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Saisonbericht 2018/19

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  • Saisonbericht 2018/19

    https://influenza.rki.de/Saisonberichte/2018.pdf


    Inhalt
    1Zusammenfassung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
    2Einleitung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
    2.1Ziel der Influenzasurveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
    2.2Geschichte und Struktur der Influenza?berwachung inDeutschland . . . . 16
    2.3Einbindung in internationale Netzwerke . . . . . . . . . . . . . . . . . . . . 17
    3Begriffs- und methodische Erl?uterungen . . . . . . . . . . . . . . . . . . . 19
    4Datenquellen und erhobene Daten . . . . . . . . . . . . . . . . . . . . . . . . 23
    4.1Syndromische ?berwachung akuter respiratorischerb Erkrankungen . . . 23
    4.2Virologische Surveillance der AGI . . . . . . . . . . . . . . . . . . . . . . . . . 26
    4.3Daten der kooperierenden Landeslabore . . . . . . . . . . . . . . . . . . . 29
    4.4Von den Gesundheits?mtern ?bermittelte Daten nach IfSG . . . . 29
    5Influenza-?berwachung in der Saison 2018/19 im Vergleich mit fr?heren Saisons . . 33
    5.1Ergebnisse der Surveillance (?bermittelte F?lle gem?? IfSG) . . . 33
    5.2Ergebnisse der Sentinel-Surveillance . . . . . . . . . . . . . . . . . . . . . . . 36
    5.3Influenza-bedingte Todesf?lle (Exzess-Sch?tzungen) . . . . . . . . . 46
    5.4Internationale Situation in der Saison 2018/19 . . . . . . . . . . . . . . 48
    6Virologische Analysen in der Influenzasaison 2018/19 . . . . . . . . 49
    6.1Influenzavirusnachweise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
    6.2Isolierte Viren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
    6.3Antigene Charakterisierung der Influenzaviren . . . . . . . . . . . . . . . 50
    6.4Molekulare Charakterisierung der Influenzaviren . . . . . . . . . . . . . 58
    6.5Untersuchungen zur antiviralen Resistenz . . . . . . . . . . . . . . . . . . 70
    6.6Untersuchungen zu weiteren respiratorischen Viren . . . . . . . . . . 73
    7Weitere Ergebnisse zur Influenzasaison 2018/19 aus syndromischen Surveillancesystemen des RKI . . 79
    7.1GrippeWeb – syndromische Surveillance akuter Atemwegserkrankungen auf Bev?lkerungsebene . . . . 79
    7.2SEEDARE – Ergebnisse zur fallbasierten Auswertung von akuten respiratorischen Erkrankungen
    in der prim?r?rztlichen, ambulanten Versorgung . . . . . . . . . . . . . . . . . . 85
    7.3ICOSARI – ICD-10-Code basierte Krankenhaussurveillance schwerer akuter respiratorischer Infektionen . . 92
    7.4Mortalit?tssurveillance in Berlin und Hessen . . . . . . . . . . . . . . . . 99
    8Influenzaimpfung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
    8.1Zusammensetzung des Impfstoffs . . . . . . . . . . . . . . . . . . . . . . . . 103
    8.2Impfempfehlung f?r saisonale Influenza in der Saison 2018/19 .......103
    8.3Wirksamkeit der Impfung gegen saisonale Influenza (Impfeffektivit?t) . . . 104
    9Influenza als Zoonose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
    9.1Avi?re Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
    9.2Porcine Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
    9.3Fazit zu Influenza an der Schnittstelle zwischen Mensch und Tier . . 113
    10Literaturhinweise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
    12Anhang . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
    12.1Abbildungsverzeichnis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
    12.2Tabellenverzeichnis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
    Impressum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132


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    Executive Summary
    The information on the epidemiology of influen-
    za in Germany for the 2018/19 season is main-
    ly based on the analysis and assessment of data
    collected by the Robert Koch Institute’s (RKI) va-
    rious surveillance systems for the monitoring of
    acute respiratory infections (ARI), particularly in-
    fluenza, in Germany. The national sentinel system
    of the Working Group on Influenza (AGI) with its
    syndromic surveillance of acute respiratory disea-
    ses and the virological surveillance of respiratory
    pathogens continues to be a central instrument
    in the overall concept of influenza surveillance in
    Germany. The virological data of the AGI on influ-
    enza are supplemented by results of six state labo-
    ratories cooperating with AGI in Baden-W?rttem-
    berg, Bavaria, Mecklenburg-Western Pomerania,
    Saxony, Saxony-Anhalt and Thuringia. Mecklen-
    burg-Western Pomerania contributed syndromic
    data from sentinel practices of the state’s own sur-
    veillance. The National Influenza Center (NIC)
    conducted additional virological analyses of circu-
    lating influenza viruses and the consultant labora-
    tory for RSV, parainfluenza viruses and metapneu-
    moviruses added characterisation results for RSV.
    Mandatory reports of laboratory confirmed cases
    of influenza were obtained from the German local
    health authorities who submitted notifications via
    state health authorities to the RKI. These were also
    included in the report, as were the results from the
    web-based participatory surveillance system Grip-
    peWeb where 14,000 participants are registered.
    Finally we present results from the electronic mo-
    dule of the AGI (SEEDARE), the hospital surveil-
    lance system for severe acute respiratory infec-
    tions (ICOSARI) and timely mortality data from
    the federal states Berlin and Hesse.
    This season we identified the first influenza
    viruses, namely A(H3N2) viruses, within the AGI
    sentinel in the 44th calendar week (CW) 2018. In
    the 2nd CW 2019 the proportion of influenza-po-
    sitive samples (positivity rate) rose to 18 %. Thus,
    in the 2018/19 season the flu epidemic began in
    the 2nd CW and it ended in the 14th CW 2019
    in early April. The activity of acute respiratory di-
    seases, measured by the so called practice index,
    reached values of high ARI activity from CW 6 to
    8 2019. However, the values of the practice index
    during the peak of the flu epidemic in the 8th and
    9th CW 2019 remained below the values of the
    last two seasons.
    We estimate that a total of approximately
    3.8 million influenza-attributable medically atten-
    ded acute respiratory illnesses (iMAARI) occurred
    (95 % confidence interval (CI), 3.0 – 4.6 million).
    including approximately 2 million iMAARI by in-
    fluenza A(H1N1)pdm09 and around 1.8 million
    iMAARI through influenza A(H3N2). Especially
    at the beginning of the flu epidemic, there was an
    overlap with MAARI, especially in infants, who
    were caused by RSV. Around one million rMAARI
    in the 2018/19 season were attributed to this pa-
    thogen. Influenza-associated (physician certified)
    incapacities for work (or the need for bed rest in
    patients who do not need a sick leave note) were
    estimated at 2.3 million (95 % CI 2.1 – 2.5 milli-
    on). The estimated number of influenza-related
    hospitalizations from primary care practices was
    18,000 (95 % CI 16,000-20,000).
    Compared with previous seasons, the estima-
    te for iMAARI is therefore significantly lower than
    in the extraordinarily severe flu epidemic in the
    2017/18 season and the severe seasons 2012/13
    and 2014/15. The estimate for influenza-attribu-
    table hospital admissions is also lower than the
    estimates for 2016/17 and 2017/18, roughly com-
    parable to the values for the 2015/16 season.
    As in the previous season, the number of
    laboratory-confirmed hospitalised influenza cases
    reported through the mandatory reporting system
    exceeded the AGI estimate, likely because the lat-
    ter is restricted to hospital admissions from GP or
    pediatric practice and does not include – for ex-
    ample – direct admissions through the emergency
    care system.
    For the 2018/19 season, no estimate of excess-
    mortality could be made, as the necessary data of
    the Federal Statistical Office are published with a
    time delay. However, the estimate for the 2017/18
    season (still lacking in the last annual report)
    has been supplemented: approximately 25,000
    influenza-related deaths exemplify – together with
    other parameters – the extraordinary severity of
    the flu epidemic 2017/18.
    According to the virological sentinel surveil-
    lance conducted by the NIC influenza A(H1N1)
    pdm09 and A(H3N2) viruses co-circulated during
    the flu epidemic from the start. Since the end of
    February influenza A(H3N2) viruses dominated.
    In total, 51 % influenza A(H1N1)pdm09 and 49 %
    influenza A(H3N2) viruses were detected. Influ-
    enza B viruses circulated only sporadically during
    the 2018/19 season, and were not identified in the
    sentinel. The influenza A(H1N1)pdm09 viruses
    reacted well with post-infection ferret antiserum
    raised against the respective vaccine viruses and
    with the vaccine strains recommended for the up-
    coming 2019/20 season. For the A(H3N2) viruses
    the antigenic analysis showed no good agreement
    with the vaccine strains. The NIC also conducted
    molecular analyses of influenza-positive samples
    in the context of the investigation and manage-
    ment of influenza outbreaks conducted by local
    health authorities where also severe cases had
    occurred. In addition, samples were analysed that
    were sent to the NIC coming from other patients
    with a severe or fatal course. Finally, the NIC had
    also tested approximately 36 % of the influenza vi-
    ruses for resistance against antivirals. Except for
    one influenza A(H1N1)pdm09 virus, where resis-
    tance may have occurred under therapy, all viruses
    tested were susceptible to the neuraminidase inhi-
    bitors oseltamivir, zanamivir and peramivir. The
    influenza viruses examined were also sensitive to
    the antiviral drug baloxavir marboxil, which has
    not yet been licensed in the EU. The RSV charac-
    terized by the consultant laboratory belonged with
    more than 60 % to group B (as was the case in
    the 2017/18 season), while in the 2016/17 season
    RSV group A viruses dominated with about 60 %.
    The analysis of the GrippeWeb data shows
    that the ILI rates in the 2018/19 influenza season
    were similar to an averaged course based on data
    from the years 2011 to 2018. In this report we
    show also the proportion of patients with ARI or
    ILI symptoms who visit a physician because of the
    symptoms.
    The distribution of the ICD-10 diagnostic
    codes for ARI in ambulatory care is shown in the
    more detailed analysis of the SEEDARE data. The
    number of consultations in which certain ICD-10
    codes for upper respiratory tract infections, in-
    fluenza or lower respiratory tract infections have
    been used, showed a clear seasonal pattern. In the
    2018/19 season, it was noticeable that especially
    infants were seriously ill and a higher proportion
    as usual was hospitalized. Using the case-based
    anonymous information from the SEEDARE modu-
    le, further respiratory syndromes can also be spe-
    cifically analysed, such as illnesses that have been
    coded as community-acquired pneumonia.
    For the assessment of progression to seve-
    re disease, valuable information was obtained in
    the context of the ICD-10 code based syndromic
    hospital surveillance for severe acute respiratory
    infections (ICOSARI) in the 2018/19 season. The
    number of hospitalized SARI patients was signifi-
    cantly lower than in the 2017/18 season, but high
    SARI case numbers in the 0- to 4-year age group
    were again documented.
    In the timely analysis of excess mortality du-
    ring the season, the report presents the estimates
    for the states Berlin and Hesse. Here too, the esti-
    mates were lower than in the more severe seasons
    2016/17 and 2017/18.
    The World Health Organization’s (WHO) an-
    nual recommendations on influenza vaccines, the
    recommendations of the German Standing Com-
    mittee on Vaccination (STIKO), and the assess-
    ment of the influenza vaccine effectiveness for the
    2018/19 season are all presented in the chapter
    ?Influenza Vaccination?. For the 2019/20 season,
    the WHO recommended a different composition
    of the influenza vaccine for the influenza A(H1N1)
    pdm09 and the A(H3N2) components in compari-
    son to the Northern Hemisphere 2018/19 season:
    ” an A/Brisbane/02/2018 (H1N1)pdm09-like vi-
    rus (new);
    ” an A/Kansas/14/2017 (H3N2)-like virus (new);
    ” a B/Colorado/06/2017-like virus (Victoria li-
    neage) unchanged; and
    ” a B/Phuket/3073/2013-like virus (Yamagata li-
    neage) unchanged.
    As in the previous seasons, the effectiveness of
    influenza vaccination in the 2018/19 season was
    assessed by analysing the virological surveillance
    data of the AGI. The overall effectiveness of seaso-
    nal influenza vaccine against laboratory-confir-
    med influenza disease was low, however, effects
    differed by subtype: effectiveness against influen-
    za A(H1N1)pdm09 disease was high, while no ef-
    fectiveness was shown against laboratory confir-
    med influenza A(H3N2) disease.
    Lastly, the chapter on zoonotic influenza descri-
    bes the situation on avian and porcine influenza
    in their respective animal species, as well as in hu-
    mans. As in previous years, no human case with
    zoonotic influenza virus infection was reported in
    Germany. However, also in the 2018/19 season,
    human infections with avian and porcine influen-
    za viruses occured worldwide. They were mostly
    attributed to exposure to infected animals. There
    was also no evidence of sustained human-to-hu-
    man transmission with these zoonotic influenza
    viruses. As long as the influenza viruses circulate
    in livestock, sporadic human infections may con-
    tinue to occur.



    I'm interested in expert panflu damage estimates
    my current links: http://bit.ly/hFI7H ILI-charts: http://bit.ly/CcRgT
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