Seasonal Flu 2008 - 2009

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

EISS - Inter-season Electronic Bulletin - Week 39 : 22/09/2008-28/09/2008 - 03 October 2008, Issue N. 273 - SPORADIC INFLUENZA ACTIVITY IN EUROPE

EISS - Inter-season Electronic Bulletin - Week 39 : 22/09/2008-28/09/2008 - 03 October 2008, Issue N. 273 - SPORADIC INFLUENZA ACTIVITY IN EUROPE

Summary:
Influenza virus detections occur very sporadically in Europe.

In week 38/2008, there were two detections and in week 39 there were nine detections reported.

Out of nine countries reporting the geographical spread indicator in week 38-39/2008, all reported no influenza activityIn weeks 38-39/2008, 11 influenza viruses were detected in Europe out of a total of 244 investigated specimens: one influenza A not subtyped virus each in Poland, Spain, Switzerland and Sweden, respectively, and four in England.

One type A(H3) in Germany, one type A(H3N2) and one type B in Sweden.

All detections were from non-sentinel specimens.

As usual for this time of the year, a number of the influenza cases are travellers who have been abroad.

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

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

In weeks 38/2008 and 39/2008, a total of 16 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).

Graph

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

<table style="width: auto;"><tbody><tr><td></td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From TABLES</td></tr></tbody></table>

Map

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

<table style="width: auto;"><tbody><tr><td></td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From TABLES</td></tr></tbody></table>

Europe, Year 2008 / Week 39

A = Dominant virus A
H1N1 = 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.
Finland : Where available, the epidemiological data are provided by a health-care district inSouth-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).

Network comments (where available)
* Sweden - The patient with Influenza A has been in London, the Influenza B patient in Senegal.
--

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

[Commonground]

Re: Seasonal Flu 2008 - 2009

[no date]

Change in weather sparks flu outbreak

By BEGENA P PRADEEP

BAHRAIN is coughing and sneezing its way out of the summer, with an outbreak of flu and cold bugs as the weather changes. More people are reporting flu and cold symptoms at health centres, says health education director Dr Amal Al Jowder.

"There is a drastic increase in the number of cases being reported. This is mainly because people are exposed to the 'different' weather conditions during the day and at night.

"It is still hot during the day, with dusty winds, as we experience the last few days of summer," she said.

The "unstable" weather leads people to being exposed to sudden heat and cold.

The weather, which varies several times during the day, is "ideal" for the viruses to thrive, said Dr Al Jowder.

"Under such weather conditions it is important to maintain personal hygiene to avoid viral infection.

"People should also maintain a healthy lifestyle, particularly now, to boost immunity because those with even slightly weak immune systems fall prey to a cold or even flu."

Dr Al Jowder said that victims in only a few cases of flu caused by viral infections, suffered from complications and needed prolonged treatment with antibiotics.

"In some cases, patients have to be referred to Salmaniya Medical Complex," she said.

"Proper rest, steam inhalation, drinking lots of water and other fluids and a cold water sponge are highly recommended."

Dr Al Jowder said that the most common complaint at the moment was sore throat and the onset of symptoms was mostly sudden.

"The common symptoms are headache, sore throat, fatigue, fever, sneezing and a running nose.

"But if the person is suffering from uncontrollable coughing and his or her sputum is green, yellow or black, earache, difficulty in breathing and muscle rigidness, they need immediate consultation.

"The infection is easily passed from one person to another by coughing and sneezing. It attacks the respiratory tract - nose, throat, and lungs."

It is usually "very unpleasant", but in most cases, symptoms get better after seven to 10 days.

"The infection rate is highest amongst children, but the rate of serious illness and sometimes death are highest among people aged 65 years and above."

http://www.gulf-daily-news.com/articles.asp?article=231060&Sn=BNEW&IssueId=2980

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

European Centre of Diseases Prevention and Control (ECDC), Influenza News, Excerpts

* Scientific advances - SCIENTIFIC ADVANCES ? INFLUENZA VACCINES

Success and problems with live (non-injected) nasal vaccines for seasonal vaccines in young children

Safety and efficacy of live attenuated influenza vaccine in children 2-7 years of age. R.B. Belshe, C.S Ambrose and T.Yi

Description:
This publication summarises the results of three trials of the new live attenuated influenza vaccines (LAIV) given nasally to young children. Two are controlled studies versus placebo and one is a trial comparing LAIV against conventional injected trivalent inactivated influenza vaccine (TIV). The publication pays particular attention to analyses the safety and efficacy of LAIV in the children of 2 years of age and older as this the age group for which LAIVs have been licensed.

In the two placebo trials there was good efficacy demonstrated compared with placebo in children aged 2?7 years in seasons with matched strains, (69.2% [95% CI: 52.7, 80.4] and 94.6% [95% CI: 88.6, 97.5]).

When compared with TIV recipients, children who had LAIV recipients and aged 2?5 years had about 50% fewer cases of confirmed influenza illness and this difference was statistically significant. In the children of two years and older the only adverse reactions noted were minor runny nose, nasal congestion and some low-grade fever.

However the trials also involved children under age 2 and here problems arose.

In the trial against injectable vaccines the LAIVs were associated with an excess of hospitalizations (for a variety of reasons) and medically significant wheezing were increased in children 6?11 and 6?23 months of age who received LAIV, respectively (compared to those receiving the injected vaccine). No such effect was seen in the older children.

ECDC Comment: (09/10/08)
Children have many immunisations by injection in their first two years of life. Injecting a baby may not be a pleasant experience for baby, parent or the injector. Therefore the live nasal vaccines have been considered a very attractive prospect by those recommending influenza vaccination in children. The unexpected finding of an increase in hospitalisations for non-specific reasons has therefore been a considerable disappointment.

The finding of significant wheezing following an oral live vaccine is not so unexpected.

The set-back is especially unfortunate in that it?s the youngest children under age 3 (and those with other chronic diseases) that seem to be those most needing influenza immunisation as they are the age group in children at highest risk of experiencing severe disease in at least one European country(1) and in North America.(2)

1. Heikkinen T, Silvennoinen H, Peltola V et al Burden of influenza in children in the community. JID 2004; 190: 1369-1973.
2. Glezen WP, Taber LH, Frank AL, Gruber WC, Piedra PA. Influenza virus infections in infants. Pediatr Inf Dis J, 1997; 16: 1065-8.
3. Fiore, AE, Shay DK, Haber P, Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR Recomm Rep, 2007. 56(RR-6): p. 1-54.

* Recent trends in vaccine coverage in the elderly in France, Germany, Italy, Spain and the UK 2001/2 to 2006/7

Influenza vaccination coverage rates in five European countries during season 2006/07 and trends over six consecutive seasons. Blank P.R. Schwenkglenks M, Szucs TD. BMC Public Health. 2008 Aug 1;8:272. http://www.biomedcentral.com/1471-2458/8/272

Description:
This article from the group that has been undertaking consumer surveys in EU countries since 2001/2 describes their experience over the six year period in the five countries where the work has been longest running. The work is supported by industry but is undertaken by a highly regarded University group and appears in peer-reviewed publications. The surveys were undertaken by applying a standard questionnaire telephoning the public (apart from in France where questionnaires are mailed).

Unlike systems using administrative methods (returns from health services) this approach allows the investigators to also ask about attitudes to immunisation and the main sources of advice. Looking at overall coverage in the population the surveys found that in 2006/7 the coverage was between 22% and 25% with a slight overall upward trend from 2001/2 onwards.

However in the most numerous ?risk group? ? older people - there were no significant trends ? uptake seems to have plateaued in these countries above the World Health Assembly target of 50% by 2006 but below that of 75% by 2010.(1)

Rates of immunisation among those with chronic illness (which only started to be measured in 2003/4) were lower than for the elderly with the highest rates in 2006/7 in the UK and the lowest in Germany.

Being both elderly and having a chronic illness increased the likelihood of being immunised in all four countries.

The most commonly cited reason for getting immunised was the recommendation of the health care provider. Immunisation uptake among health care workers was also investigated and found to be low and not increasing except in France. In 2006/7 it ranged from 12% in Italy to 22% in Germany.

ECDC Comment: (09/10/08)
There is a wealth of data in these surveys and the results are most interesting. For example the finding that being older and having a chronic illness boosts the likelihood of being immunised must have implications for interpretation of observational studies of vaccine effectiveness in the older people. It means people being immunised already have an expectation of ill-heath and so vaccine effectiveness in preventing severe illness in these countries at least will tend to be immunised. Also there is notable peak in the proportion of the population immunised in season 2005/6 across all countries, perhaps associated with the concern that season over ?bird flu? in the media and hence the general population (the effect is hardly there in older people).

It is also ironic that though health workers are cited as the most powerful source of positive advice and encouragement by those being immunised many of these health workers seem to lack enthusiasm themselves in being vaccinated.

However a difficulty is the validity of the values for vaccine coverage. Some are at variance with national figures. For example the cited figure from this work for the UK coverage in older people (over age 64 years) in 2006/7 season is around 65% while the official figures from that country reported by the national authorities to the VENICE survey and using administrative returns was 74%.(2) The confidence intervals overlap, but only just. There have been one publication comparing the results of the two systems in the UK and finding they correlated well but that does not look the case here.(3) Also would the results be put forward for publication if they did not agree.

Probably more attention should be paid to the trends rather than the absolute values but it is useful to have another figure apart from the official returns as when the two agree we have greater confidence in the official findings and when they differ it is a trigger to looking at both systems. It is therefore saddening to learn that these valuable surveys may have to cease because of funding coming to an end.

1. Resolution of the World Health Assembly 56th Assembly WHA 56.19 Agenda Item 14.14 Prevention and Control of Influenza Pandemics and Annual Epidemics May 28th 2003 http://www.who.int/gb/ebwha/pdf_files/WHA56/ea56r19.pdf
2. VENICE & ECDC Project National seasonal influenza vaccination survey in Europe 2007. (in press will be posted on VENICE web site http://venice.cineca.org/
2. Muller D, Nguyen-Van-Tam JS, Szucs TD: Influenza vaccination coverage rates in the UK: a comparison of two monitoring methods during the 2002?2003 and 2003?2004 seasons. Public health 2006, 120(11):1074-1080

* Public Health Developments - P.H. DEVELOPMENTS ? PANDEMIC INFLUENZA - PREPAREDNESS

The UK Health Department, Scientific Pandemic Influenza Sub-Group on Modelling update to their Modelling Summary document.

Description:
The UK Department of Health in London convenes a group of modellers chaired by Dr Peter Grove that have a particular interest in influenza and these come to an evidence-based agreement on how they would expect a pandemic would behave.

This is the source of the UK?s pandemic planning assumptions. The group?s advice is based on both the available evidence from prior pandemics and modelling work. For some time the Department of Health has been publishing at intervals summary papers which not only contains statements of what might happen but also the group?s view of the policy implications. This takes the form of notes on ?What we can do now? and ?Policy questions?.

The factors such as practicality, proportionality and questions of value for money are outside the remit of the sub-group and that is not cover in the particular document. The Department of Health has recently issued their most recent modelling Summary document and that can be found on the DH website.

Topics covered in the document include how the pandemic is likely to spread in the UK, the national and local pandemic profile, and its more likely impact on the population, as well as the expected effectiveness of pharmaceutical and non-pharmaceutical countermeasures.

ECDC would be interested to learn of other similar initiatives by authorities in Europe, especially if they are in the public domain.

* P.H. DEVELOPMENTS ? INFLUENZA

Influenza Vaccination - new section on the ECDC web-site and Publication of VENICE project results on Seasonal Influenza Coverage in the Elderly for the EU/EEA member States

The area dealing with influenza on the ECDC web-site has up to now been divided into three Avian Influenza, Pandemic Influenza and Seasonal Influenza each leading onto ECDC publications, Questions and Answers, Fact Sheets. From this week there will be a fourth section Influenza Vaccination through which it is possible to find ECDC?s scientific opinion on seasonal influenza risk groups, its guidance on human avian influenza ?pre-pandemic? vaccines and lists of all the scientific and public health developments relating to influenza vaccination featured in influenza news.

This development coincides with publication of the results of the VENICE Project?s 2007-8 survey on coverage of seasonal influenza vaccine coverage in older people in Europe as a Rapid Communication in Eurosurveillance and a publication of a press release from ECDC emphasising the importance of seasonal influenza immunisation programmes which are underway at present in most Member States and announcing the start of weekly surveillance through the EISS system.

* P.H. DEVELOPMENTS ?AVIAN INFLUENZA-INNOVATIONS

One Health ? an initiative which designed to unite human and veterinary medicine concerning Zoonoses

Description:
With the beginning of October new ?One Health? website was launched. One Health is a concept mostly from the veterinary world with particular relevance to zoonoses (animal infections that can infect and affect humans) including avian influenza. The developers envision this website as a method of providing worldwide ?One Health? Initiative information for the general public, political and governmental leaders, news media and all ?One Health? professionals, advocates and supporters. The 'One Health Newsletter' and its links will be prominently featured on the site as a major 'One Health' international educational publication. In addition, there will be links to the American Veterinary Medical Association 'One Health' task force recommendations published in the Journal of the AVMA (JAVMA) and other pertinent 'One Health' publications. The website is a first part of One Health concept which is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans and animals.

ECDC comment:
The development and launch of this site is associated with the forthcoming International Ministerial Conference on Avian and Pandemic Influenza in Sharm el-Sheikh, Egypt. Avian influenza is the most eye-catching zoonosis at present but of course there are many others such as rabies, some of the viral haemorrhagic fevers and many food borne infections (salmonella, campylobacter spp etc.) Cooperation has been especially strong over avian influenza and it will be interesting to see how this is captured in the One Health concept. To date most of the support for this has come from the veterinary world and it now needs to be picked up also by the medical specialists if it is to have enduring value. To visit the One health Website click here: http://www.onehealthinitiative.com

* 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 http://www.undg.org/docs/8097/12-18-...port-final.doc A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/

Retroscreen Virology Conference - Medical, Scientific and Historical Lessons from the Great Avian (H1N1) "Spanish" Influenza Pandemic of 1918:

The 90th Anniversary 10th November 2008 at The Imperial War Museum - London

This conference specifically considers the first World War and the start of the Spanish Influenza pandemic. Specifically did the war itself engender the emergence of this avian influenza A(H1N1)? Are there serious lessons from that pandemic to help today as we prepare for 21st century pandemics?Details are at http://www.retroscreen.com/rv/news/r...08/2008-09-08/
--

<cite cite="http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081009.aspx">http://ecdc.europa.eu/en/Health_Topi...za_081009.aspx</cite>

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

EISS - Weekly Electronic Bulletin Week 40 : 29/09/2008-05/10/2008 - 10 October 2008, Issue N? 274 - Low levels of influenza activity in Europe as influenza surveillance season starts [EISS]

EISS - Weekly Electronic Bulletin Week 40 : 29/09/2008-05/10/2008 10 October 2008, Issue N? 274 Low levels of influenza activity in Europe as influenza surveillance season starts

Summary:
Levels of influenza activity in Europe are currently low, and all countries reporting no or only sporadic influenza activity this week.

There have been sporadic laboratory confirmed cases of influenza across Europe in the past four weeks.

Epidemiological situation - week 40/2008:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all of the 21 countries providing these data.

For the geographical spread indicator, sporadic influenza activity was reported in Norway and Sweden and no activity in 20 countries.

Virological situation - week 40/2008:
The total number of respiratory specimens collected by sentinel physicians in week 40/2008 was 105, of which one was influenza virus positive (type A not subtyped in Spain).

Comment:
There have only been sporadic laboratory confirmed cases of influenza reported to EISS in the last month. A number of these cases were reported to be infections acquired outside of Europe (e.g. a person returning from holiday in Africa). Therefore it is currently too early to say which virus type or subtype will become dominant in Europe this season.

Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. In week 40/2008, 22 countries reported clinical data and 24 countries reported virological data to EISS. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the coordination of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (United Kingdom).

Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.

<table style="width: auto;"><tbody><tr><td></td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From TABLES</td></tr></tbody></table>

A = Dominant virus A
H1N1 = 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

Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza 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.

Finland : Where available, the epidemiological data are provided by a health-care district in South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).

Network comments (where available)
* Latvia
No influenza activity in Latvia. Local outbreaks of ARI due to parainfluenza 3 virus circulation
* Switzerland
No influenza activity was observed
--

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

[HenryN]

Re: Seasonal Flu 2008 - 2009

Background:

The Centers for Disease Control and Prevention?s (CDC) Influenza Division collects and analyzes surveillance data year-round and produces a weekly report on U.S. influenza activity from October through May. The U.S. influenza surveillance system consists of information in five different categories collected from nine different data sources.

• The five categories of influenza surveillance consist of:
• Viral Surveillance: U.S. World Health Organization (WHO) collaborating laboratories, the National Respiratory and Enteric Virus Surveillance System (NREVSS), and novel influenza A virus case reporting;
• Outpatient Illness Surveillance: US Outpatient Influenza-like Illness Surveillance Network;
• Mortality: 122-Cities Mortality Reporting System and influenza-associated pediatric mortality;
• Hospitalizations: Emerging Infections Program and the New Vaccine Surveillance Network; and,
• Summary of geographic spread of influenza: state and territorial epidemiologists? reports.

US Virologic Surveillance:

From week 21 through week 39 (weeks ending May 18 ? September 27), WHO and NREVSS laboratories located in all 50 states and Washington DC tested 25,031 specimens for influenza and 179 (0.7%) were positive. Influenza positive tests were reported from all nine public health surveillance regions during the summer. Of the positive results, 6 (3.4%) were influenza A (H1) viruses, 21 (11.7%) were influenza A (H3) viruses, 80 (44.7%) were influenza A viruses that were not subtyped, and 72 (40.2%) were influenza B viruses. More than half (63%) of these isolates were tested from mid-May through late July. Of the 40 influenza viruses reported during September (weeks 36-39), one (2.5%) was an influenza A (H1) virus, four (10.0%) were influenza A (H3) viruses, 29 (72.5%) were influenza A viruses that were not subtyped, and six (15.0%) were influenza B viruses.
Since September 30, 2007, WHO and NREVSS laboratories have tested a total of 218,493 specimens for influenza viruses and 39,407 (18.0%) were positive. Among the 39,407 influenza viruses, 28,091 (71.3%) were influenza A viruses and 11,316 (28.7%) were influenza B viruses. Eight thousand two hundred seventy-two (29.4%) of the 28,091 influenza A viruses have been subtyped: 2,173 (26.3%) were influenza A (H1) viruses and 6,099 (73.7%) were influenza A (H3) viruses.
During week 40, WHO and NREVSS laboratories reported 1,123 specimens tested for influenza viruses, eight of which were positive: five influenza A viruses that were not subtyped (Mountain, Pacific, South Atlantic and West South Central regions) and three influenza B virus (Mountain and South Atlantic regions).
<CENTER>
View WHO-NREVSS Regional Bar Charts | View Chart Data | View Full Screen </CENTER>Antigenic Characterization:

A small number of isolates were available for antigenic characterization during the summer. CDC antigenically characterized six isolates collected from May 18 ? September 27, including four influenza A (H1), one influenza A (H3), and one influenza B viruses. All six viruses are antigenically similar to the components selected for the 2008-09 influenza vaccine (A/Brisbane/59/2007-like (H1N1), A/Brisbane/10/2007-like (H3N2), and B/Florida/04/2006-like).
Novel Influenza A Viruses:

No novel influenza A virus infections were reported during the summer of 2008 or for week 40.
Antiviral Resistance:

In the United States, two groups of antiviral drugs have been approved by FDA for use in treating or preventing influenza virus infections. These two groups of antiviral drugs are: neuraminidase inhibitors (oseltamivir and zanamivir) and adamantanes (amantadine and rimantadine). A description of these drugs can be found at: http://www.cdc.gov/flu/protect/antiviral/index.htm.
A small number of isolates collected since May 18 were sent to CDC for antiviral resistance testing during the summer.

• Neuraminidase Inhibitor Antiviral Drugs: CDC performed antiviral resistance testing on 10 influenza A and B viruses collected since May 18. Two of the six influenza A (H1N1) viruses tested were found to be resistant to oseltamivir. No oseltamivir resistance has been detected in influenza A (H3N2) or influenza B viruses, and all tested viruses retain their sensitivity to zanamivir. Additional information on antiviral resistance can be found at: http://www.cdc.gov/flu/about/qa/antiviralresistance.htm
  Adamantane Antiviral Drugs:Six influenza A viruses collected since May 18 have been tested for adamantane resistance. The one influenza A (H3N2) virus tested and one of the five influenza A (H1N1) viruses tested were resistant to the adamantanes. The adamantanes are not effective against influenza B viruses.
  Based on the level of oseltamivir resistance observed in only one influenza subtype, H1N1, and the persisting high levels of resistance to the adamantanes in H3N2 viruses, CDC continues to recommend the use of oseltamivir and zanamivir for the treatment or prevention of influenza. Use of amantadine or rimantadine is not recommended. Guidance on influenza antiviral use can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm

Pneumonia and Influenza (P&I) Mortality Surveillance

No influenza-associated pediatric deaths were reported for week 40.
<CENTER>
View Full Screen</CENTER>Influenza-Associated Pediatric Mortality

No influenza-associated pediatric deaths were reported for week 40.
<CENTER>
View Full Screen</CENTER>Influenza-Associated Hospitalizations

Laboratory-confirmed influenza-associated hospitalizations are monitored in two population-based surveillance networks: the Emerging Infections Program (EIP) and the New Vaccine Surveillance Network (NVSN). EIP and NVSN estimated rates of hospitalization for influenza will be reported every two weeks starting later this season.
Outpatient Illness Surveillance:

During week 40, 0.8% of patient visits reported through the US Outpatient Influenza-like Illness Surveillance Network (ILINet), formally known as the US Influenza Sentinel Provider Surveillance Network, were due to influenza-like illness (ILI). This percentage is less than the national baseline of 2.4%. On a regional level, the percentage of visits for ILI ranged from 0.3% to 1.6%. All nine regions reported percentages of visits for ILI below their respective region-specific baselines.
<CENTER>
View Sentinel Providers Regional Charts | View Chart Data |View Full Screen
</CENTER>Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists:


During week 40 the following influenza activity was reported:

• Sporadic activity was reported in seven states (California, Connecticut, Florida, Hawaii, Idaho, New York, and Wyoming).
• No influenza activity was reported in 41states (Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Wisconsin, and West Virginia) and the District of Columbia.
• Two states (Montana and Washington) did not report.

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A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
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[HenryN]

Re: Seasonal Flu 2008 - 2009

>>>Six influenza A viruses collected since May 18 have been tested for adamantane resistance. The one influenza A (H3N2) virus tested and one of the five influenza A (H1N1) viruses tested were resistant to the adamantanes. <<<

The presence of anamtadine resistance (S31N) in one of the H1N1 isolates suggest clade 2C is also present in the isolates from the summer, which is not reflected in the antigenic analysis, which only found clade 2B.

[Commonground]

Re: Seasonal Flu 2008 - 2009

Virus outbreak shuts hospital wards

3:02pm Friday 10th October 2008
Comments (6) Have your say ?

By Andrew Napier ?

TWO wards at the Royal Hampshire County Hospital in Winchester have been closed because of the spread of the diarrhoea and vomiting bug.

The Norovirus has affected around 30 patients and staff at the RHCH.

Managers have closed two wards to new admissions in an effort to control the virus.

Patients from these wards are not being discharged, except to their own homes, until the infection is under control.

A deep clean been has been carried out and beds will only be reopened in line with the policy.

As a result of the outbreak, visitors to patients on Bartlett and St Cross wards are being asked not to come in to hospital for the time being.

http://www.dailyecho.co.uk/news/district/3747502.Virus_outbreak_shuts_hospital_wards/

[Shiloh]

Re: Seasonal Flu 2008 - 2009

Source: http://www.guampdn.com/article/20081...810150337/1002

Guam: GMH notes increase in admissions of flu-related ailments

By Beau Hodai ? Pacific Daily News ? October 15, 2008

Last week, GMH Nursing Supervisor Julietta Quinene said she has seen a marked increase in recent weeks of admissions to the hospital for respiratory problems and other symptoms linked to the flu.

Yesterday, she said she has seen the trend continue.

"We had a lot of kids, not just adults," said Quinene. "Over the weekend, we didn't have enough pediatric beds -- parents were getting angry."

Quinene said that about 80 percent of admissions she's seen over the past week have been for respiratory ailments, such as bronchitis, pneumonia and fever -- all of which she said could be attributed to the flu.

She said in the 24 hours that elapsed between last Tuesday and Wednesday, the hospital took in 33 pediatric patients suffering from respiratory ailments, one of which had to be placed on life support.

During the same period, the hospital admitted eight adults for respiratory ailments, four of whom had to be placed on life support.

Quinene said the flu season usually sets in about the time kids return to school in early August. Quinene said that she has definitely seen an increase in respiratory hospital admissions this year over last year.

Information provided in the Guam Epidemiology Newsletter, provided by the Department of Public Health and Social Services' Office of Epidemiology and Research, shows cases of acute respiratory infections increase around mid-August and level off in late October.

Linda Unpingco,[/] health services administrator at the Public Health's northern and southern clinics, said she has seen a recent increase in patients with flu-related symptoms coming into the clinics, most of whom are children.[/B]

The clinic hasn't yet received any flu vaccines, Unpingco said, though she said she expects them sometime this month.

Unpingco suggested that people use preventive measures to ensure that they do not catch the flu.

"When you sneeze or cough, cover your mouth -- basic cough etiquette," said Unpingco. "Also, wash your hands and dispose of your tissues properly."

[Commonground]

Re: Seasonal Flu 2008 - 2009

Australia

Patients isolated after gastro outbreak

Posted 1 hour 13 minutes ago

Map: Shepparton 3630

Several people are in isolation in Shepparton's public hospital because of an outbreak of gastroenteritis.

Fifteen people have been treated at the hospital for vomiting and diarrhoea in the past 24 hours.

Another six people at the Ave Maria nursing home are also sick.

Goulburn Valley Health CEO Greg Pullen says they are trying to prevent the virus from spreading.

"There are some patients that are kept in isolation on the medical ward, some on the rehabilitation ward," he said.

"We have to limit access to them unfortunately. We try and ensure that the chance of it spreading is completely reduced, but we can't always do that of course, it's a quite spreadable sort of disease."

http://www.abc.net.au/news/stories/2008/10/15/2392240.htm

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

EUROPEAN CENTRE OF DISEASES PREVENTION AND CONTROL - INFLUENZA NEWS, EXCERPTS

[European Centre of Diseases Prevention and Control (ECDC), Influenza News, Excerpts. For complete release, please follow this link: http://ecdc.europa.eu/en/Health_Topi...za_081016.aspx ]

* Scientific advances - SCIENTIFIC ADVANCES ? PANDEMIC INFLUENZA - INNOVATIONS

-- Glycan microarray technologies ? a tool which can facilitate mapping of the coarse and fine specificity of previous, current and emerging influenza viruses.

- Recent avian H5N1 viruses exhibit increased propensity for acquiring human receptor specificity. J. Stevens et al - Journal of Molecular Biology 2008 Sep 19;381(5) [URL: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WK7-4S85DTV-3&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view =c&_version=1&_urlVersion=0&_userid=10&md5=7b4dea0 57afc07d0f2103783e9e35c82 ]
- Glycan microarray technologies: tools to survey host specificity of influenza viruses. J. Stevens, O. Blixt at al - Nature Reviews Microbiology 4, 857-864 (November 2006) [URL: http://www.nature.com/nrmicro/journal/v4/n11/abs/nrmicro1530.html ]

Description:
These two articles between them describe the theory and application of a set of laboratory techniques, Glycan Microarray Technologies, that has been developed to objectively measure the specificity of influenza viruses to bind to host surface receptors in the human respiratory tract.

The technique is described in the 2006 article and then applied in the 2008 article to avian influenza A(H5N1) viruses of clade 2.2 when the mutations that seemed to make the 1957 and 1968 pandemics gain human receptor specificity are inserted into them.

The authors suggest that this makes the widely spread A(H5N1) ? clade 2.2 influenza strains at higher risk of acquiring an affinity for human receptors than other avian influenza viruses.

ECDC Comment: (16/10/08)
With novel avian influenza viruses, viruses that are essentially transmitting among birds, it is difficult to decide whether or not they are likely to be able to adapt to humans. With A(H5N1) in its current form plainly it has not yet reached that stage in that despite much exposure to humans it has failed to infect them often and transmission from human to humans is even rarer.1

However the difficulty is that one has to have good surveillance to detect a change towards better adaptation to humans and that after the change has happened it is essentially too late to intervene. This technique is one that give an important objective laboratory information as to whether any new avian influenza viruses has moved or (if previous strains are available) is moving closer to being adapted to humans.

However like all laboratory based test it is only a demonstration of human adaptation, not the entire step.

1. ECDC The public health risk from highly pathogenic avian influenza viruses emerging in Europe with specific reference to influenza type A/H5N1 June 1st 2006.

* Public Health Developments - P.H. DEVELOPMENTS ? PANDEMIC INFLUENZA- PREPAREDNESS

-- Draft WHO Guidance on Pandemic Influenza Preparedness and Response ? Core Document - Opportunity for Comment October 15th to November 3rd

For nearly the past 12 months WHO has being reviewing and revising its guidance on planning essentially updating its 2005 pandemic planning guidance.

They have now made available for comment through the internet what is to be regarded as the core document to be published later this year.

This draft guidance is available through the WHO web-site through with a rather cumbersome procedure as those wishing to see the guidance have to fist register and make a declaration before getting access to the document.

The deadline for comment is also tight as all comments have to be in before the end of November 3rd.

There are good reasons for updating the guidance since the last planning document and its accompanying Check List were published.
* Extensive experience has been gained from the pandemic planning process in Europe and elsewhere.
* There has also been much practice in responding to avian influenza outbreaks, some involving human cases in many countries.
* Influenza science has moved on including use of vaccines and antivirals which were hardly mentioned in 2005.
* Pandemic planning has moved out from the health care sector to embrace many other sectors.

Finally the 2005 International Health Regulations have come into force in 2007 providing a major step forward in efforts by the international community to address international public health concerns.

The process of revision has been rapid but detailed and comprehensive with strong involvement of European experts though this is the first consultation open to all countries and the public.

The process and progress was described by WHO in July 2008 through its web-site. It is important to appreciate that the document available now is only the core document and after it will be published a folio of supporting technical document and ?tools? on issues like outbreak communication, on-health sector preparedness, a revised check-list and sample preparedness plans etc.

* P.H. DEVELOPMENTS ? PANDEMIC INFLUENZA - PREPAREDNESS

-- WHO guidelines for emergency health interventions in community settings

Description:
In response to demand from humanitarian agencies for guidance on reducing excess mortality from common illnesses during an influenza pandemic, the WHO in collaboration with external partners has developed practical and simplified recommendations on measures that can be implemented by community-based responders to complement national Pandemic Preparedness Plans.

The two main objectives of document are:
* To provide strategies for prevention and treatment, at the community and household levels, of the most likely contributors to mortality from common illnesses during an influenza pandemic.
* To provide recommendations to support a minimum level of continuity for priority public health programmes during a pandemic.

These WHO guidelines ?Reducing excess mortality from common illnesses during an influenza pandemic ? can be found at:http://www.who.int/diseasecontrol_emergencies/common_illnesses2008_6.pdf

* P.H. DEVELOPMENTS ? PANDEMIC INFLUENZA - PREPAREDNESS

-- Simulation Exercises on Influenza Pandemic Responses in the Asia Pacific Region

Description:
The UN System Influenza Coordination (UNSIC) Asia-Pacific Regional Hub has released a compilation of simulation exercises conducted by countries to prepare for a human influenza pandemic. It has done so in collaboration with Asian Disaster Preparedness Center and the Kenan Institute Asia with contributions of more than 50 writing team members.

This booklet is a compendium of a number of simulation exercises that have been used to test pandemic preparedness and response plans in different countries and by various organizations in the Asia-Pacifi*c region.

Moreover the document provides a brief discussion on the rationale for conducting simulation exercises, different types of exercises that may be pursued, and factors that may influence the selection of types of simulation exercises.

ECDC Comment:
The last two significant pandemics have emerged from the Asia-Pacific Region as has avian influenza A(H5N1) and the most recent A(H3N2) variants. Therefore this part of the world is the most likely area for the emergence of the next pandemic and the place where WHO?s rapid containment strategy.

-- An attempt to stifle and capture a putative influenza virus
The booklet can be downloaded at:http://www.un-influenza.org/files/asia_pacific/temp/unsic_pandemic_complete.pdf

* 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 http://www.undg.org/docs/8097/12-18-07-UN-WB-AHI-Progress-Report-final.doc

A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/
--

<cite cite="http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081016.aspx">http://ecdc.europa.eu/en/Health_Topi...za_081016.aspx</cite>

[Gert van der Hoek]

Re: Seasonal Flu 2008 - 2009

Seasonal Influenza ? European Status

Summary: Levels of influenza activity in Europe are low, with all countries reporting no or only sporadic influenza activity in week 41/2008.

There have been sporadic laboratory confirmed cases of influenza in weeks 40-41/2008: 12 cases of influenza A and one case of influenza B.

http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081016.aspx#Seasonal

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

EISS - Weekly Electronic Bulletin Week 41 : 06/10/2008-12/10/2008 - 17 October 2008, Issue N. 275 - Continuing low levels of influenza activity in Europe

EISS - Weekly Electronic Bulletin Week 41 : 06/10/2008-12/10/2008 - 17 October 2008, Issue N. 275 - Continuing low levels of influenza activity in Europe

? Summary:
Levels of influenza activity in Europe are low, with all countries reporting no or only sporadic influenza activity in week 41/2008.

There have been sporadic laboratory confirmed cases of influenza in weeks 40-41/2008: 12 cases of influenza A and one case of influenza B.

? Epidemiological situation - week 41/2008:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all of the 26 countries providing these data. For the geographical spread indicator, sporadic influenza activity was reported in two countries (England and Sweden) and no activity in 24 countries.

? Cumulative epidemiological situation - 2008-2009 season (since week 40/2008):
So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (e.g. below the national baseline threshold).

? Virological situation - week 41/2008:
The total number of respiratory specimens collected by sentinel physicians in week 41/2008 was 159, of which two (1.3%) were influenza virus positive [types A (H1) and A (H3), respectively].
In addition, five influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals), of which four were type A not subtyped and one was type B.

? Cumulative virological situation - 2008-2009 season (since week 40/2008):
In the first two weeks of the current season, 13 influenza viruses were detected in three countries: eight in England, three in Spain and two in Sweden. Of the detected viruses, eight were type A not subtyped, two type A subtype H1, two type A subtype H3 and one type B.

? Comment:
There have only been a few sporadic laboratory confirmed cases of influenza reported to EISS in this surveillance season (the past two weeks). Hence, it is currently too early to comment on which virus type or subtype may become dominant in Europe this season.

? Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS.
In week 41/2008, 26 countries reported clinical data and 25 countries reported virological data to EISS.

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

? Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.

<table style="width: auto;"><tbody><tr><td></td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From TABLES</td></tr></tbody></table>
<table style="width: auto;"><tbody><tr><td></td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From TABLES</td></tr></tbody></table>

A = Dominant virus A
H1N1 = 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
Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza 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.

Finland : Where available, the epidemiological data are provided by a health-care district in South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).

? Network comments (where available)
-- Switzerland: No activity detected last week.
-
----

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

[Commonground]

Re: Seasonal Flu 2008 - 2009

October 21, 2008
CDC reports the first influenza death this year

TAIPEI, Taiwan ?? The Centers for Disease Control (CDC) said yesterday that the first death from influenza this year was reported last week in southern Taiwan, and it urged people at high risk to get free flu vaccines before the end of November.

According to CDC Deputy Minister Lin Ting, the patient was a 75-year-old woman who fell ill on Oct. 13 and died three days later of influenza with the complication of pneumonia.

?It is a pity that the woman did not get a free flu shot,? said Lin, noting that the first influenza death occurred this year much earlier than in previous years.

Lin said that the flu epidemic generally begins in October and peaks around the Christmas holidays, before receding in February.
-snip-

http://www.chinapost.com.tw/taiwan/national/national-news/2008/10/21/179562/CDC%2Dreports.htm

[HenryN]

Re: Seasonal Flu 2008 - 2009

October 5, 2008 to October 11, 2008 (Week 41)
FluWatch
Low levels of influenza activity continue to be reported in Canada; no new
laboratory detections reported this week
During week 41, influenza activity in Canada remained low with the majority of the influenza surveillance regions
reporting no activity and only six regions (in NS, QC, ON & AB) reported sporadic influenza activity (see map).
No specimens tested positive for influenza in Canada this week (percentage positive = 0&#37;; 0/1,167) (see table).
In week 41, the ILI consultation rate was 18 ILI consultations per 1,000 patient visits (see ILI graph), and is
within the expected range for this week. The sentinel response rate has been slowly increasing over the last
several weeks but remained low at 47% for this week. Fluctuations in ILI consultation rates are expected during
periods of low influenza activity and low sentinel participation. No new influenza outbreaks were reported in
week 41.
Antigenic Characterization:
Since 1 September 2008, National Microbiology Laboratory (NML) has antigenically characterized three
influenza viruses: one influenza A/Brisbane/59/2007(H1N1)-like and two influenza B/Florida/4/2006 viruses,
which are the influenza A(H1N1) and influenza B components recommended for the 2008-09 influenza vaccine.
(see pie chart)
Antiviral Resistance:
The testing results showed that the influenza A(H1N1) isolate was sensitive to amantadine, however, it was
resistant to oseltamivir due to the H274Y mutation. Both of the influenza B viruses tested were found to be
sensitive to oseltamivir.
Influenza-associated Paediatric Hospitalizations:
No laboratory-confirmed influenza-associated paediatric hospitalizations have been reported through the
Immunization Monitoring Program Active (IMPACT) network for the 2008-09 season.
International:

WHO:

During the weeks 39 and 40, overall influenza activity in the southern hemisphere continued to decline. Activity was

low in the rest of the world.

<HTTP: update en influenza disease csr www.who.int />

CDC:

During week 40, overall influenza activity was low with the majority of the states reporting no activity and only 7

states reported sporadic activity. Of the 1,123 specimens tested for influenza viruses in week 40, 8 (0.7%) were positive.
From May 18 - September 27, 2008, the CDC antigenically characterized 6 influenza viruses: 4 influenza A(H1), 1
influenza A(H3), and 1 influenza B. All six viruses are antigenically similar to the components selected for the 2008-09
influenza vaccine. CDC performed oseltamivir and zanamivir resistance testing on 10 influenza A and B viruses collected
since May 18. Two of the 6 influenza A(H1N1) viruses tested were found to be resistant to oseltamivir and the influenza
A(H3N2) and influenza B viruses tested were sensitive to oseltamivir. All tested viruses retain their sensitivity to zanamivir.
Of the 6 influenza A viruses collected since May 18 that were tested for adamantane resistance, 1 influenza A(H3N2)

virus and 1 of the 5 influenza A (H1N1) viruses tested were resistant.

<HTTP: weekly flu www.cdc.gov />

EISS:

In week 41, levels of influenza activity in Europe were low, with all countries reporting no or only sporadic influenza

activity. Since week 40, 13 influenza viruses were detected of which 8 were influenza A not subtyped, 2 were influenza
A(H1), 2 were influenza A(H3) and 1 was influenza B. It is currently too early to determine which virus type or subtype may
become dominant in Europe this season. <

http://www.eiss.org/cgi-files/bulletin_v2.cgi>

Human Avian Influenza:

No new cases of human H5N1 avian influenza infection have been reported by the WHO since

10 September 2008.

<HTTP: en disease csr www.who.int index.html avian_influenza>

Recommended composition of influenza virus vaccines for use in the 2009 southern hemisphere influenza
season:
It is recommended that vaccines for use in the 2009 influenza season (southern hemisphere winter) contain the following:
– an A/Brisbane/59/2007 (H1N1)-like virus
– an A/Brisbane/10/2007 (H3N2)-like virus
– a B/Florida/4/2006-like virus

<http://www.who.int/wer/2008/wer8341/en/index.html>
http://www.phac-aspc.gc.ca/fluwatch/...008-41-eng.pdf

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

EUROPEAN CENTRE OF DISEASES PREVENTION AND CONTROL (ECDC) - INFLUENZA NEWS (EXCERTPS)

[EUROPEAN CENTRE OF DISEASES PREVENTION AND CONTROL (ECDC) - INFLUENZA NEWS (EXCERPTS)

* Scientific advances - SCIENTIFIC ADVANCES ? PANDEMIC INFLUENZA - VACCINES

-- Influenza vaccine safety monitoring ? the US experience.

Iskander J, Broder K.

- Monitoring the safety of annual and pandemic influenza vaccines: lessons from the US experience Expert review of vaccines. 2008 Feb; 7(1):75-82

Description:
In this paper authors from the U.S. Centers for Disease Control and Prevention (CDC) discuss the issues concerning how broad and focused vaccine safety surveillance and research will be undertaken both for seasonal and for pandemic vaccines when deployed on a large scale in a pandemic.

They point out the experience from 1976-77 in the USA when severe adverse events Guillain-Barre syndrome were associated with deployment of an influenza vaccine and how this then halted an emergency vaccination campaign.(1)

They argue that the role of public health officials is to monitor unexpected and rare events during a national vaccination program, because recent experience suggests that detection of common nonserious adverse event following immunization occurs quite frequently, but can be planned for.

They argue that existing United States vaccine safety surveillance infrastructure (Vaccine Adverse Event Reporting System VAERS, Vaccine Safety Datalink VSD) may need to be enhanced in order to be able to provide large amounts of safety data in a timely manner, as may be needed during a prepandemic or pandemic vaccine campaign.

ECDC Comment: (23/10/08)
The circumstances and challenge described by CDC for the United States would apply also in Europe either with seasonal influenza vaccines or more especially human avian influenza (?per-pandemic?) vaccines (HAIVs) and specific pandemic vaccines (SPVs).

With seasonal influenza vaccines adverse events, seemingly associated with immunisation, occur on occasion and always need careful investigation.(2)

Though its rare to find a causative relationship these events are disruptive to vaccination programmes both where they occur and in other countries through media reporting. In the event of a pandemic SPVs and HAIVs would be offered to large numbers of people rapidly. While there would be some safety experience with the HAIVs this would be for a limited number of people and by definition there would be hardly any experience with the SPVs which would be being prepared rapidly and mass distributed.

By chance alone there would be adverse events taking place in association with these immunisations. It is easy to imagine that these could be perceived as having a causative relationship with vaccination and of course there would always be the possibility that this was a real relationship.(1)

The challenge for Europe would be as for the United States, namely to quickly assess reported associations and investigate and analyse those that have epidemiological and biological plausibility.

This will only be possible with pre-planning and investigations could probably not be left to vaccine producers alone if the results are to have credibility.

1. Schonberger LB, Bergman DJ, Sullivan-Bolyai JZ, et al. Guillain-Barr? syndrome following vaccination in the National Influenza Immunization Program, United States, 1976-1977. Am J Epidemiol. 1979;110:105-123.
2. ECDC Risk Assessment October 2006 ? Four sudden deaths in elderly patients associated with use of influenza vaccine in Israel.

* Public Health Developments

-- An International Pandemic Influenza Preparedness Strategy published by the UK Government

Ahead of the International Ministerial Conference on Avian and Pandemic Influenza in Egypt 24-26 October (see next item) the UK Government has this week published an international strategy on pandemic preparedness demonstrating a cross government approach for the next three to five years. ?

* 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 http://www.undg.org/docs/8097/12-18-...port-final.doc

A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/

-- Retroscreen Virology Conference - Medical, Scientific and Historical Lessons from the Great Avian (H1N1) "Spanish" Influenza Pandemic of 1918: The 90th Anniversary 10th November 2008 at The Imperial War Museum - London

This conference specifically considers the first World War and the start of the Spanish Influenza pandemic.

Specifically did the war itself engender the emergence of this avian influenza A(H1N1)?

Are there serious lessons from that pandemic to help today as we prepare for 21st century pandemics?

Details are at http://www.retroscreen.com/rv/news/r...08/2008-09-08/

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

A web-site with registration details are at http://www.espace-ethique.org/fr/pan...ember_2008.php

-- 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
-

<cite cite="http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081023.aspx">http://ecdc.europa.eu/en/Health_Topi...za_081023.aspx</cite>