Announcement

**Giuseppe** · July 31, 2009, 10:44 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Thank you Hogweed for the clarification.

**Giuseppe** · August 7, 2009, 11:34 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Weekly electronic bulletin - Week 31: 27 July 2009 - 02 August 2009 (EuroFlu, edited)

[Original Full Document: LINK. EDITED.]

EUROPEAN INFLUENZA SURVEILLANCE NETWORK

Weekly electronic bulletin - Week 31: 27 July 2009 - 02 August 2009

07 August 2009

Continued pandemic influenza virus detections across Europe with increased activity in the UK (Northern Ireland)

Summary:

All of the 84 subtyped influenza viruses detected by sentinel networks in week 31/2009 were A(H1N1)v, and the UK (Northern Ireland) reported medium activity for the first time. Ireland and the UK (England, Northern Ireland) are the only countries that have reported influenza activity above their national baseline levels since the pandemic was declared.

Epidemiological situation - week 31/2009:

For the intensity indicator, the national network levels for influenza-like illness (ILI) and/or acute respiratory infection (ARI), Ireland and the UK (England, Northern Ireland) reported medium activity. The highest consultation rates in Ireland and the UK (England, Northern Ireland) were observed among individuals aged 0?4 years and 15?64 years.

For the geographical spread indicator, widespread activity was reported in the UK (England) and local activity was reported in Spain. The remaining countries reported sporadic (Belgium, Denmark, Hungary, Ireland, Latvia, Portugal, Slovenia and the UK (Northern Ireland)) or no activity (Bulgaria, Estonia, France, Germany, Greece, Lithuania, Romania, Slovakia and Sweden). The reported trends included an increase in Denmark and the UK (Northern Ireland), a decrease in Bulgaria, Latvia and the UK (England) and stability in the rest of the reporting countries.

Cumulative epidemiological situation - weeks 16?31/2009:

Since week 16/2009, influenza activity above baseline levels was reported in the following locations: the UK (England) since week 27/2009, Ireland since week 30/2009, and UK (Northern Ireland) in week 31/2009. Influenza activity decreased in the UK (England) to medium in week 31/2009 after it was reported to be high in weeks 28?30. Influenza activity remained low in all other countries reporting to ECDC since week 16/2009.

Virological situation - week 31/2009:

The total number of respiratory specimens collected by sentinel physicians in week 31/2009 was 584, of which 99 (17%) were positive for influenza virus: 84 (85%) were subtype A(H1N1)v and 15 A unsubtyped.

The highest proportions of sentinel specimens positive for influenza were observed in Denmark (42%), Greece (40%) and Spain (29%).

In addition, 2059 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus. Of these, 2056 were type A (1725 subtype (H1N1)v, two subtype H3N2 and 329 not subtyped) and three type B.

Cumulative virological situation - weeks 16?31/2009:

Of the 11819 virus detections (sentinel and non-sentinel) since week 16/2009, 11369 (96%) were type A (7295 subtype (H1N1)v, 146 subtype H3, 106 subtype H3N2, 48 subtype H1, 38 subtype H1N1 and 3736 not subtyped) and 450 (4%) were type B. During week 31/2009, the proportion of sentinel specimens positive for influenza (17%) decreased compared to week 30/2009 when it was 27%, the highest since week 16/2009.

Based on the antigenic and/or genetic characterisation of 7080 influenza viruses reported from week 20/2008 to week 31/2009, 5178 (73%) were reported as A/Brisbane/10/2007 (H3N2)-like, 293 (4%) as A/Brisbane/59/2007 (H1N1)-like, 58 (1%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage), 1486 (21%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) and 65 (1%) as A/California/7/2009 (H1N1)v-like. From this week onwards, we will report characterisations of the pandemic virus as A/California/7/2009 (H1N1)v-like in order to be in line with the current virus strains recommended by WHO for vaccine preparation. For details click here.

All A(H1N1)v viruses tested so far have been sensitive to oseltamivir and zanamivir ? except for one specimen isolated in Denmark in a patient on oseltamivir treatment ? but resistant to M2 inhibitors. For ECDC threat assessment on this click here.

Comment:

Increased influenza activity is now being reported in the UK (England, Northern Ireland) and Ireland, while three other EU countries (Denmark, Greece and Spain) are detecting the pandemic virus in a high proportion of their sentinel specimens. The increased influenza activity reported in three neighbouring countries is not surprising, and possible reasons for this focal pandemic activity were mentioned in the week 29 bulletin.

During week 31/2009, all the positive sentinel samples subtyped were the pandemic virus and of 1730 non-sentinel samples subtyped, only five were seasonal influenza strains. This indicates that the pandemic virus is the predominant circulating influenza virus. This does not, however, preclude the co-circulation of seasonal and pandemic influenza viruses during the winter period as circulation of seasonal strains during the summer is uncommon.

Background:

The Weekly Electronic Bulletin presents and comments on influenza activity in the European Union and Norway. Of these countries, 14 reported both clinical and virological data, four reported virological data only and four reported clinical data only in week 31/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by the network under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

Other bulletins:

The EISN bulletin is prepared using reports from GP consultations and other sources, depending on individual country arrangements. It is important to recognise that different health care systems and types of measurement should also be considered when assessing the impact of influenza.

The bulletin text was written by an editorial team at the European Centre for Disease Prevention and Control (ECDC): Flaviu Plata, Phillip Zucs and Bruno Ciancio. The bulletin text was reviewed by the Community Network of Reference Laboratories for Human Influenza in Europe (CNRL) coordination team: Adam Meijer, Rod Daniels, Alan Hay and Maria Zambon. On behalf of the EISN members the bulletin text was reviewed by Joan O?Donnell (Health Protection Surveillance Centre, Ireland) and Katarina Prosenc (National Institute of Public Health, Slovenia).

Maps and commentary used in this Bulletin do not imply any opinions whatsoever of ECDC or its partners on the legal status of the countries and territories shown or concerning their borders.

(...)

-
-----

**Giuseppe** · August 14, 2009, 10:13 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Bulletin Review: Pandemic (H1N1) 2009 virus detections reported in many countries in the last month, with slightly decreasing number of detections in week 32/2009 (edited)

EuroFlu - Weekly Electronic Bulletin Week 32 : 03/08/2009-09/08/2009 14 August 2009, Issue N? 318

Pandemic (H1N1) 2009 virus detections reported in many countries in the last month, with slightly decreasing number of detections in week 32/2009

Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 13 August 2009, 46 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. Fifty-four fatalities associated with pandemic (H1N1) 2009 virus infection were reported in seven countries. An overview of the global pandemic (H1N1) 2009 situation, as of 6 August 2009, is available at: http://www.who.int/csr/don/2009_08_12/en/index.html

Summary:

In week 32/2009, a total of 1200 detections of A(H1N1)v influenza were reported. The total number of Pandemic (H1N1) 2009 virus detections in Europe was highest in week 30, and is decreasing since week 31. Although for some countries the number of detections are decreasing, other countries report increasing detections for Pandemic (H1N1) 2009 virus. All countries reported low or moderate intensity indicating a normal or slightly increased proportion of their populations were affected by respiratory illness. Fifteen countries reported A(H1)v as the dominant virus.

Epidemiological situation - week 32/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. For the geographical spread indicator, Austria, England, Israel, the Netherlands and Wales reported widespread activity, and the other countries reported local or no activity. Of ten countries reporting on the impact of the pandemic, all reported low impact ie. demands on health care services were not above usual levels (click here for definitions).

Cumulative epidemiological situation - weeks 16-32/2009:

Until week 25/2009, detections of pandemic H1N1 influenza had not caused increased levels of ILI or ARI in countries of the European Region. An increase in influenza activity has been observed for England, Luxembourg, Turkey (26/2009), Wales (27/2009), Northern Ireland (29/2009), Malta, Norway, Ireland (30/2009), Israel and Austria (31/2009). In week 32/2009, the consultations for ILI have increased in the Netherlands and Israel, and are slightly above the baseline, while decreasing rates were seen in the UK.

Virological situation - week 32/2009:

The total number of respiratory specimens collected by sentinel physicians in week 32/2009 was 597 of which 48 (8%) were positive for influenza virus: all 48 were type A (41 subtype H1v, 1 subtype H1, 1 subtype H3 and 5 not subtyped). In addition, 1495 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 1491 type A (1293 subtype H1v, 2 subtype H1, three subtype H3 and 193 not subtyped) and four type B. Of the total influenza A virus detections that were subtyped in week 32/2009 (N=1341), 99% were the pandemic (H1N1) 2009 virus.

In a large number of countries, e.g. Austria, Denmark, Estonia, Georgia, Hungary, Norway, Portugal, Ireland, and the UK, the number of Pandemic (H1N1) 2009 virus detections is decreasing. An increase in Pandemic (H1N1) 2009 virus detections was observed for Lithuania, Poland, Slovakia, Slovenia and Switzerland in week 32/2009.

Cumulative virological situation - weeks 16/2009-32/2009:

Of 12908 virus detections (sentinel and non-sentinel) since week 16/2009, 12355 (96%) were type A, 8210 subtype H1v, 342 subtype H3, 255 subtype H1 and 3548 not subtyped) and 550 (4%) were type B.

Based on the antigenic and/or genetic characterisation of 4508 influenza viruses reported from week 40/2008 to week 32/2009, 2636 (58%) were A/Brisbane/10/2007 (H3N2)-like, 155 (3%) A/Brisbane/59/2007 (H1N1)-like, 32 (1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1062 (24%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here). A total of 623 (14%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for vaccine preparation (click here).

Antiviral susceptibility reports from week 40/2008 to 32/2009 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N2) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for seasonal A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors.

All pandemic (H1N1) 2009 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).

Comment:

In week 32/2009 influenza activity was low or moderate intensity across the European region. Widespread activity was reported for Austria, Israel, the Netherlands, England and Wales. A peak in the detections of Pandemic (H1N1) 2009 virus detections was observed around week 30 for Europe as a whole (click here and is decreasing for a number of countries in week 32/2009, possibly due to some countries switching to virological monitoring rather than testing of all cases. While in the Netherlands and Israel the consultation rates were slightly increasing, in the UK (click here) and Ireland (click here) the consultation rates were levelling off or decreasing. The impact on health care services is currently considered low by ten countries.

For more information about the situation in Europe, please go to the dedicated web pages of WHO (click here) and ECDC (click here). EuroFlu provides data for the global situation updates on the the WHO headquarters website (click here).

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries in the WHO European Region. Of these countries, 26 reported both clinical and virological data, five reported virological data only and six reported clinical data only in week 32/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London

Network comments (where available)

Azerbaijan - Consultation data is cumulative for Baku, Ganja, Sumgayit, Mingechever and Shirvan Cities only.
Italy - During this last week, a newly significant decrease in the H1N1v influenza lab-confirmed cases has been reported, if compared to the previous weeks. Starting from 30th week, Italian policy has been changed: a syndromic surveillance has been implemented and only a limited number of samples have been collected from particular FLU cases (i.e. severe hospedalized cases, in-country transmission cases).
Russian Federation - Sporadic cases of pandemic influenza A(H1N1)v were detected in Moscow and St.-Petersburg according to results of virus isolation.
Switzerland - 135 A(H1N1)v viruses were detected in specimens collected by non-sentinel physicians in week 32/2009. 100 A(H1N1)v viruses were detected in week 31/2009, and 109 A(H1N1)v, as well as 2 A(H3) and 1 B in week 30/2009.

-

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · August 21, 2009, 11:06 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Bulletin Review: Low or moderate influenza activity and an overall decrease in the number of Pandemic (H1N1) 2009 virus detections (August 21, 2009, edited)

EuroFlu - Weekly Electronic Bulletin Week 33 : 10/08/2009-16/08/2009 - 21 August 2009, Issue N? 319

Low or moderate influenza activity and an overall decrease in the number of Pandemic (H1N1) 2009 virus detections

Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 19 August 2009, 47 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. Ninety fatalities associated with pandemic (H1N1) 2009 virus infection were reported in nine countries. An overview of the global pandemic (H1N1) 2009 situation is available, as of 13 August 2009.

Summary:

In week 33/2009, a total of 793 detections of A(H1N1)v influenza were reported. The number of Pandemic (H1N1) 2009 virus detections in Europe was highest in week 30, and has decreased since week 31. All countries reported low or moderate influenza activity based on normal or slightly increased levels of ILL/ARI consultations. Twenty-two countries reported pandemic A(H1)v as the dominant virus.

Epidemiological situation - week 33/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. For the geographical spread indicator, Austria, England, Israel and Sweden reported widespread activity, while other countries reported local or no activity. Of 23 countries reporting the impact of the pandemic, Ireland reported moderate impact. All other countries reported low impact, i.e. demands on health care services were not above usual levels (click here for definitions).

Cumulative epidemiological situation - weeks 16-33/2009:

Until week 25/2009, detections of pandemic H1N1 influenza had not caused increased levels of ILI or ARI in countries of the European Region. An increase in influenza activity has been observed for England, Luxembourg, Turkey (26/2009), Wales (27/2009), Northern Ireland (29/2009), Malta, Norway, Ireland (30/2009), Israel and Austria (31/2009), and the Netherlands (32/2009). Around week 32 an increase in ILI rates was observed for Norway. While the ILI rate for Norway has been elevated over the last few weeks, the proportion of ILI cases (i.e. sentinel specimens) with detectable virus is very low. The rise in ILI therefore is likely to represent increased public concern for influenza and does probably not indicate a substantial rise in the incidence of infection.

Virological situation - week 33/2009:

The total number of respiratory specimens collected by sentinel physicians in week 33/2009 was 480 of which 40 (8%) were positive for influenza virus: all 40 were type A (35 subtype H1v, 1 subtype H3 and 4 not subtyped). In addition, 1012 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported positive for influenza virus: 1010 type A (793 subtype H1v, 38 subtype H1, six subtype H3 and 173 not subtyped) and two type B. Of the total influenza A virus detections that were subtyped in week 33/2009 (N=837), 95% were the pandemic (H1N1) 2009 virus. In Portugal the number of Pandemic (H1N1) 2009 virus detections is substantially increasing (click here). In many other countries the number of detections is decreasing or levelling off.

Cumulative virological situation - weeks 16/2009-33/2009:

Of 13878 virus detections (sentinel and non-sentinel) since week 16/2009, 13316 (96%) were type A, 8958 subtype H1v, 348 subtype H3, 293 subtype H1 and 3717 not subtyped) and 562 (4%) were type B.

Based on the antigenic and/or genetic characterisation of 4609 influenza viruses reported from week 40/2008 to week 33/2009, 2640 (57%) were A/Brisbane/10/2007 (H3N2)-like, 155 (3%) A/Brisbane/59/2007 (H1N1)-like, 32 (1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1066 (23%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here). A total of 716 (16%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here).

Antiviral susceptibility reports from week 40/2008 to 32/2009 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N2) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for seasonal A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors.

All pandemic (H1N1) 2009 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).

Comment:

In week 33/2009 influenza activity was of low or moderate intensity across the European region. Widespread activity was reported for Austria, Israel, England and Sweden. A peak in Pandemic (H1N1) 2009 virus detections was observed around week 30 for Europe as a whole (click here) and is decreasing for a number of countries in week 33/2009, possibly due to some countries switching to virological monitoring rather than testing of all cases. The impact on health care services is currently considered moderate in Ireland and low in other countries.

For more information about the situation in Europe, please go to the dedicated web pages of WHO (click here) and ECDC (click here). EuroFlu provides data for the global situation updates on the WHO headquarters website (click here).

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 23 reported both clinical and virological data, six reported virological data only and seven reported clinical data only in week 33/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

(...)

Network comments (where available)

Azerbaijan. Consultation data is cumulative for Baku, Ganja, Sumgayit, Mingechever and Shirvan Cities only.
Italy. The data collected this week confirmed the trend towards decrease in the H1N1v influenza lab-confirmed cases, if compared to the previous weeks. Starting from 30th week, Italian policy has been changed: a syndromic surveillance has been implemented and only a limited number of samples have been collected from particular FLU cases (i.e. severe hospedalized cases, in-country transmission cases).
Switzerland. 144 A(H1N1)v viruses were detected in specimens collected by non-sentinel physicians in week 33/2009. 136 A(H1N1)v viruses were detected in week 32/2009, 100 in week 31/2009, and 109 A(H1N1)v, as well as 2 A(H3) and 1 B in week 30/2009.

-

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · August 28, 2009, 11:11 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - EuroFlu - Weekly Electronic Bulletin Week 34 : 17/08/2009-23/08/2009 28 August 2009, Issue N? 320 (edited)

EuroFlu - Weekly Electronic Bulletin Week 34 : 17/08/2009-23/08/2009 28 August 2009, Issue N? 320

Low or moderate influenza activity and a continued overall decrease in the number of Pandemic (H1N1) 2009 virus detections

Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 19 August 2009, 47 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. Ninety fatalities associated with pandemic (H1N1) 2009 virus infection were reported in nine countries. An overview of the global pandemic (H1N1) 2009 situation is available, as of 13 August 2009.

Summary:

In week 34/2009, a total of 697 detections of A(H1N1)v influenza were reported. The number of Pandemic (H1N1) 2009 virus detections in Europe was highest in week 30, and has decreased since week 31. All countries reported low or moderate influenza activity based on normal or slightly increased levels of ILL/ARI consultations. Twenty-one countries reported pandemic A(H1)v as the dominant virus.

Epidemiological situation - week 34/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. For the geographical spread indicator, Austria and Israel reported widespread activity, while other countries reported local or no activity. Of 14 countries reporting the impact of the pandemic, Ireland reported a moderate impact and all other countries reported a low impact, i.e. demands on health care services were not above usual levels (click here for definitions).

Cumulative epidemiological situation - weeks 16-34/2009:

Until week 25/2009, detections of pandemic H1N1 influenza had not caused increased levels of ILI or ARI in countries of the European Region. An increase in influenza activity has been observed for England, Luxembourg, Turkey (26/2009), Wales (27/2009), Northern Ireland (29/2009), Malta, Norway, Ireland (30/2009), Israel and Austria (31/2009), and the Netherlands (32/2009). Around week 31 a substantial increase in ILI rates was observed in Norway and this has continued in week 34 (click here). While the ILI rate for Norway has been elevated over the last few weeks, the proportion of ILI cases (i.e. sentinel specimens) with detectable virus remains very low. The rise in ILI is therefore likely to represent increased public concern for influenza and probably does not indicate a substantial rise in the incidence of ILI.

Virological situation - week 34/2009:

The total number of respiratory specimens collected by sentinel physicians in week 34/2009 was 466 of which 67 (14%) were positive for influenza virus: all 67 were type A (65 subtype H1v and 2 not subtyped). In addition, 722 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported positive for influenza virus: 718 type A (632 subtype H1v, 34 subtype H1, five subtype H3 and 47 not subtyped) and four type B. Of the total influenza A virus detections that were subtyped in week 34/2009 (N=736), 95% were the pandemic (H1N1) 2009 virus. In general, the number of Pandemic (H1N1) 2009 virus detections in Member States is decreasing or levelling off.

Cumulative virological situation - weeks 16/2009-34/2009:

Of 14752 virus detections (sentinel and non-sentinel) since week 16/2009, 14186 (96%) were type A, 9726 subtype H1v, 354 subtype H3, 330 subtype H1 and 3776 not subtyped) and 566 (4%) were type B.

Based on the antigenic and/or genetic characterisation of 3992 influenza viruses reported from week 40/2008 to week 34/2009, 2187 (55%) were A/Brisbane/10/2007 (H3N2)-like, 108 (3%) A/Brisbane/59/2007 (H1N1)-like, 27 (1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 996 (25%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here). A total of 674 (17%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here).

Antiviral susceptibility reports from week 40/2008 to 34/2009 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N2) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for seasonal A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors. All pandemic (H1N1) 2009 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).

Comment:

In week 34/2009 influenza activity was of low or moderate intensity across the European Region. For the geographical spread indicator, widespread activity was reported for Austria and Israel, with the other countries reporting local or no activity. A peak in Pandemic (H1N1) 2009 virus detections was observed around week 30 for Europe as a whole (click here) and total detections continued to decline in week 34/2009, possibly due in part to some countries switching to virological monitoring rather than testing of all cases. The impact on health care services is currently considered moderate in Ireland and low in other countries.

For more information about the situation in Europe, please go to the dedicated web pages of WHO (click here) and ECDC (click here). EuroFlu provides data for the global situation updates on the WHO headquarters website (click here).

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 14 reported both clinical and virological data, 18 reported virological data only and six reported clinical data only in week 34/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

Network comments (where available)

Italy. The data collected this week been matched by substantial stability in pandemic H1N1v influenza lab-confirmed cases, if compared to the previous week. Starting from 30th week, Italian policy has been changed: a syndromic surveillance has been implemented and only a limited number of samples have been collected from particular FLU cases (i.e. severe hospedalized cases, in-country transmission cases).
Netherlands. The decrease in the number of virus detections is caused by the change in the notification criteria for Pandemic (H1N1) cases in the Netherlands. Since the 15th of August only hospitalized cases and deaths in whom Influenza A or Pandemic (H1N1) virus has been confirmed are notifiable. The sentinel GP surveillance is now the most import data source to measure the extent of circulation of Pandemic (H1N1) virus in the Netherlands.

(...)
-

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · September 4, 2009, 11:19 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 35 : 24/08/2009-30/08/2009 - 04 September 2009, Issue N? 321 (edited)

EuroFlu - Weekly Electronic Bulletin Week 35 : 24/08/2009-30/08/2009 - 04 September 2009, Issue N? 321

Low or moderate influenza activity and a continued overall decrease in the number of Pandemic (H1N1) 2009 virus detections

Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 3 September 2009, 48 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. These include 125 fatalities. An overview of the global pandemic (H1N1) 2009 situation is available.

Summary:

In week 35/2009, a total of 431 detections of A(H1N1)v influenza were reported. The number of pandemic (H1N1) 2009 virus detections in Europe was highest in week 30, and has decreased since week 31. All countries reported low or moderate influenza activity based on normal or slightly increased levels of ILL/ARI consultations. Seventeen countries reported pandemic A(H1)v as the dominant virus.

Epidemiological situation - week 35/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. For the geographical spread indicator, Israel and Sweden reported widespread activity, while all other countries reported local, sporadic or no activity. An increasing trend was reported by Sweden and the Russian Federation (Northwest region and Central region). Of 17 countries reporting the impact of the pandemic, Albania and Ireland reported a moderate impact and all other countries reported a low impact, i.e. demands on health care services were not above usual levels (click here for definitions).

Cumulative epidemiological situation - weeks 16-35/2009:

Until week 25/2009, detections of pandemic H1N1 influenza had not caused increased levels of ILI or ARI in countries of the European Region. An increase in influenza activity has been observed for England, Luxembourg, Turkey (26/2009), Wales (27/2009), Northern Ireland (29/2009), Ireland, Italy, Malta, Norway (30/2009), Austria and Israel (31/2009), and the Netherlands (32/2009). Around week 31 a substantial increase in ILI rates was observed in Norway and continued in week 34 (no data for week 35). While the ILI rate for Norway has been elevated over the last few weeks, the proportion of ILI cases (i.e. sentinel specimens) with detectable virus remains very low. The rise in ILI is therefore likely to represent increased public concern for influenza and probably does not indicate a substantial rise in influenza infections.

Virological situation - week 35/2009:

The total number of respiratory specimens collected by sentinel physicians in week 35/2009 was 511 of which 46 (9%) were positive for influenza virus: 45 were type A (42 subtype H1v and 3 not subtyped) and one was type B. In addition, 666 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported positive for influenza virus: 664 type A (389 subtype H1v, 168 subtype H1, 12 subtype H3 and 95 not subtyped) and two type B. Of the total influenza A virus detections that were subtyped in week 35/2009 (N=611), 71% were the pandemic (H1N1) 2009 virus.

Cumulative virological situation - weeks 16/2009-35/2009:

Of 15612 virus detections (sentinel and non-sentinel) since week 16/2009, 15043 (96%) were type A, 10190 subtype H1v, 367 subtype H3, 600 subtype H1 and 3886 not subtyped) and 569 (4%) were type B.

Based on the antigenic and/or genetic characterisation of 3566 influenza viruses reported from week 40/2008 to week 35/2009, 1968 (55%) were A/Brisbane/10/2007 (H3N2)-like, 107 (3%) A/Brisbane/59/2007 (H1N1)-like, 27 (1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 912 (26%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here). A total of 552 (15%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here).

Antiviral susceptibility reports from week 40/2008 to 35/2009 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N2) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for seasonal A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors.

All pandemic (H1N1) 2009 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).

Comment:

In week 35/2009 influenza activity was of low or moderate intensity across the European Region. For the geographical spread indicator, widespread activity was reported for Israel and Sweden, with the other countries reporting local or no activity. A peak in pandemic (H1N1) 2009 virus detections was observed around week 30 for Europe as a whole (click here) and total detections continued to decline in week 35/2009. The impact on health care services is currently considered moderate in Albania and Ireland and low in other countries.

For more information about the situation in Europe, please go to the dedicated web pages of WHO (click here) and ECDC (click here). EuroFlu provides data for the global situation updates on the WHO headquarters website (click here).

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 14 reported both clinical and virological data, 14 reported virological data only and seven reported clinical data only in week 35/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
(...)

Network comments (where available)

Croatia: confirmed and clinical cases
Italy: During this last week, a significant increase in the H1N1v influenza lab-confirmed cases has been reported by the majority of the Italian laboratories participating in the surveillance activities
Latvia: First case of influenza A/H3 was confirmed in patient arrived from USA.

-

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · September 11, 2009, 10:34 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 36 : 31/08/2009-06/09/2009 - 11 September 2009, Issue N? 322 (edited)

EuroFlu - Weekly Electronic Bulletin Week 36 : 31/08/2009-06/09/2009 - 11 September 2009, Issue N? 322

Low or moderate influenza activity with Pandemic (H1N1) 2009 virus detections

Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 3 September 2009, 48 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. These include 125 fatalities. An overview of the global pandemic (H1N1) 2009 situation is available.

Summary:

In week 36/2009, a total of 706 detections of A(H1N1)v influenza were reported. The number of pandemic (H1N1) 2009 virus detections in Europe was highest in week 30, and has decreased since week 31. The number of detections has become stable in week 36. However, difference in trend in detections exist between countries. All countries reported low or moderate influenza activity based on normal or slightly increased levels of ILL/ARI consultations. Sixteen countries reported pandemic A(H1)v as the dominant virus.

Epidemiological situation - week 36/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. For the geographical spread indicator, Austria and Israel reported widespread activity while all other countries reported local, sporadic or no activity.

For Austria the consultation rate was low in week 36 and the number of Pandemic (H1N1) 2009 virus detections are slightly decreasing. In Israel the consultation rate remains around the baseline but has levelled off, the same has been observed for the number of influenza H1v virus detections. While Sweden reported widespread activity in week 35, no report on the influenza indicators was provided for week 36, but the consultation rates for ILI remained high, and an increase was also observed for the number of influenza A/H1v detections. In Ireland the ILI rate is above the baseline but stable, and in Norway the ILI rates has started to decrease, as well as the number of influenza A/H1v detections. The age group that most frequently visited the general practitioners for ILI was the 15-64 age group in Ireland, Sweden and Norway.

Of 12 countries reporting the impact of the pandemic, Ireland reported a moderate impact and all other countries reported a low impact, i.e. demands on health care services were not above usual levels (click here for definitions).

Cumulative epidemiological situation - weeks 16-36/2009:

Until week 25/2009, detections of pandemic H1N1 influenza had not caused increased levels of ILI or ARI in countries of the European Region. An increase in influenza activity has been observed for England, Luxembourg, Turkey (26/2009), Wales (27/2009), Northern Ireland (29/2009), Ireland, Italy, Malta, Norway (30/2009), Austria and Israel (31/2009), the Netherlands (32/2009) and Sweden (week 35/2009).

Virological situation - week 36/2009:

The total number of respiratory specimens collected by sentinel physicians in week 36/2009 was 718 of which 94 (13%) were positive for influenza virus: all 94 were type A (41 subtype H1v, 52 subtype H1 and 1 not subtyped). Several of the viruses entered as seasonal H1 are probably erroneously recorded and should be H1v. In addition, 709 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported positive for influenza virus: 707 type A (665 subtype H1v, 8 subtype H1, 7 subtype H3 and 27 not subtyped) and two type B. Of the total influenza A virus detections that were subtyped in week 36/2009 (N=773), 91% were the pandemic (H1N1) 2009 virus.

Whereas in several countries the number of pandemic (H1N1) 2009 virus detections are stable or decreasing, a slight increase in the number of Pandemic (H1N1) 2009 virus detections was observed for the Russian Federation (region Central) (click here) and Georgia (click here). Additionally an increase in influenza A/H1v detections was observed for Luxembourg after an initial drop in week 33 and 34.

Cumulative virological situation - weeks 16/2009-36/2009:

Of 17713 virus detections (sentinel and non-sentinel) since week 16/2009, 17142 (97%) were type A (11210 subtype H1v, 375 subtype H3, 1640 subtype H1 and 3917 not subtyped) and 571 (3%) were type B.

Based on the antigenic and/or genetic characterisation of 4316 influenza viruses reported from week 40/2008 to week 36/2009, a total of 956 (22%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here). Furthermore, 2215 (51%) were A/Brisbane/10/2007 (H3N2)-like, 111 (3%) A/Brisbane/59/2007 (H1N1)-like, 29 (<1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1005 (23%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

The graph for Europe shows that influenza A subtype H3N2 peaked during the winter around week 04/2009 and the Pandemic (H1N1) 2009 virus in the summer period, around week 30/2009 (click here). Part of the decrease in virus detections since week 30 is likely to be attributable to more restrictive testing practices that were introduced in many countries.

Antiviral susceptibility reports from week 40/2008 to 36/2009 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N2) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for seasonal A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors. All pandemic (H1N1) 2009 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).

Comment:

In week 36/2009 influenza activity was of low or moderate intensity across the European Region. For the geographical spread indicator, widespread activity was reported for Austria and Israel, with the other countries reporting local, sporadic or no activity. A peak in pandemic (H1N1) 2009 virus detections was observed around week 30 for Europe as a whole (click here) and the total number of detections levelled off in week 36/2009. The impact on health care services is currently considered moderate Ireland and low in eleven countries.

For more information about the situation in Europe, please go to the dedicated web pages of WHO (click here) and ECDC (click here). EuroFlu provides data for the global situation updates on the WHO headquarters website (click here).

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 22 reported both clinical and virological data, nine reported virological data only and seven reported clinical data only in week 36/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

Erratum:

The rate in the Table is incorrect for Uzbekistan. The number of ILI cases in week 36 was 0.

(...)
-

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · September 18, 2009, 10:45 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 37 : 07/09/2009-13/09/2009 - 18 September 2009, Issue N? 323 (edited)

EuroFlu - Weekly Electronic Bulletin Week 37 : 07/09/2009-13/09/2009 18 September 2009, Issue N? 323

Low or moderate influenza activity with ongoing pandemic (H1N1) 2009 virus detections

Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 11 September 2009, 48 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. These include 140 fatalities. For an overview of the global pandemic (H1N1) 2009 situation, click here).

Summary:

In week 37/2009, a total of 769 detections of A(H1N1)v influenza were reported, similar to the previous week. All countries reported low or moderate influenza activity, however Netherlands, Israel, Northern Ireland, and Norway reported influenza-like-illness consultation rates that are above seasonal baseline thresholds. Twenty countries reported pandemic (H1N1) 2009 as the dominant virus in circulation. No countries reported any other influenza subtypes as dominant.

Epidemiological situation - week 37/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. The geographic spread of influenza illness was reported to be widespread in Israel, localized in three countries, sporadic in eight countries and reported as ?none? in eight countries. The impact of influenza on health services was reported to be low in 16 countries, and moderate in Ireland.

Several countries have reported a rise in ILI (Israel, Netherlands, Northern Ireland, Norway and Sweden) or ARI (Belgium, Estonia, France, Germany, Russian Federation, across every region, Slovenia and Ukraine) consultation rates over the previous 2-6 weeks. Comparisons with historical data in several of these countries suggest that this is consistent with the timing of the start of influenza and other respiratory diseases in the region. Influenza-like-illness consultation rates in Ireland, Israel, Netherlands and Norway are currently above seasonal baseline thresholds.

These trends should be interpreted with care and should be validated by virological data available in the country. For example, following a significant rise in outpatient ILI consultation rates between weeks 30 and 35 in Norway, ILI consultation rates have declined during each of the last two weeks but still remain above the baseline threshold. However, there have been few influenza virus detections from the sentinel surveillance system in Norway and the increased levels of ILI may represent increased public concern for influenza and not indicate a substantial rise in the incidence of influenza.

Virological situation - week 37/2009:

The total number of respiratory specimens collected by sentinel physicians in week 37/2009 was 661 of which 85 (13%) were positive for influenza virus: all 85 were type A (13 were subtyped as pandemic A(H1N1), 70 were subtyped as pandemic A(H1) and 2 were not subtyped). In addition, 684 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 680 were influenza type A (175 of these were subtyped as pandemic A(H1N1), 458 were subtyped as pandemic A(H1), 3 were subtyped as A(H3), 4 were subtyped as seasonal A(H1) and 40 were not subtyped). Four influenza B viruses were also detected. Of the total influenza A virus detections that were subtyped in week 37/2009 (N=723), 716 or 99% were the pandemic (H1N1) 2009 virus. The decrease in detections of pandemic (H1N1) 2009 that has been observed since week 30 is likely attributable to more restrictive testing practices that were introduced in many countries.

Cumulative virological situation - weeks 16/2009-37/2009:

Of 21788 virus detections (sentinel and non-sentinel) since week 16/2009, 21205 (97%) were type A. Of the influenza type A viruses, 15175 (71%) were subtyped as pandemic A(H1), 375 (2%) were subtyped as A(H3), 1640 (8%) were subtyped as seasonal A( H1) and 3917 (19%) were not subtyped. There were 571 type B viruses (3% of total virus detections).

Based on the antigenic and/or genetic characterisation of 4795 influenza viruses reported from week 40/2008 to week 37/2009, a total of 1028 (21%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here). Furthermore, 2464 (51%) were A/Brisbane/10/2007 (H3N2)-like, 183 (7%) A/Brisbane/59/2007 (H1N1)-like, 29 (<1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1091 (23%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

Five countries reported antiviral susceptibility testing of pandemic (H1N1) viruses since week 16. All viruses tested for resistance to oseltamivir (424/424) and zanamivir (415/415) were found to be sensitive to these neuraminidase inhibitors. The United Kingdom has also reported that of 839 viruses analysed for the marker commonly associated with resistance to oseltamivir in seasonal influenza (H274Y), none were found to carry this marker (17 of these have been reported to EuroFlu) (click here). Of the few cases of oseltamivir resistance reported globally, one has been reported in Denmark (click here).

Comment:

In week 37/2009 influenza activity was of low or moderate intensity across the European Region. Four countries are now reporting ILI consultation rates that are above seasonal baseline thresholds, however not all countries have established baselines. For the geographical spread indicator, widespread activity was reported for Israel, with the other countries reporting local, sporadic or no activity. The impact on health care services is currently considered moderate in Ireland and low in 16 countries.

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 39 reported clinical or epidemiological data, and 35 reported virological data in week 37/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
(...)
-
-----

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · September 25, 2009, 11:11 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 38 : 14/09/2009-20/09/2009 - 25 September 2009, Issue N? 324 (edited)

EuroFlu - Weekly Electronic Bulletin Week 38 : 14/09/2009-20/09/2009 - 25 September 2009, Issue N? 324

Three countries report influenza activity above the baseline level in week 38/2009: Ireland, Israel and the Russian Federation

Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 22 September 2009, 48 of the 53 countries in the WHO European Region have reported to WHO over 52,000 confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. These include 156 deaths in 14 countries. For an overview of the global pandemic (H1N1) 2009 situation, click here).

Summary:

In week 38/2009, a total of 812 detections of pandemic (H1N1) influenza were reported, which is a similar number to the two previous weeks. Ireland reported a high intensity of influenza activity and Israel and the Russian Federation reported a medium intensity. All other countries reported a low intensity. Sixteen countries reported pandemic (H1N1) 2009 as the dominant virus and twelve countries reported no dominant virus.

Epidemiological situation - week 38/2009:

For the intensity indicator, the reported levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were high in Ireland and medium in Israel and the Russian Federation. In all other countries they were low. The geographic spread of influenza illness was reported to be widespread in Ireland and Israel, local in two countries, sporadic in eight countries and no activity was reported in five countries. The impact of influenza on health services was reported to be low in nine countries, and moderate in Ireland, based mainly on a surge on outpatient providers.

Several countries have reported a rise in ILI (Israel, Netherlands, Northern Ireland, Norway and Sweden) or ARI (Belgium, Estonia, France, Germany, Russian Federation, across every region, Slovenia and Ukraine) consultation rates over the past 2-6 weeks. Influenza-like illness consultation rates in Ireland, Israel and Norway are currently above seasonal baseline thresholds.

Increased levels of ILI/ARI in a country should be interpreted with care and should be validated by virological data. In Norway there was a significant rise in outpatient ILI consultation rates between weeks 30 and 35 but there were few influenza virus detections from the sentinel surveillance system and the increased levels of ILI may have represented increased public concern for influenza and not a substantial rise in the incidence of influenza.

Virological situation - week 38/2009:

The total number of respiratory specimens collected by sentinel physicians in week 38/2009 was 839 of which 195 (23%) were positive for influenza virus: 192 were type A (37 were subtyped as pandemic A(H1N1), 151 were subtyped as pandemic A(H1) and 4 were not subtyped) and 3 type B. In addition, 662 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 655 were influenza type A (624 were subtyped as pandemic A(H1), of which 182 were determined as pandemic A(H1N1), eight were subtyped as A(H3), five were subtyped as seasonal A(H1) and 18 were not subtyped) and seven were influenza type B.

Of the total influenza A virus detections that were subtyped in week 38/2009 (N=847), 812 or 96% were the pandemic (H1N1) 2009 virus. It is likely that the decrease in detections of pandemic (H1N1) 2009 that has been observed since week 30 (click here) can be attributed to more restrictive testing practices that were introduced in many countries.

Cumulative virological situation - weeks 16/2009-38/2009:

Of 21949 virus detections (sentinel and non-sentinel) since week 16/2009, 21353 (97%) were type A. Of the influenza type A viruses, 16619 (78%) were subtyped as pandemic A(H1), 385 (2%) were subtyped as A(H3), 276 (1%) were subtyped as seasonal A(H1) and 4073 (19%) were not subtyped. There were 596 type B viruses (3% of total virus detections).

Based on the antigenic and/or genetic characterisation of 4515 influenza viruses reported from week 40/2008 to week 38/2009, a total of 1069 (24%) were pandemic A(H1N1), A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here). Furthermore, 2202 (49%) were A/Brisbane/10/2007 (H3N2)-like, 183 (4%) A/Brisbane/59/2007 (H1N1)-like, 27 (<1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1034 (23%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

Six countries have reported antiviral susceptibility testing of pandemic (H1N1) viruses since week 40/2008. All viruses tested for resistance to oseltamivir (424/424) and zanamivir (415/415) were found to be sensitive to these neuraminidase inhibitors. The United Kingdom has also reported that of 973 viruses (17 of these have been reported to EuroFlu) analysed for the marker commonly associated with resistance to oseltamivir in seasonal influenza (H274Y), two were found to carry this marker (click here). Of the few cases of oseltamivir resistance reported globally, one has been reported in Denmark (click here) and two in the United Kingdom (see above for reference).

Comment:

In week 38/2009 Ireland reported the dominant virus was pandemic (H1N1) 2009 and a high intensity of influenza activity. The Russian Federation and Israel reported a medium intensity and all other countries that reported this indicator reported a low intensity. In the Russian Federation, four of the seven Districts reported a medium intensity (Central, Northwestern, Urals and Siberian) and three reported a low intensity (Far eastern, Southern and Volga). For the geographical spread indicator, widespread activity was reported for Ireland and Israel, with the other countries reporting local, sporadic or no activity. The impact on health care services is currently considered moderate in Ireland and low in 16 countries.

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 14 reported both clinical and virological data, 15 reported virological data only and five reported clinical data only in week 36/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

Erratum:

The number of sentinel specimens that were positive in week 38/2009 was 8 and not 78 (see Table below)

Note:

Serbia reported a stable trend, low intensity and low impact in week 38/2009

(...)
-
-----

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · October 2, 2009, 11:06 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 39 : 21/09/2009-27/09/2009 - 02 October 2009, Issue N? 325 (edited)

EuroFlu - Weekly Electronic Bulletin Week 39 : 21/09/2009-27/09/2009 - 02 October 2009, Issue N? 325

Low to moderate influenza activity with increasing trends in respiratory disease

Pandemic (H1N1) 2009 virus detections have been reported in the European Region since the first week of May 2009. To date, 48 of the 53 countries in the WHO European Region have reported to WHO over 56,000 laboratory confirmed cases of pandemic (H1N1) 2009 virus infection. As of 27 September, 176 deaths have been reported in laboratory-confirmed cases. For an overview of the global pandemic (H1N1) 2009 situation, click here).

Summary:

In week 39/2009, 14% of respiratory swabs collected from sentinel surveillance sites were positive for influenza. Of 854 influenza A virus detections that were subtyped in week 39/2009, 840 or 98% were pandemic (H1N1) 2009 viruses. This is similar to the weekly number of pandemic (H1N1) 2009 detections that have been reported since week 34. Twenty-five countries entered epidemiologic data into the EuroFlu platform this week: the data from 12 of these suggest increasing influenza-like-illness (ILI) or acute respiratory illness (ARI) consultation rates since week 34, and 5 are reporting levels at or above seasonal baseline thresholds. However ILI and ARI consultation rates commonly increase at this time of year. In Belgium, Ireland, Israel and Northern Ireland, increasing ILI consultation rates during recent weeks are consistent with trends in the number of influenza positive specimens collected from sentinel sites.

Epidemiological situation - week 39/2009:

Of the 21 countries that reported on the intensity indicator, Belgium, Israel and the Russian Federation reported medium intensity of respiratory disease transmission, while the other 18 countries reported a low intensity. The geographic spread of influenza-like-illness was reported as widespread in Belgium and Israel, local in two countries, sporadic in seven countries, and ten countries reported no activity. The impact of influenza on health services was reported low in the 17 countries reporting this indicator. Of the 19 countries that reported a dominant subtype, all reported a dominance of pandemic influenza A(H1N1) 2009.

Data from 12 countries suggest an overall increase in ILI and/or ARI consultation rates, including increases in three or more weeks, since week 34.

In Belgium, Ireland, Israel and Northern Ireland, the recent increases in epidemiologic data also are consistent with concurrent trends in the number of influenza positive specimens collected from sentinel sites. These are also the only countries that have reported ILI consultation rates to be the highest in the 5-14 year age group.

Nine countries that reported epidemiological data in week 39 have established quantitative baseline thresholds for ILI and/or ARI consultation rates based on historical data.

Of these countries, Ireland, Israel, Netherlands and Norway are currently at or above seasonal baseline thresholds for ILI consultations, and France has exceeded its baseline threshold for ARI consultations.

Virological situation - week 39/2009:

The total number of respiratory specimens collected by sentinel physicians in week 39/2009 was 1017 of which 139 (14%) were positive for influenza virus: 138 were type A (131 were identified as pandemic A(H1) and 7 not subtyped) and 1 type B. In addition, 751 non-sentinel source specimens (e.g. specimens collected for routine diagnostic purposes in the community, hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 745 were influenza type A (709 pandemic A(H1), nine A(H3), five seasonal A(H1) and 22 not subtyped) and six type B.

Cumulative virological situation - weeks 16/2009-39/2009:

Of 22952 influenza virus detections (sentinel and non-sentinel) since week 16/2009, 22346 (97%) were type A. Of these, 17612 (79%) were pandemic A(H1), 402 (2%) were A(H3), 205 (1%) were seasonal A(H1) and 4127 (18%) were not subtyped. There were 606 type B viruses (3% of total virus detections).

Based on the antigenic and/or genetic characterisation of 4890 influenza viruses reported from week 40/2008 to week 39/2009, a total of 1116 (23%) were pandemic A(H1N1), A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here). Furthermore, 2469 (50%) were A/Brisbane/10/2007 (H3N2)-like, 185 (4%) A/Brisbane/59/2007 (H1N1)-like, 29 (<1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1091 (22%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

This week, two of 1023 pandemic viruses tested in the United Kingdom have been confirmed to carry a mutation which confers resistance to the antiviral drug oseltamivir; both have been shown phenotypically to be resistant to the drug but retain sensitivity to zanamivir. (click here).

Cases of oseltamivir-resistant viruses continue to be sporadic and infrequent, with no evidence that oseltamivir-resistant pandemic H1N1 viruses are circulating within communities or worldwide. For more information on antiviral use and the risk of drug resistance go to (click here).

Comment:

Influenza activity is low or moderate among countries reporting to EuroFlu and five countries are currently at or above seasonal baseline thresholds for ILI or ARI consultations. While increases in ILI or ARI consultation rates have been observed in 12 countries since week 34, this is consistent with normal seasonal increases in respiratory disease. Increases in ILI or ARI consultation rates should be interpreted with care and should be validated by virological data, especially when public concern for influenza is high. However influenza activity appears to be increasing in Belgium, Ireland, Israel and Northern Ireland where recent increases in ILI consultation rates are also consistent with concurrent trends in the number of influenza positive specimens collected from sentinel sites.

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Epidemiological, virological and/or qualitative data is presented for 40 countries in week 39/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

(...)
-
------

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · October 9, 2009, 11:27 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 40 : 28/09/2009-04/10/2009 - 09 October 2009, Issue N? 326 (edited)

EuroFlu - Weekly Electronic Bulletin Week 40 : 28/09/2009-04/10/2009 - 09 October 2009, Issue N? 326

Low to moderate influenza activity and normal increases in respiratory illness in some European countries

Key Points Week 40/2009:

This week marks the start of the 2009-2010 influenza season. Graphs and cumulative summaries of virological data have been reset for the new season but historical data can still be accessed on the EuroFlu web site.
Thirty-nine of 53 countries in the region have reported this week.
Eleven countries reported consistent increases in ILI and/or ARI since week 37. Of these, only six reported consultation rates above those observed in 2008. This is consistent with a pattern of influenza and respiratory illness activity that is normally observed at this time of the year.
The percentage of influenza positive respiratory specimens collected from sentinel surveillance systems in the European Region was 17.5% (range 0% to 49.2% in countries testing 20 or more sentinel swabs this week). Over 25% of sentinel specimens tested positive for influenza this week in 6 countries: Belgium, Ireland, Israel, Slovenia, Spain and UK (Northern Ireland).
As of October 5, 49 of the 53 countries in the WHO European Region have reported to WHO over 59,000 laboratory confirmed cases of pandemic (H1N1) 2009 virus infection, 193 of these were laboratory confirmed deaths.

Current situation - week 40/2009:

The geographic spread of ILI was reported as widespread in seven countries (Belgium, Ireland, Israel, Luxembourg, Netherlands and UK (England and Wales)), regional in Spain, and local or sporadic in 17 countries. Twelve countries reported no activity. The impact of influenza on health services was reported as moderate in Ireland and low in 25 countries. Of the 16 countries reporting a dominant subtype, pandemic (H1N1) 2009 was dominant.

Eleven countries have reported increasing trends in ILI and/or ARI consultation rates since week 37, but of these, only Belgium (31%), Hungary (20%), Ireland (37%), Spain (31%) and UK (Northern Ireland) (28%) are reporting rates of influenza positive sentinel specimens at or above 20 percent. Despite flat or declining outpatient consultation rates in recent weeks, high influenza positive rates in Israel (43%) and Slovenia (30%) also indicate the circulation of influenza. Among these seven countries, ILI consultation rates are higher than those observed during week 40, 2008 in Belgium, Ireland, Israel, Spain and UK (Northern Ireland). In countries performing sentinel surveillance for ILI, consultation rates were highest in the 5-14 year age group in Belgium, Israel, Ireland, Portugal, Spain, and the UK (England, Northern Ireland and Scotland).

Virological update- week 40/2009:

The total number of respiratory specimens collected by sentinel physicians in week 40/2009 was 1691 of which 296 (17.5%) were positive for influenza virus: 295 were type A (282 were identified as pandemic A(H1), one seasonal A(H1) and 12 not subtyped) and 1 type B. In addition, 1191 non-sentinel source specimens (e.g. specimens collected for routine diagnostic purposes in the community, hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 1175 were influenza type A (977 pandemic A(H1), 10 A(H3), 11 seasonal A(H1) and 177 not subtyped) and 16 type B.

Worldwide, through the WHO Global Influenza Surveillance Network, more than 10,000 pandemic H1N1 viruses have been analysed for susceptibility to oseltamivir. To date, only 28 resistant viruses have been detected in sporadic incidents mostly related to oseltamivir-treatment/prophylaxis regimens. A few patients that have not been exposed to oseltamivir have also been found. In all cases a H275Y mutation was present in the neuraminidase gene. For more information on antiviral use and the risk of drug resistance click here.

Comment:

Due to circulation of pandemic H1N1 viruses, the percent of sentinel specimens testing positive for influenza in week 40/2009 is considerably elevated compared to week 40/2008 (17.5% vs. 1%) but influenza activity is generally low in the region. However, sentinel surveillance suggests active circulation of influenza virus in the United Kingdom, Ireland, and four additional countries. Clinical surveillance data in several of these countries also show increasing incidence rates in the 5-14 years age range which may be indicative of increasing influenza activity. It is essential that countries maintain sentinel surveillance to monitor the relative proportions of seasonal, pandemic, and other respiratory viruses in circulation; to detect the presence of any antigenically drifted A/Perth/16/2009 (H3N2)-like viruses; to monitor for any changes in pandemic H1N1 (2009) or other influenza viruses; and to track the geographic spread of the current influenza season, which in several recent years has followed a west to east progression across the European Region.

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Epidemiological, virological or qualitative data is presented for 39 countries in week 40/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
(...)
-
-----

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · October 16, 2009, 10:30 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin (October 16, 2009, edited)

EuroFlu - Weekly Electronic Bulletin

Week 41 : 05/10/2009-11/10/2009 - 16 October 2009, Issue N? 327

[Original Page: LINK. EDITED.]

Early start of influenza activity in the European region

Key Points Week 41/2009:

Fourty-three of 53 countries in the region have reported data this week.
Increased levels in ILI and/or ARI rates were observed in Belgium, Ireland, Spain, United Kingdom (Wales and Northern Ireland) and these data were confirmed with substantial virological detections of the pandemic H1N1 virus
The percentage of influenza positive respiratory specimens collected from sentinel surveillance systems in the European Region was 25%. Eight countries with at least 10 specimens had rates of 25% or more: Belgium, Ireland, Israel, Malta, Norway, Spain, Sweden and UK (Northern Ireland). The high percentage of positive sentinel specimens is unusual for this time of the year, in the previous winter season only 1% were positive for influenza in week 41/2008.
As of October 5, 49 of the 53 countries in the WHO European Region have reported to WHO over 59,000 laboratory confirmed cases of pandemic (H1N1) 2009 virus infection, 193 of these were laboratory confirmed deaths.

Current situation - week 41/2009:

The intensity of influenza activity was high in Ireland, Luxembourg and the United Kingdom (Northern Ireland). The geographic spread of ILI was reported as widespread in six countries (Belgium, Ireland, Israel, Luxembourg, Netherlands and UK (England, Wales)), regional in four countries (Austria, Malta, Spain, Sweden), and local or sporadic in 16 countries. Eleven countries reported no activity. The impact of influenza on health services was reported as moderate in Ireland and low in 25 countries.

Of the 20 countries reporting a dominant subtype, pandemic (H1N1) 2009 was dominant in all countries. For Belgium, Ireland, Israel, Malta, Spain, Sweden and UK (Northern Ireland), at least 25% of sentinel specimens tested positive for influenza in week 41/2009. An increase in clinical incidence was observed for Belgium, Ireland, Spain, Sweden and the UK.

In countries performing sentinel surveillance for ILI, consultation rates were highest in the 5-14 year age group in Belgium, Israel, Ireland, the Netherlands, Spain, and the UK (England, Northern Ireland and Scotland). In the United Kingdom (Wales) the young children, aged 0-4 years, presented with highest consultation rates.

Virological update- week 41/2009:

The total number of respiratory specimens collected by sentinel physicians in week 41/2009 was 1751 of which 430 (25%) were positive for influenza virus: 429 were type A (398 were identified as pandemic A(H1), 31 not subtyped) and 1 type B. In addition, 1283 non-sentinel source specimens (e.g. specimens collected for routine diagnostic purposes in the community, hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 1278 were influenza type A (768 pandemic A(H1), 13 A(H3), 374* seasonal A(H1) and 123 not subtyped) and 5 type B.

Cumulative virological update- week 40/2009-41/2009:

A total of 3349 influenza viruses have been detected. Of these, 2350 were identified as pandemic A(H1), 603* seasonal A(H1), 350 A not subtyped, 23 A(H3N2) and 23 B. Out of 1435 N-subtyped viruses 1432 were pandemic A(H1N1) and 3 were influenza A(H3N2).

Worldwide, through the WHO Global Influenza Surveillance Network, more than 10,000 pandemic H1N1 viruses have been analysed for susceptibility to oseltamivir.

To date, only 28 resistant viruses have been detected in sporadic incidents mostly related to oseltamivir-treatment/prophylaxis regimens. A few patients that have not been exposed to oseltamivir have also been found.

In all cases a H275Y mutation was present in the neuraminidase gene. In the EuroFlu database all 599 H1N1v viruses that were tested were sensitive for oseltamivir and zanamivir. For more information on antiviral use and the risk of drug resistance click here.

Comment:

Influenza activity is low in most countries in Europe: 23 countries reported a low intensity of influenza activity and no or sporadic influenza activity for the geographical spread indicator. However, for example in Belgium, Israel, the Netherlands, Norway, and the UK consultation ILI/ARI rates are above the baseline, this is unusual for this time of the year. Similarly the number of influenza detections is very high for the season, and indicates influenza activity is starting.

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Epidemiological, virological or qualitative data is presented for 43 countries in week 41/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

*Erratum: For the non-sentinel data in week 41/2009 there was a problem in the technical reporting of data. The number for seasonal A/H1 are incorrect and actually present pandemic H1 detections.

-
------

**mixin** · October 16, 2009, 12:15 PM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

To date, only 28 resistant viruses have been detected in sporadic incidents mostly related to oseltamivir-treatment/prophylaxis regimens.

To date, 35 resistant pandemic H1N1 influenza viruses have been detected and characterized worldwide. All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir.

http://www.who.int/csr/disease/swine.../en/index.html

The numbers are off just a little.

**Giuseppe** · October 23, 2009, 10:18 AM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 42 : 12/10/2009-18/10/2009 (edited)

EuroFlu - Weekly Electronic Bulletin Week 42 : 12/10/2009-18/10/2009

23 October 2009, Issue N? 328: Increasing influenza activity across Europe

Key points

This week?s report is based on material received from 44 of the 53 countries in the WHO European Region.
The incidence of influenza-like illness (ILI)/ acute respiratory infection (ARI) is increasing in several countries.
32% of specimens collected from sentinel sources were positive for influenza virus: a very high level for this time of the year, compared to rates in the previous 5 years.
Pandemic (H1N1) 2009 virus was dominant in 24 countries and accounted for more than 95% of influenza virus subtype detections.
As of 19 October 2009, European countries had reported over 63 000 laboratory-confirmed pandemic (H1N1) 2009 cases to WHO, including 236 deaths.

Data reported in week 42

Clinical

Eight countries reported increases in ILI and/or ARI consultations (defined as countries with increases in each of the previous three weeks).

In four of these (Belgium, Ireland, the Netherlands and the United Kingdom (Northern Ireland)) the positivity rate of swab specimens exceeded 20% (minimum number of tested specimens: 20).

The intensity of clinical activity was described as very high in Iceland, high in Ireland, Luxembourg and the United Kingdom (Northern Ireland), medium in 10 countries and low in the remaining 25 countries reporting.

The occurrence of ILI was reported as widespread in Belgium, Iceland, Ireland, Israel, Luxemburg, the Netherlands and the United Kingdom (England); regional in Austria, Norway, Spain, Sweden and Turkey; local and sporadic in a further 16 countries; 11 countries reported no activity.

The impact of influenza on health services was in general reported as low: 23 countries reported low impact and 3 (Albania, Ireland and Turkey), medium impact.

Virological

The 1848 specimens submitted by sentinel physicians were examined, of which 586 (32%) were positive for influenza.

Of these, 548 were positive for the pandemic (H1N1) 2009 virus and a further 38, positive for others.

Influenza virus positivity in the sentinel specimens was very high compared to rates for week 42 in the previous 5 years (ranging from 0.9% in 2005 to 2% in 2008).

The 2522 positive specimens from non-sentinel sources included 1925 positive for pandemic (H1N1) 2009 influenza. Among the countries reporting more than 50 sentinel specimens, the 3 with the highest positivity rates were Ireland (53%), Belgium (48%) and Spain (43%).

Of the 41 countries reporting a dominant subtype, pandemic (H1N1) 2009 was dominant in 24.

Comment

The virological data collected support the conclusion that influenza activity is increasing in the European Region. The pandemic (H1N1) 2009 virus is dominant in most countries, and the increased levels of influenza activity are unusual for the month of October.

Most national clinical ARI and ILI data sets show the highest incidence in children aged 0?4 and 5?14 years, respectively, and minimal increases in people aged over 65 years.

The widespread though gradual increases in ILI/ARI activity and the continuing detections of pandemic (H1N1) 2009 virus suggest that continued increases in influenza incidence should be anticipated over the next four weeks.

Worldwide, more than 10 000 (H1N1) viruses have been further examined for the presence of resistance; 35 have been found resistant to oseltamivir, all showing H275Y point mutation in the neuraminidase gene. More information on antiviral use and the risk of drug resistance is available from WHO headquarters.

Further information

The EuroFlu bulletin presents and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe and WHO headquarters web sites.
(...)
-

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

**Giuseppe** · October 30, 2009, 12:37 PM

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 43 : 19/10/2009-25/10/2009 (edited)

EuroFlu - Weekly Electronic Bulletin Week 43 : 19/10/2009-25/10/2009

30 October 2009, Issue N? 329

Rapidly increasing influenza activity in the WHO European Region

Key points, week 43/2009

This report is based on material received from 43 of the 53 countries.
37% of specimens collected from sentinel sources were positive for influenza virus.
The incidence of clinical respiratory illness has increased over each of the past three weeks in 17 countries and for 8 of these the proportion of sentinel specimens testing positive for influenza this week was 20% or greater.
Pandemic (H1N1) 2009 was dominant in 24 countries and accounted for 100% of influenza A virus subtype detections in sentinel specimens.
45 deaths, involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection were reported by 13 countries during the period of 21 to 27 October. However, the majority of pandemic cases have resolved without complication.

Current Situation, week 43/2009

Seventeen countries reported increases in ILI and/or ARI consultations (defined as countries with increases in each of the previous three weeks). In eight of these countries (Belgium [69.2%], Germany [27.4%], Ireland [54.9%], Netherlands [51.1%], Norway [65.6%], Spain [46.0%], Sweden [32.7%] and the United Kingdom (Northern Ireland) [80.8%]), the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens: 20). These increases have been particularly notable in the 5-14 years age category.

The intensity of clinical activity was described as very high in Iceland and Ireland and high in Belarus, Luxembourg, Malta, Sweden and in Northern Ireland, though not in the United Kingdom generally. While the intensity of clinical activity was reported as medium overall in the Russian Federation, high intensity was reported in the Urals and Far Eastern regions. The clinical incidence of ILI and/or ARI was reported as widespread in Belgium, Iceland, Ireland, Israel, Luxembourg, the Netherlands, Norway, the Russian Federation (Far Eastern region), Spain and most of the United Kingdom.

The impact of influenza on health services was reported as moderate in Albania, Ireland, Norway and Ukraine and low in 21 additional countries.

Forty-five deaths associated with laboratory confirmed pandemic (H1N1) 2009 infection were reported by 13 countries in the period of 21 to 27 October. This raises the total number of deaths reported since April 2009 from 236 to 281. The Czech Republic, Finland, the Republic of Moldova, the Russian Federation, Serbia and Turkey all reported their first laboratory-confirmed deaths, seven in total, during this week.

The Minister of Health of Ukraine has reported 12 fatal pneumonia cases in the Ternopol region with another 17 pneumonia patients in intensive care units and a further 6 fatal pneumonia cases in a neighboring region. These cases are reported to have occurred at the same time as increases in less severe acute respiratory illness in local populations. Epidemiologic and virologic investigations are ongoing click here .

Five recent fatalities in Sweden were temporally associated with pandemic influenza vaccination. Investigation by the Medical Products Agency of Sweden revealed that all five patients were receiving medical treatment for previously diagnosed chronic conditions.

A public report released on 29 October 2009 states that currently there is nothing to support a causal association between the vaccination and death in these cases click here.

Virological update, week 43/2009

Of the 15 countries testing 20 or more sentinel specimens this week, influenza positive rates ranged from 0% (Albania, Azerbaijan, Croatia, Georgia) to 81% (United Kingdom-Northern Ireland). The total number of respiratory specimens collected by sentinel physicians in the Region in week 43/2009 was 2595, of which 971 (37%) were positive for influenza virus. This is a much higher proportion than is typical for week 43 (less than 2% during 2004-2008). Of the 971 influenza virus detections, 970 were type A (897 pandemic A(H1), 73 not subtyped) and 1 was type B. In addition, 4004 non-sentinel source specimens were reported positive for influenza virus: 3991 type A (3151 pandemic A(H1), 16 A(H3), 50 seasonal A(H1), 774 not subtyped, and 13 type B.

The seasonal influenza A subtype detections were reported by Kazakhstan and the Russian Federation.

Comment

Qualitative reporting, clinical trend data and virological data all are consistent with an increasing intensity and geographic spread of influenza infections in the Region. The pandemic (H1N1) 2009 virus is dominant in most countries and has initiated an early start to the influenza season. There have also been recent and concomitant increases in outpatient illness with reports of severe cases and deaths attributable to pandemic (H1N1) 2009. Continued priority should continue to be placed on timely case management, increased access to neuraminidase inhibitors, and the implementation of vaccination programmes.

Further information

The EuroFlu bulletin presents and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe and WHO headquarters web sites.

(...)
-

<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>

Announcement

Archive. EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance (at December 31, 2009)

Comment

Comment

Comment

Comment

Comment

Comment

Comment

Comment

Comment

Comment

Comment

Comment

Comment

Comment

Comment