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WHO, Influenza Update N? 205, 24 February 2014: Severe H1N1pdm09 cases in Egypt, cluster of NAI-resistant H1 in Sapporo, Japan

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  • WHO, Influenza Update N? 205, 24 February 2014: Severe H1N1pdm09 cases in Egypt, cluster of NAI-resistant H1 in Sapporo, Japan

    [Source: World Health Organization, full PDF document: (LINK). Edited.]

    Influenza Update N? 205, 24 February 2014

    • In North America, influenza A(H1N1)pdm09 virus remained predominant. Influenza activity continued decreasing in Canada, Mexico and the United States of America, but remained at elevated levels.
    • In Europe, overall influenza activity remained elevated. Trends suggests the wave of influenza activity is moving from south to north overall, with both influenza A viruses circulating.
    • In Eastern Asia, influenza activity remained high with influenza A(H1N1)pdm09 predominant.
    • In Northern Africa and Western Asia, influenza activity was variable, with Egypt reporting high activity of influenza A(H1N1)pdm09 and increased number of severe cases.

    Based on FluNet reporting (as of 24 February 2014, 08:20 UTC), during weeks 5 to 6 (26 January 2014 to 8 February 2014, National Influenza Centres (NICs) and other national influenza laboratories from 93 countries, areas or territories reported data.

    The WHO GISRS laboratories tested more than 87 378 specimens.

    20 777 were positive for influenza viruses, of which 18 487 (89%) were typed as influenza A and 2290 (11%) as influenza B.

    Of the sub-typed influenza A viruses, 9141 (77%) were influenza A(H1N1)pdm09, 2735 (23%) were influenza A(H3N2) and 1 (0%) was influenza A(H5N1).

    Of the characterized B viruses, 127 (74.7%) belong to the B-Yamagata lineage and 43 (25.3%) to the B-Victoria lineage.

    For updates on human infections with avian influenza A(H7N9) virus see the WHO website

    The WHO Consultation and Information Meeting on the Composition of Influenza Virus Vaccines for the Northern Hemisphere 2014-2015 took place and the recommendations are posted at the WHO website:


    Countries in the temperate zone of the northern hemisphere

    North America

    In North America, influenza activity varied between countries, but the overall laboratory confirmed detections decreased. Influenza A(H1N1)pdm09 was the predominant virus detected.

    Canada experienced a continued decrease in influenza activity. Influenza A(H1N1)pdm09 remained the predominant virus , and overall influenza activity was within expected levels for this time of year.

    In the United States of America (USA), influenza activity continued a decreasing trend, but circulation remained elevated overall. The proportion of outpatient visits for influenza-like illness (ILI) decreased from 3.8% to 3.0%, however, this is still above the national baseline of 2.0%. All 10 regions reported ILI above region-specific baseline levels. The age groups experiencing the most hospitalisations were 18-49 years and 50-64 years.

    Additionally, the proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.

    In Mexico, influenza activity remained elevated. The proportion of ILI/SARI-associated medical visits was 3.8% in the first week of February, an increase compared to the previous week. Both ARI and pneumonia rates increased from the previous week and are above expected levels for this time of year.



    In the European region, influenza activity remained elevated. Influenza A(H1N1)pdm09 and A(H3N2) viruses co-circulated throughout the region with variability in predominance among different countries, with A(H1N1)pdm09 being detected slightly more often overall. Influenza activity trends suggested increasing activity among countries in the northern regions and decreasing activity incountries in the southern regions, with the exception of Greece which still showed an increasing trend. Consultation rates for influenza-like illness (ILI) increased in most countries.


    Northern Africa and the Western and Central Asia region

    In Central and Western Asia, influenza activity was variable.

    Turkey reported a decreased number of influenza positive specimens and ILI activity compared to the previous week and the Islamic Republic of Iran detected less influenza positive samples.

    Egypt continued to experience high A(H1N1)pdm09 activity and has reported an increase in severe cases.

    The Syrian Arab Republic reported an increase in SARI cases in January and beginning of February. Influenza activity remained low in the remainder of the region.

    Eastern Asia

    In the Eastern Asian region, overall influenza activity was variable, with most countries experiencing increasing influenza activity, following seasonal trends.

    A(H1N1)pdm09, A(H3N2), and influenza B viruses co-circulated, however A(H1N1)pdm09 virus remained the predominant subtype.

    In China, influenza activity in the north and south remained at high levels, however the Chinese Centre for Disease Control reported decreasing ILI activity and laboratory detections of influenza positive samples.

    Mongolia continued to experience high influenza activity, predominantly A(H1N1)pdm09.

    Influenza activity continued to increase in the Republic of Korea, with similar proportions of influenza A(H1N1)pdm09, A(H3N2), and influenza B viruses.

    Japan continued to experience increased influenza activity. In Sapporo, Japan, a cluster of six influenza A(H1N1)pdm09 with reduced inhibition to oseltamivir and peramivir were reported from November to December 2013. The cases were community acquired , had no direct link with each other and all cases had not been treated with antivirals prior to the test.

    Countries in the tropical zone

    Tropical countries of the Americas/Central America and the Caribbean

    Overall influenza activity in the Caribbean, Central America and tropical areas of South America was at low levels.

    Central African tropical region

    In Africa, influenza activity remained low. Influenza B activity continued to be elevated in Ghana, and Madagascar continued to report increased A(H3N2) activity.

    Tropical Asia

    Influenza activity among South-East Asian countries was variable.
    Indonesia and Thailand continued to report increased influenza activity with A(H1N1)pdm09, A(H3N2), and influenza B viruses co-cirulating.

    Influenza activity remained sporadic in other South-East Asian countries.

    Countries in the temperate zone of the southern hemisphere

    In the Southern Hemisphere ILI activity remained relatively low, with sporadic detections of influenza A(H1N1)pdm09, A(H3N2)and influenza B viruses.


    Source of data

    The Global Influenza Programme monitors influenza activity worldwide and publishes an update every two weeks.

    The updates are based on available epidemiological and virological data sources, including FluNet (reported by the WHO Global Influenza Surveillance and Response System) and influenza reports from WHO Regional Offices and Member States. Completeness can vary among updates due to availability and quality of data available at the time when the update is developed.

    Link to web pages