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EuroFlu - Weekly Electronic Bulletin - Week 3 : 13/01/2014-19/01/2014 - 24 January 2014, Issue No. 514: H1N1pdm09 dominant; 33 deaths is Spain & France

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  • EuroFlu - Weekly Electronic Bulletin - Week 3 : 13/01/2014-19/01/2014 - 24 January 2014, Issue No. 514: H1N1pdm09 dominant; 33 deaths is Spain & France

    [Source: EuroFlu, full page: (LINK). Extract.]

    EuroFlu - Weekly Electronic Bulletin - Week 3 : 13/01/2014-19/01/2014 - 24 January 2014, Issue No. 514

    Influenza season has begun in some European countries

    Summary, week 3/2014
    • The influenza season has begun in some countries in the WHO European Region. Growing numbers of countries in the Region reported increasing consultation rates for influenza-like illness (ILI) and/or acute respiratory infection (ARI).
    • The percentage of influenza-positive sentinel samples has gradually increased over recent weeks, along with the number of specimens tested for influenza.
    • The number of reported hospitalised laboratory-confirmed and fatal influenza cases increased over the last several weeks in western European countries.
    • This week Spain and France reported 33 fatal cases, 19 (58%) of them infected with influenza A(H1)pdm09 virus.

    The EuroFlu bulletin describes and comments on influenza activity in the 53 Member States in the WHO European Region to provide information to public health specialists, clinicians and the public on the timing of the influenza season, the spread of influenza, the prevalence and characteristics of circulating viruses (type, subtype and lineage) and severity.

    For a description of influenza surveillance in the WHO European Region see below.

    Virological surveillance for influenza

    During week 03/2014 the numbers of specimens tested and influenza detections in the Region continued to increase from those in recent weeks.

    In total, 10 447 specimens from sentinel and non-sentinel sources were tested for influenza, 1628 (16%) of which were positive: 1573 (97%) influenza A and 55 (3%) influenza B (Fig. 1 and 2). Influenza A has remained dominant since week 40/2013.


    Of the 978 influenza A viruses that were subtyped during week 03/2014, 608 (62%) were A(H1N1)pdm09 and 370 (38%) A(H3N2) (Fig. 2a), showing a higher proportion of A(H1N1)pdm09 viruses than in previous weeks.

    Since the beginning of weekly monitoring (week 40/2013), sentinel and non-sentinel sources have yielded 5972 influenza detections, with an increasing proportion of influenza A viruses detected: 5571 (93%) were influenza A and 401 (7%) influenza B viruses (Fig. 2b).

    Of the 3899 influenza A viruses that have been subtyped, 2110 (54%) were A(H1N1)pdm09 and 1789 (46%) were A(H3N2).

    In addition, since week 40/2013, the lineage of 46 influenza B viruses has been determined: 42 (91%) belonged to the B/Yamagata lineage and 4 (9%) to B/Victoria.



    With an increase in the number of influenza detections, more countries reported data on dominant viruses during week 03/2014 than in previous weeks.

    All countries (N=17) reported influenza A as the dominant type (Map 1 and country table).

    In countries providing data on dominant subtypes, influenza A(H3N2) was reported as dominant in Slovenia, the former Yugoslav Republic of Macedonia and Turkey, while Bulgaria, Greece, Portugal, Sweden, Spain and the United Kingdom (Scotland) reported A(H1N1)pdm09 as dominant.

    The Russian Federation and Switzerland reported A (H1N1)pdm09 and A(H3N2) as co-dominant.

    Virus strain characterizations

    Circulating influenza viruses are assessed each season for their antigenic and genetic characteristics, to determine the extent of their antigenic similarity to the viruses included in the seasonal influenza vaccine, and determine the prevalence of mutations that affect pathogenicity or are associated with susceptibility to antiviral drugs.

    For the 2013/2014 northern hemisphere influenza season, WHO recommended inclusion of A/California/7/2009 (H1N1)pdm09-like, A/Texas/50/2012 (H3N2)-like (an egg-adapted virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011) and B/Massachusetts/2/2012-like (Yamagata lineage) viruses in vaccines (see the WHO headquarters web site).

    Since week 40/2013, 93 influenza viruses characterized antigenically by 9 countries (Denmark, Finland, Germany, Latvia, Norway, Portugal, Romania, the Russian Federation and the United Kingdom (England)) corresponded with the viruses recommended by WHO for inclusion in the current northern hemisphere seasonal influenza vaccine (Fig. 3).

    8 countries (Belgium, Denmark, Finland, the Netherlands, Norway, Portugal, Spain and Sweden) have characterized 173 influenza viruses genetically (Fig. 4).


    (#) Included in the WHO-recommended composition of influenza virus vaccines for use in the 2012/2013 northern hemisphere influenza season.

    (*) Included in the WHO-recommended composition of influenza virus vaccines for use in the 2013 southern hemisphere influenza season.

    Monitoring of susceptibility to antiviral drugs

    Since week 40/2013, 6 countries (the Netherlands, Norway, Portugal, Spain, Sweden and the United Kingdom (England)) have screened 126 influenza A(H1N1)pdm09, 56 influenza A(H3N2) and 13 influenza B viruses for susceptibility to oseltamivir and zanamivir.

    All showed susceptibility to both drugs.

    The 57 influenza A(H1N1)pdm09 and 47 influenza A(H3N2) viruses screened for susceptibility to adamantanes were found to be resistant.

    Outpatient surveillance for influenza-like illness (ILI) and/or acute respiratory infection (ARI)

    During week 03/2014, most European countries continued to report low-intensity influenza activity (Map 2), although the majority reported increasing trends (Map 4). Regarding geographic spread, influenza activity was predominantly sporadic (Map 3), with only Portugal, Spain and the United Kingdom (England) reporting widespread activity.

    During week 03/2014, consultation rates for ILI and/or ARI continued to increase, but remained below the national thresholds or at low levels in all countries reporting clinical data, except for Albania and Israel.


    During week 03/2014, 568 sentinel samples tested positive for influenza, with the majority being reported by Spain and Turkey.


    During week 03/2014, 568 (30%) of the 1892 specimens collected from sentinel sources tested positive for influenza, the majority being influenza A(H1N1)pdm09 and reported mainly by Spain (Fig. 6a). Click here for a detailed overview in a table format.


    Hospital surveillance for SARI

    The number of SARI hospitalizations has started to increase in reporting countries participating in hospital surveillance for SARI in the WHO European Region. (Fig. 7). The majority of cases are in the group aged 0?4 years.


    During week 03/2014, 3 (2%) of the 129 SARI samples collected in Albania, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Romania, the Russian Federation, Serbia, Slovakia and Ukraine tested positive for influenza A, with 2 being A(H3N2) (Fig. 8a). Click here for a detailed overview in table format.


    Since week 40/2013, France, Ireland, Romania, Spain, Sweden and the United Kingdom have reported 759 hospitalized laboratory-confirmed influenza cases in total: 14 influenza B, 388 A(H1N1)pdm09, 96 A(H3) and 261 type A not subtyped.

    During week 03/2014 France and Spain reported 33 fatal cases, 19 (58%) of these being infected with influenza A(H1N1)pdm09 virus.

    For more information on surveillance of confirmed hospitalized influenza, please see ECDC?s Weekly Influenza Surveillance Overview (WISO) at European Centre for Disease Prevention and Control web site.

    Respiratory syncytial virus (RSV)

    Based on the data presented by countries reporting on RSV, the positivity rate has been gradually increasing since week 40/2013 and picked up in week 50/2013 giving a slightly later start compared to the previous season. (see Country data and graphs for individual country data).

    EuroMOMO (European Mortality Monitoring Project)

    EuroMOMO is a project set up to develop and operate a routine public health mortality monitoring system to detect and measure, on a real-time basis, excess deaths related to influenza and other possible public health threats across 20 European Union (EU) countries.

    Pooled analysis of week data for 3/2014 showed that all-cause mortality was within the normal range for all reporting countries. Results of pooled analysis may vary, depending on which countries are included in the weekly analysis.

    For more information about the EUROMOMO mortality monitoring system please click here.


    Country comments (where available)

    Republic of Moldova: 26 samples were tested for Influenza A and B - 3 of them were positive for RNA Influenza A(H3N2). 2 samples were positive for RNA hRSV, and 2 - for RNA Parainfluenza virus type 1.