Announcement

**sharon sanders** · April 23, 2008, 11:43 AM

Seasonal Influenza 2008

This is a thread for seasonal influenza outbreaks and related information.

**Commonground** · April 23, 2008, 11:44 AM

Re: Seasonal Influenza 2008

Canada

Flu still spreading across N.B.
Last Updated: Tuesday, April 22, 2008 | 3:46 PM AT
CBC News
Flu season hasn't yet peaked in New Brunswick, according to provincial health officials.

A second strain of the flu virus is working its way across the province and many more people will likely fall ill over the next two weeks, said Dr. Wayne MacDonald, New Brunswick's chief medical officer of health.

"In the past three to four weeks, the activity has increased noticeably ? and probably even perhaps a little higher than expected," MacDonald said.

Flu season in New Brunswick typically peaks in late February to March but it hasn't yet this year, he said, and it isn't expected to for another week or more.

Getting a flu shot won't likely help because the vaccine was targeted at a different type of illness, he said. "So even if you had the vaccine you may be affected by it."

Flu sufferers may be able to find relief of some of the symptoms with over-the-counter medication, said pharmacist Jennifer Flower.

"Mostly just rest would be the main thing," Flower said. "Stay home and treat your fever and your aches, if you need to, with some painkillers out there."

Sorry - we can't find that page

http://www.cbc.ca/canada/new-brunswick/story/2008/04/22/flu-season.html?ref=rss

**Commonground** · April 23, 2008, 11:45 AM

Re: Seasonal Influenza 2008

hat-tip Helblindi

CDC Media Briefing: Influenza Vaccine Effectiveness
April 17, 2008, 12:00 p.m. ET

(...)

DAN JERNIGAN, DEPUTY DIRECTOR, CDC INFLUENZA DIVISION, NCIRD: (...) I'd like to next take a few minutes to discuss what we've been finding throughout the year in the laboratory. Most of the circulating influenza viruses this season have been less than optimally matched to the viruses in the vaccine. Influenza A H3N2, one of the two types of Influenza A, and Influenza A H1N1, the other type of Influenza A and Influenza B viruses have been co-circulating in the United States this year. H3N2 viruses, however, are the predominant virus that we have seen this year.

Of the viruses tested, about three quarters were Influenza A and most of those, around another three quarters, were the H3N2 subtype and up those about 70 percent were a string known as A-Brisbane10/ 2007. This particular strain is the one that is the predominant strain this year and is drifted, but it is still somewhat related to the A-Wisconsin strain, which in the 2007 - 2008 vaccine. The majority of the influenza B viruses, and 94 percent were characterized as B Florida, which is belonging to what we call the Yamagada lineage. This is a very different lineage of Influenza B than the Victoria lineage that's in the vaccine this year. No resistance to all Inhibitor has been observe in the other type of influenza AH3N2 or the influenza B viruses. CDC is continuing to monitor the situation closely. Finally, let me now spend a few minutes discussing the vaccine effect of this year's vaccine. Despite a less and optimum match in two of the three vaccine components this year, interim data indicates that the vaccine provided substantial protection against the predominant influenza viruses this season the H3N2 influenza A virus. Interim results of the vaccine effectiveness study carried out at the Marshfield clinic in Wisconsin appeared in this week's MMWR.

These results are from patients enrolled in the Marshfield studies in January 21st to February 8th of 2008. The article summarizes initial vaccine effect in this result for the trivalent inactivated vaccine, flu shot, in preventing medically attended laboratory confirmed influenza among patients living in a 14 zip code areas surrounding Marshfield, Wisconsin during this past influenza season. The study found in overall vaccine effectiveness are 44 percent against all types of influenza both A and B circulating in a community in Wisconsin. However, when you look at the effectiveness of the vaccine at preventing influenza A infections, they found a vaccine effectiveness of 58 percent against circulating influenza A H3N2 viruses, that's the predominant strain this year. There was no vaccine effectiveness against influenza B viruses found. There were no influenza A H1N1 viruses detected, so no vaccine effectiveness is available for the type of influenza A H1N1. While the vaccine effectiveness against the H3N2 viruses is less than might be expected during the season when the viruses and the vaccine, and circulating viruses are well matched, this interim result suggest that vaccination provided substantial protection against H3N2 influenza assorted, associated medically attended illness in the study population. This means that people in the study who are vaccinated were 44 percent less likely to have laboratory diagnosed influenza than those in the study that were not vaccinated. In regarding prevention of the influenza A H3N2, the predominant strain this year, those in the study that were vaccinated were 58 percent less likely to have laboratory diagnosed H3N2 infections than those that were not vaccinated.

(...)

JEANNE SANTOLI, DEPUTY DIRECTOR, CDC IMMUNIZATION SERVICES DIVISION, NCIRD: Hello, there. So, as Curtis told you, I wanted to provide you with an end of season look at the vaccines supply and distribution, and also to speak very briefly about what we're thinking about for the upcoming 2008/2009 season. So, for the 2007/2008 season, as you know there were six manufacturers who are licensed to produce vaccine for the U.S., and these manufacturers together produced a record amount of influenza vaccine approximately 140 million doses. This is about 20 million doses more than were produced in the prior season. Now, based on data that were reported to CDC by influenza vaccine manufacturers and distributors throughout last season, we know that approximately a 113 million doses of that vaccine were distributed. And, this is more vaccine that has been distributed in the U.S. in a single season before and it is about 10 million more doses than were distributed in the last season.

Now, looking ahead, we anticipate that next season's vaccine supply will be similar or somewhat increased to what we had available this season. But, we'll be receiving projections to understand that better from influenza vaccine manufacturers some time in the next month. Another thing to keep in mind, of course, about next season is that in February of this year, CDC's advisory committee on immunization practices voted to expand the annual influenza recommendations to include healthy children and adolescents 5 to 18 years of age. This recommendation is to be implemented during the upcoming 2008/2009 season as feasible and no later than the 2009/2010 season.

Now, you probably are well aware, prior recommendations for the vaccination of children and adolescents included all children 6 months through the fifth birthday, children 5 to 18 years of age with high risk medical conditions like asthma, diabetes or heart disease and children 5 to 18 years, who were the household contacts of high risk children and adults. Now this expanded recommendation for next season increases the number of children recommended for vaccination by about 30 million children although we know from experience with other vaccine recommendations that not all of these newly recommended children and adolescents will be vaccinated during the first season following this recommendation. Thank you very much.

(...)

HELEN BRANSWELL, CANADIAN PRESS: Hi. Thanks very much for taking my question. This efficacy study was done in week 6 which was kind of that around the time when H3 and H3N2 is making its surge and before the late season B surged. With that sort of paint ? because the picture was taken at that point, would it paint a nicer picture than actually might have been the case?

DAN JERNIGAN: The study was initiated when they first started seeing circulation in that community. And so, while compared to the overall U.S. population, it target at a relatively earlier point of that ? for that community. If that's your ? if your concern is that the initiation of the study tended to provide better results to the initiation of the study was done at the time when circulation began in that community.

(...)

CDC Transcript

Plenty more at the source

**gsgs** · April 23, 2008, 11:55 AM

Re: Seasonal Influenza 2008

effectiveness is meant as against lab-confirmed influenza here.
Ususally this is called "efficacy", I think. They should make this clear.

Whether and how much the vaccine reduced Influenza-symptoms
is not considered. This depends on the vaccination-coverage
of the participating population. This is not talked about (why ?).

Assuming average Wisconsin-coverage, I see no reduction
in influenza-like-symptoms for vaccinated people.
Arising the question whether the vaccine might reduce the
flu but at the same time increase other flu-like-illness ???

**Commonground** · April 24, 2008, 03:05 PM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

hat-tip Aurora:

Rash of illness at Marion County Courthouse

Associated Press - April 24, 2008 9:35 AM ET

SALEM, Ore. (AP) - Workers are getting sick at the Marion County Courthouse in downtown Salem.

The court manager's office had to close yesterday when a security guard became sick and had to be taken to the hospital by ambulance.

Three other employees from the office became ill over the last week. A 40-year-old administrative assistant was hospitalized last week and she remains in intensive care.

Health official say she has a serious case of the flu, even though the peak of the flu season has passed.

Workers are cleaning the court manager's office wearing masks and gloves, along with a nearby courtroom.

Page not found - KTVZ

http://www.ktvz.com/Global/story.asp?S=8220111

Flu breaks out in Oregon assisted living facility
4/24/2008, 8:58 a.m. PDT
The Associated Press

CORVALLIS, Ore. (AP) ? Health officials are monitoring a flu outbreak at a Corvallis assisted living center.

Officials say they confirmed 14 cases of an upper respiratory illness in residents and staff members at Stoneybrook Assisted Living by Wednesday.

Patients came down with symptoms that health officials first assumed were linked to pneumonia. But tests later revealed they had instead contracted influenza types A and B. [snip]

404 Page Not Found

http://tinyurl.com/4325jf

hat-tip Tomo:

FYI-
Corvallis and Albany where the Marion Co. courthouse is (from the above article) are only 15-20 mi apart and a lot of people commute back and forth..

**Commonground** · April 24, 2008, 03:05 PM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

Flu warning
Updated: 22:04, Thursday April 24, 2008
Scientists are warning Australians they are in for one of the worst flu seasons in recent years.

They're urging everyone to get their jabs as soon as possible, while they work on a more effective vaccine.

This year's flu virus has already cause unprecedented sickness in the northern hemisphere.

'The death rate and number of hospitalisations has been over double what they would see in a normal flu year, so this year we're in for a particularly bad flu season,' said Professor Nikolai Petrovsky of Flinders Medical Centre in Adelaide.

The health department says while it's too early to confirm how bad the flu season will be, it's best to be prepared.

Scientists from Flinders Medical Centre are developing a natural booster which Professor Petrovsky says is at least 10 times more effective than the current vaccine and could also be used to guard against bird flu.

Flinders wants to recruit 1,000 volunteers aged over 60 or with chronic illness to test the drug on people with lower immunity.

The new vaccine should be available within the next two years.

Nocookies | Sky News Australia

http://www.skynews.com.au/news/article.aspx?id=229908

Nocookies | Sky News Australia

**Giuseppe** · April 25, 2008, 09:58 AM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

[From Weekly Epidemiological Record, http://www.who.int/wer - IOH]

Influenza(1)

This summary provides an updated report of seasonal influenza activity for weeks 14–15.

It does not include reports of avian influenza in humans, which are available at http://www.who.int/csr/disease/avian_infl uenza/fr/index.html
During weeks 14–15, the level of overall influenza activity in the world decreased.

Countries in northern hemisphere (except for Canada) reported reduced activity.

In Europe, although influenza B viruses predominated, influenza A (predominantly H1N1) viruses were also detected.

* Canada. The level of overall infl uenza activity increased in week 14 with the majority of the provinces reporting localized or widespread activity in at least one of their regions of surveillance. Widespread influenza activity was reported by 2 provinces (British Columbia and Quebec) and localized influenza activity by 25 regions (to date, the highest number reported this season).
Six regions reported no activity and 20 reported sporadic activity. Influenza A (mostly H1) viruses and influenza B viruses were detected in approximately same proportion.

* Croatia. Influenza activity declined from regional to sporadic. Influenza B viruses were detected.

* Luxembourg. Influenza activity decreased from local to sporadic, with B viruses predominating.

* Netherlands. Influenza activity remained widespread. Influenza B predominated over circulation of influenza A viruses.

* Norway. Regional outbreak was reported. Mostly influenza B viruses were detected.

* Russian Federation. Influenza activity declined from widespread to regional, with influenza A (H1 and H3) and influenza B viruses circulating.

* Slovakia. Local outbreak was reported with influenza B detected.

* United States of America. Local outbreaks were reported in week 14. Six states reported widespread influenza activity, 11 states reported regional influenza activity, 23 states reported local influenza activity; and 10 states plus the District of Columbia reported sporadic influenza activity. Influenza A (H3) viruses and infl uenza B viruses cocirculated.

* Other reports. Between weeks 14 and 15, sporadic influenza activity was detected in Belgium (A, B), Cameroon (H1),2 China (B, H3, H1), the Czech Republic (B), Denmark (B), Estonia (B), France (B), Germany (B), Greece (B), Hungary (A), Hong Kong SAR China (B, H1, H3), Ireland (B), the Islamic Republic of Iran (B), Italy (B), Japan (H3), Latvia (B, H3, H1), Mexico (B), Poland (A, B), Portugal (B, H1), Romania (B), Serbia (B), Spain (B), Sri Lanka (A, B), Sweden (B), Switzerland (B), Ukraine (B, H1) and the United Kingdom (B). Austria, Bulgaria, Lithuania, Mongolia, New Caledonia, Slovenia and South Africa reported no influenza activity.
-
1 See No. 13, 2008, pp. 115–116.
2 See No. 9, 2008, pp. 87–88.
-
Weekly epidemiological record - No. 17, 2008, 83, 145–156

The Weekly Epidemiological Record (WER)

http://www.who.int/wer

The Weekly Epidemiological Record (WER) serves as an essential instrument for the rapid and accurate dissemination of epidemiological information.

-

404

http://www.who.int/wer/2008/wer8317.pdf

Erreur 404

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**Giuseppe** · April 25, 2008, 02:44 PM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

This week WHO update about antivirals resistance among seasonal human influenza A/H1N1 (http://www.who.int/csr/disease/influ...eb20080425.pdf). Among this week's isolates, 23% are resistant.
See also, http://www.flutrackers.com/forum/sho...3&postcount=14 (with updated tables).

**Giuseppe** · May 5, 2008, 11:19 AM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

World Health organization Update on Antiviral Resistance among seasonal human influenzavirus isolates.

404

http://www.who.int/entity/csr/disease/influenza/H1N1ResistanceWeb20080505.pdf

Erreur 404

FT thread, updated: http://www.flutrackers.com/forum/sho...7&postcount=17 -

_|SEASONAL HUMAN INFLUENZA, ANTIVIRALS RESISTANCE, UPDATE(S)|_|MARCH 19 +| - FluTrackers News and Information

http://www.flutrackers.com/forum/showpost.php?p=154048&postcount=18

Among new isolates (191) 47% were resistant to oseltamivir (91). In the previous WHO report, resistant ratio was 23%.

**Commonground** · May 5, 2008, 11:43 AM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

Chart from Post #10:

**Commonground** · May 5, 2008, 11:47 AM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

(continued)

**Commonground** · May 5, 2008, 11:53 AM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

(continued)

**Giuseppe** · May 8, 2008, 10:22 AM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

[ANTIVIRALS, SEASONAL INFLUENZA, ECDC, UPDATES] Seasonal Influenza – European Status - Oseltamivir Resistance
[See also updated post with graphs in FT thread http://www.flutrackers.com/forum/sho...9&postcount=20 ]

Resistance to oseltamivir (Tamiflu) in some European influenza virus samples
As the influenza season is over all data including that on the WHO web-site this ECDC website and the EISS web-site will now be updated only monthly with the next update at the end of May.

§ Updated 7th May 2008
In late January 2008 antiviral drug susceptibility surveillance of seasonal influenza viruses in Europe (the EU-EEA-EFTA countries) by the EU-funded VIRGIL network and National Influenza Centres revealed that some of the A (H1N1) viruses circulating this season (winter 2007-8) were resistant to the antiviral drug, oseltamivir through mutation at position 274 in the viral neuraminidase gene.

Analysis of 2680 A(H1N1) viruses from 24 European (European Union, EEA/EFTA) countries isolated between November 2007 and April (data archived on May 7th) showed that 660 were resistant to oseltamivir, but retained sensitivity to zanamivir and amantadine.
The data are shown as a figure with a linked table.

This week’s totals include a report of the first resistant A/H1N1 viruses having been detected in Romania.

It should be noted that the influenza season has now finished in Europe so that new detections like this and other changes in the totals are the result of testing of specimens from during the season and checking of data for example to eliminate duplicates.

The proportion of A(H1N1) viruses that are oseltamivir resistant varied significantly across Europe. The highest proportion of resistant viruses to date have been in Norway where 168 (67&#37 of the 252 samples are resistant to oseltamivir, whereas no resistant viruses have been detected in five of the 24 countries.

Surveillance in previous years by the Virgil Project found <1% of circulating viruses to be resistant The predominant influenza A viruses in Europe in winter 07/08 were A(H1N1) viruses, antigenically similar to the A/Solomon Islands/3/2006 virus included in the 2007/08 N Hemisphere vaccine.

As the season progressed influenza B viruses started to circulate and then predominated. There were only limited circulation of other influenza A in Europe.

Further details on country to country virus distribution this season are available on the European Influenza Surveillance Scheme (EISS) weekly update which were also summarised in ECDC’s Influenza News.

Following the observation of a high level of resistance to oseltamivir in the A H1N1 viruses circulating in Norway, the Norwegian authorities notified their EU partners and the World Health Organization (WHO) of this situation at the end of January. The Norwegian Public Health Institute also published an advisory to doctors and the public.

The country with the second highest proportion has been France with 231 (47%) of 496 specimens showing the marker for oseltamivir resistance. This was followed by the Netherlands and Luxembourg with proportions of 30% and 26% respectively.

There is no evidence that the appearance of these new viruses are related to use of oseltamivir which is currently seemingly not widely prescribed in most European countries. ECDC is now working with the manufacturer and national authorities to gather more information on routine oseltamivir use in Europe.

Experts from the European Centre for Disease Prevention and Control (ECDC), the European Commission, the European Influenza Surveillance Scheme and the World Health Organization (WHO) are currently assessing the significance of the data from the EISS VIRGIL network. An interim European risk assessment has been published by ECDC and comments on this are welcomed to influenza@ecdc.europa.eu. Global surveillance has started coordinated by WHO and has this has found evidence of similarly resistant viruses in Russia, North America and the Far East.

Although sporadic low level transmission of drug resistant viruses may have taken place since 1999 when the Neuraminidase Inhibitor drugs first were licensed, the 07/08 winter season is the first time there has been widespread and sustained transmission of such viruses in the community.
Similar viruses have been seen before, but usually following treatment .

Such viruses previously have not been able to readily transmit and have rapidly disappeared. Clinical experience in Norway suggests that people who become ill with an oseltamivir resistant strain of A(H1N1) have a similar spectrum of illness to those infected with “normal” seasonal influenza A which can cause severe disease or death in vulnerable people (older people, those with debilitating illnesses and the very young). This is now being investigated in national and international studies coordinated by ECDC.

At this stage the significance of these findings remains uncertain. The emergence of drug resistance in the context of limited drug use is unexpected, and the extent of future circulation is difficult to predict. ECDC, WHO, EISS, VIRGIL and authorities in the member states are undertaking intensive surveillance and progress will be reported through this and other relevant web-pages. A summary of the arrangements for the EU EEA & EFTA Countries is available.

Briefing for policy makers in the EU and EEA/EFTA Member States

For information on seasonal influenza and how to protect yourself against it .

Data were provided by the European Influenza Surveillance Scheme http://www.eiss.org/index.cgi and the VIRGIL Project http://www.virgil-net.org/ ECDC would like to thank all countries, virologists, clinicians and others for contributing data. Funding for the VIRGIL project comes from the European Union FP6 Research Programme

Page not found

http://ecdc.europa.eu/Health_topics/influenza/antivirals.html

The requested page or file cannot be found

-
http://ecdc.europa.eu/Health_topics/influenza/antivirals_table.html
http://ecdc.europa.eu/Health_topics/influenza/antivirals_graph.html
--------

**Giuseppe** · May 30, 2008, 02:23 AM

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

[Update from ECDC]

[ANTIVIRALS, SEASONAL INFLUENZA, ECDC, UPDATES] Resistance to oseltamivir (Tamiflu) in some European influenza virus samples

As the influenza season is over, all data on the WHO, ECDC and EISS web-sites will now be updated only monthly with the next update at the end of June. Data can be expected to change because of testing of specimens taken earlier in the season

Updated 28th May 2008
In late January 2008, antiviral drug susceptibility surveillance of seasonal influenza viruses in Europe (the EU-EEA-EFTA countries) by the EU-funded VIRGIL network and National Influenza Centres revealed that some of the A (H1N1) viruses circulating this season (winter 2007-8) were resistant to the antiviral drug, oseltamivir through mutation at position 274 in the viral neuraminidase gene.

Analysis of 2748 A(H1N1) viruses from 24 European (European Union, EEA/EFTA) countries isolated between November 2007 and late May (data archived on May 28th) showed that 680 were resistant to oseltamivir, but retained sensitivity to zanamivir and amantadine.

The data are shown as a figure with a linked table.

It should be noted that the influenza season has now finished in Europe so that new detections like this and other changes in the totals are the result of testing of specimens from during the season and checking of data for example to eliminate duplicates.

The proportion of A(H1N1) viruses that are oseltamivir resistant varied significantly across Europe.

The highest proportion of resistant viruses to date have been in Norway where 182 (67%) of the 270 samples are resistant to oseltamivir, whereas no resistant viruses have been detected in five of the 24 countries.

Surveillance in previous years by the Virgil Project found <1% of circulating viruses to be resistant The predominant influenza A viruses in Europe in winter 07/08 were A(H1N1) viruses, antigenically similar to the A/Solomon Islands/3/2006 virus included in the 2007/08 N Hemisphere vaccine.

As the season progressed influenza B viruses started to circulate and then predominated.

There were only limited circulation of other influenza A in Europe.

Further details on country to country virus distribution this season are available on the European Influenza Surveillance Scheme (EISS) weekly update which were also summarised in ECDC?s Influenza News.

Following the observation of a high level of resistance to oseltamivir in the A(H1N1) viruses circulating in Norway, the Norwegian authorities notified their EU partners and the World Health Organization (WHO) of this situation at the end of January.

The Norwegian Public Health Institute also published an advisory to doctors and the public.

The country with the second highest proportion has been France with 231 (47%) of 496 specimens showing the marker for oseltamivir resistance.

This was followed by the Netherlands and Luxembourg with proportions of 30% and 26% respectively. There is no evidence that the appearance of these new viruses are related to use of oseltamivir which is currently seemingly not widely prescribed in most European countries. ECDC is now working with the manufacturer and national authorities to gather more information on routine oseltamivir use in Europe.

Experts from the European Centre for Disease Prevention and Control (ECDC), the European Commission, the European Influenza Surveillance Scheme and the World Health Organization (WHO) are currently assessing the significance of the data from the EISS VIRGIL network.

An interim European risk assessment has been published by ECDC and comments on this are welcomed to influenza@ecdc.europa.eu.

Global surveillance has started coordinated by WHO and has this has found evidence of similarly resistant viruses in North America and the Far East. All data including that on the WHO web-site are updated every Thursday at present.

Although sporadic low level transmission of drug resistant viruses may have taken place since 1999 when the Neuraminidase Inhibitor drugs first were licensed, the 07/08 winter season is the first time there has been widespread and sustained transmission of such viruses in the community.

Similar viruses have been seen before, but usually following treatment.

Such viruses previously have not been able to readily transmit and have rapidly disappeared.

Clinical experience in Norway suggests that people who become ill with an oseltamivir resistant strain of A(H1N1) have a similar spectrum of illness to those infected with ?normal? seasonal influenza A which can cause severe disease or death in vulnerable people (older people, those with debilitating illnesses and the very young). This is now being investigated in national and international studies coordinated by ECDC.

At this stage the significance of these findings remains uncertain.

The emergence of drug resistance in the context of limited drug use is unexpected, and the extent of future circulation is difficult to predict.

ECDC, WHO, EISS, VIRGIL and authorities in the member states are undertaking intensive surveillance and progress will be reported through this and other relevant web-pages.

A summary of the arrangements for the EU EEA & EFTA Countries is on the ECDC web-site this is also available in a pdf version as a briefing for policy makers in the EU and EEA/EFTA Member States

For information on seasonal influenza and how to protect yourself against it.

Data were provided by the European Influenza Surveillance Scheme and the VIRGIL Project

ECDC would like to thank all countries, virologists, clinicians and others for contributing data. Funding for the VIRGIL project comes from the European Union FP6 Research Programme

Information on Antivirals and Antiviral Resistance
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Announcement

Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

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