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<TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=#0063c8 height=3></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD align=middle width=780 bgColor=#0063c8 height=1>EISS - Weekly Electronic Bulletin</TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#0063c8 height=1><TABLE border=0><TBODY><TR bgColor=white><TD noWrap width=254 bgColor=#0063c8>Week 42 : 13/10/2008-19/10/2008</TD><TD noWrap align=middle width=258 bgColor=#0063c8></TD><TD noWrap align=right width=254 bgColor=#0063c8>24 October 2008, Issue N? 276</TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=3></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD> Continuing low levels of influenza activity in Europe Summary: Levels of influenza activity in Europe are low, with all countries reporting no or only sporadic influenza activity in week 42/2008. Only a few laboratory confirmed cases of influenza have been reported during the weeks 40-42/2008.
Epidemiological situation - week 42/2008: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all of the 23 countries providing these data. For the geographical spread indicator, sporadic influenza activity was reported in two countries (England and Ireland) and no activity in 21 countries. Definitions for the epidemiological indicators can be found here.
Cumulative epidemiological situation ? 2008-2009 season (weeks 40-42/2008): So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (e.g. below the national baseline threshold).
Virological situation - week 42/2008: The total number of respiratory specimens collected by sentinel physicians in week 42/2008 was 199, of which four (2%) were influenza virus positive, two type A not subtyped in Ireland and two subtype A(H3N2), one each in The Netherlands and Sweden. In addition, six influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals), of which three were type A not subtyped,[two in England and one in Sweden], one subtype A(H1) in Germany, one A(H3N2) in Sweden and one was type B in England.
Cumulative virological situation ? 2008-2009 season (weeks 40-42/2008): During the first three weeks of the current season, 22 influenza viruses were detected in six countries: 11 type A not subtyped, three subtype A(H1), five A(H3) [of which three were A(H3N2)] and three type B. In addition to England, Spain and Sweden, virus has now also been detected in Germany, Ireland and The Netherlands.
Comment: There have only been a few sporadic laboratory confirmed cases of influenza reported to EISS in this surveillance season (the past three weeks). Hence, it is currently too early to comment on which virus type or subtype may become dominant in Europe this season.
Background: The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. In week 42/2008, 23 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 responsibility of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (United Kingdom).
Other bulletins: To view national/regional bulletins in Europe and other bulletins from around the world, please click here. </TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE width=780 border=0><TBODY><TR><TD>Map
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.
</TD><TD></TD><TD vAlign=top>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). </TD></TR></TBODY></TABLE></CENTER></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD>Network comments (where available)
<TABLE><TBODY><TR><TD width=20> </TD><TD width=700>Netherlands
In week 42, a specimen from a sentinel boy patient of 3 years old with ILI was positive for infleunza virus A(H3N2). The patient got ill on the day of returning from Mexico. This is the first influenza virus positive sentinel patient this season in the Netherlands. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE width=780><TBODY><TR><TD>Table and graphs (where available)
EISS is funded by the European Centre for Disease Prevention and Control. Specific projects within EISS are funded by F. Hofmann-La Roche Ltd. (Switzerland) and Sanofi Pasteur. Neither the European Centre for Disease Prevention and Control, F. Hofmann-La Roche Ltd. (Switzerland) or Sanofi Pasteur, nor any person acting on their behalf is liable for the use that may be made of the information contained in this bulletin. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD align=middle width=780 bgColor=#0063c8>EISS : Weekly Electronic Bulletin</TD></TR></TBODY></TABLE>
Reporting date: 8 May 2008
Over the 2007-2008 influenza season in the northern hemisphere, a total of 476 H1N1 viruses
were tested for oseltamivir resistance (H274Y) in Canada, of which 123 viruses (26%) were
found to be resistant.
Table 1
Month of sampling Sept
07
Oct
07
Nov
07
Dec
07
Jan
08
Feb
08
Mar
08
Apr
08
No.of H1N1 isolates
tested 1 1 18 114 153 126 56 7
No. (%) of viruses
resistant to
oseltamivir
0
(0%)
0
(0%)
0
(0%)
16
(14%)
26
(17%)
37
(29%)
38
(68%)
6
(86%)
Influenza A(H3N2) viruses and B viruses have been also tested for oseltamivir susceptibility
INFLUENZA A (H1N1) VIRUS, OSELTAMIVIR RESISTANCE (08): EUROPE
************************************************** ***********
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Identification in the UK of the 1st oseltamivir-resistant influenza
A(H1N1) virus of the 2008/09 season
---------------------------
Since week 34/08, several sporadic, laboratory-confirmed influenza
infections have been detected in the United Kingdom (UK): isolates
have included influenza A(H3N2), A(H1N1) and influenza B.
The 1st oseltamivir resistant
influenza A(H1N1) for the 2008/09 season has also
been identified in the UK through the HPA
sentinel GP virological surveillance scheme. The
virus contains the H274Y mutation but remains
sensitive to zanamivir and amantadine, and is
antigenically similar to the H1N1 reference
strain A/Brisbane/ 59/2007, which is included in
this season's influenza vaccine. Antiviral
susceptibility tests on A(H3) isolates showed
that they are sensitive to oseltamivir and zanamivir.
With laboratory-confirmed sporadic influenza
infections of various strains in circulation at
the start of this autumn season, it is important
to emphasise that people in the defined influenza
risk groups should take up the recommendation of
influenza vaccination. It is too early in the
season to predict the course of the 2008/09
influenza season, and whether it will be
dominated by the circulation of H1N1, H3N2, or
influenza B. The Agency will be closely
monitoring the characteristics of circulating
isolates in order to determine the overall
prevalence of drug resistant influenza A and B isolates.
Influenza virus detections across Europe have
been low so far in the 2008/09 influenza season
(13 to date) and the above-mentioned H1N1
oseltamivir-resistant influenza isolate is, to
the Agency's knowledge, the 1st detected in
Europe. Influenza A oseltamivir resistance 1st
emerged last season with a number of circulating
influenza A(H1N1) isolates with the H274Y
mutation, which confers resistance to
oseltamivir, but not to zanamivir. By the end of
the 2007/08 season, 26 out of 33 reporting
European countries reported H1N1 oseltamivir
resistance ranging from 4 percent in Spain to 67
percent in Norway, with 11 percent (38/347) in
the UK [1,2].
The epidemiological evidence from the 2007/08 season suggested no
reported increase in morbidity associated with these confirmed
oseltamivir-resistant cases.
Reports between the 2nd quarter 2008 and September 2008 from WHO
showed high prevalence of resistance in the southern hemisphere with
100 percent (129/129) of H1N1 strains oseltamivir resistant in South
Africa, and 96 percent (25/26) strains in Australia [2].
References
-------------
1. Centre for Disease Prevention and Control.
Antivirals and antiviral-resistant influenza
resistance to oseltamivir (Tamiflu) in some
influenza A(H1N1) virus samples. ECDC website
[online] September 2008 [cited 24 October 2008].
<http://ecdc.europa.eu/Health_topics/influenza/antivirals.html>
First Confirmed H1N1 in CanadaTamiflu Resistant Recombinomics Commentary 20:02
October 23, 2008
Since 1 September 2008, National Microbiology Laboratory (NML) has antigenically characterized three influenza viruses: one influenza A/Brisbane/59/2007(H1N1)-like and two influenza B/Florida/4/2006 viruses, which are the influenza A(H1N1) and influenza B components recommended for the 2008-09 influenza vaccine.
The testing results showed that the influenza A(H1N1) isolate was sensitive to amantadine, however, it was resistant to oseltamivir due to the H274Y mutation.
The above data from the most recent (week 41) report on seasonal flu in Canada indicates that the first confirmed influenza A case this season was H1N1 and was Tamiflu (oseltamivir) resistant. Data had been trickling in for influenza in the northern hemisphere this flu season. Several countries, including the US and Canada had high frequencies of H274Y in H1N1 isolates, but the above report is on the first Canadian isolate in the 2008/2009 season.
In the southern hemisphere, several countries (South Africa, New Zealand, New Caledonia) reported frequencies of 100%, raising concerns that H274Y was becoming fixed in human H1N1. The high levels in last season in the northern hemisphere was limited to clade 2B (Brisbane/59), as found in the isolate in Canada. H274Y was present in patients who had not recently taken Tamiflu, indicating the sub-clade with H274Y did not have a fitness penalty, and the increase to 100% levels indicated that the sub-clade had a selection advantage.
The early data from Canada supports concerns that the H274Y levels in H1N1 in the northern hemisphere will be close to 100% 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
First Confirmed H1N1 in United Kingdom is Tamiflu Resistant Recombinomics Commentary 06:21
October 27, 2008
The 1st oseltamivir resistant influenza A(H1N1) for the 2008/09 season has also been identified in the UK through the HPA sentinel GP virological surveillance scheme.
Antiviral susceptibility tests on A(H3) isolates showed that they are sensitive to oseltamivir and zanamivir.
The above comments describe the first confirmed H1N1 isolate with H274Y in the UK this season. The comments on the lack of resistance in H3, suggests that the H1N1 isolate may be the first H1N1 tested in the UK. The finding of H274Y in the first H1N1 isolate(s) in the UK is similar to the results from Canada, which showed that the first confirmed influenza A case there this season was H1N1 with H274Y.
Last season H274Y was widespread in Europe and North America, but levels in most countries ranged form 10-65%. However, several countries in the southern hemisphere had H274Y levels at 100% in H1N1 isolates. The most dramatic was South Africa where 225/225 isolates had H274Y. Other countries at 100% were New Zealand and New Caledonia, with levels approaching 100% in Australia and the Philippines.
These high levels in the southern hemisphere raised concerns that similar levels would be seen in the 2008/2009 season in Europe and North America. The detection of H274Y in the first H1N1 isolate(s) in the UK increase those concerns.
.
"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
Maryn McKenna * Contributing Writer
Oct 27, 2008 ? WASHINGTON, DC (CIDRAP News) ?
Health officials worldwide are becoming increasingly concerned about influenza viruses' resistance to antiviral drugs, which can shut down a flu infection or mitigate symptoms.
Flu antivirals are vital for reducing severe illness and death in average flu seasons and could be essential bulwarks against an influenza pandemic if one began.
There are currently only four antiviral drugs for flu, grouped into two classes, the adamantanes (amantadine and rimantadine) and the neuraminidase inhibitors (oseltamivir, or Tamiflu, and zanamivir, or Relenza).
Flu scientists have known since 2005 that seasonal flu viruses have become widely resistant to the adamantanes, with at least 90% of H3N2 strains and at least 15% of H1N1 strains impervious to the drugs.
That leaves only oseltamivir and the less widely used zanamivir as treatment options and has made oseltamivir the most commonly used influenza antiviral in the world.
But speaking at a major infectious-disease meeting here Sunday, Dr. Nila Dharan of the Centers for Disease Control and Prevention (CDC) disclosed that 12.6% (142 of 1,124) of H1N1 isolates sent to the CDC from around the United States during the 2007-08 season were resistant to oseltamivir, versus less than 1% before 2007.
And in a troubling addition, the CDC found that none of the patients who gave the isolates had taken oseltamivir, casting doubt on the widely held belief that oseltamivir resistance, when it occurs, is not transmissible. 1. (Dharan NJ, Gubareva L, Klimov A, et al. Oseltamivir-resistant influenza A [H1N1] in the United States, 2007-2008 [Abstract V-918])
The finding was announced on the second day of the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy, a 15,000-person gathering known as ICAAC, which this year is being held in conjunction with the 46th annual meeting of the Infectious Diseases Society of America.
It comes on the heels of an Oct 14 World Health Organization (WHO) announcement that during the southern hemisphere flu season this past summer, oseltamivir-resistant viruses were found in South Africa, Australia, Argentina, Chile, Kenya, New Caledonia, New Zealand, and Uruguay.
Last January, toward the end of the 2007-08 northern hemisphere flu season, the WHO reported that surveillance networks had found oseltamivir-resistant viruses in 9 out of 18 European countries surveyed, though the sample sizes were small.
Worrisomely, the mutation that confers resistance also appears in areas where seasonal flu co-exists with avian influenza H5N1.
"In the last year or so we have seen a massive increase in seasonal flu resistance to oseltamivir," Dr. Jeremy Farrar of the Oxford University Clinical Research Unit at Vietnam?s Hospital for Tropical Diseases said today at the conference. "In Ho Chi Minh City at the moment, 60% of seasonal flu isolates are drug-resistant."
Farrar was part of the treatment team for two Vietnamese H5N1 patients who were found to have the mutated virus in 2005 during treatment with oseltamivir and who died of the infection.
"There is a lot of concern about emerging resistance to oseltamivir," Dr. Trish Perl, director of hospital epidemiology and infection control at the Johns Hopkins Hospital in Baltimore, said at the meeting yesterday during a separate presentation on hospitals' pandemic preparations.
If a flu pandemic begins, she said, "We may not have the luxury of immunoprophylaxis. We may have to rely on basic infection control."
Protecting newborns from flu
In other news from the meeting, a study presented yesterday by Dr. Emmanuel Walter Jr. of Duke Children's Hospital suggested that newborn infants, who are too young to be safely vaccinated against flu, could be protected from the disease by vaccinating their mothers, fathers and siblings before mother and baby leave the hospital.
Vaccinating the family members creates a cocoon of immunity around newborns, who are at much higher risk than older children for potentially life-threatening flu complications.
The study was carried out at Durham (North Carolina) Regional Hospital. Researchers distributed educational information, set up a vaccination clinic, and compared the number of flu shots given to new mothers and family members over 5 months with the number given at Duke, where no program was in place.
The number of flu shots given rose 16% at Durham, and 40 percent of mothers agreed to be vaccinated. (Walter EB Jr, Swamy G, Allred N, et al. Influenza immunization of household contacts of newborns in the hospital setting [Abstract G1-1209])
High-dose flu shots for elderly
At the other end of the age spectrum, researchers funded by vaccine-maker Sanofi Pasteur reported that poor response to flu shots by the elderly could be improved by giving those over age 65 a much larger dose of the vaccine.
Dr. Ann Falsey of the University of Rochester School of Medicine and Dentistry and colleagues from St. Louis University and the St. Louis VA Medical Center gave a vaccine with four times the normal amount of hemagglutinin, a flu-virus protein, to 2,575 volunteers over age 65, and gave the normal vaccine to an additional 1,262 volunteers.
Four weeks after the shot, the high-dose volunteers showed twice the level of flu antibodies seen in the standard-dose volunteers. (Falsey AR, Capellan J, Yau E, et al. Improved immunogenicity after high dose compared to standard influenza vaccine in seronegative adults aged [at least] 65 Years [Abstract G-1191])
Testing nondrug flu defenses
In another study focused on prevention, University of Michigan researchers led by assistant professor of epidemiology Allison Aiello found that wearing standard surgical masks and regularly using an alcohol-based hand sanitizer can cut flu transmission in the community by up to 50%.
Participants were randomly assigned to a control group or to using a mask or mask plus hand sanitizer for 6 weeks in the 2006-07 flu season. Only those who used both the mask and the gel reported a drop in their rate of flu-like symptoms such as fever, chills, and body aches.
The researchers cautioned, though, that the results may not be robust because the 2006-07 season was relatively mild. They are currently computing results from the same intervention conducted in the 2007-08 season, which was more severe.
The study is the first prospective investigation to report that nonpharmaceutical interventions?a broad category that includes home quarantine and isolation, social distancing, and school closings?can play a role in reducing flu transmission. That could be an important finding in an influenza pandemic, when pharmaceutical measures such as vaccine and antivirals are expected to be in short supply. (Aiello AE, Murray G, Coulborn R, et al. Mask use reduces seasonal influenza-like illness in the community setting [Abstract V-924])
C difficile peak follows flu peak
And in an example of unintended consequences, Dr. Philip Polgreen of the University of Iowa reported a newly recognized statistical association between influenza outbreaks and the incidence of Clostridium difficile?associated disease, a severe diarrheal illness that can be drug-resistant and that occurs after antibiotics wipe out the normal bacterial inhabitants of the gut.
Using 8 years' worth of hospital discharge data, Polgreen plotted the monthly incidence of C difficile outbreaks in the United States and found that the disease routinely peaks within 2 months after the height of flu season. He theorizes that the outbreaks are the after-effect of antibiotics prescribed during flu season. The antibiotics may have been appropriately prescribed for secondary bacterial illnesses as well as inappropriately for viral symptoms that the drugs would not affect, he said. (Polgreen PM, Bohnett LC, Cavanaugh JE. A time series analysis of C. difficile and its seasonal association with influenza [Abstract K-502])
See also:
Oct 14 WHO report on H1N1 virus resistance to oseltamivir in the southern hemisphere in 2008 http://www.who.int/csr/disease/influ...1200801013.pdf
Nicoll A, Ciancio B, Kramarz P. Observed oseltamivir resistance in seasonal influenza viruses in Europe: interpretation and potential implications. Eurourveillance 2008 Jan 31;13(5) [Full text]
Deyde VM, Xu X, Bright RA, et al. Surveillance of resistance to adamantanes among influenza A(H3N2) and A(H1N1) viruses isolated worldwide. J Infect Dis 2007 Jul 15;196(2):249 (Full text)
de Jong MD, Tran TT, Truong HK, et al. Oseltamivir resistance during treatment of influenza A (H5N1) infection. N Engl J Med 2005 Dec 22;353(25):2667-72 [Full text]
Aug 25 CIDRAP News story "H1N1 viruses growing more resistant to Tamiflu" http://www.cidrap.umn.edu/cidrap/con...08tamiflu.html
-
- Can you predict the peak of seasonal influenza epidemics from early observations?
* Predictions by early indicators of the time and height of yearly influenza outbreaks in Sweden - Kuhlmann-Berenzon S. Linde A. at al - Scand J Public Health. 2008 Jul;36(5):475-82.
Description:
In this study, some statistical methods are described and applied to weekly national (Swedish) data from 1994 onwards concerning influenza-like illness (ILI) and confirmed laboratory diagnoses of influenza (LDI).
Both simple and more advanced rules for how to predict the timing and height of the peak of LDI are suggested. The predictions are made using covariates calculated from data in early LDI reports. The simple rules are based on the observed LDI values, while the advanced ones are based on smoothing by the statistical technique unimodal regression. The suggested predictors were evaluated by cross-validation and by application to the observed seasons.
The research suggested that the percentage of ILI was not a good predictor for LDI, however analyse on solely LDI, the time of the onset of outbreak (TO) and the initial slope (TD) showed the rule that the average time between onset (when the LDI exceed 10 in the first wee) and the peak is 8 weeks (with a median error of 0.9 weeks).
Furthermore linear regression fitted to HP and TO data suggested the rule that the predicted height of the peak is 500 ? 25 the time of outbreak (with a median error of 30% of the average HP)
In simple terms the finding was that in Sweden at least seasons that started early tended to be more intense (have higher peaks) than late ones.
ECDC Comment (30/10/08):
This study based on early indicator data from 8 seasons in Sweden shows that basic statistical methods may be useful in predicting the characteristic of seasonal epidemic and planning the public health response on it. Especially in intensifying vaccination campaigns it will be interesting to test this hypothesis to other countries and prospectively.
ECDC invites comment from other Member States on the method and its application in other counties influenza@ecdc.europa.eu. The influenza team also thank the Swedish State Epidemiologist Dr Annika Linde for drawing it to our attention.
* Public Health Developments
- Publication of the full report of the VENICE survey of seasonal influenza vaccination in Europe, 2006-7
Description:
Last week in influenza news it was noted that the VENICE group had publishing a peer-reviewed summary of their Europe wide survey of seasonal influenza policies, practices and performance. This week the full detailed report is published. The document is the result of a cross-sectional survey that was undertaken with all the European Union (EU) Member States, Norway and Iceland to describe seasonal influenza immunisation in the 2006-7 season, in particular to identify country-specific recommendations for risk groups, obtain vaccine uptake information and allow comparison with global recommendations.
A standardised questionnaire was completed electronically by each country?s project gatekeeper who are listed in the report.
Of the 29 countries surveyed, 28 recommended seasonal influenza vaccination for older age groups (22 for those aged > 65 years), and in one country (Austria) vaccine was recommended for all age groups. All countries recommended vaccinating patients with chronic pulmonary and cardiovascular diseases and most countries advised to immunise patients with haematologic or metabolic disorders (n=28), immunologic disorders (n=27) and renal disease (n=27), as well as residents of long-term care facilities (n=24).
Most countries recommended vaccination for staff in hospitals (n=25), long-term care facilities (n=25) and outpatient clinics (n=23), and one-third had such recommendations for workers in essential (n=10), military (n=10) and veterinary services (n=10) and poultry industry (n=13). Only eight countries recommended vaccine for pregnant women; and five advised to vaccinate children (with age limits ranging from 6 months to 5 years). Twenty countries measured influenza vaccine uptake among those aged > 65 years (range 1.8%-82.1%), seven reported uptake in healthcare workers (range 14%-48%) and seven assessed coverage in persons with underlying medical conditions (range 27.6%-75.2%).
The data provided by this study can assist EU states to assess and compare their influenza vaccination programme performance with other countries. The information provides a comprehensive overview of policies and programmes and their outcomes and can be used to inform joint discussions on how the national policies in the EU might be standardised in the future to achieve optimal coverage. Annual surveys could be used to monitor changes in these national policies. Enquiries and questions about the survey and its results should be made to the VENICE group.
* Meetings and workshops
- Retroscreen Virology Conference - Medical, Scientific and Historical Lessons from the Great Avian (H1N1) "Spanish" Influenza Pandemic of 1918: The 90th Anniversary 10th November 2008 at The Imperial War Museum - London
This conference specifically considers the first World War and the start of the Spanish Influenza pandemic. Specifically did the war itself engender the emergence of this avian influenza A(H1N1)? Are there serious lessons from that pandemic to help today as we prepare for 21st century pandemics?
- European Scientific Conference on Applied Infectious Disease Epidemiology, Berlin 19-21 November 2008.
The second annual European Scientific Conference on Applied Infectious Disease Epidemiology ? ESCAIDE ? is fast approaching. The event is being held in Berlin from 19-21 November, and over 500 health experts from across Europe and beyond are expected to come together to share scientific knowledge and experience on all areas related to infectious disease epidemiology.
It is possible to register for the conference for a reduced fee of 100 Euros- the deadline for early registration is 1st October. It is also still possible to submit a ?late breaker abstract? to the conference- the deadline for submission is 29th September.
Details of the full conference programme, participant registration, and abstract submission can be found on the ESCAIDE website
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Flu Showing Up Early This Year Posted: <script language="JavaScript">var wn_last_ed_date = getLEDate("Oct 29, 2008 12:42 PM EST"); document.write(wn_last_ed_date);</script>Oct 29, 2008 12:42 PM
ST. LOUIS, MO (KAIT) - The bug may be going around sooner rather than later this year. Flu cases in Missouri are already showing up - a month earlier than last year. A spokesman for a local Missouri Health Department says there is a plentiful supply of vaccine this year, but he says it's too soon to know how effective the vaccine will be against the different strains of influenza. A number of vaccines are being administered this year at various locations across Region 8. To see a list of these, click here or visit the health page.
<TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD align=middle width=780 bgColor=#0063c8 height=1>EISS - Weekly Electronic Bulletin</TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#0063c8 height=1><TABLE border=0><TBODY><TR bgColor=white><TD noWrap width=254 bgColor=#0063c8>Week 43 : 20/10/2008-26/10/2008</TD><TD noWrap align=middle width=258 bgColor=#0063c8></TD><TD noWrap align=right width=254 bgColor=#0063c8>31 October 2008, Issue N? 277</TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=3></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD> Continuing low levels of influenza activity in Europe Summary: Levels of influenza activity in Europe were low, with all countries reporting no or only sporadic influenza activity in week 43/2008. Only a few laboratory confirmed cases of influenza were reported during the weeks 40-43/2008.
Epidemiological situation - week 43/2008: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all of the 25 countries providing these data. For the geographical spread indicator, sporadic influenza activity was reported in England and no activity in the remaining 24 countries. Definitions for the epidemiological indicators can be found here.
Cumulative epidemiological situation ? 2008-2009 season (weeks 40-43/2008): So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (e.g. below the national baseline threshold).
Virological situation - week 43/2008: The total number of respiratory specimens collected by sentinel physicians in week 43/2008 was 209, of which five (2.4%) were influenza virus positive: one subtype A(H3) in England, two type B in Germany as well as one subtype A(H1N1) and one subtype A(H3N2) in Spain. In addition, 19 influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals): 11 in England and three in Sweden were type A not subtyped, three were subtype A(H1) and one subtype A(H3) in England, and one in Germany was type B.
Cumulative virological situation ? 2008-2009 season (weeks 40-43/2008): During the first three weeks of the current season, 51 influenza viruses were detected in six countries: 26 type A not subtyped, seven subtype A(H1) [of which one was A(H1N1)], 11 A(H3) [of which four were A(H3N2)] and seven type B. These detections were reported from England, Germany, Ireland, Spain, Sweden and The Netherlands.
Comment: Only comparably few laboratory confirmed cases of influenza have so far been reported to EISS in this surveillance season. Hence, it is too early to comment on which virus type or subtype may become dominant in Europe this season.
Background: The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. In week 43/2008, 25 countries reported clinical data and 23 countries reported virological data to EISS. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the responsibility of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (United Kingdom). </TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE width=780 border=0><TBODY><TR><TD>Map
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.
</TD><TD></TD><TD vAlign=top>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). </TD></TR></TBODY></TABLE></CENTER></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD>Network comments (where available)
EISS is funded by the European Centre for Disease Prevention and Control. Specific projects within EISS are funded by F. Hofmann-La Roche Ltd. (Switzerland) and Sanofi Pasteur. Neither the European Centre for Disease Prevention and Control, F. Hofmann-La Roche Ltd. (Switzerland) or Sanofi Pasteur, nor any person acting on their behalf is liable for the use that may be made of the information contained in this bulletin. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD align=middle width=780 bgColor=#0063c8>EISS : Weekly Electronic Bulletin</TD></TR></TBODY></TABLE>
<!-- InstanceBeginEditable name="topstrip" --><!-- InstanceEndEditable -->2008-2009 Influenza Season Week 43, ending October 25, 2008 (All data are preliminary and may change as more reports are received.) <H2>Synopsis: </H2>During week 43 (October 19-25, 2008), a low level of influenza activity was reported in the United States.
Five (0.4%) 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.
Thirteen states and Puerto Rico reported sporadic influenza activity; 36 states and the District of Columbia reported no influenza activity; and one state did not report.
</TH><TH noWrap align=middle width=300 colSpan=3>Data for current week</STRONG></TH><TH noWrap align=middle width=276 colSpan=5>Data cumulative for the season</TH></TR><TR vAlign=top><TH align=middle width=72>Out-patient ILI*</TH><TH align=middle width=72>% positive for flu?</TH><TH align=middle width=96>Number of jurisdictions reporting regional or widespread activity?</TH><TH noWrap align=middle width=48>A (H1)</TH><TH noWrap align=middle width=48>A (H3)</TH><TH align=middle width=60>A Unsub-typed</TH><TH noWrap align=middle width=48>B</TH><TH align=middle width=72>Pediatric Deaths</TH></TR><TR><TD align=left width=85>Nation</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.4 % </TD><TD noWrap align=middle width=96>0 of 51 </TD><TD noWrap align=middle width=48>1</TD><TD noWrap align=middle width=48>6</TD><TD noWrap align=middle width=60>35</TD><TD noWrap align=middle width=48>14</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>New England</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.0 % </TD><TD noWrap align=middle width=96>0 of 6</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>Mid-Atlantic</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.1 % </TD><TD noWrap align=middle width=96>0 of 3</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>1</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>East North Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.0 % </TD><TD noWrap align=middle width=96>0 of 5</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>West North Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.0 % </TD><TD noWrap align=middle width=96>0 of 7</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>South Atlantic</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.7 % </TD><TD noWrap align=middle width=96>0 of 9</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>9</TD><TD noWrap align=middle width=48>3</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>East South Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.0 % </TD><TD noWrap align=middle width=96>0 of 4</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>West South Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.9 % </TD><TD noWrap align=middle width=96>0 of 4</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>7</TD><TD noWrap align=middle width=48>2</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>Mountain</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>3.1 % </TD><TD noWrap align=middle width=96>0 of 8</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>6</TD><TD noWrap align=middle width=60>3</TD><TD noWrap align=middle width=48>3</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>Pacific</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>2.1 % </TD><TD noWrap align=middle width=96>0 of 5</TD><TD noWrap align=middle width=48>1</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>15</TD><TD noWrap align=middle width=48>6</TD><TD noWrap align=middle width=72>0</TD></TR></TBODY></TABLE>* 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 <H2>U.S. Virologic Surveillance:</H2>During week 43, WHO and NREVSS laboratories located in all 50 states and Washington D.C. reported 1,251 specimens tested for influenza viruses, five of which were positive: three influenza A viruses that were not subtyped (Pacific and West South Central regions) and two influenza B viruses (Pacific and South Atlantic regions).
<CENTER> View WHO-NREVSS Regional Bar Charts| View Chart Data | View Full Screen </CENTER><H2>Pneumonia and Influenza (P&I) Mortality Surveillance</H2>During week 43, 6.5% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below the epidemic threshold of 6.7% for week 43.
<CENTER> View Full Screen</CENTER><H2>Influenza-Associated Pediatric Mortality</H2>No influenza-associated pediatric deaths were reported during week 43.
<CENTER> View Full Screen</CENTER><H2>Influenza-Associated Hospitalizations</H2>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. <H2>Outpatient Illness Surveillance:</H2>During week 43, 1.0% 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 2.1%. All nine regions reported percentages of visits for ILI below their respective region-specific baselines.
<CENTER> View Sentinel Providers Regional Charts | View Chart Data |View Full Screen
</CENTER><H2>Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists: </H2>
During week 43 the following influenza activity was reported:
Sporadic activity was reported in Puerto Rico and 13 states (Alaska, California, Connecticut, Florida, Hawaii, Idaho, Indiana, Massachusetts, New York, Pennsylvania, Texas, Utah, and Wyoming).
No influenza activity was reported in the District of Columbia and 36 states (Alabama, Arizona, Arkansas, Colorado, Delaware, Georgia, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, and Wisconsin).
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A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
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Page last updated October 31, 2008.
Content Source: Coordinating Center for Infectious Diseases (CCID)
- Health benefits of Universal Influenza Immunization Program in Ontario, Canada
The Effect of Universal Influenza Immunization on Mortality and Health Care Use - Kwong JC, Stukel TA et al.PLoS Med 2008; 5(10): e211 Accompanying Perspective - Health benefits of universal influenza vaccination strategy - Viboud C, Miller M.Plos Med 2008; 5(10):e216
Description:
In this study, the researchers investigate the possible health benefits of what has been the world's first free universal influenza immunization program (UIIP), which was started in 2000 in the Canadian province of Ontario which then uniquely started offering free annual seasonal influenza vaccination to the whole population.
The researchers, from a variety of Canadian health science bodies, look at the impact on influenza-associated deaths and health care use comparing this with the effects of targeted vaccine programs on the same outcomes in Canadian districts.
To compare the results of the two vaccination strategies data including hospitalizations, emergency department use, doctors' office visits for pneumonia and influenza, and all-cause mortality data from 1997 to 2004 were used. It was modelled using Poisson regression, controlling for age, sex, province, influenza surveillance data, and temporal trends, and used to estimate the expected baseline outcome rates in the absence of influenza activity.
The primary outcome was then defined as influenza-associated events, or the difference between the observed events and the expected baseline events.
Changes in influenza-associated outcome rates before and after UIIP introduction in Ontario were compared to the corresponding changes in other provinces.
Between the pre-UIIP 1996?1997 estimate to the mean UIIP vaccination rate, influenza vaccination rates for the household population aged ≥12 y increased 20 percentage points (18%?38%) for Ontario, compared to 11 percentage points (13%?24%) for other provinces (p < 0.001). For those <65 y, the vaccination rate increases were greater in Ontario than in other provinces, while for those ≥75 y, the increase was smaller in Ontario.
The investigation found when looking at mortality that after UIIP introduction, influenza-associated mortality for the overall population decreased 74% in Ontario (RR=0,26) compared to 57% in other provinces (RR=0,43) (ratio of RRs = 0.61, p = 0.002) however in age specific analyses, larger mortality decreases in Ontario were found only in those ≥ 85 years.
Considering overall influenza-associated health care use, this decreased more in Ontario than other provinces for hospitalizations (RR = 0.25 versus 0.44, ratio of RRs = 0.58, p < 0.001), ED use (RR = 0.31 versus 0.69, ratio of RRs = 0.45, p < 0.001), and doctors' office visits (RR = 0.21 versus 0.52, ratio of RRs = 0.41, p < 0.001).
In age-specific analyses, greater decreases were consistently observed in Ontario than other provinces for age groups <65 y. For seniors, greater decreases were observed in Ontario than other provinces for hospitalizations among those aged 65?84 y and for ED use among those 65?74 y.
Sensitivity analyses has shown a dose-response relationship where greater increases in vaccine uptake were associated with greater decreases in influenza-associated outcomes for all health care use outcomes for age groups <65 y. For the elderly, the opposite relationship was observed for mortality and hospitalizations, and no relationship was noted for ED use and office visits.
ECDC Comment (06/11/08):
This intervention has been unique in that no-where else in the world has attempted annual immunisation across almost all age groups (children under 6 months are excluded). Hence the long-awaited results are of great interest it is concluded that the gain in vaccination coverage does not always have a one-to-one correlation. Here the largest gain was seen in areas with a low coverage initially. Arguably the study could have employed other statistical methods. Poisson regression is, a well known methodology, but it might have better to apply a Negative binomial regression model, which takes the variation in data into account more widely. The article further states that the developed model did not optimally fit the short-lived spikes during peak weeks. This is probably due how the baseline data is estimated.
The authors propose a methodology based on a sinus curve with a seasonality of one year, the disadvantage of this is that it cannot compensate when and the magnitude of the peaks occur different weeks during different seasons. An issue which is addressed elsewhere [1].
However a greater interest is towards the challenge that is made by the results to basic immunisation strategies. Traditionally the approach for seasonal vaccine is to only immunise the vulnerable (older people and those with chronic diseases). These results question that by suggesting the optimal approach is to combine this with trying to immunise those accounting for the most transmission those in younger age groups. The editorial from US National Institute of Health concludes by suggesting large scale community trials to resolve what is the optimal strategy.
1. Clifford, R.E., et al., Excess mortality associated with influenza in England and Wales. Int J Epidemiol, 1977. 6(2): p. 115-28.
* PUBLIC HEALTH DEVELOPMENT ? PANDEMIC INFLUENZA - VACCINES
- European Vaccine Manufacturers (EVM) launches updated Pandemic Influenza `Proposal for Action Plan`
Description:
European Vaccine Manufacturers (EVM) launched its first pandemic influenza Proposal for Action Plan in 2004, as concern grew in the public health community about the rapid spread of the H5N1 influenza virus and its potential to evolve into a human pandemic strain.
Subsequently, EVM has reviewed the progress made across the region and issued updated proposals in 2006 and now in late 2008.
From this year onwards EVM members will continue to contribute to pandemic preparedness in the key areas defined in the 2006 plan: strengthen research and development activities, adapt & prepare vaccine production for pandemic, assess vaccination strategies.
In Proposal for Action Plan EVM call for an increased partnership with the European Institutions and member states.
?The EVM Proposal for an Action Plan to ensure availability of effective vaccines in the event of an influenza pandemic? can be downloaded here.E
CDC will describe and comment on this further next week but in the meantime ECDC welcomes comments and suggestions from European Institutions and member states to influenza@ecdc.europa.eu
* Meetings and workshops
- Retroscreen Virology Conference - Medical, Scientific and Historical Lessons from the Great Avian (H1N1) "Spanish" Influenza Pandemic of 1918: The 90th Anniversary 10th November 2008 at The Imperial War Museum - London
This conference specifically considers the first World War and the start of the Spanish Influenza pandemic.
Specifically did the war itself engender the emergence of this avian influenza A(H1N1)? Are there serious lessons from that pandemic to help today as we prepare for 21st century pandemics?
Comment