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Archive. ECDC and EuroFlu Influenza Updates, 2011.

EuroFlu - Weekly Electronic Bulletin - Week 16 : 18/04/2011-24/04/2011 - 29 April 2011, Issue N? 400 (edited)

EuroFlu - Weekly Electronic Bulletin - Week 16 : 18/04/2011-24/04/2011 - 29 April 2011, Issue N? 400 (edited)

[Source: EuroFlu, full page: (LINK). Extract, edited.]

EuroFlu - Weekly Electronic Bulletin - Week 16 : 18/04/2011-24/04/2011 - 29 April 2011, Issue N? 400



Influenza activity has returned to ?out of season? levels in most countries of the WHO European Region

This issue is based on data reported in week 16/2011 by 45 Member States in the WHO European Region.
Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) activity are below baseline thresholds or at pre-season levels in most countries.
Hospitalizations for severe acute respiratory infection (SARI) continue to decline in most countries with sentinel hospital-based surveillance for SARI.
5% of sentinel specimens from patients with ILI or ARI, and 3% of specimens from sentinel SARI patients, tested positive for influenza.
Current situation ? week 16/2011

During week 16/2011, 35 countries reported low intensity of respiratory-disease activity and 2 (Armenia and the Russian Federation), medium intensity. ILI or ARI consultation rates have returned to pre-season levels or are below the national baseline thresholds in all but 1 (Azerbaijan) of the 36 countries reporting epidemiological data this week.

Among the 37 countries reporting on the geographical spread of influenza, 35 reported no or sporadic activity. Armenia reported local spread, and Georgia, regional spread. The impact of influenza on health care systems was low in all but 1 (Armenia) of the 20 countries reporting on this indicator.

Data on sentinel hospital-based surveillance for SARI were reported in 10 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, Malta, the Republic of Moldova, Romania, the Russian Federation, Serbia and Ukraine. SARI hospitalizations are declining overall and are back to pre-season levels in Kazakhstan, Romania, Serbia and Ukraine.

In Georgia, SARI hospitalizations have increased over the last three weeks; this is driven by increases in hospitalizations in the group aged 0?4, however, and no sentinel SARI specimens tested positive for influenza in the country during week 16.
Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in the ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation ? week 16/2011

Influenza B virus was dominant in three countries, and co-dominant with pandemic influenza A(H1N1) 2009 in two others. Ukraine reported pandemic influenza A(H1N1) 2009 virus to be dominant.

Sentinel physicians collected 162 respiratory specimens, of which 8 (5%) were positive for influenza virus: 3 (38%) were influenza A and 5 (62%) were influenza B. Two of the three influenza A viruses were subtyped: both were pandemic A(H1).

In the 2 countries testing 20 or more sentinel specimens, influenza positivity ranged from 3% to 5%.

In addition, 140 non-sentinel specimens were reported positive for influenza: 63 (45%) influenza A and 77 (55%) influenza B. Of the influenza A viruses, 54 were subtyped: 51 (94%) as pandemic A(H1) and 3 (6%) as A(H3).

Sentinel hospitals participating in SARI surveillance in 10 countries collected 64 specimens from SARI patients of which 2 (3%) were positive for influenza.



Cumulative virological update ? weeks 40/2010 ? 16/2011

A total of 77 462 influenza virus detections was reported during this period, of which 54 949 (71%) were influenza A and 22 513 (29%) were influenza B. Of the influenza A viruses, 46 281 were subtyped: 44 542 (96%) as pandemic A(H1) and 1739 (4%) as A(H3).

From week 40/2010 through week 16/2011, 1533 out of 5525 sentinel SARI specimens (28%) tested positive for influenza: 872 (57%) were influenza A and 661 (43%) influenza B. Of the influenza A viruses, 691 were subtyped: 638 (92%) as pandemic A(H1) and 53 (8%) as influenza A(H3).

Since week 40/2010, 4515 influenza viruses have been characterized antigenically:
  • 2329 were A(H1) pandemic A/California/7/2009 (H1N1)-like;
  • 1860 were B/Brisbane/60/2008-like (B/Victoria/2/87 lineage);
  • 151 were A(H3) A/Perth/16/2009 (H3N2)-like;
  • 173 were B/Florida/4/2006-like (B/Yamagata/16/88 lineage), and
  • 2 were B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage).
Based on the genetic characterization of 585 influenza viruses:
  • 166 belonged to the pandemic A/California/7/2009 A(H1N1) clade;
  • 10 belonged to the pandemic A/Christchurch/16/2010 A(H1) clade;
  • 46 belonged to the pandemic A/Hong Kong/2213/2010 A(H1) clade;
  • 136 belonged to the recently emerged A/England/142/2010 subgroup characterized by S185T substitution in the HA;
  • 12 belonged to the A(H3) clade represented by A/Perth/16/2009;
  • 5 belonged to the A(H3) clade represented by A/Victoria/208/2009;
  • 29 belonged to the subgroup represented by A/Hong Kong/2121/2010 in the A/Victoria/208/2009 A(H3) clade;
  • 20 belonged to the B/Bangladesh/3333/2007 clade (Yamagata lineage), and
  • 161 to the B/Brisbane/60/2008 clade (Victoria lineage).
Since week 40/2010, 9 countries (Denmark, Germany, Ireland, Italy, Netherlands, Norway, Spain, Switzerland and the United Kingdom) have screened 3519 viruses for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir.
The United Kingdom analysed most of the viruses screened (1672).

Of the 3164 pandemic A(H1N1) 2009 viruses that were tested, 3072 were sensitive to both inhibitors and 92 viruses (2.9%) carried the NA H275Y mutation.

These 92 viruses were resistant to oseltamivir but remained sensitive to zanamivir.

9 influenza A(H3N2) viruses were tested and found to be sensitive to both inhibitors.

All of the 346 influenza B viruses tested for susceptibility to oseltamivir and the 340 tested for susceptibility to zanamivir were found to be sensitive.

All 197 pandemic influenza A(H1N1) 2009 viruses and 10 A(H3N2) viruses that were screened for susceptibility to adamantanes were found to be resistant.



Comment

Influenza activity has returned to pre-season levels in most countries across the WHO European Region. At present, a very low percentage (< 5%) of sentinel ILI/ARI and SARI specimens is testing positive for influenza.



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. For an update on the influenza situation and WHO/Europe recommendations, see the WHO/Europe web site.

Further information can be obtained from the web sites of WHO/Europe, WHO headquarters and the European Centre for Disease Prevention and Control (ECDC).

Further information on severe cases associated with influenza virus infections in the European Region can be found in the ECDC Weekly Influenza Surveillance Overview.

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EuroFlu - Weekly Electronic Bulletin - Week 17 : 25/04/2011-01/05/2011 - 06 May 2011, Issue N? 401 (extract, edited)

EuroFlu - Weekly Electronic Bulletin - Week 17 : 25/04/2011-01/05/2011 - 06 May 2011, Issue N? 401 (extract, edited)

[Source: EuroFlu, full page: (LINK). Extract, edited.]

EuroFlu - Weekly Electronic Bulletin - Week 17 : 25/04/2011-01/05/2011 - 06 May 2011, Issue N? 401



Influenza season ending in the WHO European Region

This issue is based on data reported in week 17/2011 by 44 Member States in the WHO European Region.
Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) are now at pre-season levels in all countries.
Sentinel-hospital surveillance data for severe acute respiratory infection (SARI) from seven countries shows that SARI hospitalizations have declined to levels observed at the beginning of the season.
Less than 2% of sentinel specimens from patients with ILI or ARI, and 2% of specimens from sentinel SARI patients tested positive for influenza.

Current situation ? week 17/2011

During week 17/2011, all but one country (Armenia) reported low influenza activity.

ILI or ARI consultation rates either continued to decline further or were at very low levels in all of the 36 countries reporting clinical data this week.

Among 39 countries reporting on the geographical spread of influenza, 37 reported no or sporadic activity.

Armenia and Lithuania reported local spread, and Georgia, regional activity.

The impact of influenza on health care systems was low in 20 and moderate in 2 of the 22 countries reporting on this indicator.

Seven countries reported data from sentinel hospital-based surveillance systems for SARI: Armenia, Kazakhstan, the Republic of Moldova, Romania, the Russian Federation, Serbia and Ukraine.

SARI hospitalizations have returned to pre-season levels in these countries and, although influenza detections have been reported from sentinel sites in recent weeks, the percentage of samples testing positive is very low.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in the ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation ? week 17/2011

Sentinel physicians collected 136 respiratory specimens, of which only 2 (2%) were positive for influenza virus: 1 was pandemic A(H1) and 1 was influenza B.

One country, the Russian Federation, tested 20 or more sentinel specimens, and influenza was detected in 2% of the samples.

In addition, 70 non-sentinel specimens were reported positive for influenza: 37 (53%) influenza B and 33 (47%) influenza A. Of the influenza A viruses, 25 were subtyped: 21 (84%) as pandemic A(H1) and 4 (16%) as A(H3).

Sentinel hospitals participating in SARI surveillance collected 41 respiratory specimens, of which 1 (2%) was positive for influenza.

Only the Russian Federation tested more than 10 sentinel SARI specimens, finding 1 positive specimen, to yield a 3% positivity in the country.



Cumulative virological update ? weeks 40/2010 ? 17/2011

A total of 83 369 influenza virus detections were reported during this period, of which 59 075 (71%) were influenza A and 24 294 (29%) were influenza B.

Of the influenza A viruses, 47 068 were subtyped: 45 311 (96%) as pandemic A(H1) and 1757 (4%) as influenza A(H3).

From week 40/2010 to week 17/2011, 1540 out of 5622 sentinel SARI specimens (27%) tested positive for influenza.

Of these influenza viruses, 876 (57%) were influenza A and 664 (43%) influenza B.

Of the influenza A viruses, 696 were subtyped: 643 (92%) as pandemic A(H1) and 53 (8%) as influenza A(H3).

Since week 40/2010, 5250 influenza viruses have been characterized antigenically:
  • 2622 were A(H1) pandemic A/California/7/2009 (H1N1)-like;
  • 2255 were B/Brisbane/60/2008-like (B/Victoria/2/87 lineage);
  • 197 were B/Florida/4/2006-like (B/Yamagata/16/88 lineage);
  • 174 were A(H3) A/Perth/16/2009 (H3N2)-like; and
  • 2 were B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage).
Based on the genetic characterization of 607 influenza viruses:
  • 169 belonged to the pandemic A/California/7/2009 A(H1N1) cluster;
  • 10 belonged to the pandemic A/Christchurch/16/2010 A(H1) cluster;
  • 46 belonged to the pandemic A/Hong Kong/2213/2010 A(H1) cluster;
  • 142 belonged to the recently emerged A/England/142/2010 subgroup characterized by S185T substitution in the HA;
  • 12 belonged to the A(H3) clade represented by A/Perth/16/2009;
  • 5 belonged to the A(H3) clade represented by A/Victoria/208/2009;
  • 29 belonged to the subgroup represented by A/Hong Kong/2121/2010 in the A/Victoria/208/2009 A(H3) clade;
  • 23 belonged to the B/Bangladesh/3333/2007 clade (Yamagata lineage), and
  • 171 to the B/Brisbane/60/2008 clade (Victoria lineage).
Since week 40/2010, nine countries (Denmark, Germany, Ireland, Italy, the Netherlands, Norway, Spain, Switzerland and the United Kingdom) had screened 3533 viruses for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir.

The United Kingdom analysed most of the viruses screened (1672).

Of the 3169 pandemic A(H1N1) 2009 viruses that were tested, 3077 were sensitive to both inhibitors and 92 viruses (2.9%) carried the NA H275Y mutation.

These 92 viruses were resistant to oseltamivir but remained sensitive to zanamivir.

18 influenza A(H3N2) viruses were tested and found to be sensitive to both inhibitors.

All of the 346 influenza B viruses tested for susceptibility to oseltamivir and the 340 tested for susceptibility to zanamivir were found to be sensitive.

All 197 pandemic influenza A(H1N1) 2009 viruses and 10 A(H3N2) viruses that were screened for susceptibility to adamantanes were found to be resistant.



Comment

ILI and ARI consultation rates are low throughout the WHO European Region. The great majority of countries is reporting no or sporadic influenza activity and the percentage of sentinel ILI, ARI, and SARI samples testing positive for influenza has declined to pre-season levels.



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. For an update on the influenza situation and WHO/Europe recommendations, see the WHO/Europe web site.

Further information can be obtained from the web sites of WHO/Europe, WHO headquarters and the European Centre for Disease Prevention and Control (ECDC).

Further information on severe cases associated with influenza virus infections in the European Region can be found in the ECDC Weekly Influenza Surveillance Overview.

(?)



Country comments (where available)

Spain

In Spain information concerning severe illness due to influenza infection with associated admission to hospitals comes from a surveillance system developed during the 2009/2010 pandemic season specifically for this purpose.

Since week 40/2010 and up to week 17/2011 1409 severe hospitalised confirmed influenza cases have been reported.
Severely affected cases were mostly in the 15-64 year age groups (63%) and 15% were less than five years old and 18% were more than 64 years old.

26% of them with no known risk factors.

Of 1407 cases with outcome information 165 died (12% with no known risk factors).

Of the severe cases 899 had information available on the status of influenza vaccination for the 2010/2011 season and only 136 (15%) cases had been immunised.

Monovalent pandemic vaccines 2009 were reported to have been received for 10% of hospitalised cases.

Most of severe and fatal cases included in the groups which were recommended influenza vaccination had not been vaccinated this season.


(?)
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EuroFlu - Weekly Electronic Bulletin - Week 18 : 02/05/2011-08/05/2011 - 13 May 2011, Issue N? 402 (extract, edited): sporadic influenza activity in European Region

EuroFlu - Weekly Electronic Bulletin - Week 18 : 02/05/2011-08/05/2011 - 13 May 2011, Issue N? 402 (extract, edited): sporadic influenza activity in European Region

[Source: EuroFlu, full page: (LINK). Extract, edited.]

EuroFlu - Weekly Electronic Bulletin - Week 18 : 02/05/2011-08/05/2011 - 13 May 2011, Issue N? 402


Sporadic influenza activity of low intensity in the WHO European Region
  • This issue is based on data reported in week 18/2011 by 46 Member States in the WHO European Region.
  • Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) are at low levels in all countries.
  • Sentinel-hospital surveillance data for severe acute respiratory infection (SARI) from eight countries shows that SARI hospitalizations continue to decline.
  • 2% of sentinel specimens from patients with ILI or ARI, and 4% of specimens from sentinel SARI patients tested positive for influenza.

Current situation ? week 18/2011

During week 18/2011, all but one country (Armenia) reported low influenza activity.

ILI and ARI consultation rates are below the national baselines or at pre-season levels in all 34 countries reporting clinical data.

Among 39 countries reporting on the geographical spread of influenza, 38 reported no or sporadic activity, while 1 (Armenia) reported local spread.

Only two countries reported moderate impact of influenza on their health care systems (Albania and Armenia).

This week, 8 countries reported data from sentinel hospital-based surveillance systems for SARI: Armenia, Georgia, Kazakhstan, Malta, the Republic of Moldova, Romania, the Russian Federation and Serbia.

The number of SARI hospitalizations remains at low levels in most of them. Only one country (Romania) reported influenza infection associated with a SARI case.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in the ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation ? week 18/2011

Sentinel physicians collected 170 respiratory specimens, of which 4 (2%) were positive for influenza B. Only one country, the Russian Federation, tested more than 20 sentinel specimens, and influenza B was detected in 3% of the samples.

In addition, 32 non-sentinel specimens were reported positive for influenza: 18 (56%) influenza A and 14 (44%) influenza B. Of the influenza A viruses, 6 were subtyped: 5 as pandemic A(H1) and 1 as A(H3).

Sentinel hospitals from 8 countries collected 56 respiratory specimens from SARI patients, of which 2 (4%) were positive for influenza B. Both cases were in Romania.



Cumulative virological update ? weeks 40/2010 ? 18/2011

A total of 82 146 influenza virus detections were reported during this period, of which 58 464 (71%) were influenza A and 23 682 (29%) were influenza B. Of the influenza A viruses, 46 507 were subtyped: 44 891 (97%) as pandemic A(H1) and 1 616 (3%) as influenza A(H3).

From week 40/2010 to week 18/2011, 1545 out of 5737 sentinel SARI specimens (27%) tested positive for influenza. Of these influenza viruses, 877 (57%) were influenza A and 668 (43%) influenza B. Of the influenza A viruses, 697 were subtyped: 644 (92%) as pandemic A(H1) and 53 (8%) as influenza A(H3).

Since week 40/2010, 5318 influenza viruses have been characterized antigenically:
  • 2643 were A(H1) pandemic A/California/7/2009 (H1N1)-like;
  • 2297 were B/Brisbane/60/2008-like (B/Victoria/2/87 lineage);
  • 198 were B/Florida/4/2006-like (B/Yamagata/16/88 lineage);
  • 174 were A(H3) A/Perth/16/2009 (H3N2)-like; and
  • 6 were B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage).
Based on the genetic characterization of 632 influenza viruses:
  • 179 belonged to the pandemic A/California/7/2009 A(H1N1) cluster;
  • 10 belonged to the pandemic A/Christchurch/16/2010 A(H1) cluster;
  • 46 belonged to the pandemic A/Hong Kong/2213/2010 A(H1) cluster;
  • 144 belonged to the A/England/142/2010 subgroup characterized by S185T substitution in the HA;
  • 12 belonged to the A(H3) clade represented by A/Perth/16/2009;
  • 5 belonged to the A(H3) clade represented by A/Victoria/208/2009;
  • 29 belonged to the subgroup represented by A/Hong Kong/2121/2010 in the A/Victoria/208/2009 A(H3) clade;
  • 23 belonged to the B/Bangladesh/3333/2007 clade (Yamagata lineage), and
  • 184 to the B/Brisbane/60/2008 clade (Victoria lineage).
Since week 40/2010, 9 countries (Denmark, Germany, Ireland, Italy, the Netherlands, Norway, Spain, Switzerland and the United Kingdom) have screened 3533 viruses for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir.

The United Kingdom analysed most of the viruses screened (1672).
Of the 3169 pandemic A(H1N1) 2009 viruses that were tested, 3077 were sensitive to both inhibitors and 92 viruses (2.9%) carried the NA H275Y mutation.

These 92 viruses were resistant to oseltamivir but remained sensitive to zanamivir.

Eighteen influenza A(H3N2) viruses were tested and found to be sensitive to both inhibitors.

All of the 346 influenza B viruses tested for susceptibility to oseltamivir and the 340 tested for susceptibility to zanamivir were found to be sensitive.

All 197 pandemic influenza A(H1N1) 2009 viruses and 10 A(H3N2) viruses that were screened for susceptibility to adamantanes were found to be resistant.



Comment

ILI and ARI consultation rates are at very low levels in the WHO European Region and half of the countries reported no influenza activity this week. The percentages of sentinel samples from ILI, ARI, and SARI surveillance testing positive for influenza continue to be low.



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. For an update on the influenza situation and WHO/Europe recommendations, see the WHO/Europe web site.

Further information can be obtained from the web sites of WHO/Europe, WHO headquarters and the European Centre for Disease Prevention and Control (ECDC).

Further information on severe cases associated with influenza virus infections in the European Region can be found in the ECDC Weekly Influenza Surveillance Overview.

(?)


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Influenza virus characterisation, summary Europe, April 2011 (ECDC, May 19 2011, extract, edited)

Influenza virus characterisation, summary Europe, April 2011 (ECDC, May 19 2011, extract, edited)

[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document (LINK). Extract, edited.]


TECHNICAL DOCUMENT

Community Network of Reference Laboratories (CNRL) for Human Influenza in Europe

Influenza virus characterisation


Summary

Influenza A(H1N1)pdm, influenza A(H3N2), influenza B/Victoria/2/87 lineage and B/Yamagata/16/88 lineage viruses have been characterised genetically and antigenically.
  • Recently isolated H1N1pdm viruses fall into several genetic groups but all groups show antigenic similarity to the currently recommended vaccine virus A/California/7/2009.
  • H3N2 viruses also fall into distinct genetic groups but there is no consistent correlation between any group and antigenic differences from the currently used vaccine virus A/Perth/16/2009.
  • Influenza B viruses of the B/Victoria/2/87 lineage have continued to predominate over those of the B/Yamagata/2/87 lineage. Most of the B/Victoria/2/87 lineage viruses are genetically and antigenically similar to the currently recommended vaccine virus B/Brisbane/60/2008.
http://www.ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=677
Over 700 virus specimens (propagated virus isolates or clinical samples) collected since December 2010 have been received from EU and affiliated countries at the WHO CC in London (Table 1). Predominantly, these viruses were type A influenza H1N1pdm viruses and type B influenza viruses of the B/Victoria/2/87 lineage, although type A influenza H3N2 viruses and type B influenza viruses of the B/Yamagata/16/88 lineage continued to be detected. In Table 1, batches for which analysis has yet to be completed are shown as in progress.



Influenza A(H1N1)pdm virus analysis

Table 2 shows representative HI results for viruses received since the previous report. The majority of viruses continue to react well with the panel of post-infection ferret antisera, including that raised against the vaccine virus A/California/7/2009. All the viruses in Table 2 show good reactivity with all the antisera.

Nucleotide sequence analysis of the HA1 coding region of the HA gene has been carried out and a representative phylogenetic tree is shown in Figure 1. The phylogenetic tree shows residues that define four genetic groups that have been predominant over the last five months; also marked on the tree are sporadic observations of particular amino acid substitutions or polymorphisms.

As described previously (ibid) four genetic groups can be defined:
  • i) A134T and S183P, now seen in at least six countries globally;
  • ii) N125D, observed originally in an emerging genetic group in the Southern Hemisphere and subsequently widespread in the Northern Hemisphere;
  • iii) D97N, R205K, I216V and V249L, observed in at least 10 countries;
  • iv) S185T, with many viruses in this group carrying the additional substitution D97N or alternative additional substitutions of S143G and A197T, detected in most countries in Europe and the world.
The viruses highlighted in Table 2 as included in the HA gene phylogenetic analysis belong to genetic groups (iii)and (iv).

The sporadic amino acid substitutions that have been marked on the phylogenetic trees encode substitutions or polymorphisms at amino acid residues 153-157, 222 and 223. Substitutions at residues 153-157 in the HA are often associated with reduced titres in HI assays and often the substitution or polymorphism is not seen when the nucleotide sequence of the corresponding clinical specimen has been analysed. Often polymorphism at residues 153-157 is a result of cell culture.

Substitution and polymorphism at amino acid residue 222 continues to be detected and the change D222G has been postulated to be detected more often in viruses recovered from patients suffering with severe disease.
Substitutions at residue 223 (Q223R) have also been observed and are associated with isolation or propagation of the virus in hens? eggs.



Influenza A(H3N2) virus analysis

Since December 2010 influenza A(H3N2) viruses have been successfully isolated and propagated from 15 countries affiliated with ECDC. The problems with antigenic characterisation of recent H3N2 viruses have been described previously (ibid). Shown in Table 3 are the results of an HI assay using guinea pig red blood cells in the presence of oseltamivir to reduce any effect on the agglutination of the red blood cells by the virus neuraminidase (Lin et al. 2010).

The results show that, of the six viruses tested, three have a reduction in titre of eightfold with the post-infection ferret antiserum raised against the vaccine virus A/Perth/16/2009 compared with the homologous reaction between the antiserum and A/Perth/16/2009. However, all the viruses in the test reacted well with a ferret antiserum raised against A/Wisconsin/15/2009, a virus genetically and antigenically closely related to A/Perth/16/2009.

All viruses in the test showed low reactivity with antisera raised against A/Victoria/208/2009 and A/Victoria/210/2009, but these viruses show anomalously high titres with their corresponding antisera. All test viruses showed good reactivity with antisera raised against A/Alabama/5/2010 and A/Perth/10/2010.

Nucleotide sequence analysis of the HA1 coding region of the HA gene has been carried out on representative H3N2 viruses and a phylogenetic tree is shown in Figure 2. The five reference viruses and the vaccine virus A/Perth/16/2009 used in the HI test are shown in boldface type and coloured in black and red respectively.

Viruses from ECDC-affiliated countries fall into both of the genetic clades of the H3N2 HA gene, the A/Perth/16/2009 clade and the A/Victoria/208/2009 clade, with the majority of viruses falling within the A/Victoria/208/2009 genetic clade. Distinct genetic groups within the HA gene are seen within both genetic clades. As described in the last report (ibid), there are five main genetic groups that are marked on the phylogenetic tree. These groups are characterised by encoded amino acid substitutions at: within the A/Perth/16 clade, i) I260M and R261Q with E50K and P162S, and ii) N133D, R142G A212T and V213A; and, within the A/Victoria/208 clade, iii) N145S and V223I, iv) N312S, and v) D53N, Y94H, I230V, E280A and S312N.

Viruses from ECDC-affiliated countries fall into each of these genetic groups.

A correlation of the viruses analysed in the HI assay (Table 3) with the phylogenetic tree of the HA gene (Figure 2) shows that all the viruses fall into genetic group (v), but A/Genoa/01/2010, A/Lisboa/SU23/2011 and A/Valladolid/40/2011 carry the additional amino acid substitution S199A in the HA, and A/Iasi/47704/2011 carries an additional substitution I192T in the HA. Viruses in this genetic group show no consistent reduced reaction in HI assays with antisera raised against the vaccine virus and genetically closely related viruses.

Analysis of viruses from each genetic group has indicated that there is no consistent change in antigenicity associated with any emerging genetic group.



Influenza B virus analyses

As in our previous report, influenza B viruses of the B/Victoria/2/87 lineage (~ 85%) have continued to predominate over those of the B/Yamagata/16/88 lineage (~ 15%).



B/Victoria lineage viruses

Representative results of antigenic analysis of influenza B/Victoria viruses are shown in Table 4. In the HI assay some viruses showed low reactivity with antisera raised against B/Brisbane/60/2008, the egg-propagated vaccine virus. It has been known for many years that HI assays for influenza B viruses propagated only in cells frequently show reduced HI titres when tested with antisera raised against egg-propagated reference strains, including vaccine strains (Schild et al. 1983). As a consequence, the antigenic properties of cell propagated viruses are assessed with antisera raised against viruses genetically closely related to the vaccine virus but propagated in cells. In Table 4, the cell-propagated reference viruses B/Paris/1762/2008, B/Hong Kong/514/2009 and B/Odessa/3886/2010 are genetically closely related to the vaccine virus B/Brisbane/60/2008 and post-infection ferret antisera have been raised against these viruses. All the test viruses analysed in Table 4 showed good reactivity with antisera raised against these three viruses and so are considered to be antigenically similar to the vaccine virus.

Figure 3 shows a phylogenetic tree based on the HA1-coding region of the HA gene. Amino acid substitutions N75K, N165K and S172P define the B/Brisbane/60/2008 genetic clade. The vast majority of recently collected viruses from EU and affiliated countries fall into the B/Brisbane/60/2008 genetic clade. The majority of viruses carry the amino acid substitution I146V in the HA compared with the vaccine virus B/Brisbane/60/2008 and many also carry the substitution L58P. Neither substitution has a marked affect on antigenicity of the viruses.


B/Yamagata lineage viruses

Table 5 shows the results of antigenic analysis of representative recently collected influenza B/Yamagata viruses as assessed by HI assay using turkey red blood cells. The majority of the test viruses from EU and affiliated countries reacted well with the panel of antisera, but many showed markedly reduced reactivity when assessed with post-infection antisera raised against the most recently used vaccine virus of the B/Yamagata lineage, B/Florida/4/2006, an egg-propagated vaccine virus. Generally the viruses showed better reactivity with antisera raised against the reference viruses B/Bangladesh/3333/2007 and B/Wisconsin/1/2010, also propagated in hens? eggs, than they did with antisera raised against B/Florida/4/2006, with the best reactivity being seen with the post-infection antiserum raised against B/Wisconsin/1/2010.

Figure 4 shows phylogenetic analysis of the HA1 coding region of the HA gene of representative influenza B/Yamagata lineage viruses. The HA gene of all but four viruses (B/Estonia/55669/2011, B/Estonia/55763/2011, B/Finland/33/2010 and B/Finland/39/2010) fell into the B/Bangaldesh/3333/2007 genetic clade. The B/Bangaldesh/3333/2007 genetic clade is characterised by the amino acid substitutions S150I, N165Y and G229D in the HA. Minor genetic groups can be discerned within this clade, notably one genetic group is defined by the amino acid substitution M251V which is seen in combination with the substitutions G183R or T181A and K253R in some viruses; another group is characterised by the substitution N202S in the HA, with some viruses carrying the additional substitutions of either A146S or N116K; a third genetic group can be characterised by the amino acid substitution T181K. Viruses from EU and affiliated countries fell into two of the three minor genetic groups, those characterised by M251A and by T181K, as well as falling into the main B/Banglasdesh/3333/2007 genetic clade. Antigenic analysis of the two viruses from Finland shown in the phylogenetic tree (B/Finland/33/2010 and B/Finland/39/2010) has been described in a previous report. Table 5 and the results presented in the previous two reports indicate that the large majority of viruses of the B/Bangladesh genetic clade are antigenically closely related to the reference viruses B/Banglasdesh/3333/2007 and B/Wisconsin/1/2010.



Note to the figures

The phylogenetic trees were constructed using neighbour-join in MEGA4. The bars indicate the proportion of nucleotide changes in the sequence. Reference strains are viruses to which post-infection ferret antisera have been raised. The colours indicate the date of sample collection. Isolates from ECDC countries are highlighted in yellow. Sequences for some of the viruses from non-European countries were recovered from GISAID and we acknowledge all laboratories who submitted sequences directly to the London WHO CC.

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EuroFlu - Weekly Electronic Bulletin - Week 19 : 09/05/2011-15/05/2011 - 20 May 2011, Issue N? 403 (Extract, edited)

EuroFlu - Weekly Electronic Bulletin - Week 19 : 09/05/2011-15/05/2011 - 20 May 2011, Issue N? 403 (Extract, edited)

[Source: EuroFlu, full text: (LINK). Extract, edited.]

EuroFlu - Weekly Electronic Bulletin - Week 19 : 09/05/2011-15/05/2011 - 20 May 2011, Issue N? 403


The 2010-11 influenza season is coming to an end in the WHO European Region
This issue is based on data reported in week 19/2011 by 42 Member States in the WHO European Region.
Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) are at low levels in all countries.
Sentinel-hospital surveillance data for severe acute respiratory infection (SARI) from seven countries shows that SARI hospitalizations continue to decline.
1% of sentinel specimens from patients with ILI or ARI, and no specimens from sentinel SARI patients tested positive for influenza.
Current situation ? week 19/2011

During week 19/2011, all but one country (Armenia) reported low influenza activity. ILI and ARI consultation rates were below the national baselines or at pre-season levels in all 38 countries reporting clinical data.

All 37 countries reporting on the geographical spread of influenza, reported no or sporadic activity. Only one country (Armenia) reported moderate impact of influenza on their health care system.

This week, 7 countries reported data from sentinel hospital-based surveillance systems for SARI: Armenia, Georgia, Kazakhstan, the Republic of Moldova, Romania, the Russian Federation and Ukraine. The number of SARI hospitalizations remains at low levels in most of them. No country reported influenza infection associated with a SARI case.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in the ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation ? week 19/2011

Sentinel physicians collected 151 respiratory specimens, of which 2 (1%) were positive for influenza virus: 1 pandemic A(H1) influenza and 1 influenza B. In the 3 countries testing 20 or more sentinel specimens, influenza positivity ranged from 0% in Belarus and Spain to 5% in the Russian Federation. In addition, 21 non-sentinel specimens were reported positive for influenza: 10 (48%) influenza A and 11 (52%) influenza B. Of the influenza A viruses, 6 were subtyped: 5 as pandemic A(H1) and 1 as A(H3).

Sentinel hospitals from 7 countries collected 34 respiratory specimens from SARI patients, and none of them were positive for influenza .



Cumulative virological update ? weeks 40/2010 ? 19/2011

A total of 82 175 influenza virus detections were reported during this period, of which 58 478 (71%) were influenza A and 23 697 (29%) were influenza B. Of the influenza A viruses, 46 518 were subtyped: 44 897 (97%) as pandemic A(H1) and 1 621 (3%) as influenza A(H3).

From week 40/2010 to week 19/2011, 1547 out of 5774 sentinel SARI specimens (27%) tested positive for influenza. Of these influenza viruses, 878 (57%) were influenza A and 669 (43%) influenza B. Of the influenza A viruses, 697 were subtyped: 644 (92%) as pandemic A(H1) and 53 (8%) as influenza A(H3).

Since week 40/2010, 5352 influenza viruses have been characterized antigenically:
  • 2663 were A(H1) pandemic A/California/7/2009 (H1N1)-like;
  • 2307 were B/Brisbane/60/2008-like (B/Victoria/2/87 lineage);
  • 202 were B/Florida/4/2006-like (B/Yamagata/16/88 lineage);
  • 174 were A(H3) A/Perth/16/2009 (H3N2)-like; and
  • 6 were B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage).
Based on the genetic characterization of 659 influenza viruses:
  • 180 belonged to the pandemic A/California/7/2009 A(H1N1) cluster;
  • 10 belonged to the pandemic A/Christchurch/16/2010 A(H1) cluster;
  • 46 belonged to the pandemic A/Hong Kong/2213/2010 A(H1) cluster;
  • 144 belonged to the A/England/142/2010 subgroup characterized by S185T substitution in the HA;
  • 12 belonged to the A(H3) clade represented by A/Perth/16/2009;
  • 5 belonged to the A(H3) clade represented by A/Victoria/208/2009;
  • 29 belonged to the subgroup represented by A/Hong Kong/2121/2010 in the A/Victoria/208/2009 A(H3) clade;
  • 24 belonged to the B/Bangladesh/3333/2007 clade (Yamagata lineage), and
  • 209 to the B/Brisbane/60/2008 clade (Victoria lineage).
Since week 40/2010, 10 countries (Denmark, Germany, Ireland, Israel, Italy, Netherlands, Norway, Spain, Switzerland and the United Kingdom) have screened 3535 viruses for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir.

The United Kingdom analysed most of the viruses screened (1672).
Of the 3171 pandemic A(H1N1) 2009 viruses that were tested, 3077 were sensitive to both inhibitors and 94 viruses (3.0%) carried the NA H275Y mutation.

These 94 viruses were resistant to oseltamivir but remained sensitive to zanamivir.

18 influenza A(H3N2) viruses were tested and found to be sensitive to both inhibitors.

All 346 influenza B viruses tested for susceptibility to oseltamivir and the 340 influenza B viruses tested for susceptibility to zanamivir were found to be sensitive.

All 197 pandemic influenza A(H1N1) 2009 viruses and 10 A(H3N2) viruses that were screened for susceptibility to adamantanes were found to be resistant.



Comment

ILI and ARI consultation rates are at very low levels in the WHO European Region and half of the countries reported no influenza activity this week. The percentages of sentinel samples from ILI, ARI, and SARI surveillance testing positive for influenza are very low.



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. For an update on the influenza situation and WHO/Europe recommendations, see the WHO/Europe web site.

Further information can be obtained from the web sites of WHO/Europe, WHO headquarters and the European Centre for Disease Prevention and Control (ECDC).

Further information on severe cases associated with influenza virus infections in the European Region can be found in the ECDC Weekly Influenza Surveillance Overview.

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Archive. ECDC and EuroFlu Influenza Updates, 2011.

[Source: EuroFlu, full page: (LINK). Extracts, edited.]

EuroFlu - Weekly Electronic Bulletin - Week 20 : 16/05/2011-22/05/2011 - 27 May 2011, Issue N? 404



Seasonal influenza activity is over in WHO/European Region
  • This issue is based on data reported in week 20/2011 by 40 Member States in the WHO European Region.
  • Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) are at low levels in all countries.
  • Sentinel-hospital surveillance data for severe acute respiratory infection (SARI) from 7 countries show that SARI hospitalizations continue to decline.
  • 1% of sentinel specimens from patients with ILI or ARI, and 2% of specimens from sentinel SARI patients tested positive for influenza.
  • This is the last winter report. The next EuroFlu bulletin will be published on 17 June and will summarize the situation in weeks 21?23/2011.
Current situation ? week 20/2011

During week 20/2011, all but one country (Armenia) reported low influenza activity. ILI and ARI consultation rates were below the national baselines or at pre-season levels in all 34 countries reporting clinical data. The 35 countries reporting on the geographical spread of influenza, reported no or sporadic activity. Only one country (Armenia) reported moderate impact of influenza on its health care system.

This week, 7 countries reported data from sentinel hospital-based surveillance systems for SARI: Armenia, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Romania and the Russian Federation. The number of SARI hospitalizations remains at low levels in most of them. Only one country (Armenia) reported influenza infection associated with a SARI case.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in the ?Overview of sentinel SARI systems in EuroFlu?.


Virological situation ? week 20/2011

Sentinel physicians collected 159 respiratory specimens, of which 1 (1%) was positive for influenza B virus. In addition, 24 non-sentinel specimens were reported positive for influenza: 19 (79%) influenza A and 5 (21%) influenza B. Of the influenza A viruses, 8 were subtyped as pandemic A(H1).

Sentinel hospitals in 7 countries collected 42 respiratory specimens from SARI patients, of which 1 (2%) was positive for pandemic influenza A(H1) virus.


Cumulative virological update ? weeks 40/2010 ? 20/2011

A total of 82 156 influenza virus detections were reported during this period, of which 58 499 (71%) were influenza A and 23 657 (29%) were influenza B. Of the influenza A viruses, 46 538 were subtyped: 44 907 (96%) as pandemic A(H1) and 1 631 (4%) as influenza A(H3).

From week 40/2010 to week 20/2011, 1548 out of 5816 sentinel SARI specimens (27%) tested positive for influenza. Of these influenza viruses, 879 (57%) were influenza A and 669 (43%) influenza B. Of the influenza A viruses, 698 were subtyped: 645 (92%) as pandemic A(H1) and 53 (8%) as influenza A(H3).

Since week 40/2010, 5361 influenza viruses have been characterized antigenically:
  • 2671 were A(H1) pandemic A/California/7/2009 (H1N1)-like;
  • 2308 were B/Brisbane/60/2008-like (B/Victoria/2/87 lineage);
  • 202 were B/Florida/4/2006-like (B/Yamagata/16/88 lineage);
  • 174 were A(H3) A/Perth/16/2009 (H3N2)-like; and
  • 6 were B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage).
Based on the genetic characterization of 714 influenza viruses:
  • 174 belonged to the pandemic A/California/7/2009 A(H1N1) cluster;
  • 11 belonged to the pandemic A/Christchurch/16/2010 A(H1) cluster;
  • 46 belonged to the pandemic A/Hong Kong/2213/2010 A(H1) cluster;
  • 168 belonged to the A/England/142/2010 subgroup characterized by S185T substitution in the HA;
  • 14 belonged to the A(H3) clade represented by A/Perth/16/2009;
  • 13 belonged to the A(H3) clade represented by A/Victoria/208/2009;
  • 35 belonged to the subgroup represented by A/Hong Kong/2121/2010 in the A/Victoria/208/2009 A(H3) clade;
  • 26 belonged to the B/Bangladesh/3333/2007 clade (Yamagata lineage);
  • 1 belonged to the B/Brisbane/3/2007 clade (Yamagata lineage) and
  • 226 to the B/Brisbane/60/2008 clade (Victoria lineage).
Since week 40/2010, 23 countries (Austria, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Israel, Italy, Latvia, Malta, the Netherlands, Norway, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland and the United Kingdom) had screened 4076 viruses for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir.

The United Kingdom analysed most of the viruses screened (1672).

Of the 3526 pandemic A(H1N1) 2009 viruses that were tested, 3417 were sensitive to both inhibitors and 109 viruses (3.1%) carried the NA H275Y mutation. These 109 viruses were resistant to oseltamivir but remained sensitive to zanamivir.

All of the 90 influenza A(H3N2) viruses tested for susceptibility to oseltamivir and the 88 tested for susceptibility to zanamivir were found to be sensitive.

All of the 460 influenza B viruses tested for susceptibility to oseltamivir and the 447 tested for susceptibility to zanamivir were found to be sensitive.

All 261 pandemic influenza A(H1N1) 2009 viruses and 43 A(H3N2) viruses that were screened for susceptibility to adamantanes were found to be resistant.


Comment

ILI and ARI consultation rates are at very low levels in the WHO European Region and most countries reported no influenza activity this week. Very low percentages of sentinel samples from ILI, ARI, and SARI surveillance tested positive for influenza.


Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. For an update on the influenza situation and WHO/Europe recommendations, see the WHO/Europe web site.

Further information can be obtained from the web sites of WHO/Europe, WHO headquarters and the European Centre for Disease Prevention and Control (ECDC).

Further information on severe cases associated with influenza virus infections in the European Region can be found in the ECDC Weekly Influenza Surveillance Overview.


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ECDC and WHO Europe annual influenza surveillance meetings: Working on influenza crucial - especially when it is less newsworthy (June 15 2011, edited)

ECDC and WHO Europe annual influenza surveillance meetings: Working on influenza crucial - especially when it is less newsworthy (June 15 2011, edited)

[Source: European Centre for Disease Prevention and Control (ECDC), full page: (LINK). Edited.]

ECDC and WHO Europe annual influenza surveillance meetings: Working on influenza crucial - especially when it is less newsworthy



15 Jun 2011

ECDC

On 7-9 June 2011, ECDC and the WHO Regional Office for Europe held jointly, for the first time, their annual influenza surveillance meeting in Ljubljana, Slovenia. Hosted by the Slovenian National Public Health Institute and supported by the WHO Country Office, Slovenia, the meeting attracted over 150 representatives from all Member States.

Reports on the unusual 2010-2011 influenza epidemics in Europe were presented, together with progress and recommendations on a wide range of virological and epidemiological related subjects.
Member States representatives expressed their full support to ECDC to continue undertaking annual seasonal influenza risk assessments with WHO, as recommended in the report on the handling of the 2009 pandemic recently agreed at the 64th World Health Assembly.

In closing the meeting together with Dr Caroline Brown (WHO), ECDC?s Influenza Programme Head Professor Angus Nicoll stated: ?This is an excellent example of how ECDC and WHO are cooperating together with Member States on pandemic and seasonal influenza. The achievements reached in the last year and the progress still needed show how important it is for influenza to have enduring and consistent work between pandemics, especially when influenza is less newsworthy?.


Read more:
Meeting programme
Meeting scope and purpose
ECDC working document (31st May)
ECDC review: WHO?s Final Report on the functioning of the International Health Regulations (IHR) in relation to the 2009 A(H1N1) pandemic ? the Fineberg report
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Influenza virus characterisation - Summary Europe, August and September 2011 (ECDC, October 7 2011, extract, edited)

Influenza virus characterisation - Summary Europe, August and September 2011 (ECDC, October 7 2011, extract, edited)

[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Extract, edited.]


TECHNICAL DOCUMENT

Community Network of Reference Laboratories (CNRL) for Human Influenza in Europe

Influenza virus characterisation - Summary Europe, August and September 2011



Influenza virus characterisation

Summary
  • Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria- and B/Yamagata-lineage viruses have been characterised genetically and antigenically.
  • A(H1N1)pdm09 viruses collected since 1 February 2011 fall into several genetic groups but all groups show antigenic similarity to the currently recommended vaccine virus A/California/7/2009.
  • A(H3N2) viruses collected since 1 February 2011 fall into distinct genetic groups. There is no consistent correlation of altered antigenicity compared to the vaccine virus, A/Perth/16/2009, with any genetic group.
  • Influenza B viruses of the B/Victoria/2/87 lineage have predominated over those of the B/Yamagata/16/88 lineage. Most of the B/Victoria/2/87 lineage viruses remain genetically similar to the currently recommended vaccine virus B/Brisbane/60/2008 and antigenically similar to cell-propagated viruses that are genetically closely related to the vaccine virus B/Brisbane/60/2008.
  • The majority of influenza B viruses of the B/Yamagata-lineage are in the B/Bangladesh/3333/2007 genetic clade.
Table 1 provides an updated summary since the last influenza virus characterisation report on the influenza viruses collected between February and August 2011 in ECDC-affiliated countries and received at the WHO CC in London.

As noted previously, viruses were predominantly of type A(H1N1)pdm09 and type B of the B/Victoria/2/87 lineage, although type A(H3N2) viruses and type B viruses of the B/Yamagata/16/88 lineage have continued to be received. In Table 1, batches of specimens for which analysis has yet to be completed are shown as in progress.



Influenza A(H1N1)pdm09 virus analysis

Table 2 shows HI results for viruses recovered and analysed since the previous report; these viruses were from Slovenia and Portugal. The majority of viruses continued to react well with the panel of post-infection ferret antisera, including antiserum raised against the vaccine virus A/California/7/2009.

Two viruses, A/Slovenia/808/2011 and A/Slovenia/861/2011, showed more than a four-fold reduction in HI titre with the antiserum raised against the vaccine virus, A/California/7/2009, compared to the titre with the vaccine virus itself.

An updated representative phylogenetic tree of the HA gene is shown in Figure 1. The phylogenetic tree shows residues that define genetic groups predominant over the last six months; residues in black are located in the HA1 polypeptide chain, those in brown indicate residues in HA2.

Certain sporadic amino acid substitutions or polymorphisms are also shown: K154X, G155X/E and N156D are frequently associated with low reactivity in HI assays and commonly result from propagation of viruses in certain tissue culture cells as they are observed rarely in clinical samples.

The sequence change of D222G, or the polymorphism D222X, is postulated to be detected more often in viruses recovered from patients suffering with severe disease.

The amino acid substitution Q223R is associated with the isolation and passage of virus in hens? eggs.

We have described at least six genetic groups for the circulating A(H1N1)pdm09 viruses. These groups can be defined by amino acid substitutions and are numbered groups 2 to 7:
  • Group 2:
    • N31D, S162N (adding a glycosylation site) and A186T in HA1, e.g. A/Czech Republic/32/2011;
  • Group 3:
    • A134T and S183P, e.g. A/Toulon/1173/2011 with some viruses also carrying the substitutions A141S, I295V in HA1 and V152A in HA2, e.g. A/Umea/1/2011
  • Group 4:
    • N125D in HA1, observed originally as an emerging genetic group in the Southern Hemisphere e.g. A/Christchurch/16/2010;
  • Group 5:
    • D97N, R205K, I216V and V249L in HA1, e.g. A/Astrakhan/1/2011;
  • Group 6:
    • D97N and S185T in HA1 and S124N in HA2, e.g. A/St Petersburg/27/2011;
  • Group 7:
    • S143G, S185T and A197T in HA1 and S124N in HA2, e.g. A/St Petersburg/100/2011.
The sequence of the HA gene of A/Slovenia/861/2011, one of the pair of viruses with reduced reactivity against the panel of sera, was determined.

The virus fell into genetic group 7 but carried four additional amino acid substitutions in the HA1 coding region that might account for its unusual reactivity in the HI test.

Viruses collected since February 2011 in EU and EU-affiliated countries fall into each of the genetic groups. None of the groups shows a consistently marked change in antigenicity compared with the vaccine virus.



Influenza A(H3N2) virus analysis

For specimens collected since February 2011, influenza A(H3N2) viruses have been successfully isolated and propagated from seven ECDC-affiliated countries. The difficulties with antigenic characterisation of recent H3N2 viruses have been described previously. Shown in Table 3 are the results of HI assays using guinea pig red blood cells in the presence of oseltamivir to reduce any effect of the virus neuraminidase on the agglutination of the red blood cells (Lin et al. 2010) for three recently received viruses from Norway.

The results showed that one of the viruses tested yielded an eight-fold reduction in titre with the post-infection ferret antiserum raised against the vaccine virus A/Perth/16/2009 compared with the homologous reaction between the antiserum and the vaccine virus, and one of the three viruses showed a four-fold reduction.

All three test viruses showed good reactivity with antisera raised against A/Alabama/5/2010, A/Stockholm/18/2011 and A/South Australia/3/2011, three reference viruses propagated in tissue culture cell lines.

A phylogenetic tree of the HA1 coding region of the HA gene of representative A(H3N2) viruses is shown in Figure 2. Ten reference viruses and the vaccine virus A/Perth/16/2009 used in the HI test are highlighted.

The majority of viruses from ECDC-affiliated countries continue to fall within the A/Victoria/208/2009 genetic clade and a minority in the A/Perth/16/2009 clade. Distinct genetic groups within the HA gene are seen within both genetic clades.

Seven genetic groups can be described in recently circulating A(H3N2) viruses.

Within the A/Perth/16/2009 genetic clade there are two genetic groups (1 and 2) defined by amino acid substitutions:
  • Group 1:
    • I260M, R261Q, e.g. A/Victoria/210/2009 with some viruses also carrying P162S and substitutions of either E50K, e.g. A/Norway/1186/2011, or N81D, e.g. A/Niigata/510/2011;
  • Group 2:
    • N133D (resulting in the loss of a glycosylation site), R142G, T212A and V213A, e.g. A/Norway/1330/2010. This group has not been shown in Figure 2 since very few of these viruses have been circulating in recent months.
There are at least four genetic groups in the A/Victoria/208/2009 genetic clade of A(H3N2) viruses. These are defined by additional amino acid substitutions to those that define viruses of the A/Victoria/208/2009 clade compared with the A/Perth/16/2009 clade (K62E, K144N resulting in the gain of a glycosylation site and T212A):
  • Group 3:
    • V223I, with some viruses having the substitution N144D that results in the loss of a glycosylation site, and N145S e.g. A/Stockholm/18/2011; and another group with the substitution A198S with either N145S, e.g. A/Norway/1762/2011, or the substitutions S45N (resulting in the gain of a glycosylation site), T48I and N312S, e.g. A/Slovenia/537/2011;
  • Group 4:
    • N312S, with many viruses also carrying T48A and K92R, e.g. A/Iraq/7/2011;
  • Group 5:
    • D53N, Y94H, I230V and E280A, e.g. the reference viruses A/Alabama/05/2010 and A/Perth/10/2010;
  • Group 6:
    • D53N, Y94H, S199A, I230V and E280A e.g. A/Iowa/19/2010 and A/Ireland/M27357/2011; with some encoding an additional glycosylation site as a result of S45N substitution e.g. A/Hong Kong/3951/2011.
A further genetic group can be considered but is not presently numbered:
  • S45N, which results in an additional glycosylation site, e.g. A/Norway/685/2011.
The viruses shown in Table 3, all from Norway and collected in July or August, fall into genetic group 3.

Viruses from genetic groups 1, 3, 5 and 6, as well as the unnumbered group, have been collected in ECDC-affiliated countries since February 2011. Analysis of viruses from each of the emerging genetic groups has indicated that no group shows consistent significant change in antigenicity compared with the vaccine virus, A/Perth/16/2009.



Influenza B virus analyses

Influenza B viruses of the B/Victoria/2/87 lineage (83%) have continued to predominate over those of the B/Yamagata/16/88 lineage (17%).



B/Victoria-lineage viruses

Antigenic analysis of influenza B/Victoria-lineage viruses recently received and propagated is shown in Table 4 ? all the viruses were from Slovenia.

In the HI assay all showed low reactivity with antiserum raised against B/Brisbane/60/2008, the egg-propagated vaccine virus. As described previously, HI assays for influenza B/Victoria lineage viruses propagated only in cells frequently show reduced HI titres when tested with antisera raised against egg-propagated reference viruses, including vaccine viruses (Schild et al. 1983 and see also previous ECDC/CNRL Influenza Virus Characterisation Technical Reports). As a consequence, the antigenic properties of cell-propagated viruses are assessed with antisera raised against viruses which are genetically closely related to the vaccine virus but propagated in cells.

In Table 4 the cell-propagated reference viruses B/Paris/1762/2008, B/Hong Kong/514/2009 and B/Odessa/3886/2010 are genetically closely related to the vaccine virus B/Brisbane/60/2008. All the test viruses analysed in Table 4 showed good reactivity with antisera raised against these three reference viruses, hence they are considered to be antigenically similar to the vaccine virus.

Figure 3 shows a phylogenetic tree based on the HA1-coding region of the HA gene of selected viruses of the B/Victoria-lineage. Amino acid substitutions N75K, N165K and S172P define the B/Brisbane/60/2008 genetic clade. All recently collected influenza B viruses of the B/Victoria-lineage from EU and EU-affiliated countries come within the B/Brisbane/60/2008 genetic clade. The majority of viruses carry the amino acid substitution I146V in the HA compared with the vaccine virus B/Brisbane/60/2008 and many also carry the substitution L58P. Neither substitution has a marked affect on the antigenicity of the viruses.



B/Yamagata-lineage viruses

No new antigenic results have been generated for B/Yamagata-lineage viruses since our last report. Figure 4 shows a phylogenetic tree based on the HA1-coding region of the HA gene of selected viruses of the B/Yamagata-lineage. Amino acid substitutions S150I, N165Y and G229D define the B/Bangladesh/3333/2007 genetic clade.

The majority of recently collected viruses are in the B/Bangladesh/3333/2007 genetic clade and can be divided into several genetic sub-groups. A cluster of viruses from Sweden, Finland and Estonia, coming within a distinct genetic clade with B/Brisbane/3/2007 as the clade-prototype virus, was described in our previous report.



Note to the figures

The phylogenetic trees were constructed using neighbour-join in MEGA4. The bars indicate the proportion of nucleotide changes in the sequence. Reference strains are viruses against which post-infection ferret antisera have been raised. The colours indicate the date of sample collection. Isolates from ECDC countries are highlighted in yellow. Sequences for some of the viruses from non-European countries were recovered from GISAID and we acknowledge all laboratories who submitted sequences directly to the London WHO CC.

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Surveillance and immunisation are keys to protect Europe against seasonal influenza (ECDC, October 10 2011)

Surveillance and immunisation are keys to protect Europe against seasonal influenza (ECDC, October 10 2011)

[Source: European Centre for Disease Prevention and Control (ECDC), full text: (LINK).]

Surveillance and immunisation are keys to protect Europe against seasonal influenza



‎10 October ‎2011


ECDC_Abstract:

The 2011 seasonal influenza immunisation campaigns have started across Europe. As in previous years ECDC is marking the start of the 2011-12 surveillance season in Week 40 with the publication of regular weekly updates of the main epidemiological and virological developments in the Weekly Influenza Surveillance Overview (WISO).

ECDC_ArticleDate/Deadline: 10/10/2011 00:00


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EuroFlu - Weekly Electronic Bulletin - Week 40 : 03/10/2011-09/10/2011 - 14 October 2011, Issue N? 414 (Extract, edited)

EuroFlu - Weekly Electronic Bulletin - Week 40 : 03/10/2011-09/10/2011 - 14 October 2011, Issue N? 414 (Extract, edited)

[Source: EuroFlu, full text: (LINK). Extract, edited.]

EuroFlu - Weekly Electronic Bulletin - Week 40 : 03/10/2011-09/10/2011 - 14 October 2011, Issue N? 414


Low influenza activity in Europe at the start of the 2011/2012 influenza season


Week 40 marks the beginning of the 2011/2012 influenza season, during which the EuroFlu bulletin will be published weekly.
  • This issue is based on data reported for week 40 by 37 Member States in the WHO European Region.
  • Levels of influenza activity in Europe are low.
  • Sporadic detections of influenza A (H3N2), pandemic influenza A(H1N1) 2009, and influenza B were reported in previous weeks.
Current situation: week 40/2011

Of the 30 countries reporting clinical data on influenza-like illness (ILI) and acute respiratory infection (ARI), 10 reported increases in consultation rates: Albania, Armenia, Azerbaijan, Bulgaria, Poland, the Republic of Moldova, Serbia, Slovakia, Ukraine and the United Kingdom (Northern Ireland).

Overall, influenza activity remains low throughout the Region, however, with only the Russian Federation reporting medium activity.



Virological situation: week 40/2011

Sentinel physicians collected 89 respiratory specimens, none of which tested positive for influenza virus.

Among specimens tested from non-sentinel sources, only 2 were positive for influenza: 1 pandemic influenza A(H1) and 1 influenza B (both from the Russian Federation).

No antigenic or genetic characterizations were reported to WHO this week.



Comment

Influenza activity is at low levels throughout the WHO European Region. The virus strains recommended for vaccine composition for the northern hemisphere in 2011/2012 are unchanged from those in the previous season and include: A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like and B/Brisbane/60/2008-like viruses.

While it is too early to predict which influenza viruses will predominate during the upcoming influenza season, data from the inter-season period in Europe and the recent southern hemisphere influenza season suggest that pandemic influenza A (H1N1) 2009 virus will continue to co-circulate with influenza B and influenza A(H3N2) viruses in the northern hemisphere.

Please note that, owing to an error in data transmission between EuroFlu and TESSy, information on virology from European Union (EU)/European Economic Area (EEA) Member States is not included in this week?s bulletin.



Further information


The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe and WHO headquarters web sites.

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EuroFlu - Weekly Electronic Bulletin - Week 41 : 10/10/2011-16/10/2011 - 21 October 2011, Issue N? 415 (extract, edited)

EuroFlu - Weekly Electronic Bulletin - Week 41 : 10/10/2011-16/10/2011 - 21 October 2011, Issue N? 415 (extract, edited)

[Source: EuroFlu, full page: (LINK). Extract, edited.]


EuroFlu - Weekly Electronic Bulletin - Week 41 : 10/10/2011-16/10/2011 - 21 October 2011, Issue N? 415


Low influenza activity in the WHO European Region
  • This issue is based on data reported for week 41 by 44 Member States in the WHO European Region.
  • Levels of influenza activity in Europe remain low. Sporadic detections of influenza A(H3N2), pandemic influenza A(H1N1) 2009 and influenza B have been reported.
Current situation: week 41/2011

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be low throughout the WHO European Region.

Of the 34 countries reporting clinical data for week 41, 10 reported some increases in consultation rates: Albania, Armenia, Azerbaijan, Belarus, Bulgaria, Hungary, Ireland, Poland, Serbia and Ukraine.

Of the 36 countries reporting on geographical distribution of influenza activity, 30 reported no spread.

Data from sentinel hospital-based surveillance for severe acute respiratory infection (SARI) were reported by 7 countries: Armenia, Georgia, Kazakhstan, the Republic of Moldova, the Russian Federation, Serbia and Ukraine.

Sentinel SARI hospitalizations in all countries are currently at pre-season levels.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in ?Overview of sentinel SARI systems in EuroFlu?.


Virological situation: week 41/2011

Sentinel outpatient clinics collected 378 respiratory specimens, none of which tested positive for influenza virus.

Among specimens tested from non-sentinel sources, 7 were positive for influenza: 4 were pandemic influenza A(H1); 1 was A(H3) and 2 influenza B.

Sentinel hospitals collected 53 respiratory specimens from SARI patients, none of which tested positive for influenza virus.

No antigenic or genetic characterizations were reported to WHO this week.



Cumulative virological data: weeks 40?41/2011

During this period, 21 influenza virus detections were reported: 14 (67%) were influenza A and 7 (33%) were influenza B. Of the influenza A viruses, 3 were subtyped as A(H3).



Comment

Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region. There have been sporadic detections of influenza A(H3N2), pandemic influenza A(H1N1) and influenza B during the last 2 weeks.



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.


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EuroFlu - Weekly Electronic Bulletin - Week 42 : 17/10/2011-23/10/2011 - 28 October 2011, Issue N? 416 (edited)

EuroFlu - Weekly Electronic Bulletin - Week 42 : 17/10/2011-23/10/2011 - 28 October 2011, Issue N? 416 (edited)

[Source: EuroFlu, full page: (LINK). Extract, edited.]


EuroFlu - Weekly Electronic Bulletin - Week 42 : 17/10/2011-23/10/2011 - 28 October 2011, Issue N? 416


Only a few sporadic cases of influenza detected in the WHO European Region
  • This issue is based on data reported for week 42 by 47 Member States in the WHO European Region.
  • Levels of influenza activity in Europe remain low.
  • Sporadic detections of influenza A(H3N2), influenza A(H1N1)pdm09 and influenza B have been reported.
Current situation: week 42/2011

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be low throughout the WHO European Region.

Of the 38 countries reporting clinical data for week 42, 10 reported some increases in consultation rates: Albania, Armenia, Georgia, Hungary, Kazakhstan, Poland, the Republic of Moldova, Serbia, Slovakia and Ukraine.

Consultation rates were generally highest in young children.

Of the 39 countries reporting on geographical distribution of influenza activity, 34 reported no spread. All of these countries reported low intensity of influenza activity.

Data from sentinel hospital-based surveillance for severe acute respiratory infection (SARI) were reported by 8 countries: Albania, Armenia, Georgia, Kazakhstan, the Republic of Moldova, the Russian Federation, Serbia and Ukraine.

Sentinel SARI hospitalizations in all countries are currently at pre-season levels.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation: week 42/2011

Sentinel outpatient clinics collected 458 respiratory specimens, of which 2 (0.4%) tested positive for influenza virus. Of these, 1 was influenza A(H1)pdm09 (Spain) and 1 was influenza A(H3) (England).

Among specimens tested from non-sentinel sources, 7 were influenza A and 3 were influenza B. Of the influenza A viruses 5 were subtyped, 2 as A(H1)pdm09 and 3 as influenza A(H3).

Sentinel hospitals collected 65 respiratory specimens from SARI patients, none of which tested positive for influenza virus.

No antigenic or genetic characterizations were reported to WHO/Europe this week.



Cumulative virological data: weeks 40-42/2011

During this period, 36 influenza virus detections were reported: 23 (64%) were influenza A and 13 (36%) were influenza B. Of the influenza A viruses, 15 were subtyped: 11 A(H3) and 4 A(H1)pdm09.



Comment

Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region. There have been sporadic detections of influenza A (H3N2), influenza A(H1N1)pdm09 and influenza B during recent weeks.



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries of the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.

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Country comments (where available)

Scotland: The one case being reported is a dual infection of Influenza A H1N1 (2009) & Influenza B.


Spain: In week 42/2011 the first influenza virus A(H1N1)2009 has been detected in Spain from a sentinel source in the North of Spain (Baske Country). Influenza activity remains stable and at a low level in all the country.
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Influenza vaccine effectiveness: results of the ECDC/I-MOVE studies and other studies (ECDC, October 28 2011)

Influenza vaccine effectiveness: results of the ECDC/I-MOVE studies and other studies (ECDC, October 28 2011)

[Source: European Centre for Disease Prevention and Control (ECDC), full page: (LINK). Edited.]

Influenza vaccine effectiveness: results of the ECDC/I-MOVE studies and other studies



28 Oct 2011, ECDC

On the 26 October 2011, The Lancet Infectious Diseases published a systematic review and a meta-analysis, combining the results of several studies undertaken on influenza vaccine effectiveness.

Overall the influenza vaccine was effective in the majority of the seasons and of the studies. Acknowledging the burden of influenza, the authors confirmed that vaccination was the most effective way of preventing it. However, they noted what many other independent groups, including ECDC and its collaborators, have found: influenza vaccines do not give complete protection to all who receive them. The authors also agree with ECDC views that there are critical gaps in high quality evidence for the effectiveness of licensed influenza vaccines especially for some age groups.

As highlighted in the ECDC Scientific Advance published today, at European level, ECDC has been funding and, with Epiconcept, coordinating the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE). These are undertaken with many Member States to monitor seasonal and pandemic influenza vaccine effectiveness in ten European Union countries. I-MOVE monitors seasonal and pandemic vaccine effectiveness on a routine basis. Results for the seasons 2008/09 and 2009/2010 have been published and are included in the literature review published in The Lancet Infectious Diseases. The 2010-2011 results have been accepted for publication and will be published soon.

Overall, the results from the I-MOVE studies are broadly in line with the ones published by The Lancet Infectious Diseases in the mentioned article. In general, influenza vaccine effectiveness as measured in the multicentric I-MOVE studies ranged from around 59% in 2008/2009 when only individuals older than 65 years were included to around 72% during the 2009/10 pandemic season when all age-groups were included.

ECDC notes that although influenza vaccines do not provide a complete protection against influenza virus but they are the most effective preventive measure. Development of more effective vaccines is certainly to be considered by ECDC to be a priority for researchers and vaccine manufacturers.

Through the studies undertaken by the I-MOVE collaboration, ECDC and its partners in EU Member States have been actively contributing to bridge the gaps in evidence highlighted by the authors of the article published by The Lancet Infectious Diseases. Since influenza viruses continue to change every season, also post-marketing studies of vaccine effectiveness should continue in Europe the future in order to monitor possible variations.

These studies are important to inform policymakers and the public of the contemporary state of performance of these important vaccines.



Related links:
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EuroFlu - Weekly Electronic Bulletin - Week 43 : 24/10/2011-30/10/2011 - 04 November 2011, Issue N? 417 (extract)

EuroFlu - Weekly Electronic Bulletin - Week 43 : 24/10/2011-30/10/2011 - 04 November 2011, Issue N? 417 (extract)

[Source: EuroFlu.org, full page: (LINK). Extract, edited.]


EuroFlu - Weekly Electronic Bulletin - Week 43 : 24/10/2011-30/10/2011 - 04 November 2011, Issue N? 417


Influenza detections in WHO European Region remain sporadic
  • This issue is based on data reported for week 43/2011 by 46 Member States in the WHO European Region.
  • Levels of influenza activity in the Region remain low.
  • All sentinel samples collected in the Region were negative for influenza.
Current situation: week 43/2011

Consultation rates were low and generally stable in the 39 countries reporting clinical data on influenza-like illness (ILI) and/or acute respiratory infection (ARI).

Out of 41 countries reporting on trends, 30 said they were stable, while 4 countries reported increasing trends and 7, decreasing trends.

Consultation rates were generally highest in young children.
Of the 41 countries reporting on geographical distribution of influenza activity, 34 reported no spread.

All countries reported low intensity of influenza activity and low impact on their health care services.

Data from sentinel hospital-based surveillance for severe acute respiratory infection (SARI) were reported by 7 countries: Armenia, Georgia, Kazakhstan, the Republic of Moldova, the Russian Federation, Serbia and Ukraine. Sentinel SARI hospitalizations in these countries are currently at pre-season levels.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation: week 43/2011

Sentinel outpatient clinics collected 508 respiratory specimens, none of which tested positive for influenza virus.
Among specimens tested from non-sentinel sources, 17 were influenza A and 4 were influenza B.

Of the influenza A viruses, 12 were subtyped: 4 as A(H1)pdm09 and 8 as influenza A(H3).

Sentinel hospitals collected 80 respiratory specimens from SARI patients, none of which tested positive for influenza virus.

No antigenic or genetic characterizations were reported to WHO/Europe this week.



Cumulative virological data: weeks 40?43/2011

During this period, 59 influenza virus detections were reported: 42 (71%) were influenza A and 17 (29%) were influenza B. Of the influenza A viruses, 29 were subtyped: 20 as A(H3) and 9 as A(H1)pdm09.



Comment

Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region. There have been sporadic detections of influenza A(H3N2), influenza A(H1N1)pdm09 and influenza B during recent weeks.



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.


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Country comments (where available)

Armenia: A new sentinel site (in patient hospital), the Medical Center 'Erebuni' has been added to the SARI sentinel surveillance system of Yerevan city in the Republic of Armenia. Medical center ' Erebuni' is a multi-functional hospital. The intensive care unit and cardiopulmonary departments participate in SARI sentinel surveillance. The training was organized for personnel and technical support is provided.

Kazakhstan: In the week 43/2011 189 respiratory specimens were collected, of which 0 tested positive for influenza virus. Of the 189 respiratory specimens tested for other respiratory viruses, 16 (8.5%) were positive: 8 (50%) Adenoviruses, 6 (38%) Respiratory syncytial viruses (RSV) and 2 (12%) Parainfluenza-1.

Scotland: No Death due to confirmed Flu or SARI have been reported to HPS this week


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EuroFlu - Weekly Electronic Bulletin - Week 44 : 31/10/2011-06/11/2011 - 11 November 2011, Issue N? 418 (edited): sporadic flu activity detected

EuroFlu - Weekly Electronic Bulletin - Week 44 : 31/10/2011-06/11/2011 - 11 November 2011, Issue N? 418 (edited): sporadic flu activity detected

[Source: Euroflu.org, full page: (LINK). Extract, edited.]


EuroFlu - Weekly Electronic Bulletin - Week 44 : 31/10/2011-06/11/2011 - 11 November 2011, Issue N? 418



Sporadic Influenza detections in WHO European Region
  • This issue is based on data for week 44/2011 reported by 44 Member States in the WHO European Region.
  • Levels of influenza activity in the Region remain low.
  • Sporadic detections of influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B have been reported.

Current situation: week 44/2011

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be low throughout the WHO European Region.

Out of 39 countries reporting on trends, 27 countries reported stable trends, while 5 countries reported increasing and 7, decreasing trends.

Consultation rates were in general highest in young children.
Of the 40 countries reporting on geographical distribution of influenza activity, 5 countries reported sporadic spread: the Czech Republic, Finland, France, Norway and Sweden.

All countries reported low intensity of influenza activity and low impact on their health care services.

Data from sentinel hospital-based surveillance for severe acute respiratory infection (SARI) were reported by 7 countries: Armenia, Georgia, Kazakhstan, the Republic of Moldova, the Russian Federation, Serbia and Ukraine. Sentinel SARI hospitalizations in these countries are currently at pre-season levels.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation: week 44/2011

Sentinel outpatient clinics collected 544 respiratory specimens, of which 9 (1.7%) tested positive for influenza virus: 8 were influenza A and 1 was influenza B.

Of the influenza A viruses, 2 were subtyped as influenza A(H3).

In addition, 20 non-sentinel specimens were reported positive for influenza: 12 influenza A and 8 influenza B.

Of the influenza A viruses, 7 were subtyped: 1 as A(H1)pdm09 and 6 as A(H3).

Sentinel hospitals collected 59 respiratory specimens from SARI patients, none of which tested positive for influenza virus.

No antigenic or genetic characterizations were reported to WHO/Europe this week.



Cumulative virological data: weeks 40?44/2011

During this period, 88 influenza virus detections were reported: 63 (72%) were influenza A and 25 (28%) were influenza B. Of the influenza A viruses, 38 were subtyped: 10 as A(H1)pdm09 and 28 as A(H3).



Comment

Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region. There have been sporadic detections of influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B during recent weeks.



Further information


The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.

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EuroFlu - Weekly Electronic Bulletin - Week 45 : 07/11/2011-13/11/2011 - 18 November 2011, Issue N? 419 (edited)

EuroFlu - Weekly Electronic Bulletin - Week 45 : 07/11/2011-13/11/2011 - 18 November 2011, Issue N? 419 (edited)

[Source: EuroFlu, full page: (LINK). Extract, edited.]


EuroFlu - Weekly Electronic Bulletin - Week 45 : 07/11/2011-13/11/2011 - 18 November 2011, Issue N? 419


Sporadic influenza detections in the WHO European Region
  • This issue is based on data for week 45/2011 reported by 48 Member States in the WHO European Region.
  • Levels of influenza activity in the Region remain low.
  • Sporadic detections of influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B have been reported.

Current situation: week 45/2011

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be low throughout the WHO European Region.

Out of 41 countries reporting on trends, 29 reported stable trends, while 7 reported increasing and 5 reported decreasing trends.

Consultation rates were in general highest in young children.
Of the 41 countries reporting on geographical distribution of influenza activity, 6 reported sporadic activity: the Czech Republic, France, Norway, the Russian Federation, Spain and Sweden.

All countries reported a low intensity of influenza activity and low impact on their health care services.

Data from sentinel hospital-based surveillance for severe acute respiratory infection (SARI) were reported by 8 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Serbia and Ukraine.

Sentinel SARI hospitalizations in these countries are currently at pre-season levels.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation: week 45/2011

Sentinel outpatient clinics collected 596 respiratory specimens, of which 6 (1.0%) tested positive for influenza virus: 2 were type A and 4 were type B.

Of the influenza A viruses, 1 was subtyped as influenza A(H3).
In addition, 30 non-sentinel specimens were reported positive for influenza: 23 type A and 7 type B.

Of the influenza A viruses, 15 were subtyped: 11 as A(H1)pdm09 and 4 as A(H3).

Sentinel hospitals collected 48 respiratory specimens from SARI patients, none of which tested positive for influenza virus.



Cumulative virological data: weeks 40-45/2011

During this period, 125 influenza virus detections were reported: 89 (71%) were influenza A and 36 (29%) were influenza B.

Of the influenza A viruses, 55 were subtyped: 21 as A(H1)pdm09 and 34 as A(H3).

Since week 40/2011, 5 influenza viruses have been characterized antigenically: 2 were A(H1)pdm09 A/California/7/2009 (H1N1)-like; 1 was A(H3) A/Perth/16/2009 (H3N2)-like; 1 was B/Florida/4/2006-like (B/Yamagata/16/88 lineage), and 1 was B/Brisbane/60/2008-like (B/Victoria/2/87 lineage).



Comment

Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region. There have been sporadic detections of influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B during recent weeks.



Further information


The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.

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EuroFlu - Weekly Electronic Bulletin - Week 46 : 14/11/2011-20/11/2011 - 25 November 2011, Issue N? 420: Czech Rep., 28 year old female died of A(H1N1)pdm09

EuroFlu - Weekly Electronic Bulletin - Week 46 : 14/11/2011-20/11/2011 - 25 November 2011, Issue N? 420: Czech Rep., 28 year old female died of A(H1N1)pdm09

[Source: EuroFlu, full page: (LINK). Extract, edited.]


EuroFlu - Weekly Electronic Bulletin - Week 46 : 14/11/2011-20/11/2011 - 25 November 2011, Issue N? 420


Low levels of influenza activity in the WHO European Region
  • This issue is based on data for week 46/2011 reported by 46 Member States in the WHO European Region.
  • Levels of influenza activity in the Region remain low.
  • Sporadic detections of influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B have been reported.

Current situation: week 46/2011

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be low throughout the WHO European Region.

Out of 38 countries reporting on trends, 26 reported stable trends, while 10 reported increasing and 2 reported decreasing trends.

In general, consultation rates were highest in young children.
Of the 39 countries reporting on geographical distribution of influenza activity, 7 reported sporadic activity (the Czech Republic, France, Ireland, Norway, the Russian Federation, Spain and Sweden) and 1 reported local activity (the Netherlands).

All countries reported a low intensity of influenza activity and low impact on their health care services.

Data from sentinel hospital-based surveillance for severe acute respiratory infection (SARI) were reported by 8 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, Romania, the Russian Federation, Serbia and Ukraine. Sentinel SARI hospitalizations in these countries are currently at pre-season levels.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation: week 46/2011

Sentinel outpatient clinics collected 734 respiratory specimens, of which 12 (1.6%) tested positive for influenza viruses: 8 were type A and 4 were type B.

Of the influenza A viruses, 7 were subtyped as influenza A(H3) and 1 was subtype as influenza A(H1)pdm09.

In addition, 29 non-sentinel specimens were reported positive for influenza: 22 type A and 7 type B.

Of the influenza A viruses, 11 were subtyped: 2 as A(H1)pdm09 and 9 as A(H3).

Sentinel hospitals collected 177 respiratory specimens from SARI patients, none of which tested positive for influenza virus.



Cumulative virological data: weeks 40?46/2011

During this period, 172 influenza virus detections were reported: 122 (71%) were influenza A and 50 (29%) were influenza B.

Of the influenza A viruses, 76 were subtyped: 24 (32%) as A(H1)pdm09 and 52 (68%) as A(H3).

Since week 40/2011, 5 influenza viruses have been characterized antigenically: 2 were A(H1)pdm09 A/California/7/2009 (H1N1)-like; 1 was A(H3) A/Perth/16/2009 (H3N2)-like; 1 was B/Florida/4/2006-like (B/Yamagata/16/88 lineage), and 1 was B/Brisbane/60/2008-like (B/Victoria/2/87 lineage).



Comment

Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region. There have been sporadic detections of influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B during recent weeks. The percentage of sentinel samples that tested positive was low (1.6%). As is common at this time of year, the number of influenza detections remains low, with respiratory syncytial virus detections slowly increasing (see graphs for Europe, season 2011/2012).



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.



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Country comments (where available)

Czech Republic: We are reporting first confirmed influenza death in this season:
  • female born 1973
  • hospitalized from 25 October at intensive care unit
  • first symptoms 19 October
  • influenza isolate A H1N1 pdm confirmed at national influenza reference laboratory
  • antiviral treatment during hospitalization
  • death on 9 November
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EuroFlu - Weekly Electronic Bulletin - Week 47 : 21/11/2011-27/11/2011 - 02 December 2011, Issue N? 421 (extract, edited)

EuroFlu - Weekly Electronic Bulletin - Week 47 : 21/11/2011-27/11/2011 - 02 December 2011, Issue N? 421 (extract, edited)

[Source: EuroFlu.org, full text: (LINK). Extracts, edited.]

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EuroFlu - Weekly Electronic Bulletin - Week 47 : 21/11/2011-27/11/2011 - 02 December 2011, Issue N? 421




Continued low level of influenza activity in the WHO European Region
  • This issue is based on data for week 47/2011 reported by 46 Member States in the WHO European Region.
  • Levels of influenza activity in the Region remain low.
  • Sporadic detections of influenza A(H3N2), influenza B, and influenza A(H1N1)pdm09 have been reported.

Current situation: week 47/2011

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be low throughout the WHO European Region.

Out of 42 countries reporting on trends, 31 reported stable trends, while 9 reported increasing and 2 reported decreasing trends.

In general, consultation rates were highest in young children.

Of the 42 countries reporting on geographical distribution of influenza activity, 9 reported sporadic activity (Azerbaijan, the Czech Republic, France, Ireland, Norway, the Russian Federation, Spain, Sweden and Switzerland) and 1 reported local activity (the Netherlands).

All countries reported a low intensity of influenza activity and low impact on their health care services.

In week 47, data from sentinel hospital-based surveillance for severe acute respiratory infection (SARI) were reported by 9 countries: Albania, Armenia, Georgia, Kazakhstan, the Republic of Moldova, Romania, the Russian Federation, Serbia and Ukraine. Sentinel SARI hospitalizations in these countries are currently at pre-season levels.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation: week 47/2011

Sentinel outpatient clinics collected 834 respiratory specimens, of which 7 (0.8%) tested positive for influenza viruses: 5 were type A and 2 were type B.

All 5 influenza A viruses were subtyped as influenza A(H3).
In addition, 37 non-sentinel specimens were reported positive for influenza: 30 type A and 7 type B.

Of the influenza A viruses, 21 were subtyped: 1 as A(H1)pdm09 and 20 as A(H3).

Sentinel hospitals collected 117 respiratory specimens from SARI patients, none of which tested positive for influenza virus.



Cumulative virological data: weeks 40?47/2011

During this period, 219 influenza virus detections were reported: 160 (73%) were influenza A and 59 (27%) were influenza B.

Of the influenza A viruses, 110 were subtyped: 25 (23%) as A(H1)pdm09 and 85 (77%) as A(H3).

Since week 40/2011, 5 influenza viruses have been characterized antigenically: 2 were A(H1)pdm09 A/California/7/2009 (H1N1)-like; 1 was A(H3) A/Perth/16/2009 (H3N2)-like; 1 was B/Florida/4/2006-like (B/Yamagata/16/88 lineage), and 1 was B/Brisbane/60/2008-like (B/Victoria/2/87 lineage).

Out of 2 influenza viruses characterized genetically, 1 belonged to the group represented by A/Stockholm/18/2011 and 1 to the group represented by A/Iowa/19/2010, both in the A/Victoria/208/2009 A(H3) clade.



Comment

Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region.

There have been sporadic detections of influenza A(H3N2), influenza B and influenza A(H1N1)pdm09 during recent weeks.

The percentage of sentinel samples that tested positive for influenza in week 47/2011 (0.8%) remained low, as is common for this time of year, while respiratory syncytial virus detections have slowly increased (see graphs for Europe, season 2011/2012).



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.


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EuroFlu - Weekly Electronic Bulletin - Week 48 : 28/11/2011-04/12/2011 - 09 December 2011, Issue N? 422 (edited)

EuroFlu - Weekly Electronic Bulletin - Week 48 : 28/11/2011-04/12/2011 - 09 December 2011, Issue N? 422 (edited)

[Source: EuroFlu, full page: (LINK). Extract, edited.]

EuroFlu - Weekly Electronic Bulletin -
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Week 48 : 28/11/2011-04/12/2011 - 09 December 2011, Issue N? 422



Continued low influenza activity in the WHO European Region
  • This issue is based on data for week 48/2011 reported by 46 Member States in the WHO European Region.
  • Levels of influenza activity in the Region remain low.
  • Sporadic detections of influenza A(H3N2), influenza B, and influenza A(H1N1)pdm09 have been reported.

Current situation: week 48/2011

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be low throughout the WHO European Region.

Out of 41 countries reporting on trends, 26 reported stable trends, while 9 reported increasing and 6 reported decreasing trends.

In general, consultation rates were highest in young children.
Of the 41 countries reporting on the geographical distribution of influenza activity, 7 reported sporadic activity (Azerbaijan, the Czech Republic, France, Norway, Spain, Sweden and Uzbekistan) and 1 reported local activity (the Netherlands). All countries reported low intensity of influenza activity and low impact on their health care services.

In week 48, data from sentinel hospital-based surveillance for severe acute respiratory infection (SARI) were reported by 8 countries: Albania, Georgia, Kazakhstan, the Republic of Moldova, Romania, the Russian Federation, Serbia and Ukraine.

Sentinel SARI hospitalizations in these countries are at pre-season levels.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in ?Overview of sentinel SARI systems in EuroFlu?.



Virological situation: week 48/2011

Sentinel outpatient clinics collected 932 respiratory specimens, of which 17 (1.8%) tested positive for influenza viruses: 14 were type A and 3 were type B.

Of the influenza A viruses, 10 were subtyped as influenza A(H3) and 1 as A(H1)pdm09.

In addition, 48 non-sentinel specimens were reported positive for influenza: 40 type A and 8 type B.

Of the influenza A viruses, 17 were subtyped: 14 as A(H3) and 3 as A(H1)pdm09.

Sentinel hospitals collected 122 respiratory specimens from SARI patients, none of which tested positive for influenza virus.



Cumulative virological data: weeks 40?48/2011

During this period, 295 influenza virus detections were reported: 226 (77%) were influenza A and 69 (33%) were influenza B.

Of the influenza A viruses, 148 were subtyped: 118 (80%) as A(H3) and 30 (20%) as A(H1)pdm09.

Since week 40/2011, 5 influenza viruses have been characterized antigenically: 2 were A(H1)pdm09 A/California/7/2009 (H1N1)-like; 1 was A(H3) A/Perth/16/2009 (H3N2)-like; 1 was B/Florida/4/2006-like (B/Yamagata/16/88 lineage), and 1 was B/Brisbane/60/2008-like (B/Victoria/2/87 lineage).

Out of 4 influenza viruses characterized genetically, 2 belonged to the B/Bangladesh/3333/2007 clade (Yamagata lineage); 1 belonged to the group represented by A/Stockholm/18/2011 and 1 to the group represented by A/Iowa/19/2010, both in the A/Victoria/208/2009 A(H3) clade.



Comment

Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region. There have been sporadic detections of influenza A(H3N2), influenza B and influenza A(H1N1)pdm09 during recent weeks. The percentage of sentinel samples that tested positive for influenza in week 48/2011 (1.8%) remained low, as is common for this time of year, while respiratory syncytial virus detections have slowly increased since week 40/2011(see the graphs for Europe, season 2011/2012.



Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.

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Country comments (where available)

Latvia:

In week 48/2011 the first case of influenza, identificated as B/Victoria- lineage virus, has been detected from non-sentinel sourse in Latvia.

For 89.5% of SARI cases laboratory investigations have been performed.

The etiologies detected by now are the following: 7 Parainfluenza virus type 1; 2 Parainfluenza virus type 4; 2 RSV type B; 2 Adenovirus; 1 Rhinovirus; 1 Bocavirus and 1 Str.pneumoniae. The total positivity rate for SARI cases is 47% and the positivity rate for influenza in SARI cases is 0% by now. In one of the two deaths registered in SARI cases an Adenovirus was detected. For the other one the laboratory investigation is ongoing.
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