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Archive. EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance (at December 31, 2009)

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 35 : 24/08/2009-30/08/2009 - 04 September 2009, Issue N? 321 (edited)

EuroFlu - Weekly Electronic Bulletin Week 35 : 24/08/2009-30/08/2009 - 04 September 2009, Issue N? 321

Low or moderate influenza activity and a continued overall decrease in the number of Pandemic (H1N1) 2009 virus detections


Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 3 September 2009, 48 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. These include 125 fatalities. An overview of the global pandemic (H1N1) 2009 situation is available.


Summary:

In week 35/2009, a total of 431 detections of A(H1N1)v influenza were reported. The number of pandemic (H1N1) 2009 virus detections in Europe was highest in week 30, and has decreased since week 31. All countries reported low or moderate influenza activity based on normal or slightly increased levels of ILL/ARI consultations. Seventeen countries reported pandemic A(H1)v as the dominant virus.


Epidemiological situation - week 35/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. For the geographical spread indicator, Israel and Sweden reported widespread activity, while all other countries reported local, sporadic or no activity. An increasing trend was reported by Sweden and the Russian Federation (Northwest region and Central region). Of 17 countries reporting the impact of the pandemic, Albania and Ireland reported a moderate impact and all other countries reported a low impact, i.e. demands on health care services were not above usual levels (click here for definitions).


Cumulative epidemiological situation - weeks 16-35/2009:

Until week 25/2009, detections of pandemic H1N1 influenza had not caused increased levels of ILI or ARI in countries of the European Region. An increase in influenza activity has been observed for England, Luxembourg, Turkey (26/2009), Wales (27/2009), Northern Ireland (29/2009), Ireland, Italy, Malta, Norway (30/2009), Austria and Israel (31/2009), and the Netherlands (32/2009). Around week 31 a substantial increase in ILI rates was observed in Norway and continued in week 34 (no data for week 35). While the ILI rate for Norway has been elevated over the last few weeks, the proportion of ILI cases (i.e. sentinel specimens) with detectable virus remains very low. The rise in ILI is therefore likely to represent increased public concern for influenza and probably does not indicate a substantial rise in influenza infections.


Virological situation - week 35/2009:

The total number of respiratory specimens collected by sentinel physicians in week 35/2009 was 511 of which 46 (9%) were positive for influenza virus: 45 were type A (42 subtype H1v and 3 not subtyped) and one was type B. In addition, 666 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported positive for influenza virus: 664 type A (389 subtype H1v, 168 subtype H1, 12 subtype H3 and 95 not subtyped) and two type B. Of the total influenza A virus detections that were subtyped in week 35/2009 (N=611), 71% were the pandemic (H1N1) 2009 virus.


Cumulative virological situation - weeks 16/2009-35/2009:

Of 15612 virus detections (sentinel and non-sentinel) since week 16/2009, 15043 (96%) were type A, 10190 subtype H1v, 367 subtype H3, 600 subtype H1 and 3886 not subtyped) and 569 (4%) were type B.

Based on the antigenic and/or genetic characterisation of 3566 influenza viruses reported from week 40/2008 to week 35/2009, 1968 (55%) were A/Brisbane/10/2007 (H3N2)-like, 107 (3%) A/Brisbane/59/2007 (H1N1)-like, 27 (1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 912 (26%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here). A total of 552 (15%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here).

Antiviral susceptibility reports from week 40/2008 to 35/2009 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N2) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for seasonal A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors.

All pandemic (H1N1) 2009 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).


Comment:

In week 35/2009 influenza activity was of low or moderate intensity across the European Region. For the geographical spread indicator, widespread activity was reported for Israel and Sweden, with the other countries reporting local or no activity. A peak in pandemic (H1N1) 2009 virus detections was observed around week 30 for Europe as a whole (click here) and total detections continued to decline in week 35/2009. The impact on health care services is currently considered moderate in Albania and Ireland and low in other countries.

For more information about the situation in Europe, please go to the dedicated web pages of WHO (click here) and ECDC (click here). EuroFlu provides data for the global situation updates on the WHO headquarters website (click here).


Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 14 reported both clinical and virological data, 14 reported virological data only and seven reported clinical data only in week 35/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
(...)


Network comments (where available)

  • Croatia: confirmed and clinical cases
  • Italy: During this last week, a significant increase in the H1N1v influenza lab-confirmed cases has been reported by the majority of the Italian laboratories participating in the surveillance activities
  • Latvia: First case of influenza A/H3 was confirmed in patient arrived from USA.
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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 36 : 31/08/2009-06/09/2009 - 11 September 2009, Issue N? 322 (edited)

EuroFlu - Weekly Electronic Bulletin Week 36 : 31/08/2009-06/09/2009 - 11 September 2009, Issue N? 322

Low or moderate influenza activity with Pandemic (H1N1) 2009 virus detections


Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 3 September 2009, 48 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. These include 125 fatalities. An overview of the global pandemic (H1N1) 2009 situation is available.


Summary:

In week 36/2009, a total of 706 detections of A(H1N1)v influenza were reported. The number of pandemic (H1N1) 2009 virus detections in Europe was highest in week 30, and has decreased since week 31. The number of detections has become stable in week 36. However, difference in trend in detections exist between countries. All countries reported low or moderate influenza activity based on normal or slightly increased levels of ILL/ARI consultations. Sixteen countries reported pandemic A(H1)v as the dominant virus.


Epidemiological situation - week 36/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. For the geographical spread indicator, Austria and Israel reported widespread activity while all other countries reported local, sporadic or no activity.

For Austria the consultation rate was low in week 36 and the number of Pandemic (H1N1) 2009 virus detections are slightly decreasing. In Israel the consultation rate remains around the baseline but has levelled off, the same has been observed for the number of influenza H1v virus detections. While Sweden reported widespread activity in week 35, no report on the influenza indicators was provided for week 36, but the consultation rates for ILI remained high, and an increase was also observed for the number of influenza A/H1v detections. In Ireland the ILI rate is above the baseline but stable, and in Norway the ILI rates has started to decrease, as well as the number of influenza A/H1v detections. The age group that most frequently visited the general practitioners for ILI was the 15-64 age group in Ireland, Sweden and Norway.

Of 12 countries reporting the impact of the pandemic, Ireland reported a moderate impact and all other countries reported a low impact, i.e. demands on health care services were not above usual levels (click here for definitions).


Cumulative epidemiological situation - weeks 16-36/2009:

Until week 25/2009, detections of pandemic H1N1 influenza had not caused increased levels of ILI or ARI in countries of the European Region. An increase in influenza activity has been observed for England, Luxembourg, Turkey (26/2009), Wales (27/2009), Northern Ireland (29/2009), Ireland, Italy, Malta, Norway (30/2009), Austria and Israel (31/2009), the Netherlands (32/2009) and Sweden (week 35/2009).


Virological situation - week 36/2009:

The total number of respiratory specimens collected by sentinel physicians in week 36/2009 was 718 of which 94 (13%) were positive for influenza virus: all 94 were type A (41 subtype H1v, 52 subtype H1 and 1 not subtyped). Several of the viruses entered as seasonal H1 are probably erroneously recorded and should be H1v. In addition, 709 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported positive for influenza virus: 707 type A (665 subtype H1v, 8 subtype H1, 7 subtype H3 and 27 not subtyped) and two type B. Of the total influenza A virus detections that were subtyped in week 36/2009 (N=773), 91% were the pandemic (H1N1) 2009 virus.

Whereas in several countries the number of pandemic (H1N1) 2009 virus detections are stable or decreasing, a slight increase in the number of Pandemic (H1N1) 2009 virus detections was observed for the Russian Federation (region Central) (click here) and Georgia (click here). Additionally an increase in influenza A/H1v detections was observed for Luxembourg after an initial drop in week 33 and 34.


Cumulative virological situation - weeks 16/2009-36/2009:

Of 17713 virus detections (sentinel and non-sentinel) since week 16/2009, 17142 (97%) were type A (11210 subtype H1v, 375 subtype H3, 1640 subtype H1 and 3917 not subtyped) and 571 (3%) were type B.

Based on the antigenic and/or genetic characterisation of 4316 influenza viruses reported from week 40/2008 to week 36/2009, a total of 956 (22%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here). Furthermore, 2215 (51%) were A/Brisbane/10/2007 (H3N2)-like, 111 (3%) A/Brisbane/59/2007 (H1N1)-like, 29 (<1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1005 (23%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

The graph for Europe shows that influenza A subtype H3N2 peaked during the winter around week 04/2009 and the Pandemic (H1N1) 2009 virus in the summer period, around week 30/2009 (click here). Part of the decrease in virus detections since week 30 is likely to be attributable to more restrictive testing practices that were introduced in many countries.

Antiviral susceptibility reports from week 40/2008 to 36/2009 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N2) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for seasonal A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors. All pandemic (H1N1) 2009 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).


Comment:

In week 36/2009 influenza activity was of low or moderate intensity across the European Region. For the geographical spread indicator, widespread activity was reported for Austria and Israel, with the other countries reporting local, sporadic or no activity. A peak in pandemic (H1N1) 2009 virus detections was observed around week 30 for Europe as a whole (click here) and the total number of detections levelled off in week 36/2009. The impact on health care services is currently considered moderate Ireland and low in eleven countries.

For more information about the situation in Europe, please go to the dedicated web pages of WHO (click here) and ECDC (click here). EuroFlu provides data for the global situation updates on the WHO headquarters website (click here).


Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 22 reported both clinical and virological data, nine reported virological data only and seven reported clinical data only in week 36/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).


Erratum:

The rate in the Table is incorrect for Uzbekistan. The number of ILI cases in week 36 was 0.

(...)
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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 37 : 07/09/2009-13/09/2009 - 18 September 2009, Issue N? 323 (edited)

EuroFlu - Weekly Electronic Bulletin Week 37 : 07/09/2009-13/09/2009 18 September 2009, Issue N? 323

Low or moderate influenza activity with ongoing pandemic (H1N1) 2009 virus detections


Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 11 September 2009, 48 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. These include 140 fatalities. For an overview of the global pandemic (H1N1) 2009 situation, click here).


Summary:

In week 37/2009, a total of 769 detections of A(H1N1)v influenza were reported, similar to the previous week. All countries reported low or moderate influenza activity, however Netherlands, Israel, Northern Ireland, and Norway reported influenza-like-illness consultation rates that are above seasonal baseline thresholds. Twenty countries reported pandemic (H1N1) 2009 as the dominant virus in circulation. No countries reported any other influenza subtypes as dominant.


Epidemiological situation - week 37/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. The geographic spread of influenza illness was reported to be widespread in Israel, localized in three countries, sporadic in eight countries and reported as ?none? in eight countries. The impact of influenza on health services was reported to be low in 16 countries, and moderate in Ireland.

Several countries have reported a rise in ILI (Israel, Netherlands, Northern Ireland, Norway and Sweden) or ARI (Belgium, Estonia, France, Germany, Russian Federation, across every region, Slovenia and Ukraine) consultation rates over the previous 2-6 weeks. Comparisons with historical data in several of these countries suggest that this is consistent with the timing of the start of influenza and other respiratory diseases in the region. Influenza-like-illness consultation rates in Ireland, Israel, Netherlands and Norway are currently above seasonal baseline thresholds.

These trends should be interpreted with care and should be validated by virological data available in the country. For example, following a significant rise in outpatient ILI consultation rates between weeks 30 and 35 in Norway, ILI consultation rates have declined during each of the last two weeks but still remain above the baseline threshold. However, there have been few influenza virus detections from the sentinel surveillance system in Norway and the increased levels of ILI may represent increased public concern for influenza and not indicate a substantial rise in the incidence of influenza.


Virological situation - week 37/2009:

The total number of respiratory specimens collected by sentinel physicians in week 37/2009 was 661 of which 85 (13%) were positive for influenza virus: all 85 were type A (13 were subtyped as pandemic A(H1N1), 70 were subtyped as pandemic A(H1) and 2 were not subtyped). In addition, 684 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 680 were influenza type A (175 of these were subtyped as pandemic A(H1N1), 458 were subtyped as pandemic A(H1), 3 were subtyped as A(H3), 4 were subtyped as seasonal A(H1) and 40 were not subtyped). Four influenza B viruses were also detected. Of the total influenza A virus detections that were subtyped in week 37/2009 (N=723), 716 or 99% were the pandemic (H1N1) 2009 virus. The decrease in detections of pandemic (H1N1) 2009 that has been observed since week 30 is likely attributable to more restrictive testing practices that were introduced in many countries.


Cumulative virological situation - weeks 16/2009-37/2009:

Of 21788 virus detections (sentinel and non-sentinel) since week 16/2009, 21205 (97%) were type A. Of the influenza type A viruses, 15175 (71%) were subtyped as pandemic A(H1), 375 (2%) were subtyped as A(H3), 1640 (8%) were subtyped as seasonal A( H1) and 3917 (19%) were not subtyped. There were 571 type B viruses (3% of total virus detections).

Based on the antigenic and/or genetic characterisation of 4795 influenza viruses reported from week 40/2008 to week 37/2009, a total of 1028 (21%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here). Furthermore, 2464 (51%) were A/Brisbane/10/2007 (H3N2)-like, 183 (7%) A/Brisbane/59/2007 (H1N1)-like, 29 (<1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1091 (23%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

Five countries reported antiviral susceptibility testing of pandemic (H1N1) viruses since week 16. All viruses tested for resistance to oseltamivir (424/424) and zanamivir (415/415) were found to be sensitive to these neuraminidase inhibitors. The United Kingdom has also reported that of 839 viruses analysed for the marker commonly associated with resistance to oseltamivir in seasonal influenza (H274Y), none were found to carry this marker (17 of these have been reported to EuroFlu) (click here). Of the few cases of oseltamivir resistance reported globally, one has been reported in Denmark (click here).


Comment:

In week 37/2009 influenza activity was of low or moderate intensity across the European Region. Four countries are now reporting ILI consultation rates that are above seasonal baseline thresholds, however not all countries have established baselines. For the geographical spread indicator, widespread activity was reported for Israel, with the other countries reporting local, sporadic or no activity. The impact on health care services is currently considered moderate in Ireland and low in 16 countries.


Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 39 reported clinical or epidemiological data, and 35 reported virological data in week 37/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
(...)
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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 38 : 14/09/2009-20/09/2009 - 25 September 2009, Issue N? 324 (edited)

EuroFlu - Weekly Electronic Bulletin Week 38 : 14/09/2009-20/09/2009 - 25 September 2009, Issue N? 324

Three countries report influenza activity above the baseline level in week 38/2009: Ireland, Israel and the Russian Federation


Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 22 September 2009, 48 of the 53 countries in the WHO European Region have reported to WHO over 52,000 confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. These include 156 deaths in 14 countries. For an overview of the global pandemic (H1N1) 2009 situation, click here).


Summary:

In week 38/2009, a total of 812 detections of pandemic (H1N1) influenza were reported, which is a similar number to the two previous weeks. Ireland reported a high intensity of influenza activity and Israel and the Russian Federation reported a medium intensity. All other countries reported a low intensity. Sixteen countries reported pandemic (H1N1) 2009 as the dominant virus and twelve countries reported no dominant virus.


Epidemiological situation - week 38/2009:

For the intensity indicator, the reported levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were high in Ireland and medium in Israel and the Russian Federation. In all other countries they were low. The geographic spread of influenza illness was reported to be widespread in Ireland and Israel, local in two countries, sporadic in eight countries and no activity was reported in five countries. The impact of influenza on health services was reported to be low in nine countries, and moderate in Ireland, based mainly on a surge on outpatient providers.

Several countries have reported a rise in ILI (Israel, Netherlands, Northern Ireland, Norway and Sweden) or ARI (Belgium, Estonia, France, Germany, Russian Federation, across every region, Slovenia and Ukraine) consultation rates over the past 2-6 weeks. Influenza-like illness consultation rates in Ireland, Israel and Norway are currently above seasonal baseline thresholds.

Increased levels of ILI/ARI in a country should be interpreted with care and should be validated by virological data. In Norway there was a significant rise in outpatient ILI consultation rates between weeks 30 and 35 but there were few influenza virus detections from the sentinel surveillance system and the increased levels of ILI may have represented increased public concern for influenza and not a substantial rise in the incidence of influenza.


Virological situation - week 38/2009:

The total number of respiratory specimens collected by sentinel physicians in week 38/2009 was 839 of which 195 (23%) were positive for influenza virus: 192 were type A (37 were subtyped as pandemic A(H1N1), 151 were subtyped as pandemic A(H1) and 4 were not subtyped) and 3 type B. In addition, 662 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 655 were influenza type A (624 were subtyped as pandemic A(H1), of which 182 were determined as pandemic A(H1N1), eight were subtyped as A(H3), five were subtyped as seasonal A(H1) and 18 were not subtyped) and seven were influenza type B.

Of the total influenza A virus detections that were subtyped in week 38/2009 (N=847), 812 or 96% were the pandemic (H1N1) 2009 virus. It is likely that the decrease in detections of pandemic (H1N1) 2009 that has been observed since week 30 (click here) can be attributed to more restrictive testing practices that were introduced in many countries.


Cumulative virological situation - weeks 16/2009-38/2009:

Of 21949 virus detections (sentinel and non-sentinel) since week 16/2009, 21353 (97%) were type A. Of the influenza type A viruses, 16619 (78%) were subtyped as pandemic A(H1), 385 (2%) were subtyped as A(H3), 276 (1%) were subtyped as seasonal A(H1) and 4073 (19%) were not subtyped. There were 596 type B viruses (3% of total virus detections).

Based on the antigenic and/or genetic characterisation of 4515 influenza viruses reported from week 40/2008 to week 38/2009, a total of 1069 (24%) were pandemic A(H1N1), A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here). Furthermore, 2202 (49%) were A/Brisbane/10/2007 (H3N2)-like, 183 (4%) A/Brisbane/59/2007 (H1N1)-like, 27 (<1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1034 (23%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

Six countries have reported antiviral susceptibility testing of pandemic (H1N1) viruses since week 40/2008. All viruses tested for resistance to oseltamivir (424/424) and zanamivir (415/415) were found to be sensitive to these neuraminidase inhibitors. The United Kingdom has also reported that of 973 viruses (17 of these have been reported to EuroFlu) analysed for the marker commonly associated with resistance to oseltamivir in seasonal influenza (H274Y), two were found to carry this marker (click here). Of the few cases of oseltamivir resistance reported globally, one has been reported in Denmark (click here) and two in the United Kingdom (see above for reference).


Comment:

In week 38/2009 Ireland reported the dominant virus was pandemic (H1N1) 2009 and a high intensity of influenza activity. The Russian Federation and Israel reported a medium intensity and all other countries that reported this indicator reported a low intensity. In the Russian Federation, four of the seven Districts reported a medium intensity (Central, Northwestern, Urals and Siberian) and three reported a low intensity (Far eastern, Southern and Volga). For the geographical spread indicator, widespread activity was reported for Ireland and Israel, with the other countries reporting local, sporadic or no activity. The impact on health care services is currently considered moderate in Ireland and low in 16 countries.


Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 14 reported both clinical and virological data, 15 reported virological data only and five reported clinical data only in week 36/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).


Erratum:

The number of sentinel specimens that were positive in week 38/2009 was 8 and not 78 (see Table below)


Note:

Serbia reported a stable trend, low intensity and low impact in week 38/2009

(...)
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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 39 : 21/09/2009-27/09/2009 - 02 October 2009, Issue N? 325 (edited)

EuroFlu - Weekly Electronic Bulletin Week 39 : 21/09/2009-27/09/2009 - 02 October 2009, Issue N? 325

Low to moderate influenza activity with increasing trends in respiratory disease


Pandemic (H1N1) 2009 virus detections have been reported in the European Region since the first week of May 2009. To date, 48 of the 53 countries in the WHO European Region have reported to WHO over 56,000 laboratory confirmed cases of pandemic (H1N1) 2009 virus infection. As of 27 September, 176 deaths have been reported in laboratory-confirmed cases. For an overview of the global pandemic (H1N1) 2009 situation, click here).


Summary:

In week 39/2009, 14% of respiratory swabs collected from sentinel surveillance sites were positive for influenza. Of 854 influenza A virus detections that were subtyped in week 39/2009, 840 or 98% were pandemic (H1N1) 2009 viruses. This is similar to the weekly number of pandemic (H1N1) 2009 detections that have been reported since week 34. Twenty-five countries entered epidemiologic data into the EuroFlu platform this week: the data from 12 of these suggest increasing influenza-like-illness (ILI) or acute respiratory illness (ARI) consultation rates since week 34, and 5 are reporting levels at or above seasonal baseline thresholds. However ILI and ARI consultation rates commonly increase at this time of year. In Belgium, Ireland, Israel and Northern Ireland, increasing ILI consultation rates during recent weeks are consistent with trends in the number of influenza positive specimens collected from sentinel sites.


Epidemiological situation - week 39/2009:

Of the 21 countries that reported on the intensity indicator, Belgium, Israel and the Russian Federation reported medium intensity of respiratory disease transmission, while the other 18 countries reported a low intensity. The geographic spread of influenza-like-illness was reported as widespread in Belgium and Israel, local in two countries, sporadic in seven countries, and ten countries reported no activity. The impact of influenza on health services was reported low in the 17 countries reporting this indicator. Of the 19 countries that reported a dominant subtype, all reported a dominance of pandemic influenza A(H1N1) 2009.

Data from 12 countries suggest an overall increase in ILI and/or ARI consultation rates, including increases in three or more weeks, since week 34.

In Belgium, Ireland, Israel and Northern Ireland, the recent increases in epidemiologic data also are consistent with concurrent trends in the number of influenza positive specimens collected from sentinel sites. These are also the only countries that have reported ILI consultation rates to be the highest in the 5-14 year age group.

Nine countries that reported epidemiological data in week 39 have established quantitative baseline thresholds for ILI and/or ARI consultation rates based on historical data.

Of these countries, Ireland, Israel, Netherlands and Norway are currently at or above seasonal baseline thresholds for ILI consultations, and France has exceeded its baseline threshold for ARI consultations.


Virological situation - week 39/2009:

The total number of respiratory specimens collected by sentinel physicians in week 39/2009 was 1017 of which 139 (14%) were positive for influenza virus: 138 were type A (131 were identified as pandemic A(H1) and 7 not subtyped) and 1 type B. In addition, 751 non-sentinel source specimens (e.g. specimens collected for routine diagnostic purposes in the community, hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 745 were influenza type A (709 pandemic A(H1), nine A(H3), five seasonal A(H1) and 22 not subtyped) and six type B.


Cumulative virological situation - weeks 16/2009-39/2009:

Of 22952 influenza virus detections (sentinel and non-sentinel) since week 16/2009, 22346 (97%) were type A. Of these, 17612 (79%) were pandemic A(H1), 402 (2%) were A(H3), 205 (1%) were seasonal A(H1) and 4127 (18%) were not subtyped. There were 606 type B viruses (3% of total virus detections).

Based on the antigenic and/or genetic characterisation of 4890 influenza viruses reported from week 40/2008 to week 39/2009, a total of 1116 (23%) were pandemic A(H1N1), A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here). Furthermore, 2469 (50%) were A/Brisbane/10/2007 (H3N2)-like, 185 (4%) A/Brisbane/59/2007 (H1N1)-like, 29 (<1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 1091 (22%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

This week, two of 1023 pandemic viruses tested in the United Kingdom have been confirmed to carry a mutation which confers resistance to the antiviral drug oseltamivir; both have been shown phenotypically to be resistant to the drug but retain sensitivity to zanamivir. (click here).

Cases of oseltamivir-resistant viruses continue to be sporadic and infrequent, with no evidence that oseltamivir-resistant pandemic H1N1 viruses are circulating within communities or worldwide. For more information on antiviral use and the risk of drug resistance go to (click here).


Comment:

Influenza activity is low or moderate among countries reporting to EuroFlu and five countries are currently at or above seasonal baseline thresholds for ILI or ARI consultations. While increases in ILI or ARI consultation rates have been observed in 12 countries since week 34, this is consistent with normal seasonal increases in respiratory disease. Increases in ILI or ARI consultation rates should be interpreted with care and should be validated by virological data, especially when public concern for influenza is high. However influenza activity appears to be increasing in Belgium, Ireland, Israel and Northern Ireland where recent increases in ILI consultation rates are also consistent with concurrent trends in the number of influenza positive specimens collected from sentinel sites.


Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Epidemiological, virological and/or qualitative data is presented for 40 countries in week 39/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 40 : 28/09/2009-04/10/2009 - 09 October 2009, Issue N? 326 (edited)

EuroFlu - Weekly Electronic Bulletin Week 40 : 28/09/2009-04/10/2009 - 09 October 2009, Issue N? 326

Low to moderate influenza activity and normal increases in respiratory illness in some European countries


Key Points Week 40/2009:

  1. This week marks the start of the 2009-2010 influenza season. Graphs and cumulative summaries of virological data have been reset for the new season but historical data can still be accessed on the EuroFlu web site.
  2. Thirty-nine of 53 countries in the region have reported this week.
  3. Eleven countries reported consistent increases in ILI and/or ARI since week 37. Of these, only six reported consultation rates above those observed in 2008. This is consistent with a pattern of influenza and respiratory illness activity that is normally observed at this time of the year.
  4. The percentage of influenza positive respiratory specimens collected from sentinel surveillance systems in the European Region was 17.5% (range 0% to 49.2% in countries testing 20 or more sentinel swabs this week). Over 25% of sentinel specimens tested positive for influenza this week in 6 countries: Belgium, Ireland, Israel, Slovenia, Spain and UK (Northern Ireland).
  5. As of October 5, 49 of the 53 countries in the WHO European Region have reported to WHO over 59,000 laboratory confirmed cases of pandemic (H1N1) 2009 virus infection, 193 of these were laboratory confirmed deaths.

Current situation - week 40/2009:

The geographic spread of ILI was reported as widespread in seven countries (Belgium, Ireland, Israel, Luxembourg, Netherlands and UK (England and Wales)), regional in Spain, and local or sporadic in 17 countries. Twelve countries reported no activity. The impact of influenza on health services was reported as moderate in Ireland and low in 25 countries. Of the 16 countries reporting a dominant subtype, pandemic (H1N1) 2009 was dominant.

Eleven countries have reported increasing trends in ILI and/or ARI consultation rates since week 37, but of these, only Belgium (31%), Hungary (20%), Ireland (37%), Spain (31%) and UK (Northern Ireland) (28%) are reporting rates of influenza positive sentinel specimens at or above 20 percent. Despite flat or declining outpatient consultation rates in recent weeks, high influenza positive rates in Israel (43%) and Slovenia (30%) also indicate the circulation of influenza. Among these seven countries, ILI consultation rates are higher than those observed during week 40, 2008 in Belgium, Ireland, Israel, Spain and UK (Northern Ireland). In countries performing sentinel surveillance for ILI, consultation rates were highest in the 5-14 year age group in Belgium, Israel, Ireland, Portugal, Spain, and the UK (England, Northern Ireland and Scotland).


Virological update- week 40/2009:

The total number of respiratory specimens collected by sentinel physicians in week 40/2009 was 1691 of which 296 (17.5%) were positive for influenza virus: 295 were type A (282 were identified as pandemic A(H1), one seasonal A(H1) and 12 not subtyped) and 1 type B. In addition, 1191 non-sentinel source specimens (e.g. specimens collected for routine diagnostic purposes in the community, hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 1175 were influenza type A (977 pandemic A(H1), 10 A(H3), 11 seasonal A(H1) and 177 not subtyped) and 16 type B.

Worldwide, through the WHO Global Influenza Surveillance Network, more than 10,000 pandemic H1N1 viruses have been analysed for susceptibility to oseltamivir. To date, only 28 resistant viruses have been detected in sporadic incidents mostly related to oseltamivir-treatment/prophylaxis regimens. A few patients that have not been exposed to oseltamivir have also been found. In all cases a H275Y mutation was present in the neuraminidase gene. For more information on antiviral use and the risk of drug resistance click here.


Comment:

Due to circulation of pandemic H1N1 viruses, the percent of sentinel specimens testing positive for influenza in week 40/2009 is considerably elevated compared to week 40/2008 (17.5% vs. 1%) but influenza activity is generally low in the region. However, sentinel surveillance suggests active circulation of influenza virus in the United Kingdom, Ireland, and four additional countries. Clinical surveillance data in several of these countries also show increasing incidence rates in the 5-14 years age range which may be indicative of increasing influenza activity. It is essential that countries maintain sentinel surveillance to monitor the relative proportions of seasonal, pandemic, and other respiratory viruses in circulation; to detect the presence of any antigenically drifted A/Perth/16/2009 (H3N2)-like viruses; to monitor for any changes in pandemic H1N1 (2009) or other influenza viruses; and to track the geographic spread of the current influenza season, which in several recent years has followed a west to east progression across the European Region.


Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Epidemiological, virological or qualitative data is presented for 39 countries in week 40/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin (October 16, 2009, edited)

EuroFlu - Weekly Electronic Bulletin
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Week 41 : 05/10/2009-11/10/2009 - 16 October 2009, Issue N? 327


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[Original Page: LINK. EDITED.]
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Early start of influenza activity in the European region



Key Points Week 41/2009:

  1. Fourty-three of 53 countries in the region have reported data this week.
  2. Increased levels in ILI and/or ARI rates were observed in Belgium, Ireland, Spain, United Kingdom (Wales and Northern Ireland) and these data were confirmed with substantial virological detections of the pandemic H1N1 virus
  3. The percentage of influenza positive respiratory specimens collected from sentinel surveillance systems in the European Region was 25%. Eight countries with at least 10 specimens had rates of 25% or more: Belgium, Ireland, Israel, Malta, Norway, Spain, Sweden and UK (Northern Ireland). The high percentage of positive sentinel specimens is unusual for this time of the year, in the previous winter season only 1% were positive for influenza in week 41/2008.
  4. As of October 5, 49 of the 53 countries in the WHO European Region have reported to WHO over 59,000 laboratory confirmed cases of pandemic (H1N1) 2009 virus infection, 193 of these were laboratory confirmed deaths.

Current situation - week 41/2009:


The intensity of influenza activity was high in Ireland, Luxembourg and the United Kingdom (Northern Ireland). The geographic spread of ILI was reported as widespread in six countries (Belgium, Ireland, Israel, Luxembourg, Netherlands and UK (England, Wales)), regional in four countries (Austria, Malta, Spain, Sweden), and local or sporadic in 16 countries. Eleven countries reported no activity. The impact of influenza on health services was reported as moderate in Ireland and low in 25 countries.


Of the 20 countries reporting a dominant subtype, pandemic (H1N1) 2009 was dominant in all countries. For Belgium, Ireland, Israel, Malta, Spain, Sweden and UK (Northern Ireland), at least 25% of sentinel specimens tested positive for influenza in week 41/2009. An increase in clinical incidence was observed for Belgium, Ireland, Spain, Sweden and the UK.


In countries performing sentinel surveillance for ILI, consultation rates were highest in the 5-14 year age group in Belgium, Israel, Ireland, the Netherlands, Spain, and the UK (England, Northern Ireland and Scotland). In the United Kingdom (Wales) the young children, aged 0-4 years, presented with highest consultation rates.


Virological update- week 41/2009:


The total number of respiratory specimens collected by sentinel physicians in week 41/2009 was 1751 of which 430 (25%) were positive for influenza virus: 429 were type A (398 were identified as pandemic A(H1), 31 not subtyped) and 1 type B. In addition, 1283 non-sentinel source specimens (e.g. specimens collected for routine diagnostic purposes in the community, hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported to be positive for influenza virus: 1278 were influenza type A (768 pandemic A(H1), 13 A(H3), 374* seasonal A(H1) and 123 not subtyped) and 5 type B.


Cumulative virological update- week 40/2009-41/2009:


A total of 3349 influenza viruses have been detected. Of these, 2350 were identified as pandemic A(H1), 603* seasonal A(H1), 350 A not subtyped, 23 A(H3N2) and 23 B. Out of 1435 N-subtyped viruses 1432 were pandemic A(H1N1) and 3 were influenza A(H3N2).


Worldwide, through the WHO Global Influenza Surveillance Network, more than 10,000 pandemic H1N1 viruses have been analysed for susceptibility to oseltamivir.


To date, only 28 resistant viruses have been detected in sporadic incidents mostly related to oseltamivir-treatment/prophylaxis regimens. A few patients that have not been exposed to oseltamivir have also been found.



In all cases a H275Y mutation was present in the neuraminidase gene. In the EuroFlu database all 599 H1N1v viruses that were tested were sensitive for oseltamivir and zanamivir. For more information on antiviral use and the risk of drug resistance click here.


Comment:


Influenza activity is low in most countries in Europe: 23 countries reported a low intensity of influenza activity and no or sporadic influenza activity for the geographical spread indicator. However, for example in Belgium, Israel, the Netherlands, Norway, and the UK consultation ILI/ARI rates are above the baseline, this is unusual for this time of the year. Similarly the number of influenza detections is very high for the season, and indicates influenza activity is starting.


Background:


The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Epidemiological, virological or qualitative data is presented for 43 countries in week 41/2009. The spread of influenza viruses and their epidemiological impact in Europe is being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).

*Erratum: For the non-sentinel data in week 41/2009 there was a problem in the technical reporting of data. The number for seasonal A/H1 are incorrect and actually present pandemic H1 detections.


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Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

To date, only 28 resistant viruses have been detected in sporadic incidents mostly related to oseltamivir-treatment/prophylaxis regimens.
Click to expand...

To date, 35 resistant pandemic H1N1 influenza viruses have been detected and characterized worldwide. All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir.
Click to expand...
http://www.who.int/csr/disease/swineflu/laboratory16_10_2009/en/index.html

The numbers are off just a little.
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 42 : 12/10/2009-18/10/2009 (edited)

EuroFlu - Weekly Electronic Bulletin Week 42 : 12/10/2009-18/10/2009

23 October 2009, Issue N? 328: Increasing influenza activity across Europe


Key points

  • This week?s report is based on material received from 44 of the 53 countries in the WHO European Region.
  • The incidence of influenza-like illness (ILI)/ acute respiratory infection (ARI) is increasing in several countries.
  • 32% of specimens collected from sentinel sources were positive for influenza virus: a very high level for this time of the year, compared to rates in the previous 5 years.
  • Pandemic (H1N1) 2009 virus was dominant in 24 countries and accounted for more than 95% of influenza virus subtype detections.
  • As of 19 October 2009, European countries had reported over 63 000 laboratory-confirmed pandemic (H1N1) 2009 cases to WHO, including 236 deaths.

Data reported in week 42

Clinical

Eight countries reported increases in ILI and/or ARI consultations (defined as countries with increases in each of the previous three weeks).

In four of these (Belgium, Ireland, the Netherlands and the United Kingdom (Northern Ireland)) the positivity rate of swab specimens exceeded 20% (minimum number of tested specimens: 20).

The intensity of clinical activity was described as very high in Iceland, high in Ireland, Luxembourg and the United Kingdom (Northern Ireland), medium in 10 countries and low in the remaining 25 countries reporting.

The occurrence of ILI was reported as widespread in Belgium, Iceland, Ireland, Israel, Luxemburg, the Netherlands and the United Kingdom (England); regional in Austria, Norway, Spain, Sweden and Turkey; local and sporadic in a further 16 countries; 11 countries reported no activity.

The impact of influenza on health services was in general reported as low: 23 countries reported low impact and 3 (Albania, Ireland and Turkey), medium impact.


Virological

The 1848 specimens submitted by sentinel physicians were examined, of which 586 (32%) were positive for influenza.

Of these, 548 were positive for the pandemic (H1N1) 2009 virus and a further 38, positive for others.

Influenza virus positivity in the sentinel specimens was very high compared to rates for week 42 in the previous 5 years (ranging from 0.9% in 2005 to 2% in 2008).

The 2522 positive specimens from non-sentinel sources included 1925 positive for pandemic (H1N1) 2009 influenza. Among the countries reporting more than 50 sentinel specimens, the 3 with the highest positivity rates were Ireland (53%), Belgium (48%) and Spain (43%).

Of the 41 countries reporting a dominant subtype, pandemic (H1N1) 2009 was dominant in 24.


Comment

The virological data collected support the conclusion that influenza activity is increasing in the European Region. The pandemic (H1N1) 2009 virus is dominant in most countries, and the increased levels of influenza activity are unusual for the month of October.

Most national clinical ARI and ILI data sets show the highest incidence in children aged 0?4 and 5?14 years, respectively, and minimal increases in people aged over 65 years.

The widespread though gradual increases in ILI/ARI activity and the continuing detections of pandemic (H1N1) 2009 virus suggest that continued increases in influenza incidence should be anticipated over the next four weeks.

Worldwide, more than 10 000 (H1N1) viruses have been further examined for the presence of resistance; 35 have been found resistant to oseltamivir, all showing H275Y point mutation in the neuraminidase gene. More information on antiviral use and the risk of drug resistance is available from WHO headquarters.


Further information

The EuroFlu bulletin presents 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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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 43 : 19/10/2009-25/10/2009 (edited)

EuroFlu - Weekly Electronic Bulletin Week 43 : 19/10/2009-25/10/2009

30 October 2009, Issue N? 329

Rapidly increasing influenza activity in the WHO European Region


Key points, week 43/2009

  • This report is based on material received from 43 of the 53 countries.
  • 37% of specimens collected from sentinel sources were positive for influenza virus.
  • The incidence of clinical respiratory illness has increased over each of the past three weeks in 17 countries and for 8 of these the proportion of sentinel specimens testing positive for influenza this week was 20% or greater.
  • Pandemic (H1N1) 2009 was dominant in 24 countries and accounted for 100% of influenza A virus subtype detections in sentinel specimens.
  • 45 deaths, involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection were reported by 13 countries during the period of 21 to 27 October. However, the majority of pandemic cases have resolved without complication.

Current Situation, week 43/2009

Seventeen countries reported increases in ILI and/or ARI consultations (defined as countries with increases in each of the previous three weeks). In eight of these countries (Belgium [69.2%], Germany [27.4%], Ireland [54.9%], Netherlands [51.1%], Norway [65.6%], Spain [46.0%], Sweden [32.7%] and the United Kingdom (Northern Ireland) [80.8%]), the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens: 20). These increases have been particularly notable in the 5-14 years age category.

The intensity of clinical activity was described as very high in Iceland and Ireland and high in Belarus, Luxembourg, Malta, Sweden and in Northern Ireland, though not in the United Kingdom generally. While the intensity of clinical activity was reported as medium overall in the Russian Federation, high intensity was reported in the Urals and Far Eastern regions. The clinical incidence of ILI and/or ARI was reported as widespread in Belgium, Iceland, Ireland, Israel, Luxembourg, the Netherlands, Norway, the Russian Federation (Far Eastern region), Spain and most of the United Kingdom.

The impact of influenza on health services was reported as moderate in Albania, Ireland, Norway and Ukraine and low in 21 additional countries.

Forty-five deaths associated with laboratory confirmed pandemic (H1N1) 2009 infection were reported by 13 countries in the period of 21 to 27 October. This raises the total number of deaths reported since April 2009 from 236 to 281. The Czech Republic, Finland, the Republic of Moldova, the Russian Federation, Serbia and Turkey all reported their first laboratory-confirmed deaths, seven in total, during this week.

The Minister of Health of Ukraine has reported 12 fatal pneumonia cases in the Ternopol region with another 17 pneumonia patients in intensive care units and a further 6 fatal pneumonia cases in a neighboring region. These cases are reported to have occurred at the same time as increases in less severe acute respiratory illness in local populations. Epidemiologic and virologic investigations are ongoing click here .

Five recent fatalities in Sweden were temporally associated with pandemic influenza vaccination. Investigation by the Medical Products Agency of Sweden revealed that all five patients were receiving medical treatment for previously diagnosed chronic conditions.

A public report released on 29 October 2009 states that currently there is nothing to support a causal association between the vaccination and death in these cases click here.


Virological update, week 43/2009

Of the 15 countries testing 20 or more sentinel specimens this week, influenza positive rates ranged from 0% (Albania, Azerbaijan, Croatia, Georgia) to 81% (United Kingdom-Northern Ireland). The total number of respiratory specimens collected by sentinel physicians in the Region in week 43/2009 was 2595, of which 971 (37%) were positive for influenza virus. This is a much higher proportion than is typical for week 43 (less than 2% during 2004-2008). Of the 971 influenza virus detections, 970 were type A (897 pandemic A(H1), 73 not subtyped) and 1 was type B. In addition, 4004 non-sentinel source specimens were reported positive for influenza virus: 3991 type A (3151 pandemic A(H1), 16 A(H3), 50 seasonal A(H1), 774 not subtyped, and 13 type B.

The seasonal influenza A subtype detections were reported by Kazakhstan and the Russian Federation.


Comment

Qualitative reporting, clinical trend data and virological data all are consistent with an increasing intensity and geographic spread of influenza infections in the Region. The pandemic (H1N1) 2009 virus is dominant in most countries and has initiated an early start to the influenza season. There have also been recent and concomitant increases in outpatient illness with reports of severe cases and deaths attributable to pandemic (H1N1) 2009. Continued priority should continue to be placed on timely case management, increased access to neuraminidase inhibitors, and the implementation of vaccination programmes.


Further information

The EuroFlu bulletin presents 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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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 44 : 26/10/2009-01/11/2009 (edited)

EuroFlu - Weekly Electronic Bulletin Week 44 : 26/10/2009-01/11/2009

06 November 2009, Issue N? 330 - Ukraine hit by pandemic, as influenza activity continues to rise in most countries in the WHO European Region


Key points: week 44/2009

  • This report is based on material received from 40 of the 53 Member States in the WHO European Region and includes an overview of the situation in Ukraine.
  • On average, 45% of specimens collected from sentinel sources in the Region were positive for influenza virus.
  • The incidence of clinical respiratory illness has increased in 17 countries over the past three weeks, and for seven of these the proportion of sentinel specimens testing positive for influenza this week was 20% or greater.
  • Pandemic (H1N1) 2009 was dominant in 28 countries and accounted for 99% of influenza A virus subtype detections.
  • From 27 October to 4 November, 11 countries reported a total of 47 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection. Nevertheless, the majority of pandemic cases have resolved without complications.

Ukraine

On Monday, 2 November, a team of nine experts ? from WHO, the European Centre for Disease Prevention and Control (ECDC), and the United Nations Children?s Fund (UNICEF) ? arrived in Ukraine to investigate high levels of acute respiratory illness (ARI). The team was dispatched at the request of the Ministry of Health of Ukraine. The experts were briefed in Kyiv before heading to the western city of Lviv and other affected areas.

Preliminary reports indicate that the rapidly evolving situation in the country is mainly related to pandemic (H1N1) 2009 influenza. The results received from the examination of samples submitted earlier by national laboratories in Kyiv to the WHO collaborating centre for reference and research on influenza in London, United Kingdom, continue to confirm cases of pandemic (H1N1) 2009 virus infection. At this stage, however, other causes for clusters of respiratory illnesses cannot be ruled out.

On 4 November, the Minister of Health of Ukraine reported 70 deaths, 235 patients in a critical condition and more than 250 000 cases of influenza-like illness (ILI). Lviv is one of the most affected regions, with more than 100 000 people reportedly sick with ILI. WHO/Europe regularly issues updated information on the situation in Ukraine on its web site.


Current situation: week 44/2009

17 countries have reported increases in ILI and/or ARI consultations (defined as countries with increases in the previous three weeks). These increases have been particularly notable in the group aged 5?14 years. In 7 of these countries (Belgium, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom (Northern Ireland)), the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens: 20). In Norway, ILI consultation rates are above the maximum rates recorded in four previous seasons. To lessen the burden on physicians and improve the accessibility of antiviral drugs (oseltamivir and zanamivir), the Norwegian Government has made them available as over-the-counter medications (see press release in Norwegian).

The intensity of clinical activity was described as very high in Iceland and Ireland for the second week in a row, and in the Russian Federation (Urals region) for the first time. Eight countries described high clinical activity: Belarus, Bulgaria, the Netherlands, Norway, Italy, Russian Federation (far eastern, Siberian, north-western and central regions), Sweden and the United Kingdom (Northern Ireland). The clinical incidence of ILI and/or ARI was reported as widespread in 11 countries: Belgium, Iceland, Ireland, Israel, Italy, the Netherlands, Norway, the Russian Federation, Spain, Sweden and most of the United Kingdom (England, Wales, Northern Ireland).

Ukraine reported medium intensity, regional clinical incidence and severe impact of influenza on health services.

Impact was reported moderate in 7 countries and low in 16 others. For an overview, see the Seasons tables section on EuroFlu.

While clinical influenza activity has increased over the past weeks in 17 countries, it may have passed its peak in Ireland, Iceland and the United Kingdom (Northern Ireland). Countries with recent increases in influenza activity include Bulgaria, Norway and the Russian Federation, indicating the further circulating of influenza across the European Region. In week 44/2009, levels of clinical influenza activity above the baseline were observed in Portugal, Serbia and Ukraine, and the level in Ukraine was significantly higher than those in the same week in six previous seasons.

In the period 27 October ? 4 November, 11 countries reported 47 new deaths associated with laboratory-confirmed pandemic (H1N1) 2009 influenza: Belgium (2), Bulgaria (1), Croatia (1), Germany (3), Ireland (8), Norway (4), Portugal (2), the Republic of Moldova (1), Turkey (8), Ukraine (1) and the United Kingdom (16). This raises the total number of deaths reported since April 2009 from 281 to 328.

Croatia and Ukraine reported their first laboratory-confirmed deaths during this week.


Virological update: week 44/2009

Of the 19 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 0% (Azerbaijan, Georgia) to 85% (United Kingdom (Northern Ireland)). Sentinel physicians in the Region collected 2730 respiratory specimens in week 44/2009, of which 1219 (45%) were positive for influenza virus. This is a much higher proportion than is typical for week 44 (less than 4% during 2004?2008). Of the 1219 influenza virus detections, 1218 were type A (1156 pandemic A(H1), 1 A(H3) and 61 not subtyped) and 1 was type B.

In addition, 7333 non-sentinel-source specimens were reported positive for influenza virus in week 44/2009: 7328 type A (5572 pandemic A(H1), 36 A(H3), 31 seasonal A(H1), 1689 not subtyped) and 5 type B. The seasonal influenza A subtype detections were reported by Kazakhstan and the Russian Federation.

Since week 40/2009, 21 851 specimens have tested positive for influenza virus. Of these, 17 644 (81%) were pandemic influenza A(H1), which accounts for 98% of all influenza A viruses that were subtyped. In addition, 335 were seasonal influenza A/H1; 87 were influenza A(H3); 3726 were influenza A not subtyped; and 59 were influenza B. Since week 40/2009, the number of influenza detections has risen sharply, from about 1600 to more than 8500 in week 44/2009. Three countries (Norway, the Russian Federation and Spain) accounted for more than 4000 of these detections. This number far exceeds the peak of detections during the summer of 2009 (about 3000 in week 30/2009) and is the highest recorded number of positive specimens in the Region in any week since 1996 (see graphs for Europe).


Comment

Qualitative reporting, clinical trend data and virological data are all consistent with an increasing intensity and geographic spread of influenza infections in the European Region. For the first time, countries in the Region reported very high intensity of clinical influenza activity. Influenza detections far exceed historical peaks and indicate a surge on the laboratories in several countries. The pandemic (H1N1) 2009 virus is dominant in most countries and continues to account for high levels of influenza activity for the time of year. Since the start of the pandemic, Ukraine is the first country to report a severe impact, mainly reflecting the strain on hospital and intensive care services. This situation highlights the need for countries to be prepared to cope with a surge of patients with severe respiratory disease, to identify best-practice scenarios for treatment and to implement vaccination programmes.


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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Network comments (where available)

  • Croatia
    • 1 case of death presenting as pneumonia (SARI) with confimed A/H1N12009 infection. This is the first new influenza associated death in Croatia Note: case included in ILI figures
  • Italy
    • During this last week, a significant increase in the H1N1v influenza lab-confirmed cases has been reported, if compared to the previous week.
  • Norway
    • The number of virus detections has continued to rise and are now very high, as is the positivity rate for all laboratories. The positivity rate in sentinel specimens is also high, but there was a decline since the previous week. The positivity rate is higher in the southeast and southwest, and lower in the north. It is also higher in densely populated areas than in many countryside communities. The decline in sentinel positivity rate seems to reflect more active sampling in areas that are lagging behind in the unfolding of the epidemic.
  • Portugal
    • Incidence rate is increasing but sligthly above the basezone.
  • Slovenia
    • Among non-sentinel 6 specimens were from hospitals, in 5 of them Influenza type A, subtype pH1 was confirmed. One of hospitalized patients died. This is the first fatal case in Slovenia.
  • Switzerland
    • In Switzerland, only data on hospitalisations for laboratory-confirmed pandemic (H1N1) 2009 cases are currently available: for these figures, the denominator is the whole population.
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​
<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin - Week 45 : 02/11/2009-08/11/2009 - 13 November 2009, Issue N? 331 (edited)

EuroFlu - Weekly Electronic Bulletin - Week 45 : 02/11/2009-08/11/2009 - 13 November 2009, Issue N? 331

Further increase in detections of pandemic (H1N1) 2009 in the WHO European Region. Seven countries report very high influenza activity


Key points: week 45/2009

  • This report is based on material received from 43 of the 53 Member States in the WHO European Region and includes an update of the situation in Ukraine.
  • On average, 45% of specimens collected from sentinel sources in the Region tested positive for influenza virus.
  • The incidence of clinical respiratory illness has increased in 17 countries over the past three weeks, and for eight of these the proportion of sentinel specimens testing positive for influenza this week was 20% or greater.
  • Notably, countries in Scandinavia, eastern Europe and south-eastern Europe reported high or very high intensity of influenza.
  • Pandemic (H1N1) 2009 was dominant in 36 countries and accounted for 99.7% of influenza A virus subtype detections.
  • Most influenza pandemic cases have resolved without complications. From 5 to 12 November, 18 countries reported a total of 145 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection.

Ukraine

There have been 174 deaths due to acute respiratory infection (ARI) reported from Ukraine and 344 people are currently in intensive care units, 45 of whom are on mechanical ventilation. Rates of ARI are at a higher level than any reported for six years and in some regions for 13 years.


Current situation: week 45/2009

Seventeen countries have reported increases in influenza-like illness (ILI) and/or ARI consultations (defined as countries with increases in the previous three weeks). These increases are particularly notable in the group aged 5?14 years. In eight of these countries (Germany, the Netherlands, Norway, Republic of Moldova, Romania, Slovakia, Spain and Sweden), the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens: 20).

The intensity of clinical activity was described as very high in Norway, Sweden, Bulgaria and the Republic of Moldova for the first time. Other countries reporting continued very high intensity this week were Iceland, Ireland and the Russian Federation (Urals region and far eastern region). Eight countries/regions described high clinical activity: Belarus, Finland, Kazakhstan, Poland, Russian Federation (central, north-western, Siberian and Volga region), Turkey, Ukraine and Northern Ireland. The clinical incidence of ILI and/or ARI was reported as widespread in 19 countries.

The Republic of Moldova reported very high intensity, widespread clinical incidence and severe impact of influenza on health services.

Impact was reported as moderate in nine countries, including Ukraine, and low in 17 others. For an overview of the season so far, click here.

Increased clinical illness was reported in Bulgaria and the Republic of Moldova. In Bulgaria, incidence rates were above the epidemic threshold in 10 out of 28 regions. The incidence was highest in children. Current rates are similar to those reported in the 2006-2007 influenza season.

For the Republic of Moldova, 555 specimens out of 1141 tested were positive for pandemic (H1N1) 2009 (including five fatal cases).

While clinical influenza activity has increased over the past weeks in 17 countries, it has passed its peak in Belgium, Iceland, and Ireland, and has levelled off or passed its peak in the United Kingdom. Low or medium levels of influenza activity are reported in southern Russian Federation, Azerbaijan, Georgia, the Baltic states, the Czech Republic and Slovakia and in most of these countries incidence is increasing.

In the period 5?12 November, 18 countries reported 145 new deaths associated with laboratory-confirmed pandemic (H1N1) 2009, raising the total since April 2009 from 326 to 471. The deaths were in Bulgaria (9), Croatia (2), Finland (5), France (4), Germany (3), Greece (2), Hungary (1), Ireland (2), Israel (8), Italy (34), the Netherlands (13), Norway (3), the Republic of Moldova (3), Serbia (6), Slovenia (1), Sweden (1), Turkey (31) and the United Kingdom (17).


Virological update: week 45/2009

Of the 27 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 3.5% (Georgia) to 68.3% (Bosnia and Herzegovina). Ten of these countries reported rates greater than 50%. Sentinel physicians in the Region collected 4129 respiratory specimens in week 45/2009, of which 1853 (45%) were positive for influenza virus. Of the 1853 influenza-virus detections, 1845 were type A (1781 pandemic A(H1) and 64 not subtyped) and 8 were type B.

In addition, 11 311 non-sentinel-source specimens were reported positive for influenza virus in week 45/2009: 11 292 type A (9682 pandemic A(H1), 25 A(H3), 14 seasonal A(H1), 1571 not subtyped) and 19 type B.

Of the total 36 087 specimens that have tested positive for influenza virus since week 40/2009, 30 308 (84%) were pandemic influenza A(H1) and these accounted for 99% of all influenza A viruses that were subtyped. In addition, 213 were seasonal influenza A(H1); 113 were influenza A(H3); 5366 were influenza A not subtyped; and 87 were influenza B. The number of influenza detections has risen sharply each week from about 1600 in week 40/2009 to over 13 000 in week 45/2009.


Comment

A total of 14 countries have reported high or very high intensity of influenza activity. A generally increasing trend in clinical data is confirmed by an increase in virological influenza detections. Notably, countries in Scandinavia, and eastern and south-eastern Europe are affected by the pandemic. Influenza detections far exceed historical peaks and indicate a surge of work in the laboratories in several countries. The pandemic (H1N1) 2009 virus is dominant and continues to account for high levels of influenza activity for the time of year. Reports are widespread of pressure on intensive care facilities.

As of week 45/2009, 16 countries have started pandemic influenza vaccination campaigns. Reports of adverse events are fewer than reported for seasonal influenza vaccination and most events are mild local or systemic reactions. Eight countries in the Region are eligible to receive vaccine donated to WHO and this will begin by late November or early December 2009.


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.


Erratum:

The percentage positive for Denmark in the table below is incorrect. A total of 38 sentinel specimens were collected of which 22 (58%) were positive for pandemic (H1N1) 2009.

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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 46 : 09/11/2009-15/11/2009 - 20 November 2009, Issue N? 332 (edited)

EuroFlu - Weekly Electronic Bulletin Week 46 : 09/11/2009-15/11/2009 - 20 November 2009, Issue N? 332

Influenza activity remains high and is widespread across much of the European Region


Key points: week 46/2009

  • This report is based on material received from 43 of the 53 Member States in the WHO European Region and includes an update on the situation in Ukraine.
  • 42% of specimens collected from sentinel sources in the Region tested positive for influenza virus.
  • The incidence of clinical respiratory illness has increased in 13 countries over the past 3 weeks. For 10 of these, the proportion of sentinel specimens testing positive for influenza this week was 20% or greater.
  • Countries throughout the Region reported high or very high intensity of influenza.
  • Pandemic (H1N1) 2009 was dominant in 36 countries and accounted for 99.2% of influenza A virus subtype detections.
  • From 13 to 20 November 2009, 21 countries reported a total of 181 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection.

Ukraine

Preliminary analyses of samples taken from patients in Ukraine show that the virus is similar to that used for production of the pandemic (H1N1) 2009 vaccine. Although influenza activity in Ukraine remains high, the incidence of acute respiratory infection (ARI) is lower than that reported last week.


Current situation: week 46/2009

Thirteen countries have reported increases in influenza-like illness (ILI) and/or ARI consultations (defined as countries with increases in the previous three weeks). These increases are particularly notable in the groups aged 0?4 and 5?14 years. In 11 of these countries (the Czech Republic, Estonia, Germany, Israel, the Netherlands, Poland, Portugal, the Republic of Moldova, Slovakia, Spain and Sweden), the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens: 20).

The intensity of clinical activity was described as very high in Italy (for the first time this season), Norway, the Republic of Moldova, the Russian Federation (Urals region) and Sweden. In addition, 14 countries reported high intensity. ILI and/or ARI was reported as geographically widespread in 24 countries. The impact on health services was described as severe in 2 countries (Albania, the Republic of Moldova), moderate in 11 and low in 16 others. For an overview of the season so far, see season tables.

While clinical influenza activity has increased over recent weeks in 13 countries, it has passed its peak in Belgium, Iceland, Ireland and parts of the United Kingdom (England and Northern Ireland). Five countries showed a decrease in clinical influenza activity during the past week: Bulgaria, Romania, the Russian Federation (in the central, far eastern and Urals regions), Serbia and Ukraine. Medium levels of influenza activity were reported in 22 countries, mainly in western and central Europe and the Baltic states. One country (Slovakia) reported low activity this week.

In the period 13?20 November, 21 countries reported 181 new deaths associated with laboratory-confirmed pandemic (H1N1) 2009 influenza, raising the total since April 2009 from 471 to 652. The deaths were reported in Belgium (4), Croatia (2), Finland (3), France (14), Germany (7), Greece (3), Ireland (1), Italy (24), Luxembourg (1), the Netherlands (5), Norway (5), Poland (2), Portugal (3), the Republic of Moldova (2), Serbia (6), Spain (34), Sweden (2), Switzerland (1), the former Yugoslav Republic of Macedonia, (1), Turkey (33) and the United Kingdom (28). Poland, Switzerland and the former Yugoslav Republic of Macedonia reported their first laboratory-confirmed deaths during this week. Most pandemic (H1N1) 2009 cases have resolved without complications.


Virological update: week 46/2009

Of the 31 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 3.1% (Azerbaijan) to 78.6% (Slovenia). Fifteen of these countries reported rates greater than 50%. Sentinel physicians in the Region collected 6179 respiratory specimens this week, of which 2602 (42.1%) were positive for influenza virus. Of these virus detections, 2591 were type A (2490 pandemic A(H1) and 90 not subtyped) and 11 were type B.

In addition, 16 794 non-sentinel-source specimens were reported positive for influenza virus in week 46/2009: 16 782 type A (15 468 pandemic A(H1), 65 A(H3), 76 seasonal A(H1), 1173 not subtyped) and 12 type B.

Of the total of 59 434 specimens that have tested positive for influenza virus since week 40/2009, 51 936 (87.4%) were pandemic influenza A(H1) and these accounted for 99% of all influenza A viruses that were subtyped. In addition, 291 were seasonal influenza A(H1); 191 were influenza A(H3); 6900 were influenza A not subtyped; and 116 were influenza B. The number of influenza detections has risen sharply each week, from about 1 600 in week 40/2009, with 18% of sentinel specimens testing positive, to over 19 000 in week 46/2009, when 45% of sentinel specimens tested positive.


Comment

The pandemic is affecting all countries in the Region, and the intensity is high in 18, especially in children up to the age of 15. In three countries in western Europe the epidemic has passed its peak. In some countries reporting reduced activity, this may have been associated with school closures. Increasing clinical incidence has been corroborated by increases in virological influenza detections. Influenza detections continue to be far higher than historical peaks, and countries are recommended to prioritize their testing strategies to reduce the burden on national influenza centres and therefore national influenza surveillance systems.

As of week 46/2009, 17 countries had started vaccination campaigns against pandemic (H1N1) 2009 influenza. Reports of adverse events are fewer than for seasonal influenza vaccination, and most events are mild local or systemic reactions. Eight countries in the Region are eligible to receive vaccine donated to WHO and distribution will begin by late November or early December 2009.


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.


Erratum

The clinical data for Belarus for week 45/2009 were incorrect and have been corrected in this week?s bulletin.
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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 47 : 16/11/2009-22/11/2009 - 27 November 2009, Issue N? 333 (edited)

EuroFlu - Weekly Electronic Bulletin Week 47 : 16/11/2009-22/11/2009 - 27 November 2009, Issue N? 333


High influenza activity in the European Region

Key points: week 47/2009

  • This report is based on data received from 43 of the 53 Member States in the WHO European Region, and includes an update on the situation in Ukraine.
  • 37% of specimens collected from sentinel sources in the Region tested positive for influenza virus.
  • The incidence of clinical respiratory illness has increased in 16 countries over the past 3 weeks. Out of 12 countries that tested at a least 20 samples, 10 reported that 20% or more of sentinel specimens had tested positive for influenza.
  • Countries throughout the Region reported high or very high intensity of influenza, with Albania and the Republic of Moldova reporting severe impact on health services.
  • Pandemic (H1N1) 2009 was dominant in 38 countries and accounted for 98.8% of influenza A virus subtype detections.
  • From 20 to 26 November 2009, 25 countries reported a total of 267 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection.

Ukraine

Overall influenza activity appears to be decreasing. Preliminary tests of samples taken from patients in Ukraine reveal no significant changes in the pandemic (H1N1) 2009 virus. Analyses are being performed by two WHO influenza collaborating centres as part of the global influenza surveillance network.


Current situation: week 47/2009

Sixteen countries have reported increases in influenza-like illness (ILI) and/or acute respiratory infection (ARI) consultations (defined as countries with increases in the previous three weeks). These increases are particularly notable in the groups aged 0?4 and 5?14 years. In 10 of these countries (Austria, the Czech Republic, Estonia, Germany, Greece, Latvia, Slovakia, Spain, Sweden and Switzerland) the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens per country: 20).

The intensity of clinical activity was described as very high in the Republic of Moldova, the Russian Federation (north-western, Siberian and Volga regions) and Sweden. Nineteen countries reported high intensity.

Twenty-three reported ILI and/or ARI as geographically widespread.

The impact on health services was described as severe in 2 countries (Albania, the Republic of Moldova), moderate in 15 and low in 12 others.

For an overview of the season so far, see season tables.

While clinical influenza activity has increased over recent weeks in 16 countries, it appears to have passed its peak in Belgium, Iceland, Ireland, Ukraine and parts of the United Kingdom (Northern Ireland, Wales).

Data for week 47 also indicate decreased activity in Bulgaria, Israel, the Netherlands, Norway and Serbia. In Germany and Spain, clinical activity is levelling off, which may indicate that it will peak soon.

In the period 20?26 November, 25 countries reported 267 new deaths associated with laboratory-confirmed pandemic (H1N1) 2009, raising the total number of deaths since April 2009 from to 919. The deaths were reported by Belgium (1), Croatia (6), the Czech Republic (1), Denmark (4), Finland (3), France (36), Germany (30), Greece (4), Hungary (3), Israel (11), Italy (20), the Netherlands (7), Norway (4), Portugal (8), the Republic of Moldova (4), Romania (2), the Russian Federation (6), Serbia (4), Slovakia (1), Slovenia (1), Spain (27), Sweden (9), Switzerland (2),Turkey (39) and the United Kingdom (34).

Romania and Slovakia reported their first laboratory-confirmed deaths during this week.

In Norway, mutation was detected in three samples of pandemic (H1N1) 2009 virus. They were isolated from the first two fatal cases in the country and one patient with severe illness. Norwegian scientists have analysed samples from more than 70 patients with clinical illness and no further instances of this mutation have been detected. For further information, see Pandemic (H1N1) 2009 briefing note 17.

A cluster of cases of oseltamivir-resistant pandemic (H1N1) 2009 virus infections among patients in a hospital ward in Wales has been reported to WHO. No further spread has been observed and the virus remained susceptible to zanamivir. For further information, see the National Public Health Service for Wales.


Virological update: week 47/2009

Of the 34 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 0% (Croatia) to 83% (Lithuania). Sentinel physicians in the Region collected 5959 respiratory specimens this week, of which 2221 (37%) were positive for influenza virus. Of these virus detections, 2216 were type A (2041 pandemic A(H1) and 175 not subtyped) and 5 were type B.

In addition, 14 294 non-sentinel specimens were reported positive for influenza virus in week 47/2009: 14 242 type A (12 817 pandemic A(H1), 83 A(H3), 102 seasonal A(H1), 1240 not subtyped) and 52 type B.

Of the 77 816 specimens that have tested positive for influenza virus since week 40/2009, 68 634 (88%) were pandemic influenza A(H1) and these accounted for 99% of all influenza A viruses subtyped. In addition, 394 were seasonal influenza A(H1); 282 were influenza A(H3); 8336 were influenza A not subtyped; and 170 were influenza B. The number of influenza detections rose sharply from week 40/2009 (about 1600, with 18% of sentinel specimens testing positive), to week 46/2009 (over 19 000, with 45% of sentinel specimens testing positive) but decreased in week 47/2009 (16 515 with 37% of sentinel specimens testing positive).

Based on the genetic characterization of 156 influenza viruses reported from week 40/2009 to week 47/2009, all (100%) were pandemic A(H1N1), A/California/7/2009-like.

Seven countries have tested isolates of pandemic (H1N1) 2009 virus for antiviral resistance. Of the 904 cases tested, 4 were resistant to oseltamivir.


Comment

Despite the decrease in influenza virus detections in week 47/2009, the pandemic is affecting most countries in the Region, with the greatest incidence in children up to the age of 15. High or very high intensity was reported in 22 countries. While influenza activity continued to increase in 16 countries, decreasing levels have been observed in 10. The vast majority of influenza viruses detected were pandemic (H1N1) 2009.

The percentage of positive sentinel specimens and the total number of influenza detections slightly decreased in week 47/2009. Less testing is desirable in order to focus on confirmation of severe cases as well as analyses of samples from cases where treatment fails.

A WHO Collaborating Centre for International Drug Monitoring, the Uppsala Monitoring Centre, in Sweden, has set up a web page on influenza vaccine monitoring.


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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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 48 : 23/11/2009-29/11/2009 - 04 December 2009, Issue N? 334 (Extracts, edited)

EuroFlu - Weekly Electronic Bulletin Week 48 : 23/11/2009-29/11/2009 - 04 December 2009, Issue N? 334

Increasing influenza activity in central and south-eastern Europe


Key points: week 48/2009

  • This report is based on data received from 46 of the 53 Member States in the WHO European Region.
  • 38% of specimens collected from sentinel sources in the European Region tested positive for influenza virus.
  • Over the past 3 weeks, the incidence of clinical respiratory illness has increased in 9 countries, mostly in central and south-eastern Europe, and decreased in 6 others.
  • Out of 28 countries that tested at least 20 sentinel specimens for influenza, 23 reported that 30% or more had tested positive for influenza.
  • 19 countries throughout the European Region reported high or very high intensity of influenza, with 13 reporting a moderate impact on health services.
  • Pandemic (H1N1) 2009 was dominant in 35 countries and accounted for nearly 100% of influenza A virus subtype detections in sentinel specimens and 98% of detections in non-sentinel specimens.
  • From 27 November to 3 December, 29 countries reported a total of 324 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection.

Current situation: week 48/2009

Nine countries reported increases in influenza-like illness (ILI) and/or acute respiratory infection (ARI) consultations (defined as countries with increases in the previous three weeks). Increasing influenza activity is most notable in central and south-eastern Europe, as the countries reporting increases are Albania, the Czech Republic, Estonia, Greece, Hungary, Latvia, Poland, the Republic of Moldova and Slovenia.

These countries also appear to be reporting relatively sharper increases in consultation rates in the group aged 5?14 years than in the group aged 0?4. Of these countries, 7 tested at least 20 sentinel specimens and have reported a mean influenza positivity rate of 47% (median 45%) with a range of 13?74%.

The intensity of clinical activity was described as very high in two countries (Greece and Lithuania) and the Siberian region of the Russian Federation. Seventeen countries reported high intensity. Twenty-six reported ILI and/or ARI as geographically widespread.

The impact on health services was described as moderate in 13 countries.

Clinical respiratory disease activity has declined over the past three weeks in Belgium, Iceland, Ireland, Norway, Serbia and Ukraine. With the exception of Iceland, these countries experienced rapid increases in clinical consultation rates associated with influenza virus circulation during the time since week 40, and reached peaks 3?4 weeks after the initial increases were observed. While consultation rates have subsequently declined somewhat more precipitously in Ukraine than the other countries, several regions in the eastern and western parts of Ukraine continue to report a medium intensity of influenza circulation and a moderate impact on health services.

From 27 November to 3 December, 29 countries reported a total of 324 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection. This raises the total number of deaths reported since April 2009 from 919 to 1243. Austria, Latvia and Lithuania reported their first such deaths during this week.


Virological update: week 48/2009

Sentinel physicians collected 4224 respiratory specimens this week, of which 1606 (38%) were positive for influenza virus. Of these virus detections, 1604 were type A (1481 pandemic A(H1), 118 not subtyped and 5 influenza A(H3)) and 2 were type B. Of the 28 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 2% (Azerbaijan) to 100% (Austria) with a median of 39%, and a mean of 44%.

In addition, 11 376 non-sentinel specimens were reported positive for influenza virus in week 48/2009: 11 335 type A (10 017 pandemic A(H1), 65 A(H3), 104 seasonal A(H1), 1149 not subtyped) and 41 type B.

Based on the antigenic characterization of 238 influenza viruses reported from week 40/2009 to week 48/2009, 237 were pandemic A(H1N1), A/California/7/2009-like and 1 was B/Brisbane/60/2008-like.

Genetic characterization of 95 of the pandemic viruses indicated that all were in the pandemic cluster represented by A/California/7/2009

Of the total of 89 129 specimens that have tested positive for influenza virus since week 40/2009, 78 614 (88.2%) were pandemic influenza A(H1) and these accounted for 99% of all influenza A viruses that were subtyped. In addition, 498 viruses were seasonal influenza A(H1); 340 were influenza A(H3); 9466 were influenza A not subtyped; and 211 were influenza B.

Seven countries have tested isolates of pandemic (H1N1) 2009 virus for oseltamivir resistance. Of the 935 cases tested, 10 were resistant to oseltamivir. All viruses tested for resistance to zanamivir (282/282) have been found to be zanamivir-sensitive and all viruses tested for resistance to adamantanes (64/64) have been found to be resistant.


Comment

The pandemic is affecting most countries in the WHO European Region, with some indication that central and south-eastern countries are currently experiencing the greatest intensity of influenza activity. The emergence of the pandemic (H1N1) 2009 virus has produced a level of influenza activity that is unusual for this time of year in Europe, as the proportion of sentinel specimens testing positive for influenza has ranged from 1% to 9% during week 48 over the previous 5 years. High or very high intensity of influenza and respiratory illness activity was reported in 19 countries, although 6 countries now appear to be past their initial peaks in disease activity


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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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 49 : 30/11/2009-06/12/2009 - 11 December 2009, Issue N? 335 (edited)

EuroFlu - Weekly Electronic Bulletin Week 49 : 30/11/2009-06/12/2009 - 11 December 2009, Issue N? 335

Heterogeneous pandemic influenza activity across the European Region


Key points: week 49/2009

  • This report is based on data received from 40 of the 53 Member States in the WHO European Region.
  • 35% of specimens collected from sentinel sources in the European Region tested positive for influenza virus.
  • Over the past 3 weeks, the incidence of clinical respiratory illness has increased in 6 countries and decreased in 10 others.
  • Out of 28 countries that tested at least 20 samples, 16 reported that 30% or more of sentinel specimens had tested positive for influenza.
  • 15 countries throughout the European Region reported high or very high intensity of influenza, with 7 of these reporting a moderate impact on health services.
  • Pandemic (H1N1) 2009 was dominant in 33 countries and accounted for nearly 100% of influenza A virus subtype detections in sentinel specimens and over 98% of detections in non-sentinel specimens.
  • From 4 to 10 December, 27 countries reported a total of 412 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection.

Current situation: week 49/2009

Six countries (Czech Republic, Estonia, France, Hungary, Montenegro and Switzerland) reported increases in influenza-like illness (ILI) and/or acute respiratory infection (ARI) consultations (defined as countries with increases in each of the previous three weeks). Of these countries, 5 tested at least 20 sentinel specimens and have reported a mean influenza positivity rate of 51% (median 54%) with a range of 28?71%.

Clinical respiratory disease activity has declined over the past 3 weeks in 10 countries (Belgium, Bulgaria, Iceland, Ireland, Israel, the Netherlands, Norway, Portugal, Sweden and Ukraine). This decrease in clinical activity was confirmed by the virological data, with a general decreasing trend in the percentage of positive specimens in 8 out of 10 countries. In week 47, the overall percentage of positive sentinel specimens was 44% (median) and decreased to 26% (median) in week 49.

The intensity of clinical activity was described as very high in Lithuania, and 14 countries reported high intensity.

Twenty-three countries reported ILI and/or ARI as geographically widespread.

The impact on health services was described as moderate in 16 countries. None of the countries reported a severe impact.

The Russian Federation has been reporting ARI deaths to the EuroFlu platform since week 43. From week 43 to week 49, it reported a total of 102 ARI deaths , of which the majority (n=41) were reported in week 48. Ninety-three percent of these deaths occurred in the population aged 15 to 64.

From 4 to 10 December, 27 countries reported a total of 412 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection. This raises the total number of deaths reported since April 2009 from 1243 to 1655. Bosnia and Herzegovina, Estonia and Montenegro reported their first such deaths during this week.


Virological update: week 49/2009

Sentinel physicians collected 3437 respiratory specimens this week, of which 1190 (35%) were positive for influenza virus. Of these virus detections, 1188 were type A (1123 pandemic A(H1), 63 not subtyped, 1 influenza A(H1), 1 influenza A(H3)) and 2 were type B. Of the 28 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 4% (Iceland) to 71% (Czech Republic and Greece), with a mean of 35%.

In addition, 9435 non-sentinel specimens were reported positive for influenza virus in week 49/2009: 9410 type A (8400 pandemic A(H1), 29 A(H3), 92 seasonal A(H1), 889 not subtyped) and 25 type B.

Based on the antigenic characterization of 417 influenza viruses reported from week 40/2009 to week 49/2009, 416 were pandemic A(H1N1), A/California/7/2009-like and one was B/Brisbane/60/2008-like.

Of the total of 105 773 specimens that have tested positive for influenza virus since week 40/2009, 93 965 (89%) were pandemic influenza A(H1) and these accounted for 99% of all influenza A viruses that were subtyped. In addition, 591 viruses were seasonal influenza A(H1); 374 were influenza A(H3); 10 608 were influenza A not subtyped; and 235 were influenza B.

While over 400 specimens of pandemic H1N1 viruses have been characterized, none of the 1200 typed or subtyped seasonal influenza viruses were characterized in the period from week 40/2009 to week 49/2009 .

For vaccine recommendation purposes, laboratories are encouraged to send seasonal influenza specimens (clinical samples or isolates) for characterization to the WHO Collaborating Centre for Reference and Research on Influenza in Mill Hill, London.

Seven countries have tested isolates of pandemic (H1N1) 2009 virus for oseltamivir resistance. Of the 944 cases tested, 19 were resistant to oseltamivir. All viruses tested for resistance to zanamivir (282) have been found to be zanamivir-sensitive and all viruses tested for resistance to adamantanes (64) have been found to be resistant.

In week 50 in the Netherlands, 11 patients were diagnosed with a mixture of oseltamivir resistant and wild-type pandemic A(H1N1) 2009 influenza viruses. In all cases this was found in a respiratory specimen following initiation of oseltamivir therapy, indicating that resistance emerged during therapy and not from infection with a resistant virus. Nine of the patients, four of whom died, were immunosuppressed due to chemotherapy/immunosuppressive therapy. Contact tracing identified no cases of onward transmission of the oseltamivir resistant viruses.


Comment

The pandemic is affecting most countries in the WHO European Region, with some indication that central and eastern countries are currently experiencing the greatest intensity of influenza activity. However, 10 countries also appear to have passed initial peaks in clinical activity, suggesting a heterogeneous picture of influenza intensity across the Region.


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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​
<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 50 : 07/12/2009-13/12/2009 - 18 December 2009, Issue N? 336 (edited)

EuroFlu - Weekly Electronic Bulletin Week 50 : 07/12/2009-13/12/2009 - 18 December 2009, Issue N? 336

Declining trends in pandemic H1N1 2009 influenza activity in Europe


Key points: week 50/2009

  • This report is based on data received from 41 of the 53 Member States in the WHO European Region.
  • 34% of specimens collected from sentinel sources in the European Region tested positive for influenza virus.
  • Over the past 3 weeks, the incidence of clinical respiratory illness has increased in 2 countries and decreased in 18 others.
  • Out of 27 countries that tested at least 20 samples, 10 reported that 30% or more of sentinel specimens had tested positive for influenza.
  • 9 countries throughout the European Region reported high or very high intensity of influenza, with 5 of these reporting a moderate impact on health services.
  • Pandemic (H1N1) 2009 was dominant in 32 countries and accounted for 100% of influenza A virus subtype detections in sentinel specimens and over 98% of detections in non-sentinel specimens.
  • From 11 to 17 December, 23 countries reported a total of 380 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection, bringing the total number of laboratory-confirmed deaths reported since April 2009 to 2045.

Current situation: week 50/2009

Two countries (Hungary and Montenegro) reported an increase in influenza-like illness (ILI) and/or acute respiratory infection (ARI) consultations (defined as countries with increases in each of the previous three weeks).

Clinical respiratory disease activity has declined over the past 3 weeks in 18 countries; 12 of these countries tested over 20 sentinel specimens with an overall of 22% (median) positive specimens. In four countries (Georgia, Romania (ARI), Serbia, Ukraine), however, influenza activity has shown some signs of a resurgence following declining trends in previous weeks. This activity will continue to be monitored. In particular the eastern regions of Ukraine showed an increase in ARI rates in week 50.

Thirty-three countries provided data on trends in clinical consultations by age. Eighteen countries reported highest rates among the group aged 5?14 years while the others reported highest rates in the group aged 0?4.

The intensity of clinical activity was described as very high in Lithuania, and 6 countries reported high intensity; 17 reported ILI and/or ARI as geographically widespread.

The impact on health services was described as moderate in 13 countries. None of the countries reported a severe impact.

From 11 to 17 December, 23 countries reported a total of 390 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection. This raises the total number of such deaths reported since April 2009 from 1655 to 2045.

Albania and Georgia reported their first deaths related to pandemic (H1N1) 2009 influenza during the week.


Virological update: week 50/2009

Sentinel physicians collected 3225 respiratory specimens this week, of which 1096 (34%) were positive for influenza virus. Of these virus detections, all were type A (1040 pandemic A(H1), 56 not subtyped. Of the 27 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 0% (Finland and Turkey) to 71% (Greece), with a mean of 35% (median 17).

In addition, 8850 (36%) of 24922 non-sentinel specimens were reported positive for influenza virus in week 50/2009: 8772 type A (8090 pandemic A(H1), 24 A(H3), 74 seasonal A(H1), 584 not subtyped) and 43 type B.

Based on the antigenic characterization of 545 influenza viruses reported from week 40/2009 to week 50/2009, 542 were pandemic A(H1N1), A/California/7/2009-like, 2 were A(H3) A/Brisbane/10/2007 (H3N2)-like, and 1 was B/Brisbane/60/2008-like. Genetic characterizations were available for 204 isolates; all belonged to the A/California/7/2009 A(H1N1) pandemic influenza lineage.

Of the total of 123 270 specimens that have tested positive for influenza virus since week 40/2009, 110 434 (90%) were pandemic influenza A(H1) and these accounted for 99% of all influenza A viruses that were subtyped. In addition, 665 viruses were seasonal influenza A(H1); 397 were influenza A(H3); 11 487 were influenza A not subtyped; and 287 were influenza B.

Seven countries have tested isolates of pandemic (H1N1) 2009 virus for oseltamivir resistance. Of the 944 cases tested, 19 were resistant to oseltamivir. All viruses tested for resistance to zanamivir (282) have been found to be zanamivir-sensitive and all viruses tested for resistance to adamantanes (64) have been found to be resistant.


Comment

While influenza activity is increasing in 2 countries, an overall decreasing trend has been observed for 18. In general, ILI/ARI consultations and influenza detections peaked early this influenza season, around week 47/2009, with an early peak reported for England around week 30/2009. In the previous influenza season the peak was around week 4 (range: week 52?12). Nevertheless, trends in clinical and virological data are being monitored to determine if additional waves of winter-time activity will occur, or the proportion of seasonal influenza viruses in circulation will change.


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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<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
 
Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance

EuroFlu - Weekly Electronic Bulletin Week 51 : 14/12/2009-20/12/2009 - 25 December 2009, Issue N? 337 (edited)

EuroFlu - Weekly Electronic Bulletin Week 51 : 14/12/2009-20/12/2009 - 25 December 2009, Issue N? 337

Ongoing influenza activity despite declining clinical trends in many countries


Key points: week 51/2009

  • This report is based on data received from 41 of the 53 Member States in the WHO European Region.
  • Thirty-five per cent of specimens collected from sentinel sources tested positive for influenza virus.
  • Over the past three weeks, the incidence of clinical respiratory illness has decreased in 20 countries and increased in two others.
  • Out of 21 countries that reported testing at least 20 sentinel specimens for influenza, 13 reported that 30% of specimens or more had tested positive for influenza.
  • Five countries reported high or very high intensity of influenza activity, with six reporting moderate or severe impact on health services.
  • Pandemic (H1N1) 2009 was dominant in 32 countries and accounted 100% of influenza A virus subtype detections in sentinel specimens and 99% of detections in non-sentinel specimens.
  • 2397 laboratory confirmed pandemic (H1N1) 2009 deaths have been reported in the Region.

Current situation: week 51/2009

Clinical respiratory disease activity has declined over the past three weeks in 20 countries. However, nine of these countries also tested at least 20 sentinel specimens for influenza during week 51/2009 and the median influenza positivity rate was 39% (mean 34%), suggesting that influenza circulation is ongoing despite declining clinical trends. Two countries, Georgia and Montenegro, have reported recent and substantial increases in influenza-like illness (ILI) (defined as increases in each of the previous three weeks). In Georgia, 66% of sentinel specimens tested positive for influenza this week, reflecting the highest positivity rate of any country testing 20 or more sentinel specimens. Qualitative reporting also suggests that there are still parts of the WHO European Region where transmission remains intense. Bulgaria, Greece, Poland, the Russian Federation (Urals Region) and Serbia reported the intensity of influenza circulation as high, and Georgia reported the intensity as very high. France, Hungary, Kyrgyzstan, Romania and Turkey reported the impact of influenza on health care services to be moderate, and Georgia reported the impact to be severe.

Reports of respiratory hospitalizations and deaths submitted to EuroFlu also reflect mixed trends in severe respiratory disease activity. Reports of deaths due to acute respiratory infection (ARI) received from the Russian Federation have declined each week since week 48/2009, reflecting a pattern similar to observed trends in ARI consultations. The weekly count of hospitalizations due to severe acute respiratory illness (SARI) reported by Kyrgyzstan has also decreased from a peak that was observed in week 47. However, three SARI sentinel surveillance sites in Ukraine have reported notable increases in hospitalized SARI cases in week 51. Similarly, weekly reports of SARI hospitalizations in Uzbekistan rose steadily between weeks 45 and 49, declined in week 50, but have again increased in week 51/2009.


Virological update: week 51/2009

Sentinel physicians collected 2340 respiratory specimens this week, of which 817 (35%) were positive for influenza virus. Of these virus detections, 816 were type A (802 pandemic A(H1), 14 not subtyped) and 1 was type B. Of the 21 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 0% (Azerbaijan) to 66% (Georgia), with a median of 38% and a mean of 35%.

In addition, 6434 non-sentinel specimens were reported to be positive for influenza virus in week 51/2009: 6420 type A (6053 pandemic A(H1), 17 A(H3), 45 seasonal A(H1), 305 not subtyped) and 14 type B. Based on the antigenic characterization of 799 influenza viruses reported from week 40/2009 to week 51/2009, 792 were pandemic A(H1N1), A/California/7/2009-like, 3 were A/Perth/16/2009 (H3N2)-like, 2 were A(H3) A/Brisbane/10/2007 (H3N2)-like, 1 was A/Brisbane/59/2007 (H1N1)-like, and 1 was B/Brisbane/60/2008-like. Genetic characterizations were available for 204 isolates; all belonged to the A/California/7/2009 A(H1N1) pandemic influenza lineage.

Ten countries have tested isolates of pandemic (H1N1) 2009 virus for oseltamivir resistance. Of the 1312 cases tested, 26 were resistant to oseltamivir. All viruses tested for resistance to zanamivir (346/346) have been found to be zanamivir-sensitive and all viruses tested for resistance to adamantanes (64/64) have been found to be resistant.


Comment

Sentinel surveillance systems throughout the Region suggest that influenza activity remains ongoing despite declining trends in clinical activity in many countries. The percentage of sentinel specimens testing positive for influenza in the Region reached 45% during week 45/2009 but has since remained between 34 and 42%. While some countries now appear to be past their initial peaks in disease activity, other countries are currently experiencing high levels of winter season influenza transmission.


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