Columbia, 2008-2009
Influenza A
Influenza B
Respiratory Syncytial Virus
Other virus
% positive (any virus)
Virus Isolates and Percentage of Respiratory Specimens Submitted to
Children and Women's Health Centre Laboratory Diagnosed Positive for
a Virus, per Week, British Columbia, 2008-2009
: Acute onset of respiratory illness with fever and cough and with one or more of the following: sore throat,
arthralgia, myalgia, or prostration which could be due to influenza virus. In children under 5, gastrointestinal
symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent.
Schools and work site outbreak
: greater than 10% absenteeism on any day, most likely due to ILI.
Residential institutions
(facilities) outbreak: two or more cases of ILI within a seven-day period.
SECTION A: Reporting Information
Person Reporting: ______________________ Title: _____________________________
Contact Phone: ______________________ Email: ____________________________
Health Authority: ______________________ HSDA: ____________________________
Full Facility Name: __________________________________________________ ________
Is this report:
First Notification (complete section B below; Section D if available)
Update (complete section C below; Section D if available)
Outbreak Over (complete section C below; Section D if available)
SECTION B: First Notification
Type of facility:
LTCF Acute Care Hospital Senior’s Residence
(if ward or wing, please specify name/number: ______________________ )
Workplace School (grades:________ ) Other ( _________ )
Date of onset of first case of ILI (dd/mm/yyyy): __________ /_______ / ______
Numbers to date Residents/Students Staff
Total
With ILI
Hospitalized
Died
SECTION C: Update AND Outbreak Declared Over
Date of onset for most recent case of ILI (dd/mm/yyyy): ________ / _______ /________
If over, date outbreak declared over (dd/mm/yyyy): ________ / _______ /________
Numbers to date Residents/Students Staff
Total
With ILI
Hospitalized
Died
SECTION D: Laboratory Information
Specimen(s) submitted?
Yes (location: ______________ ) No Don’t know
If yes, organism identified? Yes (specify: _______________ ) No Don’t know
>>Of the 608 specimens tested since the beginning of the 2008-09 flu season, 179 (29.4%) influenza isolates have been detected by SLD. Of these, 4 (2%) were influenza A (subtype unknown), 166 (93%) were influenza A(H1) and 5 (3%) were influenza A(H3). There have been 4 (2%) influenza B cases. Select isolates were sent to CDC for strain characterization.<<
The above comments from the Hawaii wekk 51 report indocate H274Y is at 100% in Hawaii and a high percentage of the resistance reported by the CDC comes from Hawaii (and Texas).
Sequences from 2 isolates from this season from Hawaii have been released.
CDC has reported antigenic characterization results from 21 influenza isolates [11 influenza A/H1, 0 influenza A/H3, and 10 influenza B viruses] received from the Texas Department of State Health Services (DSHS) Laboratory since the beginning of the 2008-09 flu season.
Influenza A/H1 [11]
Eleven (100%) of the eleven viruses were characterized as A/Brisbane/59/2007, the influenza A/H1 component of the 2008-09 influenza vaccine for the Northern Hemisphere.
Influenza A/H3 [0]
The DSHS lab has not isolated influenza A/H3 from any specimens yet this season.
Double outbreak could make thousands of pupils and staff ill for weeks
* David Smith and Denis Campbell
* The Observer, Sunday 4 January 2009
Thousands of teachers and pupils are expected to call in sick this week as widespread outbreaks of flu and the norovirus "winter vomiting bug" threaten to disrupt schools across Britain.
Teachers' unions warned that schools face a "tough time" when the new term starts tomorrow with flu cases up by 73 per cent on a year ago and the norovirus still rampant.
Mick Brookes, general secretary of the National Association of Head Teachers, said: "There are more people struggling with this very unpleasant flu bug, which seems to lay you low for weeks, and various forms of the norovirus. I think the beginning of term is going to be a tough time for schools."
Staffing would inevitably be stretched, he added. "It's not like other workplaces where they carry on; if a teacher is off, the work doesn't get done. You can't have a classroom full of pupils and no teachers. So there will be a need for supply teachers, and you have to hope they don't get ill too. It's easier to get supply teachers in some contexts than others.
"My own observation is that a lot of people are struggling. We'll have to wait until Monday to find out how many. The problem is that if they turn up at school with the virus, it spreads like wildfire."
It has been predicted that this winter could be the worst flu season in nine years. Experts believe the unusually cold weather may have contributed to the surge.
The outbreaks began a month earlier than last winter and coincide with widespread cases of the vomiting bug norovirus, the most common gastrointestinal illness in Britain. Figures from the NHS Alliance show a 25 per cent rise in demand for GP out-of-hour services over the Christmas period, with some areas seeing much higher rates.
John Dunford, general-secretary of the Association of School and College Leaders, has been suffering from the bug himself and warned that people who have caught it already are not necessarily out of the woods. "This particular strain seems to be more widespread this year," he said. "The end of the autumn term is often bad, but it may be that the start of the spring term is as bad as the end of the autumn term. It may be that the people who had it before Christmas suffer a second dose, which happened to me."
Asked if there would be enough supply teachers to step in, he added: "Cover will be patchy."
Health experts fear that schools increase the risk of transmission of the norovirus, which could become evident by the end of this week. Professor Steve Field, chairman of the Royal College of GPs, said that the length of time staff or children spend in close physical proximity to each other means that if just one or two have the bug, they could quickly infect many others.
"You would expect the norovirus to affect schools once they reopen this week, but not until the end of next week or the start of the week after, as its incubation period is a few days," said Field, a GP in Birmingham. "If someone hasn't washed their hands properly after going to the loo, someone else could pick up the virus. Simply talking could be another source of transmission, because small droplets of water come out of the mouth when we do as mouth spray."
Although the high number of cases of norovirus is putting a strain on the health service, the fact that teachers and students have not been exposed to each other over the festive break should mean that no school is forced to close this week because of it, he added. Everyone in such confined environments is urged to follow basic hygiene procedures rigorously.
-
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 52 ending December 27, 2008 (All data are preliminary and may change as more reports are received.) Synopsis:
During week 52 (December 21-27, 2008), increased influenza activity was reported in the United States.
One hundred thirty (5.0%) 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.
One pediatric influenza-associated death was reported.
The proportion of outpatient visits for influenza-like illness (ILI) was below the national baseline. The South Atlantic region reported ILI at their region-specific baseline.
Three states reported regional activity; 10 states reported local influenza activity; the District of Columbia and 30 states reported sporadic influenza activity; six 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
5.0 %
3 of 51
301
33
470
193
1
New England
Normal
1.3 %
1 of 6
3
1
14
3
0
Mid-Atlantic
Normal
2.4 %
1 of 3
20
3
14
6
0
East North Central
Normal
6.0 %
0 of 5
13
2
12
6
0
West North Central
Normal
0.8 %
0 of 7
6
0
18
7
1
South Atlantic
Normal
3.6 %
1 of 9
18
0
107
79
0
East South Central
Normal
0.8 %
0 of 4
1
0
0
2
0
West South Central
Normal
8.4 %
0 of 4
55
0
193
68
0
Mountain
Normal
4.4 %
0 of 8
14
21
36
6
0
Pacific
Normal
3.3 %
0 of 5
171
6
76
16
0
* Elevated means the % of visits for ILI is at or above the national or region-specific baseline
† National data is for current week; regional data is for the most recent three weeks.
‡ Includes all 50 states and the District of Columbia U.S. Virologic Surveillance:
WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C. report to CDC the number of respiratory specimens tested for influenza each week. Results of these tests performed during the current week and cumulative totals for the season are summarized in the table below.
Week 51
Cumulative for the Season
No. of specimens tested
2,610
45,389
No. of positive specimens (%)
130 (5.0%)
997 (2.2%)
Positive specimens by type/subtype
Influenza A
105 (80.8%)
804 (80.6%)
A (H1)
18 (17.1%)
301 (37.4%)
A (H3)
4 (3.8%)
33 (4.1%)
A (unsubtyped)
83 (79.1%)
470 (58.5%)
Influenza B
25 (19.2%)
193 (19.4%)
The District of Columbia and forty-one states from all nine surveillance regions have reported laboratory-confirmed influenza this season with three states accounting for 722 (72.4%) of the 997 reported influenza viruses.
CDC has antigenically characterized 104 influenza viruses [68 influenza A (H1N1), seven influenza A (H3N2) and 29 influenza B viruses] collected by U.S. laboratories since October 1, 2008.
All 68 influenza A (H1N1) viruses are related to the influenza A (H1N1) component of the 2008-09 influenza vaccine (A/Brisbane/59/2007). All seven influenza A (H3N2) viruses are related to the influenza A (H3N2) vaccine component (A/Brisbane/10/2007).
Influenza B viruses currently circulating can be divided into two distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. Nine influenza B viruses tested belong to the B/Yamagata lineage and are related to the influenza B vaccine component (B/Florida/04/2006). The remaining 20 viruses belong to the B/Victoria lineage and are not related to the influenza B vaccine strain. Seventeen of the 20 viruses belonging to the B/Victoria lineage were submitted from two states.
Data on antigenic characterization should be interpreted with caution given that:
Few U.S. isolates are available for testing because of limited influenza activity thus far.
The majority of viruses antigenically characterized to date come from only three states and may not be nationally representative.
Antigenic characterization data is based on hemagglutination inhibition (HI) testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination
Annual influenza vaccination is expected to provide the best protection against those virus strains that are related to the influenza vaccine strains, but limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages, as is seen with the two lineages of influenza B viruses. Antiviral Resistance:
Since October 1, 2008, 73 influenza A (H1N1), 11 influenza A (H3N2), and 33 influenza B viruses from 21 states have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). More than half (58%) of these tested viruses tested were from only three states. Seventy-three influenza A (H1N1) and 11 influenza A (H3N2) viruses from 18 states have been tested for resistance to the adamantanes (amantadine and rimantadine). More than half (56%) of these tested viruses tested were from only three states as well. The results of antiviral resistance testing performed on these viruses are summarized in the table below.
Isolates tested (n)
Resistant Viruses,
Number (%)
Isolates tested (n)
Resistant Viruses, Number (%)
Oseltamivir
Zanamivir
Adamantanes
Influenza A (H1N1)
73
72 (99%)
0 (0)
73
0 (0%)
Influenza A (H3N2)
11
0 (0)
0 (0)
11
11 (100%)
Influenza B
33
0 (0)
0 (0)
N/A*
N/A*
*The adamantanes (amantadine and rimantadine) are not effective against influenza B viruses.
With low levels of influenza activity thus far in the 2008-09 season in the United States, overall numbers of virus specimens and the number of states that have submitted specimens for testing is limited. The limited number and geographic diversity of specimens tested for antiviral resistance, as well as the uncertainty regarding which influenza virus types or subtypes will predominate during the season, make it too early to make an accurate determination of the prevalence of influenza viruses resistant to oseltamivir nationally or regionally at this time. 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 52, 6.8% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below the epidemic threshold of 7.5% for week 52.
One influenza-associated pediatric death was reported to CDC from Minnesota during week 52. This death occurred during week 51 (the week ending December 20, 2008). This was the first reported influenza-associated pediatric death occurring during the 2008-09.
Laboratory-confirmed influenza-associated hospitalizations are monitored in two population-based surveillance networks: the Emerging Infections Program (EIP) and the New Vaccine Surveillance Network (NVSN).
No influenza-associated hospitalizations have been reported from the New Vaccine Surveillance Network this season.
During October 1 – December 20, 2008, preliminary laboratory-confirmed influenza-associated hospitalization rates reported by the EIP for children aged 0-4 years and 5-17 years were 0.3 per 10,000 and 0.01 per 10,000, respectively. For adults aged 18-49 years, 50-64 years, and = 65 years, the rates were 0.03 per 10,000, 0.04 per 10,000, and 0.1 per 10,000, respectively.
During week 52, 1.8% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is less than the national baseline of 2.4%. On a regional level, the percentage of visits for ILI ranged from 0.4% to 2.4%. One region (South Atlantic) reported 2.2% of outpatient visits for ILI, which is equal to their region-specific baseline of 2.2%, while the remaining eight regions reported percentages of visits for ILI below region-specific baseline levels.
During week 52 the following influenza activity was reported:
Regional influenza activity was reported by three states (Massachusetts, New Jersey, and Virginia).
Local influenza activity was reported by 10 states (Arizona, Colorado, Florida, Hawaii, Illinois, Maine, Maryland, New Hampshire, North Carolina, and Texas).
Sporadic activity was reported in the District of Columbia and 30 states (Alaska, California, Connecticut, Delaware, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New York, North Dakota, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, Wisconsin, and Wyoming).
No influenza activity was reported in six states (Alabama, Arkansas, Kentucky, New Mexico, Ohio, and Oklahoma)
--------------------------------------------------------------------------------
A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
Commentary Hong Kong H1N1 With Tamflu and Adamantane Resistance Recombinomics Commentary 15:55
January 5, 2009
Partial MP sequences from H1N1 isolates in Hong Kong were released today at Genbank (A/Hong Kong/942/2008, A/Hong Kong/1052/2008, A/Hong Kong/1313/2008) . The MP sequences confirm that these isolates are resistant to Tamiflu (oseltamivir) and well as the adamantanes (S31N in M2). This result was not unexpected, because the NA sequences released earlier had H274Y and the HA sequences were clade 2C.
The HA sequences were closely related to the clade 2C prototype sequence, Hong Kong/2652, and this sub-clade has S31N. However, since one of the NA sequences was clade 2B, and S31N has not been reported in clade 2B, it was possible than one or more MP gene segments were also from clade 2B and would be adamantine sensitive.
However, all three partial (200 BP) were identical to each other, as well as public 2C sequences, including Hong Kong/2652. S31N has become fixed in clade 2C, and all clade 2C isolates last season and this season in the United States had S31N. Similarly, all clade 2B isolates in the United States this season have H274Y, so the co-circulation of clade 2B and clade 2C in Hong Kong could lead to recombination between the two sub-clades, leading to resistance to both classes of anti-virals (neuramindase inhibitors and ion channel blockers).
The sequences released from Hong Kong has confirmed that this has happened in H1N1 isolates collected between March and June of 2008.
.
__________________
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Re: Seasonal Flu 2008 - 2009
Linear Mode
