Seasonal Flu 2008 - 2009

[HenryN]

Re: Seasonal Flu 2008 - 2009

2008-2009 Influenza Season Week 1 ending January 17, 2009
(All data are preliminary and may change as more reports are received.)
Synopsis:

During week 2 (January 11-17, 2009), influenza activity continued to slowly increase in the United States.

• Four hundred nine (11.5%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
• Two influenza-associated pediatric deaths were reported.
• The proportion of outpatient visits for influenza-like illness (ILI) was below national and region-specific baseline levels.
• One state reported widespread influenza activity, six states reported regional activity; 11 states reported local influenza activity; the District of Columbia, Puerto Rico and 30 states reported sporadic influenza activity; and two states reported no influenza activity.

<TABLE class=table cellSpacing=0 cellPadding=3 align=center border=0><CAPTION>National and Regional Summary of Select Surveillance Components

</CAPTION><TBODY><TR vAlign=top><TH vAlign=bottom width=85 rowSpan=2>

Region

</TH><TH noWrap align=middle width=300 colSpan=3>Data for current week</STRONG></TH><TH noWrap align=middle width=276 colSpan=5>Data cumulative for the season</TH></TR><TR vAlign=top><TH align=middle width=72>Out-patient ILI*</TH><TH align=middle width=72>% positive for flu?</TH><TH align=middle width=96>Number of jurisdictions reporting regional or widespread activity?</TH><TH noWrap align=middle width=48>A (H1)</TH><TH noWrap align=middle width=48>A (H3)</TH><TH align=middle width=60>A Unsub-typed</TH><TH noWrap align=middle width=48>B</TH><TH align=middle width=72>Pediatric Deaths</TH></TR><TR><TD align=left width=85>Nation</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>11.5 % </TD><TD noWrap align=middle width=96>7 of 51 </TD><TD noWrap align=middle width=48>641</TD><TD noWrap align=middle width=48>104</TD><TD noWrap align=middle width=60>1292</TD><TD noWrap align=middle width=48>413</TD><TD noWrap align=middle width=72>2</TD></TR><TR><TD align=left width=85>New England</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>5.2 % </TD><TD noWrap align=middle width=96>1 of 6</TD><TD noWrap align=middle width=48>24</TD><TD noWrap align=middle width=48>5</TD><TD noWrap align=middle width=60>45</TD><TD noWrap align=middle width=48>8</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>Mid-Atlantic</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>5.3 % </TD><TD noWrap align=middle width=96>2 of 3</TD><TD noWrap align=middle width=48>69</TD><TD noWrap align=middle width=48>11</TD><TD noWrap align=middle width=60>102</TD><TD noWrap align=middle width=48>23</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>East North Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>16.8 % </TD><TD noWrap align=middle width=96>0 of 5</TD><TD noWrap align=middle width=48>59</TD><TD noWrap align=middle width=48>7</TD><TD noWrap align=middle width=60>24</TD><TD noWrap align=middle width=48>18</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>West North Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>4.1 % </TD><TD noWrap align=middle width=96>0 of 7</TD><TD noWrap align=middle width=48>31</TD><TD noWrap align=middle width=48>7</TD><TD noWrap align=middle width=60>49</TD><TD noWrap align=middle width=48>20</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>South Atlantic</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>5.3 % </TD><TD noWrap align=middle width=96>2 of 9</TD><TD noWrap align=middle width=48>54</TD><TD noWrap align=middle width=48>7</TD><TD noWrap align=middle width=60>192</TD><TD noWrap align=middle width=48>113</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>East South Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>1.3 % </TD><TD noWrap align=middle width=96>0 of 4</TD><TD noWrap align=middle width=48>2</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>0</TD><TD noWrap align=middle width=48>7</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>West South Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>13.4 % </TD><TD noWrap align=middle width=96>1 of 4</TD><TD noWrap align=middle width=48>93</TD><TD noWrap align=middle width=48>1</TD><TD noWrap align=middle width=60>629</TD><TD noWrap align=middle width=48>189</TD><TD noWrap align=middle width=72>1</TD></TR><TR><TD align=left width=85>Mountain</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>12.1 % </TD><TD noWrap align=middle width=96>1 of 8</TD><TD noWrap align=middle width=48>49</TD><TD noWrap align=middle width=48>56</TD><TD noWrap align=middle width=60>149</TD><TD noWrap align=middle width=48>11</TD><TD noWrap align=middle width=72>1</TD></TR><TR><TD align=left width=85>Pacific</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>5.7 % </TD><TD noWrap align=middle width=96>0 of 5</TD><TD noWrap align=middle width=48>260</TD><TD noWrap align=middle width=48>10</TD><TD noWrap align=middle width=60>102</TD><TD noWrap align=middle width=48>24</TD><TD noWrap align=middle width=72>0</TD></TR></TBODY></TABLE>
* Elevated means the % of visits for ILI is at or above the national or region-specific baseline
? National data is for current week; regional data is for the most recent three weeks.
? Includes all 50 states and the District of Columbia
U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C. report to CDC the number of respiratory specimens tested for influenza each week. The results of tests performed during the current week and cumulative totals for the season are summarized in the table below.
<TABLE class=table cellSpacing=0 cellPadding=3 align=center border=0><TBODY><TR><TH align=left width=200></TH><TH noWrap align=middle width=140>Week 2</TH><TH noWrap align=middle width=140>Cumulative for the Season</TH></TR><TR><TD align=left width=200>No. of specimens tested</TD><TD noWrap align=middle width=140>3544</TD><TD noWrap align=middle width=140>66499</TD></TR><TR><TD align=left width=200>No. of positive specimens (%)</TD><TD noWrap align=middle width=140>409 (11.5%)</TD><TD noWrap align=middle width=140>2,450 (3.7%)</TD></TR><TR><TD align=left colSpan=3>Positive specimens by type/subtype</TD></TR><TR><TD align=left width=170> Influenza A</TD><TD noWrap align=middle width=140>346 (84.6%)</TD><TD noWrap align=middle width=140>2,037(83.1%)</TD></TR><TR><TD align=left width=170> A (H1)</TD><TD noWrap align=middle width=140>44 (12.7%)</TD><TD noWrap align=middle width=140>641 (31.5%)</TD></TR><TR><TD align=left width=170> A (H3)</TD><TD noWrap align=middle width=140>4 (1.2%)</TD><TD noWrap align=middle width=140>104 (5.1%)</TD></TR><TR><TD align=left width=170> A (unsubtyped)</TD><TD noWrap align=middle width=140>298 (86.1%)</TD><TD noWrap align=middle width=140>1,292 (63.4%)</TD></TR><TR><TD align=left width=170> Influenza B</TD><TD noWrap align=middle width=140>63 (15.4%)</TD><TD noWrap align=middle width=140>413 (16.9%)</TD></TR></TBODY></TABLE>
The District of Columbia and 45 states from all nine surveillance regions have reported laboratory-confirmed influenza this season.
<CENTER>
View WHO-NREVSS Regional Bar Charts| View Chart Data | View Full Screen </CENTER>Antigenic Characterization:

CDC has antigenically characterized 207 influenza viruses [142 influenza A (H1), 13 influenza A (H3) and 52 influenza B viruses] collected by U.S. laboratories since October 1, 2008.
All 142 influenza A (H1) viruses are related to the influenza A (H1N1) component of the 2008-09 influenza vaccine (A/Brisbane/59/2007). All 13 influenza A (H3N2) viruses are related to the A (H3N2) vaccine component (A/Brisbane/10/2007).
Influenza B viruses currently circulating can be divided into two distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. Seventeen influenza B viruses tested belong to the B/Yamagata lineage and are related to the vaccine strain (B/Florida/04/2006). The remaining 35 viruses belong to the B/Victoria lineage and are not related to the vaccine strain. Thirty of the 35 viruses belonging to the B/Victoria lineage were from two states.
Data on antigenic characterization should be interpreted with caution given that antigenic characterization data is based on hemagglutination inhibition (HI) testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination.
Annual influenza vaccination is expected to provide the best protection against those virus strains that are related to the vaccine strains, but limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages, as is seen with the two lineages of influenza B viruses.
Antiviral Resistance:

Since October 1, 2008, 160 influenza A (H1N1), 30 influenza A (H3N2), and 66 influenza B viruses have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). One hundred thirty-three influenza A (H1N1) and 26 influenza A (H3N2) viruses have been tested for resistance to the adamantanes (amantadine and rimantadine). The results of antiviral resistance testing performed on these viruses are summarized in the table below.
<TABLE class=table cellSpacing=0 cellPadding=3 align=center border=0><TBODY><TR><TH align=left width=160></TH><TH noWrap align=middle width=100>Isolates tested (n)</TH><TH noWrap align=middle width=200 colSpan=2>Resistant Viruses,
Number (%)</TH><TH noWrap align=middle width=100>Isolates tested (n)</TH><TH noWrap align=middle width=120>Resistant Viruses, Number (%)</TH></TR><TR><TH align=left width=160></TH><TH noWrap align=middle width=100></TH><TH noWrap align=middle width=100>Oseltamivir</TH><TH noWrap align=middle width=100>Zanamivir</TH><TH noWrap align=middle width=100></TH><TH noWrap align=middle width=120>Adamantanes</TH></TR><TR><TD noWrap align=left width=160>Influenza A (H1N1)</TD><TD noWrap align=middle width=100>103</TD><TD noWrap align=middle width=100>101 (98%)</TD><TD noWrap align=middle width=100>0 (0)</TD><TD noWrap align=middle width=100>103</TD><TD noWrap align=middle width=120>1 (1%)</TD></TR><TR><TD noWrap align=left width=160>Influenza A (H3N2)</TD><TD noWrap align=middle width=100>23</TD><TD noWrap align=middle width=100>0 (0)</TD><TD noWrap align=middle width=100>0 (0)</TD><TD noWrap align=middle width=100>23</TD><TD noWrap align=middle width=120>23 (100%)</TD></TR><TR><TD noWrap align=left width=160>Influenza B</TD><TD noWrap align=middle width=100>61</TD><TD noWrap align=middle width=100>0 (0)</TD><TD noWrap align=middle width=100>0 (0)</TD><TD noWrap align=middle width=100>N/A*</TD><TD noWrap align=middle width=120>N/A*</TD></TR></TBODY></TABLE><SUP>*The adamantanes (amantadine and rimantadine) are not effective against influenza B viruses.</SUP>


Influenza A (H1N1) viruses from 25 states have been tested for antiviral resistance to oseltamivir so far this season. In all 25 states, at least one oseltamivir-resistant influenza A (H1N1) virus has been identified. To date, all influenza A (H3N2) viruses tested are resistant to the adamantanes. Influenza activity in the United States, although increasing, remains relatively low with influenza A(H1N1) viruses predominating overall. However, the level of activity and the predominating virus has varied by region and may vary over the course of the season. This presents challenges for the selection of antiviral medications for the treatment and chemoprophylaxis of influenza and highlights the importance of testing patients for influenza and consulting local surveillance data when evaluating patients with acute respiratory infections during the influenza season. CDC issued interim recommendations for the use of influenza antiviral medications in the setting of oseltamivir resistance among circulating influenza A (H1N1) viruses on December 19, 2008. These interim recommendations are available at http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00271.
Pneumonia and Influenza (P&I) Mortality Surveillance

During week 2, 7.5% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below the epidemic threshold of 7.8% for week 2.
<CENTER>
View Full Screen</CENTER>Influenza-Associated Pediatric Mortality

Two influenza-associated pediatric deaths were reported to CDC during week 2 (Colorado and Texas). These deaths occurred during week 1 (week ending January 10, 2009). Since September 28, 2008, CDC has received a total of two reports of influenza-associated pediatric deaths that occurred during the current season.
<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).
No influenza-associated hospitalizations have been reported from the New Vaccine Surveillance Network this season.
During October 1, 2008 ? January 17, 2009, preliminary laboratory-confirmed influenza-associated hospitalization rates reported by the EIP for children aged 0-4 years and 5-17 years were 0.6 per 10,000 and 0.02 per 10,000, respectively. For adults aged 18-49 years, 50-64 years, and = 65 years, the rates were 0.05 per 10,000, 0.08 per 10,000, and 0.2 per 10,000, respectively.
<CENTER>
View Full Screen</CENTER>Outpatient Illness Surveillance:

During week 2, 1.5% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) 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 3.7%. The percentage of visits for ILI reported from all nine surveillance regions was below their respective region-specific baselines.
The increase in the percentage of patient visits for ILI over the previous weeks may have been influenced by a reduction in routine health care visits during the holiday season, as has occurred in previous seasons.
<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 2, the following influenza activity was reported:

• Widespread influenza activity was reported by one state (Virginia).
• Regional influenza activity was reported by six states (Colorado, New Hampshire, New Jersey, New York, North Carolina, and Texas).
• Local influenza activity was reported by 11 states (Arizona, Connecticut, Florida, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Montana, Pennsylvania, and Tennessee).
• Sporadic activity was reported in the District of Columbia, Puerto Rico, and 30 states (Alabama, Alaska, Arkansas, California, Delaware, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Missouri, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming).
• No influenza activity was reported by two states (Mississippi and Oklahoma).

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[HenryN]

Re: Seasonal Flu 2008 - 2009

January 11, 20098 to January 17, 2009 (Week 02)

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• RSS Feed
• Definitions for the 2008-2009 season

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• Table:

• Influenza tests in Canada

• Map:

• <A class=nav href="http://www.phac-aspc.gc.ca/fluwatch/08-09/w02_09/index-eng.php#map"><ACRONYM title="Influenza-like illness">ILI</ACRONYM> activity by province

• Graphs:

• Activity levels
• % positive influenza tests
• % positive, all respiratory virus tests
• Strain characterization
• <A class=nav href="http://www.phac-aspc.gc.ca/fluwatch/08-09/w02_09/index-eng.php#jmp-lan5"><ACRONYM title="Influenza-like illness">ILI</ACRONYM> rates in Canada
• Number of Outbreaks in Long Term Care Facilities

Other information

• Respiratory Virus Detections

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Influenza activity in Canada is increasing; six regions reporting localized activity
During week 02, influenza activity in Canada started to increase with more regions reporting localized (n=6; in ON, AB, BC & NT) and sporadic activity (n=20).The majority of regions still reported no activity (n=28) (see map). The proportion of tests that were positive for influenza continued to increase steadily with a percentage positive of 5.5% (170/3,111) this week (see table). The majority of influenza virus detections to date this season were influenza A viruses (57.4% or 335/584). In week 02, the ILI consultation rate was 16 ILI consultations per 1,000 patient visits (see ILI graph), which is below the expected range for this week. The sentinel response rate was 64%. In week 02, 5 new influenza outbreaks were reported: 3 in LTCFs (in ON, BC & NT), 1 in a hospital and 1 in a school (both from BC).
Antigenic Characterization:
Since 1 September 2008, the NML has antigenically characterized 69 influenza viruses: 16 influenza A/Brisbane/59/2007(H1N1)-like (from BC, AB, ON & NS), 2 influenza A/Brisbane/10/2007(H3N2)-like (from BC & ON), 4 influenza B/Florida/4/2006-like (from AB & ON) and 47 B/Malaysia/2506/2004-like (from QC, ON & 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:
Results from the NML:
Since the start of the season, the NML has tested 23 influenza A isolates (16 H1N1 and 7 H3N2) for amantadine resistance. All of the H1N1 isolates were susceptible; however all of the H3N2 isolates were resistant to amantadine (resistance = 100% or 7/7). The resistant isolates were from ON, AB and BC.
The NML has also tested 51 influenza isolates (15 A/H1N1, 2 A/H3N2 & 34 B) for oseltamivir (Tamiflu) resistance. All of the A/H3N2 and B isolates were sensitive; however all of the A/H1N1 isolates were resistant to oseltamivir due to the H274Y mutation (resistance = 100% or 15/15). The resistant isolates were from NS, ON, AB and BC.
All 47 influenza isolates (11 A/H1N1, 2 A/H3N2 & 34 B) tested for zanamivir resistance to date were sensitive to zanamivir.
Oseltamivir resistance findings from Provincial laboratories:
To date this season, 46 influenza isolates in BC have been sub-typed as A/H1 and were assessed genotypically for oseltamivir resistance using an SNP assay. Fourty-two isolates tested positive for the H274Y mutation (resistance = 100% or 42/42), with the other 4 specimens still pending confirmatory testing.
Influenza-associated Paediatric Hospitalizations:
In week 02, one laboratory-confirmed influenza-associated paediatric hospitalization (from QC) due to influenza A infection was reported through the Immunization Monitoring Program Active (IMPACT) network. To date, 20 hospitalizations have been reported of which half (50%) have been due to influenza A and half due to influenza B. The proportion of cases to date by age group are as follows: 15% were 0-5 month olds; 20% were 6-23 month olds; 25% were 2-4 year-olds; 15% were 5-9 year-olds; and 25% were 10-16 year-olds.
*** Due to technical difficulties with IMPACT's electronic reporting system, reports of hospitalizations were not received until this week. Over the next several weeks, more retrospective reports of cases may be reported. The first hospitalization for the 2008-2009 season occurred in late November 2008. To date, cases have been reported in QC, ON, AB & BC.
International:

CDC: During week 01, overall influenza activity in the United States remained relatively low but increased compared to previous weeks. More states reported widespread, regional and local influenza activity compared to previous weeks. Of the 3,394 specimens tested this week for influenza viruses, 242 (7.1%) were positive. Since 1 October 2008, the CDC has antigenically characterized 158 influenza viruses: 93 influenza A(H1) (all A/Brisbane/59/2007-like), 13 A(H3) (all A/Brisbane/10/2007-like) and 52 influenza B (17 were B/Florida/04/2006-like belonging to the B/Yamagata lineage and the other 35 belonged to the B/Victoria lineage). Since 1 October, 2008, 187 influenza viruses (103 A(H1N1), 23 A (H3N2), and 61 B) have been tested for resistance to neuraminidase inhibitors. Of the A(H1N1) viruses tested, 98% (101/103) 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 126 influenza A viruses (103 H1, 23 H3) for amantadine resistance: only one of the H1N1 viruses was resistant to amantadine (1%, 1/103) however all the H3N2 viruses (100%) 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 continued to intensify and spread across Europe with most countries now reporting medium to high intensity with a west-to-east spread being observed. Influenza A(H3) viruses continue to predominate. With the exception of the few B/Victoria lineage viruses, the viruses circulating in Europe are similar to the strains included in the current influenza vaccine. Of the 89 A(H3N2) isolates that were tested for adamantanes susceptibility, 88 (99%) were resistant. Of the 60 A(H1N1) virus isolates tested for resistance against neuraminidase inhibitors, 59 (98%) were resistant to oseltamivir, but all were sensitive to zanamivir.

• <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: Since 17 January 2009, the WHO has reported 5 new cases of human H5N1 avian influenza infection. Three cases were reported from China (all from different provinces) of which 1 died; and 2 cases were reported from Indonesia (also from different provinces) of which both died.

• <A href="http://www.who.int/csr/disease/avian_influenza/en/index.html" target=_blank rel=x><ACRONYM title="World Health Organization">WHO</ACRONYM>

<HR>Total number of influenza tests performed and number of positive tests by province/territory of testing laboratory, Canada, 2008-2009

<TABLE id=fluwatchtable cellSpacing=0 cellPadding=2 width="100%" border=1><TBODY><TR class=bg-colour-blue vAlign=top><TD class=alignCenter rowSpan=3>Province of
reporting
laboratories </TD><TD class=alignCenter vAlign=bottom colSpan=4>Report Period:
January 11, 2009 to January 17, 2009 </TD><TD class=alignCenter vAlign=bottom colSpan=4>Season to Date:
August 24, 2008 to January 17, 2009</TD></TR><TR class=bg-colour-blue><TD class=alignCenter rowSpan=2>Total #
Influenza
Tests </TD><TD class=alignCenter colSpan=3># of Positive Tests </TD><TD class=alignCenter rowSpan=2>Total #
Influenza
Tests</TD><TD class=alignCenter colSpan=3># of Positive Tests </TD></TR><TR class=bg-colour-blue vAlign=top><TD class=alignCenter vAlign=center>Influenza A</TD><TD class=alignCenter vAlign=center>Influenza B</TD><TD class=alignCenter vAlign=center>Total </TD><TD class=alignCenter vAlign=center>Influenza A</TD><TD class=alignCenter vAlign=center>Influenza B</TD><TD class=alignCenter vAlign=center>Total </TD></TR><TR><TD class=bg-colour-blue>NL
</TD><TD class=alignCenter>13</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>218</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD></TR><TR><TD class=bg-colour-blue>PE
</TD><TD class=alignCenter>7</TD><TD class=alignCenter>0</TD><TD class=alignCenter>1</TD><TD class=alignCenter>1</TD><TD class=alignCenter>70</TD><TD class=alignCenter>0</TD><TD class=alignCenter>1</TD><TD class=alignCenter>1</TD></TR><TR><TD class=bg-colour-blue>NS
</TD><TD class=alignCenter>38</TD><TD class=alignCenter>1</TD><TD class=alignCenter>0</TD><TD class=alignCenter>1</TD><TD class=alignCenter>323</TD><TD class=alignCenter>2</TD><TD class=alignCenter>0</TD><TD class=alignCenter>2</TD></TR><TR><TD class=bg-colour-blue>NB
</TD><TD class=alignCenter>55</TD><TD class=alignCenter>4</TD><TD class=alignCenter>0</TD><TD class=alignCenter>4</TD><TD class=alignCenter>281</TD><TD class=alignCenter>5</TD><TD class=alignCenter>0</TD><TD class=alignCenter>5</TD></TR><TR><TD class=bg-colour-blue>QC
</TD><TD class=alignCenter>963</TD><TD class=alignCenter>26</TD><TD class=alignCenter>2</TD><TD class=alignCenter>28</TD><TD class=alignCenter>8918</TD><TD class=alignCenter>91</TD><TD class=alignCenter>7</TD><TD class=alignCenter>98</TD></TR><TR><TD class=bg-colour-blue>ON
</TD><TD class=alignCenter>1187</TD><TD class=alignCenter>23</TD><TD class=alignCenter>51</TD><TD class=alignCenter>74</TD><TD class=alignCenter>11296</TD><TD class=alignCenter>67</TD><TD class=alignCenter>169</TD><TD class=alignCenter>236</TD></TR><TR><TD class=bg-colour-blue>MB
</TD><TD class=alignCenter>59</TD><TD class=alignCenter>0</TD><TD class=alignCenter>1</TD><TD class=alignCenter>1</TD><TD class=alignCenter>998</TD><TD class=alignCenter>0</TD><TD class=alignCenter>2</TD><TD class=alignCenter>2</TD></TR><TR><TD class=bg-colour-blue>SK
</TD><TD class=alignCenter>191</TD><TD class=alignCenter>2</TD><TD class=alignCenter>0</TD><TD class=alignCenter>2</TD><TD class=alignCenter>1779</TD><TD class=alignCenter>5</TD><TD class=alignCenter>0</TD><TD class=alignCenter>5</TD></TR><TR><TD class=bg-colour-blue>AB
</TD><TD class=alignCenter>503</TD><TD class=alignCenter>34</TD><TD class=alignCenter>2</TD><TD class=alignCenter>36</TD><TD class=alignCenter>9410</TD><TD class=alignCenter>92</TD><TD class=alignCenter>66</TD><TD class=alignCenter>158</TD></TR><TR><TD class=bg-colour-blue>BC
</TD><TD class=alignCenter>95</TD><TD class=alignCenter>22</TD><TD class=alignCenter>1</TD><TD class=alignCenter>23</TD><TD class=alignCenter>839</TD><TD class=alignCenter>73</TD><TD class=alignCenter>4</TD><TD class=alignCenter>77</TD></TR><TR><TD class=bg-colour-blue>Canada
</TD><TD class=alignCenter>3111</TD><TD class=alignCenter>112</TD><TD class=alignCenter>58</TD><TD class=alignCenter>170</TD><TD class=alignCenter>34132</TD><TD class=alignCenter>335</TD><TD class=alignCenter>249</TD><TD class=alignCenter>584</TD></TR></TBODY></TABLE>

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,
January 11, 2009 to January 17, 2009 (Week 02)

</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=69]


{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 2007/08 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



Please note that the above graphs may change as late returns come in.
Single Maps | Dual Maps | Animated Maps | FluWatch Reports

[HenryN]

Re: Seasonal Flu 2008 - 2009

Fourty-two isolates tested positive for the H274Y mutation (resistance = 100% or 42/42), with the other 4 specimens still pending confirmatory testing.

all of the A/H1N1 isolates were resistant to oseltamivir due to the H274Y mutation (resistance = 100% or 15/15). The resistant isolates were from NS, ON, AB and BC.

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

Hong Kong: Update on Hong Kong students returned from Chengdu (1/24/2009) [CHP]

A spokesman for the Centre for Health Protection (CHP) of the Department of Health today (January 24) said three of the 18 students and the group leader who returned from Chengdu yesterday developed symptoms compatible with influenza infection.

CHP investigation revealed that the four people, comprising two male and two female aged between 18 and 27, developed fever, sore throat, cough and runny nose.

They have been admitted to the Princess Margaret Hospital in stable condition.

Two of the four specimens taken from them showed positive result for influenza A (H1).

All specimens showed negative result for influenza H5.

The laboratory results showed that they were suffering from ordinary seasonal influenza and not avian influenza H5.

They are among a delegation from the Chinese University of Hong Kong which left for Sichuan on January 17.

The remaining 15 students do not have any symptoms of influenza infection.
-

View Original Article

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

USA. Tougher flu virus hits Jefferson County - al.com

Tougher flu virus hits Jefferson County

Monday, January 26, 2009
DAVE PARKS
News staff writer

Some of the first influenza cases in Jefferson County this season are being reported by public health officials. And it appears that the type of flu circulating in the area may be resistant to the most commonly used and effective antiviral medicine, Tamiflu.


Dr. Charles H. Woernle, assistant state health officer for Disease Control and Prevention for the Alabama Department of Public Health, said last week that the department confirmed three cases of flu in Jefferson County for the week of Jan. 11-17.

There were no cases confirmed the previous week, and there has been little influenza activity reported statewide this 2008-09 season.

"It has been pretty quiet so far, with a suggestion that it may be picking up," Woernle said.

The Centers for Disease Control recently reported that even though the United States seems to be having a mild flu season, some states have noticed that the prevalence of Type A (H1N1) influenza is showing resistance to the drug oseltamivir, or Tamiflu.

And early testing in Jefferson County shows this is the type of flu that is circulating in the area, Woernle said.

Given the situation, the CDC is recommending using a combination of oseltamivir (Tamiflu) and rimantadine (Flumadine) when treating or trying to prevent H1N1 flu. Another medication, zanamivir (Relenza) is also appropriate for treating H1N1 flu, according to the CDC's recommendation.

Authorities say the best protection against the flu is prevention with vaccination, and there is still time to get a flu shot this season.

James and Diana Noah, two influenza scientists at Southern Research Institute, said it is not unusual for flu viruses to develop resistance to antiviral drugs such as Tamiflu. A flu virus has a natural tendency to mutate quickly.

"When it reproduces it inherently includes mistakes that in some cases cause the virus to die, but in very few cases will grant a selective benefit to the virus," he said. "This is called selective pressure.

"So when a drug is applied, a virus begins churning out genetic mutations until it finds a way to replicate in the presence of the drug.

Diana Noah noted that overprescribing an antiviral drug worsens the problem, and Tamiflu has been used in large quantities in Asia in recent years to prevent or treat influenza.

"The result is you are constantly pressuring the virus, so it makes the changes," she said.

E-mail: dparks@bhamnews.com
-

<cite cite="http://www.al.com/health-fitness/birminghamnews/index.ssf?/base/living/1232961340304380.xml&coll=2">Tougher flu virus hits Jefferson County - al.com</cite>

[tropical]

Re: Seasonal Flu 2008 - 2009

#319:
"They have been admitted to the Princess Margaret Hospital in stable condition.

Two of the four specimens taken from them showed positive result for influenza A (H1)."


Seems that A1H1 realy gained more toughness if these folks must be admitted to the hospital.

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

#319:
"They have been admitted to the Princess Margaret Hospital in stable condition.

Two of the four specimens taken from them showed positive result for influenza A (H1)."


Seems that A1H1 realy gained more toughness if these folks must be admitted to the hospital.

Last year some people (most young) were admitted at HK hospitals even with serious complications such as encephalitis, miocarditis, pneumonia, etc.

Readers may found further information in archived HK epi-surveillance.

[HenryN]

Re: Seasonal Flu 2008 - 2009

USA. Tougher flu virus hits Jefferson County - al.com

James and Diana Noah, two influenza scientists at Southern Research Institute, said it is not unusual for flu viruses to develop resistance to antiviral drugs such as Tamiflu. A flu virus has a natural tendency to mutate quickly.

"When it reproduces it inherently includes mistakes that in some cases cause the virus to die, but in very few cases will grant a selective benefit to the virus," he said. "This is called selective pressure.

"So when a drug is applied, a virus begins churning out genetic mutations until it finds a way to replicate in the presence of the drug.

Diana Noah noted that overprescribing an antiviral drug worsens the problem, and Tamiflu has been used in large quantities in Asia in recent years to prevent or treat influenza.

"The result is you are constantly pressuring the virus, so it makes the changes," she said.

E-mail: dparks@bhamnews.com
-

<CITE cite=http://www.al.com/health-fitness/birminghamnews/index.ssf?/base/living/1232961340304380.xml&coll=2>Tougher flu virus hits Jefferson County - al.com</CITE>

The above has NOTHING to do with the recent emergence of H274Y Tamiflu resistance.

[tropical]

Re: Seasonal Flu 2008 - 2009

Last year some people (most young) were admitted at HK hospitals even with serious complications such as encephalitis, miocarditis, pneumonia, etc.

Readers may found further information in archived HK epi-surveillance.

More recent other news from UK with multi-strain pneumonia can't be so much usual.
UK: Pneumonia hits hospital in Suffolk

http://www.flutrackers.com/forum/showthread.php?t=92190

Seems to me (maybe I'm wrong) that we take in 2009 to be usual things that 10 years ago was rare.

If we read some public reports (US), ita./... investigation initiatives, and look at the recent "Voyager" (RAI2TV/10.00h/Sunday25.1.), we (can...) doubt about the purity of the air we breath.

Dr. Niman remark (#323) point (as previously stated at FT) at the news text which wrongly linked Tamiflu prescripted to humans versus increasing A1H1 resistance.

So, what's going on, earth wide maverick experiments?

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

ITALY. INFLUENZA, 2008/2009 SEASON. SURVEILLANCE FOR THE INCIDENCE OF INFLUENZA-LIKE ILLNESS (Data from CIRI updated Jan 28 2009)

Global Trend of Influenza-like Illness (ILI) Morbidity.

Season 2008/2009. Tables and graphs are available in original at web site of the ''Centro Interuniversitario per lo Studio dell'Influenza'' (in Italian) (CIRI)

Data showes influenza-like illnesses incidence among population, based on information collected by family doctors network participants to surveillance activities

Incidence is intended for 1,000 inhabitants and is tabulated according influenza season, surveillance week and class-age.

<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>

UPDATED AT 28-01-2009 11:05:19 GMT+1


[WEEK / Participant Family Doctors / Outpatients / CASES / 0-4 / 5-14 / 15-65 / +65 / Totale Incidence]

2008-42 - 392 - 511634 - 141 - 0,59 - 0,2 - 0,3 - 0,16 - 0,28
2008-43 - 386 - 509332 - 133 - 0,57 - 0,4 - 0,25 - 0,14 - 0,26
2008-44 - 405 - 535482 - 147 - 0,7 - 0,22 - 0,29 - 0,16 - 0,27
2008-45 - 410 - 538658 - 177 - 0,96 - 0,44 - 0,3 - 0,2 - 0,33
2008-46 - 395 - 517769 - 177 - 0,51 - 0,48 - 0,36 - 0,16 - 0,34
2008-47 - 412 - 542759 - 272 - 1,45 - 0,64 - 0,47 - 0,27 - 0,5
2008-48 - 421 - 555571 - 338 - 1,38 - 0,81 - 0,6 - 0,32 - 0,61
2008-49 - 417 - 551043 - 414 - 2,1 - 1,31 - 0,68 - 0,34 - 0,75
2008-50 - 421 - 555172 - 491 - 2,66 - 1,49 - 0,82 - 0,32 - 0,88
2008-51 - 406 - 536748 - 705 - 3,39 - 2,38 - 1,18 - 0,68 - 1,31
2008-52 - 400 - 530295 - 757 - 3,95 - 2,95 - 1,22 - 0,65 - 1,43
2009-01 - 400 - 529132 - 1371 - 4,85 - 2,78 - 2,73 - 1,5 - 2,59
2009-02 - 420 - 551986 - 2105 - 6,44 - 4,65 - 4,08 - 1,88 - 3,81
2009-03 - 411 - 539762 - 2602 - 11,37 - 8,63 - 4,56 - 1,96 - 4,82
2009-04 - 362 - 477462 - 2947 - 16,73 - 13,09 - 5,27 - 2,14 - 6,17

Influenza-like illness activity continues to rise and the highest value is associated to 0-4 years-old class-age population with an incidence of 16.73x1,000 (1,673 per 100,000). Population in 65+ years-old class-age reports the lowest value (2.14x1,000).
-
-----

[HenryN]

Re: Seasonal Flu 2008 - 2009

http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1233131066096

Thirty-eight influenza A (H1) specimens have
been tested for anti-viral drug resistance, 37 of these were resistant to oseltamivir and all were sensitive to zanamivir

and amantadine.

[HenryN]

Re: Seasonal Flu 2008 - 2009

http://www.hpa.org.uk/web/HPAwebFile.../1233131066096

Thirty-eight influenza A (H1) specimens have
been tested for anti-viral drug resistance, 37 of these were resistant to oseltamivir and all were sensitive to zanamivir

and amantadine.

Canada:

Fiftyseven
influenza A (H1N1) isolates have been tested and
found to be resistant to oseltamivir.

[HenryN]

Re: Seasonal Flu 2008 - 2009

Seasonal influenza activity in the world

23 January 2009

This summary provides an updated report of seasonal influenza activity for weeks 1-2 of 2009. It does not include reports of avian influenza in humans, which are available at: http://www.who.int/csr/disease/avian.../en/index.html

Seasonal influenza activity in the world, weeks 1-2 (as of 23 January 2009)
During the weeks 1-2, the level of overall influenza activity in the world increased. In Europe, widespread influenza activity was reported in 13 countries, regional activity in two countries as well as Wales in the United Kingdom of Great Britain and Northern Ireland, local activity in two countries and sporadic activity in 5 countries and one part of the United Kingdom (Scotland). Eight of the nine countries reporting low influenza intensity are located in the eastern and north-eastern part of Europe. The predominant influenza virus circulating in Europe is influenza A (H3). In Canada, Hong Kong Special Administrative Region of China and the United States of America overall influenza activity remained relatively low.
Austria: Influenza activity increased from sporadic to regional activity (A).
Belgium: Activity increased from sporadic to widespread (H3).
Bulgaria: Influenza activity has been reported for the first time.
Canada: During week 1, influenza activity in Canada remained low overall with the majority of the influenza surveillance regions still reporting no activity. The majority of influenza virus detections were influenza A viruses; however influenza B detections have slowly increased over the last several weeks.
Denmark: Widespread influenza A H3 activity has been reported.
France: Widespread influenza A H3 activity has been reported. Some influenza B viruses have also been detected.
Germany: Influenza activity has increased from sporadic to regional (H3).
Greece: Influenza activity has increased (H3).
Ireland: Continuing widespread influenza A activity has been reported.
Italy: Widespread influenza activity reported (H3).
Luxembourg: Activity increased from sporadic to widespread (H3).
Netherlands: Widespread influenza activity reported (H3).
Norway: Influenza activity increased from sporadic to widespread (H3).
Poland: Influenza activity has increased (H3).
Portugal: The H3 epidemic has passed its peak (week 52).
Slovenia: Influenza activity increased from sporadic to widespread (H3).
Spain: Influenza activity has increased to widespread (H3).
Sweden: Activity increased to widespread (A).
Switzerland: Activity increased from regional to widespread (H3).
United Kingdom of Great Britain and Northern Ireland: Regional influenza activity was reported for Wales while activity in England and Ireland was widespread (mainly influenza A H3 detected with low numbers of H1N1 and B). Northern Ireland reported widespread influenza activity (H3).
United States of America: Overall influenza activity in the United States increased slightly compared to previous weeks. The majority of the viruses detected have been influenza A with A(H1N1) predominating.
Sporadic influenza activity was observed in Brazil (A), Cameroon (H1, H3, B), China (H1, H3, B), China Hong Kong Special Administrative Region (H1,H3,B), Croatia (H1,H3,B), Czech Republic (H3), Estonia (H1,H3, B), Latvia (H1,H3, B), Mongolia (H1, H3, B), Romania (H1,H3, B), Russian Federation (H1,H3,B), Serbia (H1, H3, B).
Kazakhstan and Turkey reported no activity.

http://www.who.int/csr/disease/influenza/update/en/

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

ITALY. 2008/2009 INFLUENZA SEASON. VIROLOGIC SURVEILLANCE UPDATE (January 29, 2009) [Min. of Health]

VIROLOGIC SURVEILLANCE FOR INFLUENZA

January 29, 2009

Weekly Update 4/09

[Original PDF Document (in Italian) at : LINK. EDITED. Translated by IOH]

This week there is an important update about surveillance activities performed by National Influenza Centre (NIC) for antiviral resistance evaluation of viral isolates.


-- ITALY

During this surveillance week 178 clinical samples have been collected, of these 39 were influenza positive.

Among them, 38 type A viruses have been isolated and / or detected, 18 type A H3, 1 H1, from Padua University.

An additional type B virus has been isolate by Parma University laboratory.

The table below showes virological surveillance results since the start of season (week 46-08) until date (week 4-09).

<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>

[WEEK: 46 / 47 / 48 / 49 / 50 / 51 / 52 / 1 / 2 / 3 / 4 / TOT POSITIVE SAMPLES ]

- FLU A - 3 - 4 - 4 - 5 - 6 - 10 - 14 - 32 - 43 - 62 - 38 - 221
- A (unsubtyped) - ... - ... - ... - ... - ... - 2 - 2 - 12 - 11 - 10 - 19 - 56
- A/H3N2 - 3 - 4 - 4 - 5 - 6 - 8 - 12 - 20 - 32 - 47 - 18 - 159
- A/H1N1 - ... - ... - ... - ... - ... - ... - ... - ... - ... - 5 - 1 - 6
- FLU B - 0 - 0 - 2 - 0 - 1 - 1 - 0 - 1 - 0 - 0 - 1 - 6
- TOT POSITIVE SAMPLES - 3 - 4 - 6 - 5 - 7 - 11 - 14 - 33 - 43 - 62 - 39 - 227

Note: differences between this report and previous week one are due to further characterization / isolation activities.

-- FROM THE WORLD

- EUROPE

Influenza virus circulation continues to rise. Viruses Type A/H3 are at the moment the predominant strains.

During this week 3029 clinical samples have been collected. Of these 1710, (56%), were influenza positive: 1663 were type A (677 type H3, 37 type H1 and the remaining 949 not yet subtyped).

47 were influenza viruses type B.

Virus isolation and characterization demonstrated that all circulating strains to date were closely related to seasonal influenza vaccine reference strains, with the exception of some influenza B belonging to B/Victoria lineage, not included in this season vaccines.

Further informations are available at:

http://www.eiss.org/index.cgi

http://www.grog.org/

- USA
Influenza virus circulation is increasing.

3544 clinical samples have been collected, and among them 409, (11.5%), were influenza positive.

Of these 44 were type A/H1, 4 A/H3, whereas 298 were type A but not yet subtyped. The remaining 63 were type B.

Further informations at:

http://www.cdc.gov/flu/

FIRST ISOLATION IN ITALY OF INFLUENZA A/(H1N1) VIRUSES RESISTANT TO OSELTAMIVIR (2008/2009 Season).

During last surveillance week, Parma's University detected first FIVE A/(H1N1) influenza virus isolations for this season in Italy.

From the analysis performed by NIC, ALL OF THEM WERE OSELTAMIVIR RESISTANT (IC50 value very high); while resistant to oseltamivir, these viruses remained susceptible to Zanamivir.

Corresponding clinical samples were collected at Parma, during week 03/2009, from three children and two adults respectively.

Among these patients, three received this season influenza vaccine, while none of them were treated with oseltamivir.

Full genetic sequencing is undergoing both for HA and NA gene segments of these isolates.

In other EU Member States A/H1N1 viral strains demonstrated an high level of oseltamivir resistance (more than 97%) as well.

Further informations at (http://ecdc.europa.eu).
-
-----

[Giuseppe]

Re: Seasonal Flu 2008 - 2009

From post 329:

''ALL OF A/(H1N1) VIRAL SAMPLES ISOLATED SO FAR IN ITALY WERE OSELTAMIVIR RESISTANT (IC50 value very high) [phenotypic test]; while resistant to oseltamivir, these viruses remained susceptible to Zanamivir.
(...)