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<TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD align=middle width=780 bgColor=#0063c8 height=1>EISS - Weekly Electronic Bulletin</TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#0063c8 height=1><TABLE border=0><TBODY><TR bgColor=white><TD noWrap width=254 bgColor=#0063c8>Week 47 : 17/11/2008-23/11/2008</TD><TD noWrap align=middle width=258 bgColor=#0063c8></TD><TD noWrap align=right width=254 bgColor=#0063c8>28 November 2008, Issue N? 281</TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=3></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD> Influenza activity in Europe continues to be low Summary: The level of influenza activity was low in all countries reporting data in week 47/2008. Since week 40/2008, sporadic laboratory-confirmed cases of influenza have been reported from 19 countries across Europe.
Epidemiological situation - week 47/2008: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all the 27 countries providing data. For the geographical spread indicator, sporadic influenza activity was reported in nine countries (Belgium, Denmark, England, Ireland, Northern Ireland, Norway, Spain, Sweden and Switzerland) with no activity in the other 18 countries. Definitions for the epidemiological indicators can be found here.
Cumulative epidemiological situation ? 2008-2009 season (weeks 40-47/2008): So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (i.e. below the national baseline threshold).
Virological situation - week 47/2008: The total number of respiratory specimens collected by sentinel physicians in week 47/2008 was 435, of which 40 (9.2%) were positive for influenza virus: 38 type A (32 subtype H3 and six not subtyped) and two type B. In addition, 35 influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals): 34 type A (one subtype H1, eight subtype H3 and 25 not subtyped), and one type B. Detection of influenza viruses was reported from nine countries across Europe.
Cumulative virological situation ? 2008-2009 season (weeks 40-47/2008): Of 281 virus detections (sentinel and non-sentinel) since week 40/2008, 255 were type A (118 subtype H3, 19 subtype H1 and 118 not subtyped) and 26 were type B.
Based on the antigenic and/or genetic characterisation of 55 influenza viruses, three were reported as A/Brisbane/59/2007 (H1N1)-like, 49 as A/Brisbane/10/2007 (H3N2)-like, one as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and two as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) (click here).
The number of viruses tested for antiviral resistance remained unchanged compared to those reported in week 46 (click here).
Comment: Many countries continue to report sporadic influenza virus detection, although this has not been accompanied by significant increases in overall consultation rates. The 19 countries that have detected influenza viruses since week 40/2008 are geographically distributed throughout Europe. The majority (91%; 255/281) of virus detections up to week 47 have been type A. The proportion of type A viruses subtyped as H3 has increased from 83% (73/88) at week 45 to 86% (118/137) at week 47. However, while this subtype seems to account for a majority of viruses in some countries (e.g. UK, Spain, Sweden), it is still too soon to conclude which virus type or subtype may become dominant in Europe this season, as data remain less clear for many other larger countries..
Whilst influenza activity in Europe is currently low, reports of Respiratory Syncytial Virus (RSV) detections from countries in Europe that report them to EISS, showed continued increases in England, Ireland, the Netherlands and Northern Ireland). RSV infections induce clinical symptoms similar to influenza. Increase in RSV detections at this time of the year is a normal phenomenon in these countries.
Background: The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. In week 47/2008, 27 countries reported both clinical and virological data to EISS. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (UK).
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
Clicking on the map will, if available, take you through to the national web site. If 'regional' activity is reported, a pop-up text box will appear which describes the activity in greater detail.
Clicking on England and France will provide you with regional data.
</TD><TD></TD><TD vAlign=top>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 with
a 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 population
comprising 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 one
percent of the Finnish population). </TD></TR></TBODY></TABLE></CENTER></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD>Network comments (where available)
<TABLE><TBODY><TR><TD width=20> </TD><TD width=700>Italy
Three further A/H3N2 influenza viruses have been isolated during this week. Latvia
In week 47,a specimen from non-sentinel girl of 13 years old ,patient with ARI ,was positive for influenza A.It was the first laboratory- confirmed influenza case in Latvia Switzerland
no influenza virus was detected during the week 47. One additional influenza A virus was detected during the week 46. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE width=780><TBODY><TR><TD>Table and graphs (where available)
Neither the European Centre for Disease Prevention and Control (ECDC), nor any person acting on his behalf is liable for the use that may be made of the information contained in this bulletin. Maps and commentary used in this Bulletin do not imply any opinions whatsoever of ECDC or its partners on the legal status of the countries and territories shown or concerning their borders. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD align=middle width=780 bgColor=#0063c8>EISS : Weekly Electronic Bulletin</TD></TR></TBODY></TABLE>
Influenza activity in Canada remains low; lab detections and ILI consultation rates continue to increase from previous weeks
During week 47, influenza activity in Canada remained low with the majority of the influenza surveillance regions reporting no activity. Slightly more regions (n=10; in BC, AB, ON & QC ) reported sporadic influenza activity this week compared to the previous week (see map). Twenty specimens tested positive for influenza in Canada this week (percentage positive =1.2%; 20/1,683) (see table). In week 47, the ILI consultation rate increased to 17 ILI consultations per 1,000 patient visits (see ILI graph), and is within the expected range for this week. The sentinel response rate was at 60%. No new influenza outbreaks were reported in week 47.
Antigenic Characterization & Antiviral Resistance:
Since 1 September 2008, the NML has antigenically characterized six influenza viruses: one influenza A/Brisbane/59/2007(H1N1)-like (from NS), two influenza A/Brisbane/10/2007(H3N2)-like (from BC & ON), two influenza B/Florida/4/2006-like (from ON and AB) and one B/Malaysia/2506/2004-like (from AB). A/Brisbane/59/2007(H1N1), A/Brisbane/10/2007(H3N2) and B/Florida/4/2006 are the influenza A and influenza B components recommended for the 2008-09 influenza vaccine. B/Malaysia/2506/2004 was the influenza B component for the 2007-2008 season vaccine (see pie chart). Antiviral Resistance:
Since the start of the season, the NML has tested 2 influenza A isolates (1 H1N1 and 1 H3N2) for amantadine resistance and found that the H3N2 isolate was resistant to amantadine and the H1N1 isolate was susceptible; resulting in 50% (1/2) resistance among all influenza A isolates tested.
The NML has also tested 5 influenza isolates (1 A/H1N1, 1 A/H3N2 & 3 B) for oseltamivir (Tamiflu) resistance and found that the H1N1 isolate tested was resistant to oseltamivir due to the H274Y mutation whereas the H3N2 and B isolates were susceptible; resulting in 20% (1/5) resistance among all influenza isolates tested.
All 5 influenza isolates (1 A/H1N1, 1 A/H3N2 & 3 B) tested for zanamivir resistance to date were sensitive to zanamivir. 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 45 to 46, the level of overall influenza activity in the world remained low with sporadic activity observed in some countries.
<a href="http://www.who.int/csr/disease/influenza/update/en/" rel="x"><acronym title="World Health Organization">WHO</acronym>
-->CDC: During week 47, a low level of influenza activity was reported in the United States. One state (Hawaii) reported local influenza activity however the majority reported either no activity or sporadic activity. Of the 2,080 specimens tested this week for influenza viruses, 52 (2.5%) were positive. Since 1 October 2008, the CDC has antigenically characterized 21 influenza viruses: 20 influenza A(H1) (all A/Brisbane/59/2007-like) and 1 influenza B (B/Florida/04/2006-like). Since 1 October, 2008, 34 influenza viruses (21 A(H1N1), 5 A (H3N2), and 8 B) have been tested for resistance to neuraminidase inhibitors. Of the A(H1N1) viruses tested, 95% (20/21) were resistant to oseltamivir however all were sensitive to zanamivir. All of the A(H3N2) and B viruses tested were sensitive to both oseltamivir and zanamivir. The CDC tested 10 influenza A viruses (6 H1, 4 H3) for amantadine resistance: all of the H1N1 viruses were sensitive to amantadine however all the H3N2 viruses were resistant.
<A href="http://www.cdc.gov/flu/weekly/" target=_blank rel=x><ACRONYM title="Centers for Disease Control and Prevention ">CDC</ACRONYM>
EISS: Influenza activity in Europe continues to be low. The majority (91%) of virus detections have been influenza A and 86% of those subtyped were shown to be A/H3. Limited data are available on antiviral resistance: 92% (11/12) of the influenza A(H1N1) viruses analysed to date are resistant to oseltamivir. These represent very early-season isolates and therefore it is too early to comment on the antiviral resistance pattern for Europe as a whole.
<A href="http://www.eiss.org/cgi-files/bulletin_v2.cgi" target=_blank rel=x><ACRONYM title=" European Influenza Surveillance Scheme">EISS</ACRONYM>
Human Avian Influenza: No new cases of human H5N1 avian influenza infection have been reported by the WHO since 10 September 2008.
<A href="http://www.who.int/csr/disease/avian_influenza/en/index.html" target=_blank rel=x><ACRONYM title="World Health Organization">WHO</ACRONYM>
Fightflu.ca : Canada's provinces and territories and the Public Health Agency of Canada launched fightflu.ca, a pan-Canadian web portal designed to provide Canadians with one-stop access to information about influenza and ways to limit its spread. The portal also provides fact sheets on influenza and tips for avoiding infection in over 10 languages.
Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Note: Cumulative data includes updates to previous weeks; due to reporting delays, the sum of weekly report totals do not add up to cumulative totals. Abbreviations: Newfoundland/Labrador (NL), Prince Edward Island (PE), New Brunswick (NB), Nova Scotia (NS), Quebec (QC), Ontario (ON), Manitoba (MB), Saskatchewan (SK), Alberta (AB), British Columbia (BC), Yukon (YT), Northwest Territories (NT), Nunavut (NU) Respiratory virus laboratory detections in Canada, by geographic regions, are available weekly on the following website:
<http://www.phac-aspc.gc.ca/bid-bmi/dsd-dsm/rvdi-divr/index-eng.php>
Number of influenza surveillance regions? reporting widespread or localized influenza activity, Canada, by report week, 2008-2009 (N=54)
? sub-regions within the province or territory as defined by the provincial/territorial epidemiologist. Graph may change as late returns come in.
<TABLE width="100%"><TBODY><TR vAlign=top align=middle><TD colSpan=2>Influenza Activity Level by Provincial and Territorial
Influenza Surveillance Regions, Canada,
November 16, 2008 to November 22, 2008 (Week 47)
</TD></TR><TR vAlign=top align=middle><TD class=alignCenter>
</TD><TD><TABLE cellSpacing=0 cellPadding=1 border=0><TBODY><TR><TD align=middle><TABLE class=border-lite cellSpacing=1 cellPadding=1><TBODY><TR align=middle><TD>No Data </TD><TD></TD></TR><TR align=middle><TD>No Activity</TD><TD></TD></TR><TR align=middle><TD>Sporadic Activity</TD><TD></TD></TR><TR align=middle><TD>Localized Activity</TD><TD></TD></TR><TR align=middle><TD>Widespread
Activity</TD><TD></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE> Note: Influenza activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates (see graphs and tables) and outbreaks. Please refer to detailed definitions. For areas where no data is reported, late reports from these provinces and territories will appear on the FluWatch website. Select single maps by report week to get this updated information.
<http://dsol-smed.phac-aspc.gc.ca/dsol-smed/fluwatch/fluwatch.phtml?lang=e> Click on the map to view provinces/territories and maps for other weeks.
Influenza tests reported and percentage of tests positive, Canada, by report week, 2008-2009
Percent positive influenza tests, compared to other respiratory viruses, Canada, by reporting week, 2008-2009
Influenza strain characterization, Canada, cumulative, 2008-2009 influenza season by the Respiratory Viruses Section at the National Microbiology Laboratory
[N=6]
{Strain characterization, number identified, per cent of total number} NACI recommends that the trivalent vaccine for the 2008-2009 season in Canada contain A/Brisbane/59/2007 (H1N1)-like virus; an A/Brisbane/10/2007 (H3N2)-like virus; and a B/Florida/4/2006-like virus.
Influenza-like illness (ILI) consultation rates, Canada, by report week,
2008-2009 compared to 1996/97 through to 2006/07 seasons
Note: No data available for mean rate in previous years for weeks 19 to 39 (1996-1997 through 2002-2003 seasons).
Number of New Outbreaks in Long Term Care Facilities, Canada, by Report Week, 2008-2009
ITALY
During this third week of surveillance, twenty-six samples were collected by network surveillance.
Of these, four were influenza positive.
Florence University, has isolated two viruses, one of them was already characterized as an influenza A/H3N2 virus, while the other is currently under further subtyping.
The other two viruses have been isolated by laboratory of Parma's University.
Antigenic characterization, done by NIC, on the A/H3N2 viruses isolated during the first two surveillance weeks, have demonstrated the viruses belong to A/H3N2/Brisbane/1007 lineage, reference strain for the current influenza vaccines.
Table represented below summarizes the results of the first three weeks of surveillance.
Note. It is possible that table reports different data compared to previous week(s), due to further virus characterization and isolation.
Europe
In the most part of European countries virus circulation is low and there were only sporadic isolation / characterization. Among the samples collected by European network, 75 were state positive; of them, 72 were influenza A (of them 40 H3N2, a H1N1 and 31 unsubtyped).
The remaining 3 were stated influenza B positive.
The circulation of RSV is increasing (respiratory syncitial virus) along with other respiratory viruses.
USA
Influenza virus circulation remains low. Among samples collected and analyzed, only 56 (2.5%) of the total were influenza positive. 19% were influenza A, subtype H1,while the 50% were type A unsubtyped. The remaining 31% of the samples was influenza B positive.
[ITALY: MINISTRY OF HEALTH] VIROLOGIC SURVEILLANCE FOR INFLUENZA
USA
Influenza virus circulation remains low. Among samples collected and analyzed, only 56 (2.5% of the total were influenza positive. 19% were influenza A, subtype H1,while the 50% were type A unsubtyped. The remaining 31% of the samples was influenza B positive.
The HPA National Influenza Reports for 2008/09 season will be published fortnightly until activity begins to increase, when they will be published weekly. A short summary of activity will be made available in the weeks between the fortnightly reports. The next complete influenza report will be published on Wednesday 10 December 2008.
Reporting period: Week 48 (24/11/08-30/11/08)
Influenza activity remained stable at low levels across all the countries of the United Kingdom during week 48/08. Some clinical indicators of influenza have increased in England, Scotland and Wales but have slightly decreased in Northern Ireland in week 48/08, compared with week 47/08. Flu activity in countries with baseline activity thresholds are well below this level. Reports of influenza A from NHS and HPA laboratories have increased from 11 in week 47/08 to 37 in week 48/08, there have been no further influenza B reports and laboratory reports of RSV have also increased. Fifty-one samples referred to the Centre for Infections' Respiratory Virus Unit (RVU) tested positive for influenza A (48 (94.1% A (H3) and 3 A (H1)), which is an increase from 21 in week 47/08. One sample was positive for influenza B and seven were positive for RSV. In week 48/08 three sentinel samples (7.7%) and seven routine samples (13.7%) from Scotland and four non-sentinel samples from Northern Ireland tested positive for influenza A. To date one sentinel and nine non-sentinel samples have been positive for influenza A in Wales.
Levels of influenza activity in Europe were low in week 47/08.
Neuraminidase inhibitor susceptibility testing on 30 influenza A (H3) isolates since week 36/08 showed that all are sensitive to oseltamivir and zanamivir, but resistant to amantadine. One influenza B isolate received in week 47/08 has been tested and is sensitive to oseltamivir and zanamivir. In the same time period, 18influenza A (H1) isolates have been tested, of which 17 are resistant to oseltamivir but sensitive to zanamivir and amantadine. Of these 17, 14 are from South West England, one is from Wales, one from Central England and one from North England. Two oseltamivir-resistant influenza A (H1) specimens have been reported from Scotland.
Three outbreaks from nursing homes have been reported recently, one in south England in week 48/08 which has been confirmed as influenza A, and two, one in south west England and one in south east England, in week 49/08. The south west outbreak has been confirmed as influenza A. There has also been an influenza A positive outbreak in a renal unit in northern England.
Influenza vaccination uptake in England has continued to increase. The proportion vaccinated in the over 65 years old group increased from 68.3% in week 47/08 to 69.7% in week 48/08 and in the under 65 years at risk group it increased from 40% in week 47/08 to 42.2% in week 48/08.
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
Clicking on the map will, if available, take you through to the national web site. If 'regional' activity is reported, a pop-up text box will appear which describes the activity in greater detail.
Clicking on England and France will provide you with regional data.
</TD><TD></TD><TD vAlign=top>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 with
a 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 population
comprising 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 one
percent of the Finnish population). </TD></TR></TBODY></TABLE></CENTER></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD>Network comments (where available)
<TABLE><TBODY><TR><TD width=20> </TD><TD width=700>Bulgaria
No detection or isolation of Influenza viruses in sentinel and nonsentinel samples. Italy
Three further A/H3N2 influenza viruses have been isolated during this last week. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE width=780><TBODY><TR><TD>Table and graphs (where available)
Neither the European Centre for Disease Prevention and Control (ECDC), nor any person acting on his behalf is liable for the use that may be made of the information contained in this bulletin. Maps and commentary used in this Bulletin do not imply any opinions whatsoever of ECDC or its partners on the legal status of the countries and territories shown or concerning their borders. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD align=middle width=780 bgColor=#0063c8>EISS : Weekly Electronic Bulletin</TD></TR></TBODY></TABLE>
<TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD align=middle width=780 bgColor=#0063c8 height=1>EISS - Weekly Electronic Bulletin</TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#0063c8 height=1><TABLE border=0><TBODY><TR bgColor=white><TD noWrap width=254 bgColor=#0063c8>Week 48 : 24/11/2008-30/11/2008</TD><TD noWrap align=middle width=258 bgColor=#0063c8></TD><TD noWrap align=right width=254 bgColor=#0063c8>05 December 2008, Issue N? 282</TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=3></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD> Overall low levels of influenza activity in Europe, despite slowly increasing activity in some countries Summary: The level of influenza activity was low in all countries reporting data in week 48/2008. Since week 40/2008, sporadic laboratory-confirmed cases of influenza have been reported from 20 countries across Europe.
Epidemiological situation - week 48/2008: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all the 25 countries providing data. Eleven countries, however, reported increasing clinical activity (Estonia, Hungary, Latvia, Lithuania, Poland, Serbia, Slovakia, Spain, Sweden, England (two out of three regions) and Portugal). For the geographical spread indicator, sporadic influenza activity was reported in 11 countries (Belgium, Denmark, England, Germany, Hungary, Ireland, Northern Ireland, Norway, Portugal, Spain and Sweden) with no activity in the other 14 countries. Definitions for the epidemiological indicators can be found here.
Cumulative epidemiological situation ? 2008-2009 season (weeks 40-48/2008): So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (i.e. below the national baseline threshold).
Virological situation - week 48/2008: The total number of respiratory specimens collected by sentinel physicians in week 48/2008 was 536, of which 65 (12.1%) were positive for influenza virus: 63 type A (49 subtype H3, two H1 and 12 not subtyped) and two type B. In addition, 72 influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals): 68 type A (20 subtype H3, one subtype H1 and 47 not subtyped) and four type B. Detection of influenza viruses was reported from 11 countries across Europe.
Cumulative virological situation ? 2008-2009 season (weeks 40-48/2008): Of 430 virus detections (sentinel and non-sentinel) since week 40/2008, 395 were type A (197 subtype H3, 23 subtype H1 and 175 not subtyped) and 35 were type B.
Based on the antigenic and/or genetic characterisation of 79 influenza viruses, 70 were reported as A/Brisbane/10/2007 (H3N2)-like, five as A/Brisbane/59/2007 (H1N1)-like, three as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) and one as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) (click here).
Limited antiviral resistance data are available from only three countries (Austria, England and Norway). Most (18/19) of the A(H1N1) viruses analysed to date are oseltamivir-resistant but all 19 remain sensitive to zanamivir. Of 27 A(H3N2) viruses analysed to date for neuraminidase inhibitor susceptibility, all are sensitive to both oseltamivir and zanamivir. Of 26 A(H3N2) viruses analysed for adamantane susceptibility, all are resistant. Whilst these data represent early-season isolates from few countries, it appears that H1N1 is a minority circulating subtype. Most circulating influenza A at present appears to be H3N2 which remains fully sensitive to oseltamivir and zanamivir.
Comment: Many countries continue to report sporadic influenza virus detection, although this has not been accompanied by significant increases in overall consultation rates. Of the 11 countries that reported increasing clinical activity during week 48/2008, only four (Spain, Sweden, England and Portugal) also reported influenza virus detections. The 20 countries that have detected influenza viruses since week 40/2008 are geographically distributed throughout Europe. The majority (92%; 395/430) of virus detections up to week 48 have been type A. The proportion of type A viruses subtyped as H3 has increased from 86% (118/137) in week 47 to 90% (205/228) in week 48. Virological subtype analysis indicates that whilst there is mixed circulation of H1 and H3 in countries reporting isolates, the distribution so far appears to be mainly H3.
Whilst influenza activity in Europe is currently low, reports of Respiratory Syncytial Virus (RSV) detections from countries in Europe that report RSV detections to EISS, showed continued increases in England, Ireland, the Netherlands, Northern Ireland and Spain). Increase in RSV detections at this time of the year is a normal phenomenon in these countries. RSV infections induce clinical symptoms similar to influenza.
Background: The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. In week 48/2008, 27 countries reported either clinical and/or virological data to EISS. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (UK). </TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE width=780 border=0><TBODY><TR><TD>Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
Clicking on the map will, if available, take you through to the national web site. If 'regional' activity is reported, a pop-up text box will appear which describes the activity in greater detail.
Clicking on England and France will provide you with regional data.
</TD><TD></TD><TD vAlign=top>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 with
a 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 population
comprising 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 one
percent of the Finnish population). </TD></TR></TBODY></TABLE></CENTER></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD>Network comments (where available)
<TABLE><TBODY><TR><TD width=20> </TD><TD width=700>Bulgaria
No detection or isolation of Influenza viruses in sentinel and nonsentinel samples. Italy
Three further A/H3N2 influenza viruses have been isolated during this last week. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=#1d92ff height=5></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=white><TABLE width=780><TBODY><TR><TD>Table and graphs (where available)
Neither the European Centre for Disease Prevention and Control (ECDC), nor any person acting on his behalf is liable for the use that may be made of the information contained in this bulletin. Maps and commentary used in this Bulletin do not imply any opinions whatsoever of ECDC or its partners on the legal status of the countries and territories shown or concerning their borders. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD width=780 bgColor=black height=1></TD><TD width=1 bgColor=black height=1></TD></TR><TR><TD width=1 bgColor=black height=1></TD><TD align=middle width=780 bgColor=#0063c8>EISS : Weekly Electronic Bulletin</TD></TR></TBODY></TABLE>
>>Limited antiviral resistance data are available from only three countries (Austria, England and Norway). Most (18/19) of the A(H1N1) viruses analysed to date are oseltamivir-resistant <<
The above comment indicates H1N1 Tamiflu resistance in Austria is at 100% (the one sensitive isolate was reported by England weeks ago).
100% H1N1 Tamiflu Resistance in Austria Recombinomics Commentary 14:24 December 5, 2008
Limited antiviral resistance data are available from only three countries (Austria, England and Norway). Most (18/19) of the A(H1N1) viruses analyzed to date are oseltamivir-resistant
The above comments from the EISS report for Europe indicate H1N1 Tamiflu resistance in Austria is 100%. The previous report on resistance in Europe was 11/12 from England and Norway, so 7/7 of the most recent tests, which include 1-7 samples from Austria, have H274Y.
Some of the 7 recent samples could have come from England, since the resistance totals in England were last reported at 17/18, in addition to 2/2 in Scotland. Similar levels have been reported in North America (1/1 in Canada and 20/21 in the United States), confirming that H1N1 Tamiflu resistance in North America and Europe is at or near 100%.
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"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
Why does it appear there is more antiviral resistance in H1N1 and not H3N2?
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"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
Comment