Announcement

**Ronan Kelly** · January 16, 2014, 01:12 PM

Re: Spain Influenza Surveillance 2014

Weekly Report Surveillance System Influenza in Spain ( SVGE )
Week 2 /2014 ( January 6 to January 12, 2014 ) January 16, 2014 . # 376

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Influenza activity in Spain , associated with the joint movement of virus A ( H1N1) pdm09 and AH3 Intensifies

Epidemiological situation:
During week 02/ 2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . The epidemic wave continues to rise with a growing trend of influenza activity in most networks . The incidence exceeded the baseline threshold this season in week 52/2013 in the networks of Arag?n , Asturias , Navarra and the Basque Country , in week 01/ 2014 in Castilla La Mancha, Castilla y Le?n, Extremadura and La Rioja . During week 02/ 2014 exceeded the threshold in Andalusia , Aragon, Balearic Islands, Valencia , Catalonia and Madrid.
The spread of the disease increases with respect to the previous week . Nine sentinel networks point to a local two (Cantabria, Castilla La Mancha) and sporadic zero in the other networks epidemic level (Arag?n , Asturias , Baleares , Catalu?a, Castilla y Le?n, Madrid, Navarre, the Basque Country and La Rioja ) , or . The increased circulation of influenza viruses is associated with the mixed circulation of influenza A ( H1N1) virus AH3N2 pdm09 and the latter predominantly in Baleares , Cantabria , Catalonia and Navarre.
The overall incidence rate of influenza in week 02/ 2014 increased to 160.72 cases per 100,000, twice the rate of the previous week and for the second straight week, surpassing the baseline threshold for the 2013-14 season. The evolution of influenza activity is increasing compared to the previous week ( rate ratio : 1.8 , 95% CI : 1.63 to 2.99 ) . A medium level of intensity of influenza activity, an epidemic level of diffusion and an upward trend is noted .
An increasing trend in the incidence of influenza is observed , especially in those under 15 years, with statistically significant increases in the incidence rates of influenza in smaller groups of 15 and in 15 in all age groups - 64.
The map of spatiotemporal spread of flu incidence of week 02/ 2014 intensified influenza activity is observed in areas of northern Spain , mainly affecting the east of Asturias, northern Basque Country, Navarra and southern northwest of Catalonia. Also areas with higher incidence of influenza intensity in the center of Castilla La Mancha are observed. More information on the geographical analysis of the incidence of influenza is available at: vgripe.isciii.es / flu
Flu outbreaks
Since the start of the 2013-14 season have reported two flu outbreak. One virus A not subtyped in week 46/2013 , in a school in the Balearic Islands, with 10 affected. The other in Catalonia by AH3N2 in week 02/ 2014 in a nursing home with 31 affected by the time , 21 residents (out of 119 ) and 10 employees (out of 68 ) . Six residents have required hospitalization, none have admitted to ICU. As a control measure has been carried to the vaccination of all staff who was not vaccinated .

Surveillance of severe hospitalized confirmed cases of influenza
The monitoring protocol severe hospitalized confirmed cases of influenza ( CGHCG ) is available at the following link ISCIII : https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf

Since the beginning of the season have been reported 239 CGHCG by influenza virus in 13 autonomous communities of Andalusia, Arag?n , Asturias , Baleares, Cantabria, Castilla La Mancha , Catalonia , Galicia , Madrid , Murcia , Navarra , Basque Country and La Rioja, of which 51 % are women. The highest number of cases recorded in the groups of young adults and middle-aged ( 56 % ) , followed by over 64 years (32 % ) , children aged 5-14 ( 22%) and less than 1 year ( 7% ) . 74% of the detections are subtipadas virus A ( H1N1) pdm09 and 26% pdm09 virus A ( H3N2 ) .
77% (157 /205) of patients had risk factors for influenza complications , the most prevalent chronic lung disease and cardiovascular (21 % ) followed by diabetes ( 20 % ) and immunodeficiency ( 18%). 69% of patients developed pneumonia and 45 % were admitted to ICU. 76% ( 167/219 ) of patients had received antiviral treatment and in 78 % of cases the treatment was administered just after 48h of symptom onset . 33% (46 /140) of patients likely to be vaccinated had received a flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications . In under 15 years, the most prevalent risk factor is chronic lung disease ( 16%).
Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there had been 11 deaths from laboratory-confirmed influenza A (4 confirmed AH3N2 , 5 A (H1N1 )pdm09 and 2 A no subtyping ) virus. The deaths have occurred in eight regions. 90 % of patients were older than 44 years ( 45 % in the group of 44-65 years and 45 % in those over 64 years) and 90 % had an underlying chronic disease. Only 55 % of patients for whom information (5/9 ) is known , had received a flu shot this season.

Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-14 season remained about expected predictive models according to the period between weeks 48 and 50 in which excess mortality observed over expected is appreciated. This excess is mainly concentrated in the group over 74 years and represents 6.5 % compared to expectations . This period of excess mortality could be associated with the low temperatures experienced . According AEMET the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value ) throughout December and recorded many days of frost in the peninsular interior especially in the first half .
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**Ronan Kelly** · January 23, 2014, 06:59 PM

Re: Spain Influenza Surveillance Reports 2014

Weekly Report Surveillance System Influenza in Spain ( SVGE )
Week 3 /2014 ( 13 January to 19 January 2014 ) January 23, 2014 . # 377

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Continue the ascent phase of the 2013-2014 influenza epidemic wave in Spain associated with the mixed movement of virus A (H1N1 ) pdm09 and A ( H3)

Epidemiological situation:
During week 03/ 2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . Continued rise of the epidemic wave of 2013-14 season with a growing trend of influenza activity in most networks . In networks of central and northern territory under surveillance the incidence of influenza exceeded the threshold baseline at week 52 /2013 ( Asturias, Castilla La Mancha, Castilla y Leon, Navarra and the Basque Country ) and a week later in Cantabria and Extremadura . In other networks the epidemic wave began in week 02/ 2014 except Canary Islands and Melilla in the wave started in week 03/ 2014. The incidence of influenza in Ceuta is in week 03/ 2014 with pre - epidemic values. The spread of the disease increases with respect to the previous week . Fifteen sentinel networks indicate an epidemic level ( Andalusia, Aragon , Asturias , Baleares, Cantabria, Castilla La Mancha , Catalonia, Castilla y Le?n, Valencia, Extremadura , Madrid, Navarre, the Basque Country and La Rioja ), local Melilla and Ceuta sporadic . The increased circulation of influenza viruses is associated with the mixed circulation of influenza A virus ( H1N1) pdm09 and A ( H3N2 ), the latter predominantly in Extremadura and northern networks : Catalonia , Navarra and the Basque Country .
The overall incidence rate of influenza in week 03/ 2014 is 283.01 cases per 100,000 inhabitants. The evolution of influenza activity is increasing compared to the previous week ( rate ratio : 1.8 , 95% CI : 1.7-1.9 ) . A medium level of intensity of influenza activity, an epidemic level of diffusion and an upward trend is noted .
An increasing trend in the incidence of influenza , especially in those under 15 years, with statistically significant in the incidence rates of influenza in all age groups increases were observed in all age groups.

The map of spatiotemporal spread of flu incidence of week 03/ 2014 an intensification of influenza activity is observed throughout the territory under surveillance, with a north-south pattern of incidence of influenza . Areas with increased influenza activity was observed in some areas of Arag?n , followed by areas of northern peninsular (Asturias , Cantabria , Basque Country , Navarra , La Rioja ) and Castilla y Le?n, Castilla La Mancha, Andalusia and northern the island territory . More information on the geographical analysis of the incidence of influenza is available at vgripe.isciii.es / flu /

Surveillance of severe hospitalized confirmed cases of influenza
The monitoring protocol severe hospitalized confirmed cases of influenza ( CGHCG ) is available at the following link ISCIII https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf
Since the beginning of the season have been reported 540 CGHCG by influenza virus in 15 CCAA : Andaluc?a , Arag?n , Asturias , Baleares, Cantabria, Castilla La Mancha, Castilla y Leon, Catalonia, Extremadura , Galicia , Madrid , Murcia , Navarra , Basque Country and La Rioja , of which 52 % are men. Of the 71 women of childbearing age (15-49 years) 28% were pregnant ( 73% in the third trimester ) . The largest number of cases ( 56%) was recorded in the groups of young and middle-aged adults (24 % in the group aged 15-44 years and 32 % for 45-64 years ) followed by the group of over 64 years ( 32 % ) . In 99.8 % of patients influenza virus A. Virus B was identified in 0.2% and A subtipadas detections 79% were influenza A ( H1N1) and 21% pdm09 virus A ( H3) . For CCAA there is a predominance of influenza A ( H1N1) among CGHCG pdm09 reported in all except Baleares where influenza A ( H3 ) predominates .
77% ( 351/458 ) of patients had risk factors for influenza complications , the most prevalent diabetes mellitus and chronic lung disease (21 % ), followed by chronic cardiovascular disease ( 20 % ) and immunodeficiency ( 18 % ) . 63% of patients developed pneumonia and 41 % were admitted to ICU. 81% ( 410/505 ) of patients had received antiviral treatment and in 77 % of cases the treatment was administered just after 48h of symptom onset . 71 % of severe patients ( 229/321 ) , likely to be vaccinated , had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications .
In under 15 years, the most prevalent risk factor is the immunodeficiency ( 7%), followed by chronic lung disease and diabetes mellitus ( 5%).

Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 29 deaths from laboratory-confirmed influenza A (5 A (H3 ), 18 A ( H1N1)pdm09 and 6 no subtyping ) virus. The deaths have occurred in eleven regions. 83% of patients were older than 44 years ( 35 % in the group of 44-65 years and 48% in those over 64 years) and 93% of them had an underlying chronic disease. 71% ( 17/24 ) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of mortality data limits the estimates to subsequent seasons.

Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-14 season remained about expected predictive models according to the period between weeks 48 and 50 in which excess mortality observed over expected is appreciated. This excess is mainly concentrated in the group over 74 years and represents 6.5 % over expected ( Figure 9). This period of excess mortality could be associated with the low temperatures experienced . The AEMET called the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value ) and throughout December were recorded many days of frost in the peninsular interior especially in the first half .
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**Ronan Kelly** · January 30, 2014, 05:47 PM

Re: Spain Influenza Surveillance Reports 2014

Week 4 /2014 ( 20 January to 26 January 2014 )

Epidemiological situation:
During week 04/ 2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . Nine of them point to a growing trend of its influenza activity. In Asturias , Cantabria , Extremadura , Madrid and the Basque Country a tendency to stabilization might suggest the proximity of the peak in weekly flu incidence rates observed , and Aragon , La Rioja and Navarra reported a decrease in influenza activity. The spread of the disease is epidemic in 15 networks, including Galicia and Murcia. Only in Ceuta and Melilla level sporadic diffusion is observed. The increased circulation of influenza viruses is associated with the predominant circulating A ( H1N1)pdm09 and an important contribution virus A ( H3 ) that circulates mainly in Catalonia and Castile and Le?n.
The overall incidence rate of influenza in week 04/ 2014 is 292.68 cases per 100,000 inhabitants. The evolution of influenza activity is stable compared to the previous week ( rate ratio : 1.03, 95% CI 0.97 to 1.08 ) . The incidence rate of influenza shows a climb gradient of the smoothed epidemic wave with respect to the prior week surveillance . This probably indicates that we are very close to achieving a high incidence of flu season average intensity level of influenza activity , an epidemic level of diffusion and a stable development is noted .
A stabilization of incidence rates of influenza seen in all age groups.

The map of spatiotemporal spread of flu incidence of week 04/ 2014 intensified influenza activity is observed throughout the territory under surveillance. Areas with increased influenza activity was observed in some areas of Aragon and Catalonia , followed by areas of northern peninsular (Asturias , Cantabria , Basque Country , Navarra , La Rioja ) and Castilla y Le?n, Castilla La Mancha , Andalusia and the island territory .
More information on the geographical analysis of the incidence of influenza is available at vgripe.isciii.es / flu /

Flu outbreaks
Since the start of the 2013-2014 season have reported two flu outbreak. One virus A not subtyped in week 46/2013 , in a school in the Balearic Islands, with 10 affected. The other in Catalonia by AH3N2 in week 02/ 2014 in a nursing home with 31 affected , 21 residents (out of 119 ) and 10 employees (out of 68 ) . Six residents have required hospitalization, none have admitted to ICU. As a control measure has been carried to the vaccination of all staff who was not vaccinated .

Surveillance of severe hospitalized confirmed cases of influenza
Information obtained from severe hospitalized confirmed cases of influenza ( CGHCG ) comes from a surveillance system CGHCG in hospitals designated by each region involved . Your goal is to make known the clinical , epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of gravity in consensual monitoring protocol CGHCG ( https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf ) And are reported by hospitals participating in the same .
Since the beginning of the season have been reported 877 CGHCG by influenza virus in 16 autonomous communities , of which 51 % are men. Of the 113 women of childbearing age (15-49 years) 27% were pregnant ( 63% in the third trimester and 33 % in the second) . The largest number of cases ( 34%) was recorded in over 64 years , followed by 45-64 years ( 31%) and 15-44 (23 %), with therefore a high percentage of serious adult young and middle age. In 99.8 % of patients influenza virus B. A virus was identified in 0.2% and A subtipadas detections 80% were influenza A ( H1N1)pdm09 and 20% virus A ( H3) .
78% ( 555/713 ) of patients had risk factors for complications from flu, being most prevalent chronic lung disease (23 % ) and chronic cardiovascular disease ( 22%), followed by diabetes mellitus (21 %) and immunodeficiency ( 17 % ) . 66% of patients developed pneumonia and 39 % were admitted to ICU. 83% ( 693/831 ) of patients had received antiviral treatment and in 76 % of cases the treatment was administered just after 48h of symptom onset . 68 % of severe patients ( 340/498 ) , likely to be vaccinated , had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications .
In under 15 years, the most prevalent risk factors are chronic lung disease (5.4%) and immunodeficiency ( 4.8%).

Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 63 deaths from laboratory-confirmed influenza A (9 A ( H3 ), 37 A ( H1N1)pdm09 and 17 A no subtyping ) virus. The deaths have occurred in 15 regions.
87% of patients were older than 44 years , 30% belonged to the group of 44-65 years and 57 % at age 64. 89% of deaths from A ( H3 ) occurred in over 64 years , while the percentage of deaths from A ( H1N1) pdm09 in this age group is 46 %. In groups of young and middle-aged adults occur 51% of deaths from A ( H1N1) pdm09 (19% in 15-44 years and 32% in 45-64 years).
93% of deceased cases had an underlying chronic disease. 64% ( 30/47 ) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of mortality data limits the estimates to subsequent seasons.

Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-14 season remained about expected predictive models according to the period between weeks 48 and 50 in which excess mortality observed over expected is appreciated. This excess is mainly concentrated in the group over 74 years and represents 6.5 % over expected ( Figure 9). This period of excess mortality could be associated with the low temperatures experienced . The AEMET called the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value ) and throughout December were recorded many days of frost in the peninsular interior especially in the first half .
...

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**Ronan Kelly** · February 6, 2014, 10:05 AM

Re: Spain Influenza Surveillance Reports 2014

Week 5 /2014 ( January 27 to February 2, 2014 ) February 6, 2014 . # 379

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Begin the descent phase of 2013-2014 epidemic wave in Spain , once exceeded the peak incidence of influenza

Epidemiological situation:
During week 05/ 2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . Twelve of them show a decreasing trend of the influenza activity and Aragon , La Rioja , Navarra , Basque Country do for a second week so it probably reached the peak weekly incidence of influenza in week 03/ 2014. Canarias , Ceuta , Extremadura, Madrid and show a stable development and Balearic only reports a growing trend of influenza activity . The spread of the disease is epidemic in 15 networks, including Galicia and Murcia. Notifies a local broadcast Ceuta and Melilla a level of zero diffusion is observed. Predominant circulating influenza A virus with a combined circulation of influenza A ( H1N1) pdm09 and A ( H3) .
The overall incidence rate of influenza in week 05/ 2014 is 213.68 cases per 100,000 inhabitants. The evolution of influenza activity decreases with respect to the previous week ( rate ratio 0.73, 95% CI 0.69 to 0.78 ) . The incidence rate of influenza shows a marked decline in the epidemic wave it seems that the maximum peak incidence of seasonal influenza in week 04/ 2014 was reached. A medium level of intensity of influenza activity, an epidemic level of diffusion and a decreasing trend is noted .
A significant decrease in the incidence rates of influenza seen in all age groups.

The map of spatiotemporal spread of flu incidence of week 05/ 2014 a decrease in influenza activity is observed in most of the territory under surveillance , especially in the central and south peninsular . Areas with increased influenza activity was observed in Aragon , Catalonia and western Andalusia and the Balearic Islands.
More information on the geographical analysis of the incidence of influenza is available at vgripe.isciii.es / flu /

Flu outbreaks
Since the start of the 2013-2014 season have been reported six outbreaks of flu. Four outbreaks by virus A ( H3N2 ), one in a school in Baleares ( week 46/2013 ), with 10 affected , and the other three took place in nursing homes in the Basque Country ( week 01/ 2014 ), Catalonia ( week 02 / 2014 ) and Andalusia ( week 04/ 2014) , the first with 30 affected , five were hospitalized and one death , the second with 31 affected , of which six were hospitalized and the last with 15 affected , a hospitalized and three deaths. In the other two outbreaks causal agent was identified as influenza A ( H1N1) pdm09 and took place in week 3/2014 on two nursing homes in Aragon, with 37 affected , of which eight were hospitalized and one passed away . As a control measure has been carried to the vaccination of all staff who was not vaccinated .

Surveillance of severe hospitalized confirmed cases of influenza
Information obtained from severe hospitalized confirmed cases of influenza ( CGHCG ) comes from a surveillance system CGHCG in hospitals designated by each region involved . Your goal is to make known the clinical , epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of gravity in consensual monitoring protocol CGHCG ( https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf ) And are reported by hospitals participating in the same .
Since the beginning of the season have been reported by 1,254 CGHCG flu virus in 17 regions , of which 51 % are men. Of the 154 women of childbearing age (15-49 years) 22% were pregnant ( 60% in the third trimester and 37 % in the second) . The largest number of cases (35 % ) is recorded in over 64 years , followed by 45-64 years ( 32%) and 15-44 (21 %), with therefore a high percentage of serious adult young and middle-aged ( 54%). In 99.8 % of patients influenza virus B. A virus was identified in 0.2% and A subtipadas detections 81% were influenza A ( H1N1) and 19% pdm09 virus A ( H3) .
79% ( 798/1003 ) of patients had risk factors for complications from flu, being most prevalent chronic lung disease (25 % ) and chronic cardiovascular disease ( 23% ), followed by diabetes mellitus (21 %) and immunodeficiency ( 18 % ) . 68% of patients developed pneumonia and 36 % were admitted to ICU. 85% of patients had received antiviral treatment and in 73 % of cases the treatment was administered just after 48h of symptom onset . 69 % of severe patients ( 492/717 ) , likely to be vaccinated , had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications .
In under 15 years, the most prevalent risk factors are chronic lung disease (5.7% ) and immunodeficiency ( 4.9%).

Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 112 deaths from laboratory-confirmed influenza , 65 influenza A ( H1N1) pdm09 , 14 influenza A ( H3 ) viruses and 33 no subtyping ) . The deaths have occurred in 15 regions.
87 % of patients were over 44 , 31% belonged to the group of 44-65 years and 56 % at age 64. 79% of deaths from A ( H3 ) occurred in over 64 years , while the percentage of deaths from A ( H1N1) pdm09 in this age group is 48% . In groups of young and middle-aged adults occur 49% of deaths from A ( H1N1) pdm09 (17% in 15-44 years and 32% in 45-64 years).
92% of deceased cases had an underlying chronic disease. 66% ( 51/77 ) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons.
Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-2014 season remained about expected predictive models according to the period between weeks 48 and 50 in which excess mortality observed over expected is appreciated. This excess is mainly concentrated in the group over 74 years and represents 6.5 % over expected ( Figure 10). This period of excess mortality could be associated with the low temperatures experienced . The AEMET called the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value ) throughout December and recorded many days of frost in the peninsular interior especially in the first half
...

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**Ronan Kelly** · February 13, 2014, 07:57 AM

Re: Spain Influenza Surveillance Reports 2014

Epidemiological situation:
During week 06/ 2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . Fourteen of them show a decreasing trend of the influenza activity , reaching the peak of influenza activity in week 03/ 2012 ( Aragon, Castile and Le?n , La Rioja , Navarra and the Basque Country ) and at week 04/ 2014 (Andalusia, Asturias , Cantabria, Castilla La Mancha , Catalonia, Valencia , Madrid and Melilla) . Indicates a stable development Melilla and the Canary Islands and Ceuta only reported an increasing trend of influenza activity . The spread of the disease is epidemic in 14 networks, including Galicia and Murcia. Navarra and Ceuta notifies a local broadcast and Melilla a level of zero diffusion is observed. Predominant circulating influenza A virus with a combined circulation of influenza A ( H1N1) pdm09 and A ( H3) .
The overall incidence rate of influenza in week 06/ 2014 is 151.24 cases per 100,000 inhabitants. Influenza activity decreases with respect to the previous week ( rate ratio 0.71, 95% CI 0.66 to 0.76 ) . The decline in the epidemic wave is observed for the second consecutive week, after reaching the maximum peak incidence of seasonal influenza in week 04/ 2014. A medium level of intensity of influenza activity, an epidemic level of diffusion and a decreasing trend is noted .
A decrease in the incidence rates of influenza, which is significant in the under 65 seen in all age groups.

The map of spatiotemporal spread of flu incidence of week 06/ 2014 a decrease in influenza activity is observed in most of the territory under surveillance and especially in central and southern half of the peninsula . Areas with increased influenza activity was observed in Asturias , Aragon and Catalonia.
More information on the geographical analysis of the incidence of influenza is available at vgripe.isciii.es / flu /

Flu outbreaks
Since the start of the 2013-2014 season have been reported twelve outbreaks of flu in seven Autonomous Communities. Nine occurred in nursing homes , one in college and two other institutions in long stay care . All but one occurred in the epidemic period of this flu season . All of the outbreaks have been confirmed infection with influenza A virus , seven influenza A ( H3 ) and five with influenza A ( H1N1) virus pdm09 . One attack rate between 2% and 33 % was observed. During outbreaks have occurred 31 identified hospitalizations and 5 deaths . In eight of the nine outbreaks with available vaccination coverage was higher than 80 %.

Surveillance of severe hospitalized confirmed cases of influenza
Information obtained from severe hospitalized confirmed cases of influenza ( CGHCG ) comes from a surveillance system CGHCG in hospitals designated by each region involved . Your goal is to make known the clinical , epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of gravity in consensual monitoring protocol CGHCG ( https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf ) And are reported by hospitals participating in the same .
Since the beginning of the season have been reported by 1,513 CGHCG flu virus in 17 regions , of which 51 % are men. Of the 183 women of childbearing age (15-49 years) 22% were pregnant (64 % in the third trimester and 33 % in the second) . The largest number of cases ( 36%) for people aged 64 years , followed by those aged 45-64 ( 31%) and 15-44 (21 %), with therefore a high percentage of serious adult young and middle-aged ( 52%). In 99.7 % of patients influenza A virus was identified and virus B. in 0.3%. A subtyped detections 79% were influenza A ( H1N1) pdm09 and 21% virus A ( H3) .
81% ( 968/1199 ) of patients had risk factors for complications from flu, being most prevalent chronic lung disease (26 % ) and chronic cardiovascular disease ( 24%), followed by diabetes mellitus (21 %) and immunodeficiency ( 18 % ) . 68% of patients developed pneumonia and 34 % required ICU entered . 85% of patients had received antiviral treatment and in 74 % of cases the treatment was administered just after 48h of symptom onset . 68 % of severe patients ( 592/872 ) , likely to be vaccinated , had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications .
In under 15 years, the most prevalent risk factors are chronic lung disease (5.7% ) and immunodeficiency ( 4.9%).

Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 141 deaths from laboratory-confirmed influenza , 60 % for influenza A ( H1N1) pdm09 , 15 % for influenza A ( H3) , and 25% no virus subtyping ) . The deaths have occurred in 15 regions.
88% of patients were older than 44 years , 31% belonged to the group of 44-65 years and 57 % at age 64. 86% of deaths from A ( H3 ) occurred in over 64 years , while the percentage of deaths from A ( H1N1) pdm09 in this age group is 48% . In groups of young and middle-aged adults occur 50% of deaths from A ( H1N1) pdm09 (15% in 15-44 years and 35 % at 45-64 years).
94% of deceased cases had an underlying chronic disease. 66% (65 /99) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons.
Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-2014 season remained about expected predictive models according to the period between weeks 48 and 50 in which excess mortality observed over expected is appreciated. This excess is mainly concentrated in the group over 74 years and represents 6.5 % over expected ( Figure 10). This period of excess mortality could be associated with the low temperatures experienced . The AEMET called the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value ) and throughout December were recorded many days of frost in the peninsular interior especially in the first half ( https://www.aemet.es/documentos/es/s...im_2013_11.pdf ) .
...

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**Ronan Kelly** · February 28, 2014, 06:21 AM

Re: Spain Influenza Surveillance Reports 2014

Epidemiological situation:
During week 08/2014, information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain (SVGE). The evolution of influenza activity is generally decreasing with respect to the previous week with the exception of the Canary Islands and Melilla in the incidence of influenza varies. In four networks (Cantabria, Castilla La Mancha, Valencia and the Basque Country) the incidence of influenza in week 08/2014 is set for the first week of the epidemic wave of the season, in pre-epidemic values was initiated. In four other networks (Catalonia, Castilla y Le?n, Extremadura and Navarra) influenza incidence is very close to those pre-epidemic values Dissemination of continuous local disease epidemic or six five networks respectively and sporadic in the rest (six networks) compared to the previous week Nine Network reported a decrease in their levels of dissemination of the disease. Predominant circulating influenza A virus with a combined circulation of AH3 and A (H1N1) virus pdm09.

Overall incidence rate of influenza in week 08/2014 down to 69.56 cases per 100,000 people (almost half recorded in the previous week to 100.15 cases per 100,000 population) (rate ratio 0.69, 95% CI 0.63-0.77). For the fourth consecutive week influenza activity approaching falls pre-epidemic levels of incidence of influenza. A medium level of intensity of influenza activity, local media and a decreasing trend is noted.
In all age groups (except those over 64 years) a significant decrease in the incidence rates of influenza is observed.
In diffuse map spatiotemporal incidence of influenza in the week 082,014 overall decrease in influenza activity is observed. Areas with increased influenza activity was observed in Asturias, northern Aragon and Catalonia center. More information on the geographical analysis of the incidence of influenza is available at: . vgripe.isciii.es / flu /

influenza outbreaks
since the start of the 2013-2014 season have been reported fourteen flu outbreaks in seven Autonomous Communities. Nine occurred in nursing homes, one in college, two in health institutions and two institutions in other long-stay care. All but one occurred in the epidemic period of this flu season. All of the outbreaks have been confirmed infection with influenza A virus, seven influenza A (H3) and seven influenza A (H1N1) virus pdm09. One attack rate between 2% and 33% was observed. During outbreaks have occurred 35 identified hospitalizations and 5 deaths. In eight of the nine outbreaks with available vaccination coverage was higher than 80%.

Surveillance severe hospitalized confirmed cases of influenza
The information obtained from severe hospitalized confirmed influenza cases (CGHCG) comes from a surveillance system in which CGHCG participating hospitals designated by each Autonomous Community. Your goal is to make known the clinical, epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of gravity in consensual monitoring protocol CGHCG that are reported by hospitals participating in the same. since the beginning of the season have been reported by 2,018 CGHCG flu virus in 17 regions, of which 52% are men. Of the 230 women of childbearing age (15-49 years) 20% were pregnant (64% in the third trimester and 36% in the second). The largest number of cases (36%) for people aged 64 years, followed by those aged 45-64 (32%) and 15-44 (20%), with therefore a high percentage of serious adult young and middle-aged (52%). In 99.6% of patients with influenza A virus was identified in 0.4% and the B virus detections From A subtipadas 78% were influenza A (H1N1) and 22% pdm09 virus A ( H3.) 82% (1.251/1.524) of the patients had risk factors for complications from flu, being most prevalent chronic lung disease (26%) and chronic cardiovascular disease (24%), followed by diabetes mellitus (21 %) and immunodeficiency (18%). 69% of patients developed pneumonia and 35% required ICU entered. 86% of patients had received antiviral treatment and in 74% of cases the treatment was administered just after 48h of symptom onset. 67% of severe patients (755/1.126), likely to be vaccinated, had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications. At under 15 the most prevalent risk factors are chronic lung disease (5.0 %) and immunodeficiency (4.7%). related mortality Flu Deaths in severe cases hospitalized confirmed influenza Since week 40/2013 there have been 218 deaths from laboratory-confirmed influenza, 63% for influenza A (H1N1) pdm09, 14% for influenza A (H3), and 23% no virus subtyping). The deaths have occurred in 15 regions. , 86% of patients were over 44, 30% belonged to the group of 44-65 years and 56% at age 64. For over 64 years, in 83% of deaths influenza A (H3) was detected in 47% and the virus A (H1N1) pdm09. In groups of young and middle-aged adults occur 50% of deaths from A (H1N1) pdm09 (16% in 15-44 years and 34% in 45-64 years.) 94% of the deceased patients presented an underlying chronic disease. 64% (96/150) of patients likely to be vaccinated had received a flu shot this season. mortality information in CGHCG describes the clinical, epidemiological and virological CGHCG features with a fatal outcome, and the information on risk factors of severe course. This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control, however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons. Excess daily mortality from all causes during the 2013-2014 season the Monitoring System of daily mortality (MoMo) in Spain includes all deaths recorded in 2,004 computerized civil registry, which represented 77% of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-2014 season remained about expected predictive models according to the period between weeks 48 and 50 in which excess mortality observed over expected is appreciated. This excess is mainly concentrated in the group over 74 years and represents 6.5% compared to expectations. This period of excess mortality could be associated with the low temperatures experienced. The AEMET called the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value) and throughout December were recorded many days of frost in the peninsular interior especially in the first half.
...

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**Ronan Kelly** · March 7, 2014, 04:25 PM

Re: Spain Influenza Surveillance Reports 2014

Epidemiological situation:
During week 09/2014, information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain (SVGE). The evolution of influenza activity is generally decreasing with respect to the previous week except Canary Islands, Ceuta, Melilla Extremadura and in which the incidence of influenza varies. This week fall below the threshold value of sentinel networks of Aragon, Catalonia, Castilla y Leon and Navarra, while very close to the pre-epidemic levels in Asturias, Baleares and Madrid values are recorded. In Cantabria, Castilla La Mancha, Valencia, Basque Country, La Rioja, Ceuta epidemic period of the 2013-2014 season ended 2-3 weeks ago.
Spreading the disease is epidemic or local in four three sentinel networks respectively, sporadic in nine of them, in addition to Murcia and Galicia, Cantabria and zero. Predominant circulating influenza A virus, with a mixed circulation of influenza A (H1N1) pdm09 and A (H3).
During week 09/2014 epidemic period ending the 2013-14 season with an overall incidence rate of flu that falls below the baseline, reaching pre-epidemic values 47.20 cases per 100,000 population (rate ratio: 0.66, 95% CI 0.59 to 0.75). A medium level of intensity of influenza activity, local media and a decreasing trend is noted.
In all age groups (except those over 64 years) a significant decrease in the incidence rates of influenza is observed.

Outbreaks flu since the start of the 2013-2014 season have been reported fourteen flu outbreaks in seven Autonomous Communities. Nine occurred in nursing homes, one in college, two in health institutions and two institutions in other long-stay care. All but one occurred in the epidemic period of this flu season. All of the outbreaks have been confirmed infection with influenza A virus, seven influenza A (H3) and seven influenza A (H1N1) virus pdm09. One attack rate between 2% and 33% was observed. During outbreaks have occurred 35 identified hospitalizations and 5 deaths. In eight of the nine outbreaks with available vaccination coverage was higher than 80%.

Surveillance severe hospitalized confirmed cases of influenza The information obtained from severe hospitalized confirmed influenza cases (CGHCG) comes from a surveillance system in which CGHCG participating hospitals designated by each Autonomous Community. Your goal is to make known the clinical, epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of gravity in consensual monitoring protocol CGHCG and are reported by hospitals participating in the same. since the beginning of the season have been reported 2,142 CGHCG by influenza virus in 17 regions, of which 53% are men. Of the 236 women of childbearing age (15-49 years) 20% were pregnant (64% in the third trimester and 31% in the second). The largest number of cases (36%) for people aged 64 years, followed by those aged 45-64 (32%) and 15-44 (20%), with therefore a high percentage of serious adult young and middle-aged (52%). In 99.5% of patients with influenza A virus was identified in 0.5% and the B virus detections From A subtipadas 78% were influenza A (H1N1)pdm09 and 22% virus A ( H3.) 82% (1.314/1.593) of the patients had risk factors for complications from flu, being most prevalent chronic lung disease (26%) and chronic cardiovascular disease (24%), followed by diabetes mellitus (22 %) and immunodeficiency (18%). 70% of patients developed pneumonia and 35% required ICU entered. 86% of patients had received antiviral treatment and in 74% of cases the treatment was administered just after 48h of symptom onset. 66% of severe patients (805/1.212), likely to be vaccinated, had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications. In Figure 8 the prevalence of risk factors in children and adults CGHCG observed. In under 15 years, the most prevalent risk factors are chronic lung disease (5.6%) and immunodeficiency (5%).

related mortality flu deaths in hospitalized severe cases of influenza confirmed From week 40/2013 have been 233 registered deaths from laboratory-confirmed influenza, 99.6% for influenza A (65% for influenza A (H1N1) pdm09, 13% for influenza A (H3), and 21% no virus subtyping) and 0, four% due to virus B. Mortality data were produced 15 CCAA. 86% of patients were older than 44 years, 30% belonged to the group of 44-65 years and 56% at age 64. 83% of deaths from influenza A (H3) were recorded in over 64 years. In groups of young and middle-aged adults occur 48% of deaths from A (H1N1) pdm09 (15% in 15-44 years and 33% at 45-64 years). And the only B virus death occurred in the group older than 64 years. 94% of deceased cases had an underlying chronic disease. 64% (105/164) of patients likely to be vaccinated had received a flu shot this season. mortality information in CGHCG describes the clinical, epidemiological and virological CGHCG features with a fatal outcome, and the information on risk factors of severe course. This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control, however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons. Excess daily mortality from all causes during the 2013-2014 season the Monitoring System of daily mortality (MoMo) in Spain includes all deaths recorded in 2,004 computerized civil registry, which represented 77% of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-2014 season remained about expected predictive models according to the period between weeks 48 and 50 in which excess mortality observed over expected is appreciated. This excess is mainly concentrated in the group over 74 years and represents 6.5% compared to expectations. This period of excess mortality could be associated with the low temperatures experienced. The AEMET called the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value) and throughout December were recorded many days of frost in the peninsular interior especially in the first half.
...

http://vgripe.isciii.es/gripe/inicio.do

**Ronan Kelly** · March 13, 2014, 03:48 PM

Re: Spain Influenza Surveillance Reports 2014

Epidemiological situation:
During week 10/2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . The evolution of influenza activity is decreasing or stable in the territory under surveillance. This week the incidence of influenza fall below the threshold value in sentinel networks Balearic Islands, Extremadura and Madrid so in week 10/2014 all sentinel networks indicate incidence rates of influenza epidemics with pre - values.
The spread of the disease is epidemic in Melilla, zero in four networks and sporadic in the rest . Predominant circulating influenza A virus , with a mixed circulation of influenza A ( H1N1) pdm09 and A ( H3) .
During week 10/2014 the overall incidence rate of influenza cases decreased to 35.07 per 100,000 population ( rate ratio 0.74, 95% CI 0.64 to 0.86 ) . Low intensity of influenza activity , sporadic diffusion level and a decreasing trend is noted .
A decrease in the incidence rates of influenza (significant in groups 5-14 and 15-64 years ) was observed in all age groups.

The map of spatiotemporal spread of flu incidence of week 09/ 2014 a general decrease in influenza activity is observed. Areas with increased influenza activity was observed in Asturias, northern Aragon and Catalonia and the Canary Islands. More information on the geographical analysis of the incidence of influenza is available at vgripe.isciii.es / flu /

Flu outbreaks
Since the start of the 2013-2014 season have been reported fourteen flu outbreaks in seven Autonomous Communities. Nine occurred in nursing homes , one in college , two in health institutions and two institutions in other long-stay care . All but one occurred in the epidemic period of this flu season . All of the outbreaks have been confirmed infection with influenza A virus , seven influenza A ( H3) and seven influenza A ( H1N1) virus pdm09 . One attack rate between 2% and 33 % was observed. During outbreaks have occurred 35 identified hospitalizations and 5 deaths . In eight of the nine outbreaks with available vaccination coverage was higher than 80 %.

Surveillance of severe hospitalized confirmed cases of influenza
Information obtained from severe hospitalized confirmed cases of influenza ( CGHCG ) comes from a surveillance system CGHCG in hospitals designated by each region involved . Your goal is to make known the clinical , epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of gravity in consensual monitoring protocol CGHCG ( https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf ) And are reported by hospitals participating in the same .
Since the beginning of the season have been reported by 2,190 CGHCG flu virus in 17 regions (Figure 6 ) , of which 53 % are men. Of the 241 women of childbearing age (15-49 years ) 20% were pregnant ( 63% in the third trimester and 30% in the second) . The largest number of cases (37 % ) is recorded in over 64 years , followed by 45-64 years ( 32%) and 15-44 (20 %), with therefore a high percentage of serious adult young and middle-aged ( 52%). In 99.5 % of patients with influenza A virus was identified in 0.5% and the B virus detections From A subtipadas 77% were influenza A ( H1N1)pdm09 and 23% virus A ( H3 ) .
82% ( 1.352/1.640 ) of the patients had risk factors for complications from flu, being most prevalent chronic lung disease (26 % ) and chronic cardiovascular disease ( 24%), followed by diabetes mellitus (22 %) and immunodeficiency ( 19% ) . 70% of patients developed pneumonia and 35 % required ICU entered . 86% of patients had received antiviral treatment and in 74 % of cases the treatment was administered just after 48h of symptom onset . 67 % of severe patients ( 833/1.246 ) , likely to be vaccinated , had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications .
In under 15 years, the most prevalent risk factors are chronic lung disease (5.6%) and immunodeficiency ( 5%).

Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 243 deaths from laboratory-confirmed influenza , 242 for viruses [65 % for influenza A ( H1N1) pdm09 , 14% A ( H3) and 21% no virus subtyping )] and one death from virus B. The deaths occurred in 15 regions.
86% of patients were older than 44 years , 29% belonged to the group of 44-65 years and 57 % at age 64. 82% of deaths from influenza A ( H3) were recorded in over 64 years. In groups of young and middle-aged adults occur 48% of deaths from A ( H1N1) pdm09 (15% in 15-44 years and 33 % at 45-64 years). And the only B virus death occurred in the group older than 64 years.
94% of deceased cases had an underlying chronic disease. 64% (110 /171) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons.

Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-2014 season remained about expected predictive models according to the period between weeks 48 and 50/2013 in which excess mortality observed shown above expected . This excess is mainly concentrated in the group over 74 years and represents 6.5 % over expected ( Figure 10). This period of excess mortality could be associated with the low temperatures experienced . the AEMET (https://www.aemet.es/documentos/es/s...im_2013_11.pdf ) Called the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value ) throughout December and recorded many days of frost in the peninsular interior especially in the first half .
...

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**Ronan Kelly** · March 20, 2014, 03:38 PM

Re: Spain Influenza Surveillance Reports 2014

Epidemiological situation:

During week 11/2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . The evolution of influenza activity remains stable or decreases in the territory under surveillance. This week all sentinel networks indicate incidence rates of pre - flu epidemic securities except Melilla maintains a securities influenza activity above baseline threshold.
The spread of the disease is local in Melilla, sporadic in five sentinel networks, including Galicia and Murcia and zero in five others. Predominant circulating influenza A virus , a majority movement of virus A ( H3 ) and a smaller contribution of virus A ( H1N1) pdm09 .
During week 11/2014 the overall incidence rate of influenza cases decreased to 20.89 per 100,000 population ( rate ratio 0.60, 95% CI 0.50 to 0.73 ) . Low intensity of influenza activity , sporadic diffusion level and a decreasing trend is noted .
A decrease in the incidence rates of influenza, which is significant in groups 5-14 and 15-64 years were observed in all age groups.

The map of spatiotemporal spread of flu incidence of week 11/2014 a general decrease in influenza activity is observed. Areas with increased influenza activity was observed in Asturias, Basque Country western , northern Aragon and Catalonia and Castile and Le?n, Castilla La Mancha , Extremadura , Andalusia and Canary areas. More information on the geographical analysis of the incidence of influenza is available at vgripe.isciii.es / flu /

Flu outbreaks
Since the start of the 2013-2014 season have been reported 14 outbreaks of flu in seven Autonomous Communities. Nine occurred in nursing homes , one in college , two in health institutions and two institutions in other long-stay care . All but one occurred in the epidemic period of this flu season . All of the outbreaks have been confirmed infection with influenza A virus , seven influenza A ( H3) and seven influenza A ( H1N1) virus pdm09 . One attack rate between 2% and 33 % was observed. During outbreaks have occurred 35 identified hospitalizations and 5 deaths . In eight of the nine outbreaks with available vaccination coverage was higher than 80 %.

Surveillance of severe hospitalized confirmed cases of influenza
Information obtained from severe hospitalized confirmed cases of influenza ( CGHCG ) comes from a surveillance system CGHCG in hospitals designated by each region involved . Your goal is to make known the clinical , epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of consensus on the seriousness of CGHCG surveillance protocol ( refer to https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf ) And are reported by hospitals participating in the same .
Since the beginning of the season have been reported by 2,222 CGHCG flu virus in 17 regions , of which 53 % are men. Of the 244 women of childbearing age (15-49 years ) 20% were pregnant ( 63% in the third trimester and 30% in the second) . The largest number of cases (37 % ) is recorded in over 64 years , followed by 45-64 years ( 32%) and 15-44 (20 %), with therefore a high percentage of serious adult young and middle-aged ( 52%). In 99.4 % of patients with influenza A virus was identified in 0.6% and the B virus detections From A subtipadas 76% were influenza A ( H1N1) pdm09 and 24% virus A ( H3 ) .
82% ( 1.374/1.666 ) of the patients had risk factors for complications from flu, being most prevalent chronic lung disease (26 % ) and chronic cardiovascular disease ( 24%), followed by diabetes mellitus (22 %) and immunodeficiency ( 18 % ) . In under 15 years, the most prevalent risk factors are chronic lung disease (5.3%) and immunodeficiency ( 5.2%). 70% of patients developed pneumonia and 35 % required ICU entered . 86% of patients had received antiviral treatment and in 74 % of cases the treatment was administered just after 48h of symptom onset . 67 % of severe patients ( 851/1.271 ) , likely to be vaccinated , had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications .

Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 251 deaths from laboratory-confirmed influenza , 250 influenza A ( 65 % for influenza A ( H1N1) pdm09 , 14% A ( H3) virus and 21 % for A not subtyped ) and a death by virus B. The deaths occurred in 15 regions. 87% of patients were older than 44 years , 29% belonged to the group of 44-65 years and 58 % at age 64. 83% of deaths from influenza A ( H3) were recorded in over 64 years. In groups of young and middle-aged adults occur 47% of deaths from A ( H1N1) pdm09 (15% in 15-44 years and 32% in 45-64 years). And the only B virus death occurred in the group older than 64 years. 95% of deceased cases had an underlying chronic disease. 63% (112 /178) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons.
Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-2014 season remained about expected predictive models according to the period between weeks 48 and 50/2013 in which excess mortality observed shown above expected . This excess is mainly concentrated in the group over 74 years and represents 6.5 % compared to expectations . This period of excess mortality could be associated with the low temperatures experienced . The AEMET called the last half of November and very cold (average temperature of 3 ? C to 4 ? C below normal value ) and throughout December were recorded many days of frost in the peninsular interior especially in the first half ( https://www.aemet.es/documentos/es/s...im_2013_11.pdf )

**Ronan Kelly** · March 27, 2014, 03:41 PM

Re: Spain Influenza Surveillance Reports 2014

Epidemiological situation:
During week 12/2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . The evolution of influenza activity remains stable or decreases in the territory under surveillance. This week all sentinel networks indicate incidence rates of influenza with pre - epidemics values.
The spread of the disease is nil in six networks and sporadic in the rest associated with the predominant circulating influenza type A virus ( AH3 among subtyped except Basque Country circulating subtype A ( H1N1) pdm09 ) and the virus influenza B in Extremadura .
During week 12/2014 the overall incidence rate of influenza is 17.22 cases per 100,000 population ( rate ratio 0.84, 95% CI 0,67-1.0 ) . Low intensity of influenza activity , sporadic diffusion level and a stable development is noted .
One ( although not statistically significant) decrease in the incidence rates of influenza seen in all age groups.

The map of spatiotemporal spread of flu incidence of week 12/2014 a general decrease in influenza activity is observed. Areas with increased influenza activity was observed in the Canary Islands and in Asturias, northwest of Aragon, Catalonia, and parts of Castilla La Mancha , Extremadura and Andalusia.

Flu outbreaks
Since the start of the 2013-2014 season have been reported 15 outbreaks of flu in seven Autonomous Communities. Ten occurred in nursing homes , one in college , two in health institutions and two institutions in other long-stay care . All but one occurred in the epidemic period of this flu season . All of the outbreaks have been confirmed infection with influenza A virus , eight influenza A ( H3) and seven influenza A ( H1N1) virus pdm09 . One attack rate between 2% and 51 % was observed. During outbreaks have occurred 47 identified hospitalizations and 6 deaths . In nine of the ten outbreaks with available vaccination coverage was higher than 80 %.

Surveillance of severe hospitalized confirmed cases of influenza
Information obtained from severe hospitalized confirmed cases of influenza ( CGHCG ) comes from a surveillance system CGHCG in hospitals designated by each region involved . Your goal is to make known the clinical , epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of gravity in consensual monitoring protocol CGHCG ( https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf ) And are reported by hospitals participating in the same .
Since the beginning of the season have been reported by 2,312 CGHCG flu virus in 16 autonomous communities , of which 53 % are men. Of the 243 women of childbearing age (15-49 years ) 20% were pregnant ( 60% in the third trimester and 33% in the second) . The largest number of cases (37 % ) is recorded in over 64 years , followed by 45-64 years ( 32%) and 15-44 (19 %), with therefore a high percentage of serious adult young and middle-aged ( 51%). In 99.4 % of patients with influenza A virus was identified in 0.6% and the B virus detections From A subtipadas 77% were influenza A ( H1N1) pdm09 and 23% virus A ( H3 ) .
82% ( 1.376/1.669 ) of the patients had risk factors for complications from flu, being most prevalent chronic lung disease (27 % ) and chronic cardiovascular disease ( 25%), followed by diabetes mellitus (22 %) and immunodeficiency ( 19% ) . 71% of patients developed pneumonia and 35 % required ICU entered . 86% of patients had received antiviral treatment and in 75 % of cases the treatment was administered just after 48h of symptom onset . 66 % of severe patients ( 889/1.338 ) , likely to be vaccinated , had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications . In under 15 years, the most prevalent risk factors are chronic lung disease (5.3%) and immunodeficiency ( 5.2%).

Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 259 deaths from laboratory-confirmed influenza , 258 virus A ( 63 % for influenza A ( H1N1) pdm09 , 14% A ( H3) virus and 22 % for A not subtyped ) and a death by virus B. The deaths occurred in 14 regions.
86% of patients were older than 44 years , 28% belonged to the group of 44-65 years and 58 % at age 64. 83% of deaths from influenza A ( H3) were recorded in over 64 years. In groups of young and middle-aged adults occur 47% of deaths from A ( H1N1) pdm09 (14% in 15-44 years and 32% in 45-64 years). And the only B virus death occurred in the group older than 64 years.
95% of deceased cases had an underlying chronic disease. 62% (115 /185) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons.
Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-2014 season remained about expected predictive models according to the period between weeks 48 and 50/2013 , in which excess mortality observed shown above expected , which is mainly concentrated in the group older than 74 years. This excess coincides with the low temperatures experienced in Spain in this period (AEMET https://www.aemet.es/documentos/es/s...im_2013_11.pdf ) . Also, in the beginning of 2014 (weeks 2-7) , it has been observed a moderate increase in mortality from all causes in the age group between 15 and 64 years ( z -score slightly above 2). This increase may be related to the intensity of the flu this season, but other factors may also play a role.
...

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**Ronan Kelly** · April 3, 2014, 05:23 PM

Re: Spain Influenza Surveillance Reports 2014

Epidemiological situation:
During week 13/2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . The evolution of influenza activity remains stable or decreases in the territory under surveillance. This week all sentinel networks indicate incidence rates of influenza epidemics with pre - values.
The spread of disease is sporadic in six sentinel networks, including Galicia and Murcia, and zero in the rest associated with the predominant circulating influenza A virus ( H3) , among subtyped .
During week 13/2014 the overall incidence rate of influenza is 12.84 cases per 100,000 population. Low intensity of influenza activity , sporadic diffusion level and a stable development is noted . In all age groups the incidence rates of influenza are stable.

The map of spatiotemporal spread of flu incidence of week 13/2014 scant influenza activity is observed in most of the territory. Persists areas with some flu activity in the Canary Islands and some parts of the peninsula.

Flu outbreaks
Since the start of the 2013-2014 season have been reported 15 outbreaks of flu in seven Autonomous Communities. Ten occurred in nursing homes , one in college , two in health institutions and two institutions in other long-stay care . All but one occurred in the epidemic period of this flu season . All of the outbreaks have been confirmed infection with influenza A virus , eight influenza A ( H3) and seven influenza A ( H1N1) virus pdm09 . One attack rate between 2% and 51 % was observed. During outbreaks have occurred 47 identified hospitalizations and 6 deaths . In nine of the ten outbreaks with available vaccination coverage was higher than 80 %.

Surveillance of severe hospitalized confirmed cases of influenza
Information obtained from severe hospitalized confirmed cases of influenza ( CGHCG ) comes from a surveillance system CGHCG in hospitals designated by each region involved . Your goal is to make known the clinical , epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of consensus gravity in CGHCG monitoring protocol ( see https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf ) And are reported by hospitals participating in the same .
Since the beginning of the season have been reported by 2,332 CGHCG flu virus in 16 autonomous communities , of which 53 % are men. Of the 243 women of childbearing age (15-49 years ) 20% were pregnant ( 60% in the third trimester and 33% in the second) . The largest number of cases (38 % ) is recorded in over 64 years , followed by 45-64 years ( 32%) and 15-44 (19 %), with therefore a high percentage of serious adult young and middle-aged ( 51%). In 99.4 % of patients with influenza A virus was identified in 0.6% and the B virus detections From A subtipadas 77% were influenza A ( H1N1) pdm09 and 23% virus A ( H3 ) .
82% ( 1.382/1.678 ) of the patients had risk factors for complications from flu, being most prevalent chronic lung disease (27 % ) and chronic cardiovascular disease ( 25%), followed by diabetes mellitus (22 %) and immunodeficiency ( 18 % ) . In under 15 years, the most prevalent risk factors are chronic lung disease (5.3%) and immunodeficiency ( 5.2%). 71% of patients developed pneumonia and 35 % required ICU entered . 86% of patients had received antiviral treatment and in 74 % of cases the treatment was administered just after 48h of symptom onset . 67 % of severe patients ( 900/1.353 ) , likely to be vaccinated , had not received the flu shot this season. Official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications .

Mortality associated with influenza
Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 266 deaths from laboratory-confirmed influenza , 265 influenza A ( 64 % for influenza A ( H1N1) pdm09 , 13% A ( H3) virus and 23 % for A not subtyped ) and a death by virus B. The deaths occurred in 14 regions.
87% of patients were older than 44 years ; 29% belonged to the group of 44-65 years and 58 % at age 64. 83% of deaths from influenza A ( H3) were recorded in over 64 years. In groups of young and middle-aged adults occur 47% of deaths from A ( H1N1) pdm09 (14% in 15-44 years and 33 % at 45-64 years). And the only B virus death occurred in the group older than 64 years.
95% of deceased cases had an underlying chronic disease. 63% (120 /191) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons.
Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. Overall mortality observed since the start of the 2013-2014 season remained about expected predictive models according to the period between weeks 48 and 50/2013 , in which excess mortality observed shown above expected , which is mainly concentrated in the group older than 74 years. This excess coincides with the low temperatures experienced in Spain in this period (AEMET : https://www.aemet.es/documentos/es/s...im_2013_11.pdf ) . Also, in the beginning of 2014 (weeks 2-7) , it has been observed a moderate increase in mortality from all causes in the age group between 15 and 64 years ( z -score slightly above 2). This increase may be related to the intensity of the flu this season, but other factors may also play a role.
...

http://vgripe.isciii.es/gripe/inicio.do

**Ronan Kelly** · April 10, 2014, 04:30 PM

Re: Spain Influenza Surveillance Reports 2014

Epidemiological situation:
During week 14/2014 , information was received influenza surveillance sentinel networks all integrated into the System Influenza Surveillance in Spain ( SVGE ) . The evolution of influenza activity remains stable or decreases in the territory under surveillance with incidence rates of pre - flu epidemic sentinel values in all networks.
The spread of disease is sporadic in five sentinel networks, including Galicia , and zero in the rest associated with the predominant circulating influenza A virus ( H1N1) pdmo9 , among subtyped .
During week 14/2014 the overall incidence rate of influenza is 13.93 cases per 100,000 population. Low intensity of influenza activity , sporadic diffusion level and a stable development is noted .
In all age groups the incidence rates of influenza are stable.

The map of spatiotemporal spread of flu incidence of week 14/2014 scant influenza activity is observed in most of the territory. Persists areas with some flu activity in the Canary Islands and in some parts of the peninsula .
More information on the geographical analysis of the incidence of influenza is available at vgripe.isciii.es / flu /

Flu outbreaks
Since the start of the 2013-2014 season have been reported 15 outbreaks of flu in seven Autonomous Communities. Ten occurred in nursing homes , one in college , two in health institutions and two institutions in other long-stay care . All but one occurred in the epidemic period of this flu season . All of the outbreaks have been confirmed infection with influenza A virus , eight influenza A ( H3) and seven influenza A ( H1N1) virus pdm09 . One attack rate between 2% and 51 % was observed. During outbreaks have occurred 47 identified hospitalizations and 6 deaths . In nine of the ten outbreaks with available vaccination coverage was higher than 80 %.

Surveillance of severe hospitalized confirmed cases of influenza
Information obtained from severe hospitalized confirmed cases of influenza ( CGHCG ) comes from a surveillance system CGHCG in hospitals designated by each region involved . Your goal is to make known the clinical , epidemiological and virological CGHCG produced by viruses circulating influenza each season features as well as identify and characterize risk groups for the presentation of the severe forms of the disease. This system provides information only for the CGHCG that meet the definition of gravity in consensual monitoring protocol CGHCG ( https://www.isciii.es/ISCIII/es/cont...ctubre2010.pdf ) And are reported by hospitals participating in the same .
Since the beginning of the season have been reported by 2,361 CGHCG flu virus in 16 autonomous communities , of which 53 % are men. Of the 243 women of childbearing age (15-49 years ) 20% were pregnant ( 60% in the third trimester and 33% in the second) . The highest number of cases recorded in over 64 years ( 38%), followed by the 45-64 age group ( 32%) and 15-44 (19 %), with therefore a high percentage of serious adult young and middle-aged ( 51%). In 99.4 % of patients with influenza A virus was identified in 0.6% and the B virus detections From A subtipadas 77% were influenza A ( H1N1)pdm09 and 23% virus A ( H3 ) .
82% ( 1.387/1.682 patients had risk factors for complications from flu, being most prevalent chronic lung disease (27 % ) and chronic cardiovascular disease ( 25%), followed by diabetes mellitus ( 22%) and immunodeficiency ( 18%). 71% of patients developed pneumonia and 35% said admitted to the ICU . 86% of patients had received antiviral treatment and in 74 % of cases the treatment was administered just after 48h of onset of symptoms. , 67 % of severe patients likely to be vaccinated ( 917/1.378 ) had not received the flu shot this season. official recommendations for influenza vaccination collect administering the vaccine to anyone over 6 months of age with risk factors for influenza complications .
In under 15 years, the most prevalent risk factors are chronic lung disease (5.3%) and immunodeficiency ( 5.2%).

Deaths in severe hospitalized confirmed cases of influenza
Since week 40/2013 there have been 271 deaths from laboratory-confirmed influenza , 269 influenza A ( 64 % for influenza A ( H1N1) pdm09 , 14% A ( H3) virus and 22 % for A not subtyped ) and a death by virus B. The deaths occurred in 14 regions.
88% of patients were older than 44 years ; 30 % belonged to the group of 44-65 years and 58 % at age 64. 84% of deaths from influenza A ( H3) were recorded in over 64 years. In groups of young and middle-aged adults occur 47% of deaths from A ( H1N1) pdm09 (14% in 15-44 years and 33 % at 45-64 years). And the only B virus death occurred in the group older than 64 years.
95% of cases the deceased had an underlying chronic disease. 63% (124 /195) of patients likely to be vaccinated had received a flu shot this season.
Information on mortality CGHCG describes the clinical, epidemiological and virological CGHCG with a fatal outcome , as well as information on risk factors of severe course . This approach is very useful for identifying patterns of severe disease and provide information to measures of prevention and control , however, not serves to quantify the impact of influenza on mortality in the population. Quantifying the impact is made with mathematical models that estimate the excess mortality during periods of influenza activity, although the availability of data limits cause-specific mortality estimates for subsequent seasons.
Excess daily mortality from all causes
During the 2013-2014 season the Monitoring System of daily mortality ( MoMo ) in Spain includes all deaths recorded in 2,004 computerized civil registry , which represented 77 % of the Spanish population causes. Civil records included in the system are representative of all weather and all the country areas. The predictive model developed by MoMo is based on a restrictive model of historical averages. The overall mortality observed from the start of the 2013-2014 season remained about expected predictive models according to period between week 48 and 50/2013 , in which an excess of observed mortality seen above expected , which is mainly concentrated in the group older than 74 years. This excess coincides with the low temperatures experienced in Spain in this period (AEMET : https://www.aemet.es/documentos/es/s...im_2013_11.pdf ) . Also, in the beginning of 2014 (weeks 2-7) , it has been observed a moderate increase in mortality from all causes in the age group between 15 and 64 years ( z -score slightly above 2). This increase may be related to the intensity of the flu this season, but other factors may also play a role.
...

http://vgripe.isciii.es/gripe/inicio.do

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Spain Influenza Surveillance Reports 2014

Spain Influenza Surveillance Reports 2014

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