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Seasonal Flu 2008 - 2009

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  • #61
    Re: Seasonal Flu 2008 - 2009



    • #62
      Re: Seasonal Flu 2008 - 2009


      Spreading H1N1 Tamiflu Resistance in Australia?
      Recombinomics Commentary 19:25
      September 5, 2008

      AN unexpected influenza strain has swept through Geelong and blown out waiting times at the hospital emergency department, Barwon Health says.

      Barwon Health said reports of 20-hour waits in the hospital's ED were due to a "strain of influenza not covered by this year's vaccine".

      "Consequently, the Geelong Hospital is experiencing a period of high demand and high acuity," the Barwon Health statement said.

      Barwon Health could not confirm the strain's identity late yesterday, but said it caused respiratory problems, particularly among older people.

      The above comments describe a flu outbreak in Australia. Since the influenza is said to not be covered by the current vaccine, it is likely an outbreak of H1N1. The vaccine for 2007/2008 northern hemisphere flu season mismatched all three targets. However, poor reference anti-sera failed to detect significant differences between Solomon Island/3, the H1N1 vaccine target, and Brisbane/59, the dominant H1N1 sub-clade outside of Asia. Consequently, the 2008 vaccine for the southern hemisphere had new targets for H3N2 and Influenza B, but the mismatched Solomon Island/3 target was used, extending the mismatch to another season.

      As was easily seen by phylogenetic analysis, Solomon Island/3 (clade 2A) was not circulating in 2007/2008, and had been replaced by Brisbane/59 (clade 2B), which also had H274Y. The first 10 sequenced H1N1 isolates in Australia had H274Y, suggesting the Tamiflu resistance was widespread and likely to be present in the patients experiencing respiratory problems.

      Similar respiratory problems were reported in Honduras recently, and H1N1 HA sequences recently released suggests that those isolates, as well as isolates from Guatemala, which were virtually identical, had H274Y in the NA sequence.

      As was seen in the recent fatal case from the Netherlands, treatment of H274Y positive H1N1 with Tamiflu fails to reduce the viral load, which could create problems for immuno-compromised patients, leading to death.

      More information on the recent outbreak in Australia would be useful.

      "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation


      • #63
        Re: Seasonal Flu 2008 - 2009


        (1a) Decline in influenza-associated mortality among Dutch elderly following the introduction of a nationwide vaccination program.

        Jansen A, et al - Vaccine - August 20, 2008

        This article describes a retrospective nationwide cohort study in the Netherlands over 1992–2003, using mortality and viral surveillance data showing how routine influenza vaccination among Dutch elderly was statistically associated with a significant decrease in influenza-associated mortality, notably in those aged 65–69 years.

        The aim of the work was to assess the influenza-associated mortality in the elderly before and after the introduction of a nationwide influenza vaccination program in 1996 (vaccination coverage raised from below 50% to 80% in the elderly population).

        The average annual influenza-associated mortality declined in the years after the vaccination programme from 131 to 105 per 100,000 persons (relative risk 0.80). The decline was largest in the age group 65–69 years (relative risk 0.54) but less in those aged 75 years and older. Validation by undertaking different Serfling-type regression analysis revealed similar results.

        ECDC Comment (11/09/08):
        This is another in the series of ecological studies looking for temporal associations between levels of immunisation and respiratory or all cause deaths in the elderly. While it is not controversial that influenza epidemics are associated with excesses of deaths in the elderly(1) it seems harder to demonstrate that immunisation reduces the association.

        Notable studies on data in the US and Italy have failed to find associations.(2,3) Why is this?

        Firstly the protective effect on mortality in the elderly is considerably less than the 70-90% protection seen in trials measuring laboratory confirmed outputs. One of the best cohort studies found only a 12% protection in immunised versus unimmunised elderly.(4)

        Secondly mortality data does not allow discrimination between respiratory deaths due to influenza and non-influenza causes and so the effect is much diluted.

        Thirdly as we move further away from the last pandemic the circulating viruses adapt more and more to humans and are less lethal as a consequence. In the light of these considerations any study such as this that finds an effect should probably be given more weight than studies that fail to demonstrate any effect.

        1. Tillett HE, Smith JWG, Clifford RE. Excess morbidity and mortality associated with influenza in England and Wales. Lancet 1980; i: 793-5.
        2. Rizzo C, Viboud C, Montomoli E, Simonsen L, Miller MA. Influenza-related mortality in the Italian elderly: no decline associated with increasing vaccination coverage. Vaccine 2006; 24: 6468-75
        3. Simonsen L, Reichart TA, Viboud C, Blackwelder WC, Taylor RJ, Miller MA. Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med 2005; 165:265-72
        4. Mangtani J Cumberland P. Hodgson CR, Roberts JA, Cutts FT, Hall AJ.A cohort study of the effectiveness of influenza vaccine in older people, performed using the UK General Practice Research Database J I Inf Dis 2004: 190: 1-10.

        Comment to

        (1b) Report of fatal oseltamivir-resistant A(HIN1) influenza virus infection in a man with leukaemia

        Fatal oseltamivir resistant influenza virus infection - Van der Vries E, Van den Berg B, Schutten M. - NEJM 2008; 359:1074-5.

        This letter reports on a man with known chronic lymphocytic leukaemia and on immunosupressant drugs who died in the Netherlands seemingly from infection with oseltamivir resistant A(H1N1) infection.

        The patient initially presented with respiratory symptoms and was started on antibiotics. Later influenza A(H1N1) was detected and he was started on oseltamivir. Oseltamivir treatment was discontinued a week later when it was determined that the A(H1N1) was oseltamivir resistant.

        Amantadine was then started though it then turned out that the virus was also resistant to that. The patient recovered somewhat and this was thought to be due to recovery of his immune system. However later his condition deteriorated and he subsequently died.

        ECDC Comment (11/09/08):
        This case illustrates that at present there is no clinical guidelines on the management of immune-incompetent patients in the presence of significant levels of ‘fit’ (transmitting) but oseltamivir resistant viruses. Producing such clinical guidelines where there is no clear public health benefit is not within ECDC’s mandate.

        Comment to

        (1c) Guidance for Dentists issued by the UK Department of Health

        The UK Department of Health has published two guidance documents dealing with pandemic preparedness in primary care dentistry. The first “Guidance for Dental Practices” provides recommendations for reducing the risk of pandemic influenza in the setting of a dental practices.

        The recommendations include: educating staff, patients and visitors about the symptoms, transmission and prevention to influenza, time and space separations between influenza and non-influenza patients, implementing appropriate infection control precautions, environmental cleaning and disinfection, vaccination and PPE for staff and the use of antiviral drugs for staff and patients.

        Procedural aspects to mitigate infection during a pandemic are based on existing classical infection control and precautionary hygiene measures, but also include patients screening for influenza symptoms, visit limitations to pain relief or emergency treatment and collaboration with primary care trusts to retain dental care facilities to infected patients.

        The second document “Guidance on the delivery of and contract arrangements for primary care dentistry” provides specific advice to the NHS on the delivery and contract arrangements for primary care dentistry in the event of a pandemic.

        ECDC Comment (11/09/08):
        This seems to be the pandemic-specific guidance documents produced in Europe for dentists. Focusing on primary care dentistry in influenza pandemic preparedness is important due to the ease of spread of the disease in dental setting and high number of people who visit dentist.

        The “Guidance for Dental Practices” gives useful guidelines how to contain the infection, provide dental care during pandemic, control infection, and recover symptomatic patients which could be implemented by the other EU countries.

        The second document “Guidance on the delivery of and contract arrangements for primary care dentistry” illustrates organisational aspects of primary care dentistry during a pandemic. This is perhaps more focused for UK audiences with less broad application elsewhere, although the principles are universal.

        Comment to


        • #64
          Re: Seasonal Flu 2008 - 2009

          DOI: 10.3201/eid1410.080646

          Suggested citation for this article: Cowling BJ, Lau EHY, Lam CLH, Cheng CKY, Kovar J, Chan KH, et al. Effects of school closures, 2008 winter influenza season, Hong Kong. Emerg Infect Dis. 2008 Oct; [Epub ahead of print]

          Effects of School Closures, 2008 Winter Influenza Season, Hong Kong

          Benjamin J. Cowling, Eric H.Y. Lau, Conrad L.H. Lam, Calvin K.Y. Cheng, Jana Kovar, Kwok **** Chan, J.S. Malik Peiris, and Gabriel M. Leung
          Author affiliations: University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China (B.J. Cowling, E.H.Y. Lau, C.L.H. Lam, C.K.Y. Cheng, K.H. Chan, J.S.M. Peiris, G.M. Leung); and University College London, London, UK (J. Kovar)

          In winter 2008, kindergartens and primary schools in Hong Kong were closed for 2 weeks after media coverage indicated that 3 children had died, apparently from influenza.

          We examined prospective influenza surveillance data before, during, and after the closure.

          We did not find a substantial effect on community transmission.




          • #65
            Re: Seasonal Flu 2008 - 2009

            Health officials warn of pneumonia strain

            Published: Sunday, September 14, 2008 at 1:00 a.m.
            Last Modified: Sunday, September 14, 2008 at 12:29 a.m.
            Health authorities have detected the emergence of a rare but deadly "lung-eating" form of pneumonia sparked by the combination of a skin infection and the common flu.

            The national Centers for Disease Control and Prevention reported 22 deaths among children in 2007 from the dual infection. Numbers from the 2007-to-2008 flu season won't be released until October, but officials say that deaths have increased. The CDC has just begun tracking cases among all age groups.

            The number of fatalities, while low, is a sharp increase from previous years, and infectious disease experts worry that an ongoing epidemic of skin infections could drive the numbers higher. The double infection was the leading cause of bacterial pneumonia deaths during the 1957-1958 flu pandemic. Health authorities are putting out a call for people to get a simple annual flu vaccine.

            "Since so many of these pneumonias are associated with influenza, the best prevention is to prevent influenza," said Jeffrey C. Hageman, a CDC epidemiologist.



            • #66
              Re: Seasonal Flu 2008 - 2009


              Health officials watching whether flu viruses are becoming resistant to drug

              TORONTO — As flu season approaches, public health authorities will be keeping an anxious eye on one family of flu viruses to see if an unwelcome phenomenon that cropped up last winter will stage a repeat performance.

              To the surprise and dismay of scientists and governments, H1N1 viruses that were resistant to Tamiflu suddenly appeared in high numbers in Northern Europe.

              Testing elsewhere has since shown viruses resistant to the key drug - whose generic name is oseltamivir - have spread to North and South America, the Caribbean, Africa, parts of Asia, Australia and New Zealand.

              North American officials say they will quickly test for resistance once the northern hemisphere flu season begins and H1N1 viruses start to spread. And in the U.S. at least, authorities are entertaining the possibility they may have to tweak the advice they give doctors on which flu drugs to use should - as most expect - the problem recur.

              "We are thinking about the various sorts of scenarios that might occur," says Dr. Tony Fiori, who develops antiviral drug and vaccine policy in the influenza division of the U.S. Centers for Disease Control in Atlanta, Ga.

              "It's hard to imagine we'd be at a point of telling people not to use oseltamivir. We might look at possibilities like pushing people towards using zanamivir when they can, since there hasn't been resistance seen to that."

              Zanamivir is the generic name for GlaxoSmithKline's Relenza, which, like Tamiflu, belongs to a class of drugs called neuraminidase inhibitors.

              Both drugs block the ability of flu viruses to spread from infected cells to healthy ones, making symptoms less severe and speeding recovery.

              Tamiflu producer Hoffman-La Roche intends to get into the surveillance effort, mounting a multi-country study to figure out how much resistance is out there, whether the resistant viruses cause milder disease and what happens clinically to people infected with the resistant viruses who take Tamiflu.

              "So in a very short space of time we hope to get a picture on the frequency, if the strain does re-emerge in the northern hemisphere," says Dr. David Reddy, Roche's pandemic influenza task force leader.

              "We don't know what the northern hemisphere will bring," he said, expressing an optimism not supported by the resistance pattern seen in H1N1 viruses during the southern hemisphere flu season.

              Canada too will be testing early so it can inform the medical community of which kinds of flu viruses are causing the most disease and whether they are resistant to Tamiflu.

              But the Public Health Agency of Canada is unlikely to issue across-the-board recommendations, because the drug still works against two other types of flu viruses - the other influenza A subtype, H3N2 as well as influenza B viruses - and because it's unlikely there will be one single pattern of illness across the entire country.

              "This season's going to be a little bit more complicated than previous seasons. And I think one is going to have to . . . at the local and provincial level take more of a risk-assessment, risk-management approach based on what strains of flu are circulating," says Dr. John Spika, acting director general of the centre for immunization and respiratory infectious diseases.

              "Are they H1N1 predominantly or are they H3N2? And, based on the available information, then decide whether or not it is appropriate to use the oseltamivir or potentially adamantane drugs. And how zanamivir fits in with that as well."

              The adamantane drugs are older flu drugs that have their own resistance problem. In early 2006 both the CDC and the Public Health Agency told doctors not to use the drugs when it was found over 90 per cent of H3N2 viruses were resistant to them.

              As for Tamiflu and Relenza, neither drug has done remarkably well in the seasonal flu market except in Japan, where Tamiflu is widely used.

              So in some ways, the resistance problem isn't likely to have a huge impact on how doctors treat their patients who contract influenza - so long as resistance doesn't also emerge in either or both of H3N2 and influenza B viruses, experts say.

              "That's what everybody's holding their breath on," says Dr. Allison McGeer, an influenza expert at Toronto's Mount Sinai Hospital.

              "If we see H3N2 resistance at significant levels, that's the catastrophic bridge."

              But Roche has sold vast quantities of Tamiflu to governments and corporations for pandemic influenza stockpiles. Discovering the vulnerability of the main drug weapon in pandemic arsenals has unsettled governments, public health officials and flu researchers.

              "The bigger issue is loss of confidence overall and how it will shape the stockpiling," says McGeer, who says governments may be less willing to lay in stockpiles when the next generation of flu drugs hit the market for fear the Tamiflu phenomenon will repeat itself.

              It is a fact of nature that bacteria and viruses will eventually evolve to become resistant to drugs. But research had suggested that the changes flu viruses would have to undergo to become resistant to Tamiflu would so weaken them that they would lose the capacity to spread from person to person.

              Last winter nature delivered a double whammy: Not only had resistance emerged - and emerged in places where it was clear misuse wasn't responsible - but the resistant viruses spread easily.

              That demolished the theory that resistant viruses were less biologically fit viruses, at least so far as H1N1 viruses are concerned.

              "I am really staggered that this H1N1 virus has been able to spread as it has," says Jennifer McKimm-Breschkin, a flu antiviral expert at Australia's Commonwealth Scientific and Industrial Research Organization and a member of the team that developed Relenza.

              McKimm-Breschkin, who receives no royalties from sales of the drug, thinks in light of the resistance problem, public health agencies should be telling doctors to use Relenza this flu season.

              "The drugs are expensive. So if you have one drug that you know is effective against all (flu) strains, surely the logical prescribing pattern is to prescribe that drug."

              But she thinks officials would be reluctant to issue that kind of recommendation, because of the lion's share position Tamiflu holds in most pandemic drug stockpiles.

              "It is a politically sensitive issue because of the stockpiling. And governments don't want to alarm people that the stockpiles may not be useful because the bird flu still remains sensitive,"
              McKimm-Breschkin says, referring to the dangerous H5N1 strain killing poultry and occasionally people in parts of Asia and Africa.

              Other experts say the Tamiflu situation doesn't merit the same response as the adamantane drug resistance problem did. For one thing, at least in North America, the Tamiflu resistance rates were lower last winter - 26 per cent in Canada, and 11 per cent in the U.S. And for another thing, H1N1 viruses generally cause milder flu than H3N2 viruses.

              Fiori says there is another important distinction between the two situations.

              "I think what makes it somewhat different from the adamantane situation of a couple of years ago is that we had a good drug - perhaps even a better drug - in reserve at that point," he says, referring to Tamiflu.

              "And we don't at this point. We don't really have that sort of option here."


              • #67
                Re: Seasonal Flu 2008 - 2009

                EISS - Inter-season Electronic Bulletin Week 37 [EISS]
                EISS - Inter-season Electronic Bulletin Week 37 : 08/09/2008-14/09/2008 - 19 September 2008, Issue N° 272 - VERY SPORADIC INFLUENZA ACTIVITY IN EUROPE

                Influenza virus detections occur very sporadically in Europe.

                In week 36/2008, there was no detection and in week 37 there was only one detection reported.

                Out of 11 countries reporting the geographical spread indicator in week 36-37/2008, 10 countries reported no influenza activity and England reported sporadic activity.

                In week 36-37/2008, Out of a total of 137 investigated specimens in Europe only one influenza virus (type A not subtyped) was detected in England from a non-sentinel specimen.

                There have been no reports of unusual influenza activity in Europe at a community level (i.e. in a region or local area such as a city, county or district) since week 16/2008.

                The Inter-season Electronic Bulletin presents and comments influenza activity based on virological data reported to EISS.

                In weeks 36/2008 and 37/2008, a total of 14 countries reported virological data to EISS.

                The Inter-season Electronic Bulletin will be published between week 21/2008 and week 39/2008.

                The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS in collaboration with the WHO Collaborating Centre in London (United Kingdom) and the European Centre for Disease Prevention and Control in Stockholm (Sweden).

                The graph presents the total number of specimens positive for influenza A and B viruses in Europe during the inter-season period.

                The map presents the geographical spread as assessed by each of the networks in EISS.

                A = Dominant virus
                AH1N1 = Dominant virus A(H1N1)
                H3N2 = Dominant virus A(H3N2)
                H1N2 = Dominant virus A(H1N2)
                B = Dominant virus B
                A & B = Dominant virus A & B

                = : stable clinical activity
                + : increasing clinical activity
                - : decreasing clinical activity

                No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels)
                Sporadic = isolated cases of laboratory confirmed influenza infection
                Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed.
                Regional activity = influenza activity above baseline levels in one or more regions witha population comprising less than 50% of the country's total population. Laboratory confirmed.
                Widespread = influenza activity above baseline levels in one or more regions with a populationcomprising 50% or more of the country's population. Laboratory confirmed.
                <cite cite="">EISS - Bulletin Review</cite>


                • #68
                  Re: Seasonal Flu 2008 - 2009


                  NZ: SC hit by the flu
                  South Canterbury | Tuesday, 23 September 2008

                  SOUTH CANTERBURY has had the highest flu rate in the country according to latest statistics from the Ministry of Health.

                  For the second week in September, South Canterbury had the highest doctor consultation rate for influenza type symptoms, with 99 people per 50,000 of the population being seen by their doctor.

                  The second highest was Northland with 97 per 50,000.

                  The national average for the week was 24 per 50,000.

                  Overall, Ministry of Health statistics show flu rates were tracking down with the peak an average of 50 per 50,000 recorded in mid August and this had dropped to 24 per 50,000.


                  • #69
                    Re: Seasonal Flu 2008 - 2009


                    Russia may have cold and flu epidemic month earlier than planned – expert

                    23.09.2008, 20.17

                    ST. PETERSBURG, September 23 (Itar-Tass) -- A cold and flu epidemic in Russia may start in November because of early frosts, head of the World Health Organization (WHO) National Flu Center Academician Oleg Kiselyov told Itar-Tass on Tuesday.

                    “The Federal Consumer Rights and Human Well Being Service has forecasted the beginning of the cold and flu epidemic a month later, in December. Everything will depend on the weather,” the expert said. “It is still hard to predict a flu type, but one can be sure we will have no H5N1 avian influenza virus.”

                    He urged regional medical authorities to intensify cold and flu diagnostic at laboratories and to tighten sanitary control at industrial enterprises and children’s institutions.

                    The National Flu Center conducts round-the-year epidemiological monitoring in 54 largest cities of Russia and exchanges information with the WHO Geneva headquarters.


                    • #70
                      Re: Seasonal Flu 2008 - 2009

                      H3 phylogram from Sweden



                      • #71
                        Re: Seasonal Flu 2008 - 2009

                        Originally posted by niman View Post
                        In the middle of Week 38 were observed in the micro-biologist, Karolinska University Hospital, Solna the first influenza A case of the season. The sample came from a middle-aged man in the Stockholm region, which has not been abroad in the past month. He had flu-like symptoms. This test is now characterized. There is a similar to the H3N2 strains that have circulated in Sweden during the last two seasons (see Figure 1). Strain similar to that contained in this year's vaccine, H3/Brisbane/190/2007. It is sensitive to neuraminidase inhibitors Tamiflu and Relenza ® ®, however, resistant to amantadine license preparation. Amantadine is not used in Sweden and the resistant H3N2 strains circulating in the world since 2002-2003.

                        What will this mean for this year's flu season? Since last season (2007-2008) was dominated by influenza B and influenza A/H1N1, it is likely that a larger number of people are naive to H3N2, however, is similar to the strain of the influenza A/H3N2 strains that have circulated the past seasons. On ESWI (European Scientific Working Group on Influenza) conference in Portugal (14-17 September) presented C. Ringholz from NIH, Bethesda that three out of five times that H3N2 has changed more than usual have been after a season dominated by A/H1N1 or B. They had studied the circulating H3N2 strains from 1990. We see no tendency that has caused a significant change. On 22 September, WHO decided that the vaccine strains to be included in the southern hemisphere influenza vaccine for 2009 are included in the vaccine that we use before this season. While this suggests that no new variants of H3N2 has begun to circulate.

                        / Maria Break Ting (SMI), Maria Rotzén Östlund (Karolinska, Solna)



                        • #72
                          Re: Seasonal Flu 2008 - 2009

                          ECDC: Timeline for the emergence of oseltamivir resistant influenza A(H1N1) 2007-8
                          Timeline for the emergence of oseltamivir resistant influenza A(H1N1) 2007-8
                          With the help of its partners (1) ECDC is constructing a time-line of the more significant events and publications surrounding the emergence and dissemination of these viruses. This is very much a work in progress and ECDC welcomes comments and additions which should be sent to The Time line which will be update periodically.
                          Information and data in the time line were provided by the European Influenza Surveillance Scheme and the VIRGIL Project ECDC would like to thank all countries, virologists, clinicians and others for contributing data.

                          Funding for the VIRGIL project comes from the European Union FP6 Research Programme and EISS is supported by ECDC. Laboratories in EISS contribute to the Global Influenza Surveillance Network managed by WHO
                          Comment to
                          <cite cite="chrome://flock/content/shelf/notesSidebar.xul"></cite>



                          • #73
                            Re: Seasonal Flu 2008 - 2009


                            Coming to Britain - the Australian flu virus that has already killed hundreds
                            By Daniel Martin
                            Last updated at 10:53 PM on 28th September 2008

                            A flu virus more deadly than any seen in two decades is threatening Britain.

                            The strain originates in Australia where it has claimed hundreds of lives, including those of children.

                            Called Brisbane H3N2, it is so virulent that health chiefs have had to change the make-up of flu vaccines to deal with it.

                            It affects three times the number of victims hit by other strains, with many deaths resulting from pneumonia.

                            Viruses from the southern hemisphere strike in their winter months - our summer - and tend to travel north for our winter.

                            And although that did not happen after Brisbane H3N2 ravaged Australia last year, experts fear Europe will not escape it this winter.

                            Hugh Pennington, professor of bacteriology at Aberdeen University, said: 'If this flu has been busy in Australia, it is reasonable to suppose that we may get a similar situation in the UK. Viruses travel round the world very quickly now.

                            We have had some very quiet flu years recently and every year we have to assume that it will be busier than last year.

                            'Sooner or later we will have a big outbreak, and the more cases there are, the more deaths there will be.

                            'There is no doubt that elderly people are more at risk. It can tear through an old folk's home and cause a lot of harm.'

                            The last major outbreak in England and Wales came in 1989-90, when 23,046 people died, compared with a seasonal average of around 4,000. The elderly are those most at risk because they have weaker immune systems.

                            The Australian flu outbreak affected even fit young adults, and New South Wales saw more than 800 deaths from pneumonia in just five weeks in June and July 2007. Many children died.

                            Experts speculated that several winters of mild flu had left the population with little immunity. Last year the Australian inventor of the flu vaccine, Dr Graeme Laver, said the outbreak in his country meant Britain was also in danger. 'If the seasonal flu is as bad as it was in Australia, you are in for a pretty bad time,' he said.

                            'You could have a really severe epidemic. Thousands will be ill and many will die.'

                            The World Health Organisation and Sanofi Pasteur, a vaccine manufacturer, have combined the Brisbane strain with two others, one also named after the city, in their latest flu vaccine.


                            • #74
                              Re: Seasonal Flu 2008 - 2009

                              WHO: Seasonal influenza activity in the world, 2008
                              Seasonal influenza activity in the world, 2008

                              29 September 2008

                              This summary provides an updated report of seasonal influenza activity for weeks 37-38.

                              It does not include reports of avian influenza in humans, which are available at the avian influenza page.

                              Seasonal influenza activity in the world, weeks 37-38 (as of 29 September 2008)
                              During the weeks 37-38, overall influenza activity in the southern hemisphere declined, except for New Zealand, where a widespread outbreak was reported.

                              Activity was low in the rest of the world.

                              * China, Hong Kong Special Administrative Region.
                              A decline in the activity of influenza A(H3) and A(H1) viruses was observed, with influenza A(H3) still predominating. Both B/Yamagata and B/Victoria lineage viruses were detected.

                              * New Zealand.
                              Influenza activity remained widespread with influenza B viruses predominating and A(H3) co-circulating.

                              Between weeks 37 to 38, sporadic influenza activity was detected in Argentina (A,B), Canada (B), Chile (B) and the United Kingdom (A).

                              Belgium, Cameroon, Germany, the Islamic Republic of Iran, Kyrgyzstan, Mongolia, Oman, Paraguay, Poland, Slovenia, Sri Lanka and Switzerland reported no influenza activity.
                              <cite cite="">WHO | Seasonal influenza activity in the world, 2008</cite>


                              • #75
                                Re: Seasonal Flu 2008 - 2009

                                [Some excerpts from this week ECDC Influenza News. See bottom of the post for link to the ECDC website page.]

                                * Seasonal influenza vaccination for health care workers

                                Facing the challenges of influenza in healthcare settings: The ethical rationale for mandatory seasonal influenza vaccination and its implications for future pandemics.
                                Tilburt J.C. at alVaccine, Volume 26, Supplement 4, 12 September 2008

                                This article whose lead author is a well-respected ethicist considers the ethical issues around encouraging or requiring health care workers (HCWs) to be immunised pointing out how despite the reality of nosocomial transmission of influenza both to and from HCWs most efforts at voluntary vaccination, healthcare institutions have failed to achieve sustained high-level annual vaccination rates.

                                The article considers the basic principles of biomedical ethics in which welfare concerns outweigh concerns about autonomy. After considering the ‘pros’ and ‘cons’ it argues that healthcare institutions have an obligation to achieve adequate vaccination rates including, if necessary, even mandatory or conditional vaccination. It also discusses the practical implications of these arguments and mentions the potential that such policies have for future pandemic preparedness.

                                ECDC Comment: (02/10/08)
                                It is interesting considering this article in the light of the effort and experience in Germany mentioned below . Health care workers are at risk of acquiring influenza infection or passing it onto their patients and there is good evidence from a randomised trial at least that in the residential setting immunisation of staff saves lives.(1,2)

                                At a recent discussion on this topic with Prof Tilburt at the ESWI meeting in Portugal the situation for flu was contrasted with that for Tb and Hepatitis B. A majority of that audience (admittedly all people interested in influenza) considered that annual influenza immunisation should be made conditional (not mandatory) for HCWs – that is they should be expected to be immunised by their employers unless they came up with a reason by not.

                                1) Hayward, A.C., et al., Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ, 2006. 333(7581): p. 1241
                                2) Carman, W.F., et al., Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet, 2000. 355(9198): p. 93-7.

                                Comment to

                                * Public Health Developments - P.H. DEVELOPMENTS – SEASONAL INFLUENZA - VACCINES

                                tart of influenza surveillance season – How Severe will the Coming Season be? Questions and Answers
                                In ‘temperate climates’ – like Europe while there is a low level of influenza transmission all the time the epidemics occur in the winter. The exact timing varies from year to year. In recent years the epidemics have started later than in earlier decades.

                                Last season for example did not start until just about the time of the New Year (see Eurosurveillance Article) .

                                This week is the start of the Influenza Surveillance Season which runs each year from Week 40 of one season to Week 20 of the next. This is a time when the EISS network is reporting weekly on the EISS web-site and in summary in ECDC’s Influenza News

                                This year there has been some unfounded rumours that the coming season will be especially severe. ECDC can find no basis for this rumour apart from the truism that you never know what the coming season will be like.

                                However some Q & As have been constructed to respond to the questions we and national authorities are being asked
                                Comment to

                                * P.H. DEVELOPMENTS – PANDEMIC INFLUENZA - VACCINES

                                National campaign on immunization against influenza “A step ahead of the flu” in Germany – Targeting health care workers

                                The Robert Koch-Institute (RKI) in cooperation with the Federal Centre for Health Education (BZgA) has organised an on-going influenza immunization campaign “Ich komme der Grippe zuvor.” (“A step ahead of the flu.”).

                                The campaign is financed by the German Federal Ministry of Health.

                                The Starting in autumn 2006 using a ‘multiplier approach’ and supported by the German Medical Association, posters and flyers for patients were sent to all doctors giving vaccines in Germany (approximately 55,000 doctors).

                                Additionally in 2007/8 particular material for Health Care Workers was developed and sent to all hospitals (~2000) and Long Term Care Facilities (LTCFs~7300) in Germany in season 2007/08. After the 2007/8 influenza season telephone interviews of a representative sample of the target groups: doctors in practice, hospitals and LTCF were conducted to evaluate the campaign.

                                The evaluation showed good acceptance and use of the distributed materials and further need for support of local activities of physicians in practice. For evaluation of the activities in institutions, the persons in charge of medical services of the hospitals (n=200) and LTCF (n=500) were interviewed.

                                The interviews suggested only a moderate and non statistically significant increase of the average immunization rate of eligible staff in hospitals from 17.5% to 22.2% after the intervention in 2007/08.

                                To boost these low immunizations rates in hospitals the campaign has put a special focus on HCWs in season 2008/09. International experience, the evaluation of the campaign and a workshop conducted in 2007 with occupational physicians suggested the importance of multifaceted approaches to increase vaccination coverage in the hospital setting. Free and easy availability of immunization, extensive education and promotion combined with incentives along with the involvement and dedication of local actors seem to be the keys for successful interventions.

                                The national campaign of RKI and BZgA supports local activities by providing tailored posters and booklets, a CD with flash animation on influenza, a presentation for in-house education, text modules for local media work and a ‘good practice’ example of a successful intervention. Cups with the slogan of the campaign and a raffle with book gift vouchers for HCW are used as incentives to increase the motivation to get a flu shot.

                                Additionally a ‘good practice’ contest of successful interventions in participating hospitals will be conducted in cooperation with eleven Federal States and the German Hospital Association. The winning interventions will be considered as potential models for successful approaches in the following years. To increase the vaccination coverage of HCW and other influenza risk groups, it is important to secure the sustainability of the campaign.

                                To profit from the experiences of other European countries it is important to exchange materials and lessons learned from other successful campaigns on influenza prevention and immunization. The used material of the campaign in German can be ordered and downloaded from the website of the BZgA(

                                Comment to

                                * Meetings and workshops

                                International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.

                                This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007). The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union. The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009. A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting.

                                Its last report is available at

                                A web-site for the conference in Egypt has now been activated

                                * International Workshop - Ethical Issues in European National Preparedness for Pandemical Influenza, Paris, 20-21 November 2008

                                A web-site with registration details are at

                                * European Scientific Conference on Applied Infectious Disease Epidemiology, Berlin 19-21 November 2008.

                                The second annual European Scientific Conference on Applied Infectious Disease Epidemiology – ESCAIDE – is fast approaching. The event is being held in Berlin from 19-21 November, and over 500 health experts from across Europe and beyond are expected to come together to share scientific knowledge and experience on all areas related to infectious disease epidemiology.It is possible to register for the conference for a reduced fee of 100 Euros- the deadline for early registration is 1st October. It is also still possible to submit a ‘late breaker abstract’ to the conference- the deadline for submission is 29th September.

                                Details of the full conference programme, participant registration, and abstract submission can be found on the ESCAIDE website
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