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Seasonal Flu 2008 - 2009

Re: Seasonal Flu 2008 - 2009

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

The presence of anamtadine resistance (S31N) in one of the H1N1 isolates suggest clade 2C is also present in the isolates from the summer, which is not reflected in the antigenic analysis, which only found clade 2B.
 
Re: Seasonal Flu 2008 - 2009

Virus outbreak shuts hospital wards

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

By Andrew Napier ?

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

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

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

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

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

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

http://www.dailyecho.co.uk/news/district/3747502.Virus_outbreak_shuts_hospital_wards/
 
Re: Seasonal Flu 2008 - 2009

Source: http://www.guampdn.com/article/20081015/NEWS01/810150337/1002

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

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

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

Yesterday, she said she has seen the trend continue.

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

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

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

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


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

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

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

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

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

"When you sneeze or cough, cover your mouth -- basic cough etiquette," said Unpingco. "Also, wash your hands and dispose of your tissues properly."
 
Re: Seasonal Flu 2008 - 2009

Australia

Patients isolated after gastro outbreak

Posted 1 hour 13 minutes ago

Map: Shepparton 3630

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

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

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

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

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

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

http://www.abc.net.au/news/stories/2008/10/15/2392240.htm
 
Re: Seasonal Flu 2008 - 2009

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

[European Centre of Diseases Prevention and Control (ECDC), Influenza News, Excerpts. For complete release, please follow this link: http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081016.aspx ]

* Scientific advances - SCIENTIFIC ADVANCES ? PANDEMIC INFLUENZA - INNOVATIONS

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

- Recent avian H5N1 viruses exhibit increased propensity for acquiring human receptor specificity. J. Stevens et al - Journal of Molecular Biology 2008 Sep 19;381(5) [URL: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WK7-4S85DTV-3&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=7b4dea057afc07d0f2103783e9e35c82 ]
- Glycan microarray technologies: tools to survey host specificity of influenza viruses. J. Stevens, O. Blixt at al - Nature Reviews Microbiology 4, 857-864 (November 2006) [URL: http://www.nature.com/nrmicro/journal/v4/n11/abs/nrmicro1530.html ]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

* P.H. DEVELOPMENTS ? PANDEMIC INFLUENZA - PREPAREDNESS

-- WHO guidelines for emergency health interventions in community settings

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

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

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

* P.H. DEVELOPMENTS ? PANDEMIC INFLUENZA - PREPAREDNESS

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

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

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

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

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

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

* Meetings and workshops

-- International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.

This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007). The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.

The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union.

The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009.

A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting. Its last report is available at http://www.undg.org/docs/8097/12-18-07-UN-WB-AHI-Progress-Report-final.doc

A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/
--
<cite cite="http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081016.aspx">http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081016.aspx</cite>
 
Re: Seasonal Flu 2008 - 2009

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

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

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

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

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

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

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

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

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

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

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

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

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

A = Dominant virus A
H1N1 = Dominant virus A(H1N1)
H3N2 = Dominant virus A(H3N2)
H1N2 = Dominant virus A(H1N2)
B = Dominant virus B
A & B = Dominant virus A & B
= : stable clinical activity
+ : increasing clinical activity
- : decreasing clinical activity
Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza activity
No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels)
Sporadic = isolated cases of laboratory confirmed influenza infection
Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed.
Regional activity = influenza activity above baseline levels in one or more regions witha population comprising less than 50% of the country's total population. Laboratory confirmed.
Widespread = influenza activity above baseline levels in one or more regions with a populationcomprising 50% or more of the country's population. Laboratory confirmed.

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

? Network comments (where available)
-- Switzerland: No activity detected last week.
-
----
<cite cite="http://www.eiss.org/cgi-files/bulletin_v2.cgi">EISS - Bulletin Review</cite>
 
Re: Seasonal Flu 2008 - 2009

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

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

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

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

Lin said that the flu epidemic generally begins in October and peaks around the Christmas holidays, before receding in February.
-snip-
http://www.chinapost.com.tw/taiwan/national/national-news/2008/10/21/179562/CDC-reports.htm
 
Re: Seasonal Flu 2008 - 2009

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


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

low in the rest of the world.
<HTTP: update en influenza disease csr www.who.int />

CDC:


During week 40, overall influenza activity was low with the majority of the states reporting no activity and only 7
states reported sporadic activity. Of the 1,123 specimens tested for influenza viruses in week 40, 8 (0.7%) were positive.
From May 18 - September 27, 2008, the CDC antigenically characterized 6 influenza viruses: 4 influenza A(H1), 1
influenza A(H3), and 1 influenza B. All six viruses are antigenically similar to the components selected for the 2008-09
influenza vaccine. CDC performed oseltamivir and zanamivir resistance testing on 10 influenza A and B viruses collected
since May 18. Two of the 6 influenza A(H1N1) viruses tested were found to be resistant to oseltamivir and the influenza
A(H3N2) and influenza B viruses tested were sensitive to oseltamivir. All tested viruses retain their sensitivity to zanamivir.
Of the 6 influenza A viruses collected since May 18 that were tested for adamantane resistance, 1 influenza A(H3N2)

virus and 1 of the 5 influenza A (H1N1) viruses tested were resistant.
<HTTP: weekly flu www.cdc.gov />

EISS:


In week 41, levels of influenza activity in Europe were low, with all countries reporting no or only sporadic influenza
activity. Since week 40, 13 influenza viruses were detected of which 8 were influenza A not subtyped, 2 were influenza
A(H1), 2 were influenza A(H3) and 1 was influenza B. It is currently too early to determine which virus type or subtype may
become dominant in Europe this season. <

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


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

10 September 2008.
<HTTP: en disease csr www.who.int index.html avian_influenza>

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

<
http://www.who.int/wer/2008/wer8341/en/index.html>
http://www.phac-aspc.gc.ca/fluwatch/08-09/w41_08/pdf/fw2008-41-eng.pdf

 
Re: Seasonal Flu 2008 - 2009

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

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

* Scientific advances - SCIENTIFIC ADVANCES ? PANDEMIC INFLUENZA - VACCINES

-- Influenza vaccine safety monitoring ? the US experience.

Iskander J, Broder K.

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

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

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

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

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

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

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

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

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

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

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

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

* Public Health Developments

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

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

* Meetings and workshops

-- International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.

This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007).

The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.

The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union.

The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009.

A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting.

Its last report is available at http://www.undg.org/docs/8097/12-18-07-UN-WB-AHI-Progress-Report-final.doc

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

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

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

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

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

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

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

A web-site with registration details are at http://www.espace-ethique.org/fr/pandemic_ethics_november_2008.php

-- European Scientific Conference on Applied Infectious Disease Epidemiology, Berlin 19-21 November 2008.

The second annual European Scientific Conference on Applied Infectious Disease Epidemiology ? ESCAIDE ? is fast approaching.

The event is being held in Berlin from 19-21 November, and over 500 health experts from across Europe and beyond are expected to come together to share scientific knowledge and experience on all areas related to infectious disease epidemiology.

It is possible to register for the conference for a reduced fee of 100 Euros- the deadline for early registration is 1st October. It is also still possible to submit a ?late breaker abstract? to the conference- the deadline for submission is 29th September.

Details of the full conference programme, participant registration, and abstract submission can be found on the ESCAIDE website
-
<cite cite="http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081023.aspx">http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081023.aspx</cite>
 
Re: Seasonal Flu 2008 - 2009

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[SIZE=+2]Continuing low levels of influenza activity in Europe [/SIZE]

Summary: Levels of influenza activity in Europe are low, with all countries reporting no or only sporadic influenza activity in week 42/2008. Only a few laboratory confirmed cases of influenza have been reported during the weeks 40-42/2008.

Epidemiological situation - week 42/2008: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all of the 23 countries providing these data. For the geographical spread indicator, sporadic influenza activity was reported in two countries (England and Ireland) and no activity in 21 countries. Definitions for the epidemiological indicators can be found here.

Cumulative epidemiological situation ? 2008-2009 season (weeks 40-42/2008): So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (e.g. below the national baseline threshold).

Virological situation - week 42/2008: The total number of respiratory specimens collected by sentinel physicians in week 42/2008 was 199, of which four (2%) were influenza virus positive, two type A not subtyped in Ireland and two subtype A(H3N2), one each in The Netherlands and Sweden. In addition, six influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals), of which three were type A not subtyped,[two in England and one in Sweden], one subtype A(H1) in Germany, one A(H3N2) in Sweden and one was type B in England.

Cumulative virological situation ? 2008-2009 season (weeks 40-42/2008): During the first three weeks of the current season, 22 influenza viruses were detected in six countries: 11 type A not subtyped, three subtype A(H1), five A(H3) [of which three were A(H3N2)] and three type B. In addition to England, Spain and Sweden, virus has now also been detected in Germany, Ireland and The Netherlands.

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

Background: The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS. In week 42/2008, 23 countries reported clinical data and 24 countries reported virological data to EISS. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS under the responsibility of the European Centre for Disease Prevention and Control in Stockholm (Sweden) in collaboration with the WHO Collaborating Centre in London (United Kingdom).

Other bulletins: To view national/regional bulletins in Europe and other bulletins from around the world, please click here.
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</TD><TD width=780 bgColor=white><TABLE width=780 border=0><TBODY><TR><TD>[FONT=Arial, Helvetica, sans-serif][SIZE=+1]Map

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

Clicking on the map will, if available, take you through to the national web site. If 'regional' activity is reported, a pop-up text box will appear which describes the activity in greater detail.

Clicking on England and France will provide you with regional data.

<MAP name=area><AREA shape=POLY alt="Northern Ireland" coords=140,289,150,289,153,309,142,312,127,301 href="http://www.cdscni.org.uk/"><AREA shape=POLY alt=Iceland coords=88,61,88,60,83,50,72,50,59,60,56,71,56,95,66,106,79,120,101,118,136,105,136,84,135,69,116,65,105,67 href="http://www.landspitali.is"><AREA shape=POLY alt=Denmark coords=173,161,176,165,171,173,170,180,169,182,163,181,162,176,162,167,161,164,168,160 href="http://www.ssi.dk/sw2796.asp"><AREA shape=POLY alt=Norway coords=332,79,328,90,322,100,314,114,312,120,302,142,296,152,288,153,279,166,257,185,255,238,266,258,282,259,297,245,305,238,310,240,313,240,314,227,322,220,322,213,318,209,322,198,318,188,314,171,318,153,324,148,329,149,331,145,328,137,333,130,333,117,345,89,341,85,347,78 href="http://www.fhi.no"><AREA shape=POLY alt=Norway coords=434,21,423,33,411,25,408,26,406,28,401,27,398,37,400,45,398,53,397,54,390,52,384,57,373,46,364,64,355,62,353,66,354,72,350,74,344,79,316,79,322,68,331,56,343,40,360,26,378,11,394,2,419,5,432,14,429,18 href="http://www.fhi.no"><AREA shape=POLY alt=Sweden coords=371,52,377,60,384,61,390,68,393,82,402,108,390,111,310,239,314,238,315,227,322,221,321,213,318,209,319,206,323,199,319,192,314,171,316,167,316,158,322,151,324,146,329,148,331,145,327,136,334,127,332,117,338,101,345,89,341,84,347,75,353,73,354,69,354,62,359,62,365,63,369,52 href="http://www.smittskyddsinstitutet.se/SMItemplates/Article.aspx?id=3021"><AREA shape=POLY alt=Sweden coords=385,118,316,226,310,239,310,255,321,280,324,293,326,307,336,305,339,305,342,300,342,298,341,297,357,291,361,289,366,266,362,247,377,231,377,217,361,200,363,178,373,159,384,144,387,133 href="http://www.smittskyddsinstitutet.se/SMItemplates/Article.aspx?id=3021"><AREA shape=POLY alt=Denmark coords=307,260,311,273,305,279,310,286,307,295,308,300,314,293,323,290,326,300,325,310,326,310,319,319,310,319,300,314,288,314,281,311,286,305,281,302,281,296,272,297,273,278,284,278,285,274,294,271 href="http://www.ssi.dk/sw2796.asp"><AREA shape=POLY alt=Scotland coords=195,225,190,222,184,230,182,234,170,232,161,242,160,231,149,235,149,242,141,248,140,258,150,256,152,263,142,267,148,271,144,282,151,288,151,291,156,294,155,302,160,304,170,304,181,295,185,293,189,287,187,279,191,273,191,270,197,259,196,252,180,250,189,240,194,231,196,225 href="http://www.show.scot.nhs.uk/scieh/"><AREA shape=POLY alt=Scotland coords=210,199,204,206,202,209,204,217,209,217,210,210,211,206,214,199 href="http://www.show.scot.nhs.uk/scieh/"><AREA shape=POLY alt=Finland coords=380,209,379,213,380,216,386,215,388,212,385,209 href="http://www.ktl.fi"><AREA shape=POLY alt=Sweden coords=379,245,379,251,375,256,372,262,373,269,374,276,375,276,377,270,381,263,381,257,385,253,381,252,382,245 href="http://www.smittskyddsinstitutet.se/SMItemplates/Article.aspx?id=3021"><AREA onclick="return popup(this, 'notes')" shape=POLY alt=England coords=159,307,158,311,157,314,163,314,164,310,164,306,163,306 href="/cgi-files/regional.cgi?year=2008&week=42&region=England"><AREA onclick="return popup(this, 'notes')" shape=POLY alt=England coords=190,287,185,291,184,294,182,294,173,302,169,305,171,313,174,317,172,327,170,331,171,333,182,332,197,329,205,328,203,317,200,312,194,306,193,289 href="/cgi-files/regional.cgi?year=2008&week=42&region=England"><AREA onclick="return popup(this, 'notes')" shape=POLY alt=England coords=204,328,192,331,182,331,175,333,169,332,167,342,166,353,165,362,178,359,192,358,193,359,209,359,214,361,218,354,221,348,219,344,209,340,206,341,207,330 href="/cgi-files/regional.cgi?year=2008&week=42&region=England"><AREA onclick="return popup(this, 'notes')" shape=POLY alt=England coords=213,360,203,359,191,359,190,358,174,359,169,362,165,365,159,363,147,367,141,375,133,378,133,383,142,383,150,380,159,384,163,377,170,380,181,381,200,382,212,377,215,369,210,367 href="/cgi-files/regional.cgi?year=2008&week=42&region=England"><AREA shape=POLY alt=Wales coords=171,328,170,328,168,337,168,344,167,350,165,357,167,362,163,364,158,362,154,358,147,357,144,352,146,348,151,346,156,343,159,336,155,337,152,336,152,333,155,331,155,323,158,324,166,326 href="http://www2.nphs.wales.nhs.uk/icds/page.cfm?pid=507"><AREA shape=POLY alt=Ireland coords=141,287,138,284,126,285,126,290,121,292,123,297,123,300,114,296,107,296,105,306,103,313,108,318,101,328,93,331,95,345,100,348,120,346,127,343,136,344,142,337,145,319,143,312,137,307,136,306,134,307,129,303,128,300,134,293 href="http://www.ndsc.ie"><AREA shape=POLY alt="The Netherlands" coords=272,339,272,338,272,344,271,346,272,348,272,351,267,354,270,358,268,362,268,365,261,368,259,369,261,372,259,379,255,377,249,374,243,372,237,376,230,373,233,368,238,362,239,352,245,345,252,335,264,336 href="http://www.virology.nl/research/influenza.asp"><AREA shape=POLY alt=Belgium coords=258,379,259,379,258,386,262,390,262,393,257,399,256,402,256,407,256,407,253,406,245,400,246,395,242,398,239,396,236,390,232,387,229,383,225,382,223,379,223,375,231,372,237,376,243,372,251,373 href="http://www.iph.fgov.be/flu/"><AREA onclick="return popup(this, 'notes')" shape=POLY alt=France coords=223,376,212,378,211,391,195,396,192,401,182,399,181,393,172,394,174,413,164,409,159,405,144,405,138,408,139,422,151,428,153,434,161,435,162,442,168,454,174,453,178,451,179,448,177,444,180,441,192,442,200,448,200,452,217,453,221,450,229,450,236,456,244,454,248,451,252,454,262,451,268,445,272,443,274,431,276,424,280,419,277,416,266,413,261,407,254,407,246,400,246,396,242,400,240,395,235,390,228,383,223,382 href="/cgi-files/regional.cgi?year=2008&week=42&region=France"><AREA onclick="return popup(this, 'notes')" shape=POLY alt=France coords=262,452,253,455,248,451,240,455,237,456,230,451,222,450,218,453,208,452,200,452,198,446,192,442,185,441,179,442,176,443,179,448,177,452,170,455,168,453,169,468,167,486,161,499,159,504,168,514,177,516,179,521,187,521,189,520,195,521,198,528,207,528,208,530,212,529,216,529,217,518,229,510,232,513,241,515,251,521,261,517,269,510,273,504,271,502,264,497,265,491,261,485,266,482,267,479,264,473,266,471,262,463,258,465,256,465,257,460,258,456 href="/cgi-files/regional.cgi?year=2008&week=42&region=France"><AREA shape=POLY alt=Switzerland coords=306,455,302,464,301,461,302,464,301,466,295,463,292,466,288,472,285,469,282,465,278,469,276,471,269,472,266,472,265,470,262,464,257,466,254,466,257,456,261,452,267,445,273,441,283,441,289,439,295,443,296,450,302,455 href="http://www.bag.admin.ch/sentinella"><AREA shape=POLY alt=Germany coords=300,313,302,320,314,320,311,330,315,327,325,320,295,443,290,440,285,440,280,442,273,442,274,431,277,423,280,419,277,417,268,414,261,407,261,402,260,397,262,391,259,386,259,379,261,375,261,374,259,368,263,366,266,365,269,359,268,355,265,354,270,351,272,347,270,345,273,343,270,338,269,337,271,334,279,331,282,335,286,330,286,327,284,321,282,311,290,314,296,314 href="http://www.influenza.rki.de/agi"><AREA shape=POLY alt=Germany coords=324,321,331,316,336,319,342,331,344,341,342,346,342,348,346,355,348,364,347,368,352,382,347,384,343,383,334,391,321,395,326,400,327,408,343,423,331,433,333,440,325,440,315,444,311,445,307,443,304,446,294,442 href="http://www.influenza.rki.de/agi"><AREA shape=POLY alt=Bulgaria coords=451,492,454,498,466,495,478,493,490,489,497,481,519,483,520,492,516,505,523,513,513,516,509,516,503,523,501,531,489,534,479,533,463,538,457,529,451,524,450,516,455,509 href=""><AREA shape=POLY alt="Czech Republic" coords=352,381,356,383,363,386,367,385,369,388,367,390,371,393,372,389,374,387,380,392,388,396,396,401,395,404,392,410,377,418,362,419,360,417,356,416,349,423,340,424,340,419,326,406,326,400,321,395,326,395,341,385,345,383,350,383 href="http://www.szu.cz/cema/aro/aro.htm"><AREA shape=POLY alt=Slovakia coords=435,406,434,406,430,405,425,401,419,400,417,404,412,403,410,406,403,404,400,402,394,404,387,412,378,417,374,421,377,428,378,432,384,435,389,435,395,434,398,429,406,425,411,424,415,417,421,417,428,418,429,420,431,419,433,417 href="http://www.sea.host.sk/chripka.htm"><AREA shape=POLY alt=Slovenia coords=371,452,371,458,369,461,368,466,365,466,363,467,364,472,363,476,354,477,352,477,346,480,340,479,340,475,341,467,338,464,340,461,345,461,353,461,358,457,363,458 href="http://www.ivz.si/ivz/"><AREA shape=POLY alt=Poland coords=344,340,340,328,359,321,362,315,375,308,385,315,397,315,418,313,424,311,431,315,439,340,432,346,439,353,441,365,448,378,438,390,435,400 href="http://www.pzh.gov.pl/aindex.html"><AREA shape=POLY alt=Poland coords=436,398,435,406,430,404,426,402,419,401,417,405,412,403,409,407,400,403,396,402,386,396,383,394,376,391,373,390,371,394,366,390,368,387,364,386,358,386,352,381,351,374,347,366,349,365,347,362,345,352,341,348,342,346,343,338 href="http://www.pzh.gov.pl/aindex.html"><AREA shape=POLY alt=Hungary coords=433,416,439,421,443,422,443,424,435,432,432,441,427,456,419,461,416,460,412,460,406,465,401,466,399,468,389,469,385,466,383,464,373,457,372,450,373,449,373,440,375,440,373,437,375,437,377,438,380,432,383,433,389,435,398,432,400,429,407,425,413,423,416,418,426,417,431,419 href="http://www.oek.hu"><AREA onclick="return popup(this, 'notes')" shape=POLY alt=France coords=292,520,291,526,288,527,282,529,282,541,284,549,290,554,293,547,295,538,295,534,294,522 href="/cgi-files/regional.cgi?year=2008&week=42&region=France"><AREA shape=POLY alt=Italy coords=345,460,336,458,328,459,322,452,318,452,313,453,312,457,305,456,302,460,302,466,296,462,287,471,283,464,276,472,265,470,263,474,268,479,261,484,264,491,263,496,265,500,270,503,272,504,271,510,278,507,284,500,329,492,329,481,335,478,341,477,341,471,339,465,341,462 href="http://www.virologia.unimi.it/influenza"><AREA shape=POLY alt=Italy 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href="http://www.msc.es"><AREA shape=POLY alt=Portugal coords=69,511,73,513,77,509,79,515,84,516,86,517,91,516,94,515,94,518,99,519,98,521,100,526,99,528,94,530,90,532,86,549,86,555,81,555,79,561,82,562,81,570,78,571,76,576,76,581,78,584,70,590,70,598,65,600,53,598,48,596,33,591,34,587,38,587,44,592,49,594,51,587,54,573,50,570,47,564,51,553,59,542,65,530 href="http://www.dgsaude.pt/"><AREA shape=RECT alt="Portugal (Azores)" coords=2,544,22,559 href="http://www.dgsaude.pt/"><AREA onclick="return popup(this, 'notes')" shape=POLY alt=Greece coords=500,525,505,526,505,529,502,531,503,538,501,543,503,548,504,564,502,567,511,581,521,598,528,602,539,604,540,609,546,608,543,618,528,639,518,644,493,652,480,642,453,621,434,594,425,577,421,571,425,569,428,577,431,569,438,553,442,549,446,549,452,543,461,538,472,534,480,531,482,534,494,532,499,531 href="/cgi-files/regional.cgi?year=2008&week=42&region=Greece"><AREA shape=POLY alt=Estonia coords=401,248,427,247,459,252,454,233,455,218,440,214,422,219,406,225 href="http://www.tervisekaitse.ee"><AREA shape=POLY alt=Albania coords=415,537,414,528,417,522,421,525,426,525,431,533,430,544,439,554,428,576,426,570,416,563,415,553,417,543><AREA shape=POLY alt=Macedonia coords=431,533,430,544,438,553,443,549,447,548,452,543,457,543,462,538,460,530,451,523,445,526><AREA shape=POLY alt=Turkey coords=679,464,671,464,663,479,653,478,642,489,621,490,613,486,603,481,595,483,629,583,634,578,643,579,652,581,658,576,660,573,657,566,663,562,667,562,679,554,679,554><AREA shape=POLY alt=Turkey coords=596,482,566,508,542,522,521,515,508,514,500,524,506,525,505,529,502,533,503,538,500,542,504,564,502,567,516,588,525,588,524,595,530,602,539,600,541,608,548,604,557,610,578,609,579,597,598,598,609,602,619,599,629,585><AREA shape=POLY alt=Finland coords=423,32,413,26,410,24,405,28,400,28,398,37,400,45,397,53,389,51,385,56,373,45,370,50,375,58,378,61,385,63,392,73,395,92,401,108,433,66,431,62,427,56,420,56,420,46,418,42,421,39 href="http://www.ktl.fi"><AREA shape=POLY alt=Finland coords=432,67,431,75,431,82,442,96,442,114,448,123,454,127,452,134,457,140,388,160,384,157,390,152,403,127,409,111,401,106 href="http://www.ktl.fi"><AREA shape=POLY alt=Finland coords=458,139,464,147,467,152,450,191,452,195,408,218,393,214,391,204,384,159 href="http://www.ktl.fi"><AREA shape=POLY alt=Romania coords=519,483,510,483,503,480,497,483,492,483,486,491,460,493,455,496,450,489,445,482,439,484,435,481,434,476,427,473,417,461,422,459,427,453,431,439,435,430,441,423 href="http://www.cantacuzino.ro"><AREA shape=POLY alt=Romania coords=516,482,520,482,520,466,528,460,528,450,520,450,515,456,513,457,504,447,503,431,488,418,486,410,481,408,473,417,464,423,460,421,441,421,441,424 href="http://www.cantacuzino.ro"><AREA shape=POLY alt=Malta coords=355,644,357,648,357,651,364,649,364,646,360,643 href="http://www.sahha.gov.mt"><AREA shape=POLY alt=Cyprus coords=635,595,626,604,614,607,614,612,607,617,611,624,624,620,629,616,636,611,631,607,639,597><AREA shape=POLY alt=Austria coords=375,419,374,422,379,432,380,435,375,438,373,436,372,438,373,441,372,450,361,458,358,457,352,461,342,460,331,458,327,457,324,453,314,453,311,458,297,453,295,449,294,443,298,443,303,445,308,442,312,445,320,441,326,439,331,441,333,438,330,433,339,424,344,422,348,424,357,415,360,416,363,419,372,418><AREA shape=POLY alt=Croatia coords=406,464,409,472,409,478,408,479,398,476,389,476,379,478,371,476,368,478,377,501,390,518,396,524,387,526,372,521,358,506,341,487,340,478,345,481,351,477,355,478,364,474,364,467,367,466,370,459,372,458,383,465,391,470,400,468 href="http://www.hzjz.hr"><AREA shape=POLY alt="Boznia and Herzegovina" coords=407,478,412,477,414,479,410,490,415,496,414,500,416,503,413,509,405,516,404,524,394,524,378,505,373,494,368,482,369,476,376,478,392,476,400,475><AREA shape=POLY alt=Montenegro coords=413,511,424,527,418,525,416,539,397,525><AREA shape=POLY alt=Serbia coords=418,461,418,462,425,469,434,477,435,482,441,484,447,482,450,491,448,495,453,504,455,509,451,515,452,524,431,533,426,525,427,524,427,524,424,523,422,521,419,517,414,510,414,504,412,498,414,496,410,488,413,479,409,477,407,463,412,460 href="http://www.batut.org.yu/"><AREA shape=POLY alt="" coords=434,20,444,20,458,23,467,24,500,35,514,50,530,48,519,38,508,14,528,9,540,17,545,16,555,0,679,0,679,177,451,193,452,182,459,170,466,151,461,140,452,134,452,129,454,126,451,124,442,113,440,94,431,81,431,72,433,67,427,57,422,57,419,50,419,44,419,41,423,33,424,31><AREA shape=POLY alt="" coords=452,194,457,203,448,212,456,224,451,234,457,245,459,253,466,270,451,282,456,293,452,309,436,320,440,339,434,347,448,378,680,373,680,172><AREA shape=POLY alt="" coords=449,376,437,390,434,398,434,406,432,415,441,423,460,421,465,423,480,411,487,410,490,420,504,432,504,448,514,457,521,451,527,451,536,427,543,375><AREA shape=POLY alt="" coords=671,463,667,453,636,442,615,434,596,429,587,441,573,454,560,443,552,437,535,424,541,374,679,371,679,465><AREA shape=POLY alt=Lithuania coords=414,278,401,286,402,300,417,300,421,304,421,312,428,314,433,323,439,321,450,309,452,302,456,292,452,283,446,279,437,275,434,278 href="http://www.aids.lt"><AREA shape=POLY alt="" coords=394,306,391,317,412,314,418,314,422,305,417,299,398,300><AREA shape=POLY alt=Luxembourg coords=255,400,254,407,260,408,263,402,261,395 href="http://www.ms.etat.lu/"><AREA shape=POLY alt=Latvia coords=398,283,430,279,449,281,464,270,457,251,439,247,423,250,396,250 href="http://www.sva.lv"><AREA shape=CIRCLE alt=Denmark coords=347,310,5 href="http://www.ssi.dk/sw2796.asp"><AREA shape=RECT alt=Norway coords=290,8,326,41 href="http://www.fhi.no"></MAP><FORM name=form1 action="" method=post>You may select the type of map :</B> Intensity <INPUT onclick="movepic('button','/bulletin_maps/2008_42_int_v2.png')" type=radio CHECKED value=radiobutton name=radiobutton> Geographical spread <INPUT onclick="movepic('button','/bulletin_maps/2008_42_v2.png')" type=radio value=radiobutton name=radiobutton> </FORM><CENTER>
2008_42_int_v2.png
</CENTER>
<CENTER><TABLE cellSpacing=5><TBODY><TR><TD vAlign=top noWrap>[FONT=Arial, Helvetica, sans-serif]A = Dominant virus A
H1N1 = Dominant virus A(H1N1)
H3N2 = Dominant virus A(H3N2)
H1N2 = Dominant virus A(H1N2)
B = Dominant virus B
A & B = Dominant virus A & B

= : stable clinical activity
+ : increasing clinical activity
- : decreasing clinical activity

[/FONT]</TD><TD>
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</TD><TD vAlign=top>[FONT=Arial, Helvetica, sans-serif]Low = no influenza activity or influenza at baseline levels
Medium = usual levels of influenza activity
High = higher than usual levels of influenza activity
Very high = particularly severe levels of influenza activity

No activity = no evidence of influenza virus activity (clinical activity remains at baseline levels)
Sporadic = isolated cases of laboratory confirmed influenza infection
Local outbreak = increased influenza activity in local areas (e.g. a city) within a region,
or outbreaks in two or more institutions (e.g. schools) within a region. Laboratory confirmed.
Regional activity = influenza activity above baseline levels in one or more regions with
a population comprising less than 50% of the country's total population. Laboratory confirmed.
Widespread = influenza activity above baseline levels in one or more regions with a population
comprising 50% or more of the country's population. Laboratory confirmed.

Finland : Where available, the epidemiological data are provided by a health-care district in
South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately one
percent of the Finnish population).
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</TD><TD width=780 bgColor=#1d92ff height=5>
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</TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD>[FONT=Arial, Helvetica, sans-serif][SIZE=-1][SIZE=+1]Network comments[/SIZE] [SIZE=-1](where available)[/SIZE]

<TABLE><TBODY><TR><TD width=20> </TD><TD width=700>[FONT=Arial, Helvetica, sans-serif][SIZE=-1]Netherlands
In week 42, a specimen from a sentinel boy patient of 3 years old with ILI was positive for infleunza virus A(H3N2). The patient got ill on the day of returning from Mexico. This is the first influenza virus positive sentinel patient this season in the Netherlands.
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</TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1>
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</TD><TD width=780 bgColor=#1d92ff height=5>
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</TD></TR><TR><TD width=1 bgColor=black height=1>
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</TD><TD width=780 bgColor=white><TABLE width=780><TBODY><TR><TD>[FONT=Arial, Helvetica, sans-serif][SIZE=-1][SIZE=+1]Table and graphs[/SIZE] [SIZE=-1](where available)[/SIZE]

<CENTER><TABLE cellSpacing=0 cellPadding=2 bgColor=white border=0><TBODY><TR><TD bgColor=#808080 colSpan=14>
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</TD></TR><TR><TD vAlign=top bgColor=white>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD vAlign=top bgColor=white>[FONT=Arial, Helvetica, sans-serif]Intensity[/FONT]</TD><TD vAlign=top bgColor=white>[FONT=Arial, Helvetica, sans-serif]Geographic
Spread
[/FONT]</TD><TD vAlign=top bgColor=white>[FONT=Arial, Helvetica, sans-serif]Sentinel
swabs
[/FONT]</TD><TD vAlign=top bgColor=white>[FONT=Arial, Helvetica, sans-serif]Percentage
positive
[/FONT]</TD><TD vAlign=top bgColor=white>[FONT=Arial, Helvetica, sans-serif]Dominant
type
[/FONT]</TD><TD vAlign=top align=middle bgColor=white colSpan=2>[FONT=Arial, Helvetica, sans-serif]ILI per
100,000
[/FONT]</TD><TD vAlign=top align=middle bgColor=white colSpan=2>[FONT=Arial, Helvetica, sans-serif]ARI per
100,000
[/FONT]</TD><TD vAlign=top noWrap bgColor=white>[FONT=Arial, Helvetica, sans-serif]Virology graph
and pie chart
[/FONT]</TD></TR><TR><TD bgColor=#808080 colSpan=13>
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</TD></TR><TR id=r2c0><TD class=relative id=r2c1 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11)>[FONT=Arial, Helvetica, sans-serif]Belgium[/FONT]</TD><TD class=relative id=r2c2 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r2c3 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r2c4 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11)>[FONT=Arial, Helvetica, sans-serif]8[/FONT]</TD><TD class=relative id=r2c5 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r2c6 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r2c7 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11) align=right>[FONT=Arial, Helvetica, sans-serif]42.2[/FONT]</TD><TD class=relative id=r2c8 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r2c9 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11) align=right>[FONT=Arial, Helvetica, sans-serif]1467.7[/FONT]</TD><TD class=relative id=r2c10 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r2c11 onmouseover=crossRow_over(2,11) onmouseout=crossRow_out(2,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r8c0><TD class=relative id=r8c1 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]Bulgaria[/FONT]</TD><TD class=relative id=r8c2 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r8c3 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r8c4 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]0[/FONT]</TD><TD class=relative id=r8c5 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r8c6 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r8c7 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r8c8 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r8c9 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11) align=right>[FONT=Arial, Helvetica, sans-serif]641.3 [/FONT]</TD><TD class=relative id=r8c10 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r8c11 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r3c0><TD class=relative id=r3c1 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11)>[FONT=Arial, Helvetica, sans-serif]Czech Republic[/FONT]</TD><TD class=relative id=r3c2 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r3c3 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r3c4 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11)>[FONT=Arial, Helvetica, sans-serif]18[/FONT]</TD><TD class=relative id=r3c5 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r3c6 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r3c7 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11) align=right>[FONT=Arial, Helvetica, sans-serif]20.6 [/FONT]</TD><TD class=relative id=r3c8 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r3c9 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11) align=right>[FONT=Arial, Helvetica, sans-serif]922.6 [/FONT]</TD><TD class=relative id=r3c10 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r3c11 onmouseover=crossRow_over(3,11) onmouseout=crossRow_out(3,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r4c0><TD class=relative id=r4c1 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11)>[FONT=Arial, Helvetica, sans-serif]Denmark[/FONT]</TD><TD class=relative id=r4c2 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r4c3 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r4c4 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11)>[FONT=Arial, Helvetica, sans-serif]0[/FONT]</TD><TD class=relative id=r4c5 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r4c6 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r4c7 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11) align=right>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r4c8 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r4c9 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11) noWrap>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r4c10 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r4c11 onmouseover=crossRow_over(4,11) onmouseout=crossRow_out(4,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r5c0><TD class=relative id=r5c1 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11)>[FONT=Arial, Helvetica, sans-serif]England[/FONT]</TD><TD class=relative id=r5c2 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r5c3 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11)>[FONT=Arial, Helvetica, sans-serif]Sporadic[/FONT]</TD><TD class=relative id=r5c4 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11)>[FONT=Arial, Helvetica, sans-serif]37[/FONT]</TD><TD class=relative id=r5c5 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r5c6 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11) noWrap>[FONT=Arial, Helvetica, sans-serif]Type A[/FONT]</TD><TD class=relative id=r5c7 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11) align=right>[FONT=Arial, Helvetica, sans-serif]6.9 [/FONT]</TD><TD class=relative id=r5c8 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r5c9 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11) align=right>[FONT=Arial, Helvetica, sans-serif]556.8 [/FONT]</TD><TD class=relative id=r5c10 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r5c11 onmouseover=crossRow_over(5,11) onmouseout=crossRow_out(5,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r6c0><TD class=relative id=r6c1 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11)>[FONT=Arial, Helvetica, sans-serif]Estonia[/FONT]</TD><TD class=relative id=r6c2 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r6c3 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r6c4 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11)>[FONT=Arial, Helvetica, sans-serif]5[/FONT]</TD><TD class=relative id=r6c5 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r6c6 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r6c7 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.5[/FONT]</TD><TD class=relative id=r6c8 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r6c9 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11) align=right>[FONT=Arial, Helvetica, sans-serif]297.1[/FONT]</TD><TD class=relative id=r6c10 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r6c11 onmouseover=crossRow_over(6,11) onmouseout=crossRow_out(6,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r8c0><TD class=relative id=r8c1 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]Germany[/FONT]</TD><TD class=relative id=r8c2 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r8c3 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r8c4 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]14[/FONT]</TD><TD class=relative id=r8c5 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r8c6 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r8c7 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r8c8 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r8c9 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11) align=right>[FONT=Arial, Helvetica, sans-serif]776.0 [/FONT]</TD><TD class=relative id=r8c10 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r8c11 onmouseover=crossRow_over(8,11) onmouseout=crossRow_out(8,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r9c0><TD class=relative id=r9c1 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11)>[FONT=Arial, Helvetica, sans-serif]Greece[/FONT]</TD><TD class=relative id=r9c2 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r9c3 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r9c4 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11)>[FONT=Arial, Helvetica, sans-serif]0[/FONT]</TD><TD class=relative id=r9c5 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r9c6 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r9c7 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0[/FONT]</TD><TD class=relative id=r9c8 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r9c9 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11) align=right>[FONT=Arial, Helvetica, sans-serif]64.0[/FONT]</TD><TD class=relative id=r9c10 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r9c11 onmouseover=crossRow_over(9,11) onmouseout=crossRow_out(9,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r10c0><TD class=relative id=r10c1 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11)>[FONT=Arial, Helvetica, sans-serif]Hungary[/FONT]</TD><TD class=relative id=r10c2 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r10c3 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r10c4 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11)>[FONT=Arial, Helvetica, sans-serif]3[/FONT]</TD><TD class=relative id=r10c5 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r10c6 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r10c7 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11) align=right>[FONT=Arial, Helvetica, sans-serif]115.1[/FONT]</TD><TD class=relative id=r10c8 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r10c9 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0[/FONT]</TD><TD class=relative id=r10c10 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r10c11 onmouseover=crossRow_over(10,11) onmouseout=crossRow_out(10,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r11c0><TD class=relative id=r11c1 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11)>[FONT=Arial, Helvetica, sans-serif]Ireland[/FONT]</TD><TD class=relative id=r11c2 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r11c3 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11)>[FONT=Arial, Helvetica, sans-serif]Sporadic[/FONT]</TD><TD class=relative id=r11c4 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11)>[FONT=Arial, Helvetica, sans-serif]3[/FONT]</TD><TD class=relative id=r11c5 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11)>[FONT=Arial, Helvetica, sans-serif]66.7%[/FONT]</TD><TD class=relative id=r11c6 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11) noWrap>[FONT=Arial, Helvetica, sans-serif]Type A[/FONT]</TD><TD class=relative id=r11c7 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11) align=right>[FONT=Arial, Helvetica, sans-serif]7.3 [/FONT]</TD><TD class=relative id=r11c8 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r11c9 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r11c10 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r11c11 onmouseover=crossRow_over(11,11) onmouseout=crossRow_out(11,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r13c0><TD class=relative id=r13c1 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11)>[FONT=Arial, Helvetica, sans-serif]Latvia[/FONT]</TD><TD class=relative id=r13c2 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r13c3 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r13c4 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11)>[FONT=Arial, Helvetica, sans-serif]0[/FONT]</TD><TD class=relative id=r13c5 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r13c6 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r13c7 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r13c8 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r13c9 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11) align=right>[FONT=Arial, Helvetica, sans-serif]1009.1 [/FONT]</TD><TD class=relative id=r13c10 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r13c11 onmouseover=crossRow_over(13,11) onmouseout=crossRow_out(13,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r14c0><TD class=relative id=r14c1 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11)>[FONT=Arial, Helvetica, sans-serif]Lithuania[/FONT]</TD><TD class=relative id=r14c2 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r14c3 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r14c4 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11)>[FONT=Arial, Helvetica, sans-serif]0[/FONT]</TD><TD class=relative id=r14c5 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r14c6 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r14c7 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.4 [/FONT]</TD><TD class=relative id=r14c8 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r14c9 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11) align=right>[FONT=Arial, Helvetica, sans-serif]484.4 [/FONT]</TD><TD class=relative id=r14c10 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r14c11 onmouseover=crossRow_over(14,11) onmouseout=crossRow_out(14,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r17c0><TD class=relative id=r17c1 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11)>[FONT=Arial, Helvetica, sans-serif]Netherlands[/FONT]</TD><TD class=relative id=r17c2 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r17c3 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r17c4 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11)>[FONT=Arial, Helvetica, sans-serif]7[/FONT]</TD><TD class=relative id=r17c5 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11)>[FONT=Arial, Helvetica, sans-serif]14.3%[/FONT]</TD><TD class=relative id=r17c6 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r17c7 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11) align=right>[FONT=Arial, Helvetica, sans-serif]28.0 [/FONT]</TD><TD class=relative id=r17c8 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r17c9 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r17c10 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r17c11 onmouseover=crossRow_over(17,11) onmouseout=crossRow_out(17,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r18c0><TD class=relative id=r18c1 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11)>[FONT=Arial, Helvetica, sans-serif]Northern Ireland[/FONT]</TD><TD class=relative id=r18c2 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r18c3 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r18c4 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11)>[FONT=Arial, Helvetica, sans-serif]1[/FONT]</TD><TD class=relative id=r18c5 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r18c6 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r18c7 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11) align=right>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r18c8 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r18c9 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11) noWrap>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r18c10 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r18c11 onmouseover=crossRow_over(18,11) onmouseout=crossRow_out(18,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r19c0><TD class=relative id=r19c1 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11)>[FONT=Arial, Helvetica, sans-serif]Norway[/FONT]</TD><TD class=relative id=r19c2 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r19c3 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r19c4 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11)>[FONT=Arial, Helvetica, sans-serif]2[/FONT]</TD><TD class=relative id=r19c5 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r19c6 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r19c7 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11) align=right>[FONT=Arial, Helvetica, sans-serif]23.0 [/FONT]</TD><TD class=relative id=r19c8 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r19c9 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r19c10 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r19c11 onmouseover=crossRow_over(19,11) onmouseout=crossRow_out(19,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r20c0><TD class=relative id=r20c1 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11)>[FONT=Arial, Helvetica, sans-serif]Poland[/FONT]</TD><TD class=relative id=r20c2 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r20c3 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r20c4 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11)>[FONT=Arial, Helvetica, sans-serif]10[/FONT]</TD><TD class=relative id=r20c5 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r20c6 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r20c7 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11) align=right>[FONT=Arial, Helvetica, sans-serif]33.8 [/FONT]</TD><TD class=relative id=r20c8 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r20c9 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r20c10 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r20c11 onmouseover=crossRow_over(20,11) onmouseout=crossRow_out(20,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r21c0><TD class=relative id=r21c1 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11)>[FONT=Arial, Helvetica, sans-serif]Portugal[/FONT]</TD><TD class=relative id=r21c2 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r21c3 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r21c4 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11)>[FONT=Arial, Helvetica, sans-serif]4[/FONT]</TD><TD class=relative id=r21c5 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r21c6 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r21c7 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11) align=right>[FONT=Arial, Helvetica, sans-serif]9.2 [/FONT]</TD><TD class=relative id=r21c8 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r21c9 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r21c10 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r21c11 onmouseover=crossRow_over(21,11) onmouseout=crossRow_out(21,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r22c0><TD class=relative id=r22c1 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11)>[FONT=Arial, Helvetica, sans-serif]Romania[/FONT]</TD><TD class=relative id=r22c2 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r22c3 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r22c4 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11)>[FONT=Arial, Helvetica, sans-serif]7[/FONT]</TD><TD class=relative id=r22c5 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r22c6 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r22c7 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r22c8 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r22c9 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11) align=right>[FONT=Arial, Helvetica, sans-serif]944.1 [/FONT]</TD><TD class=relative id=r22c10 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r22c11 onmouseover=crossRow_over(22,11) onmouseout=crossRow_out(22,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r24c0><TD class=relative id=r24c1 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11)>[FONT=Arial, Helvetica, sans-serif]Serbia[/FONT]</TD><TD class=relative id=r24c2 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r24c3 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r24c4 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11)>[FONT=Arial, Helvetica, sans-serif]0[/FONT]</TD><TD class=relative id=r24c5 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r24c6 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r24c7 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11) align=right>[FONT=Arial, Helvetica, sans-serif]73.8[/FONT]</TD><TD class=relative id=r24c8 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r24c9 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0[/FONT]</TD><TD class=relative id=r24c10 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r24c11 onmouseover=crossRow_over(24,11) onmouseout=crossRow_out(24,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r25c0><TD class=relative id=r25c1 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11)>[FONT=Arial, Helvetica, sans-serif]Slovakia[/FONT]</TD><TD class=relative id=r25c2 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r25c3 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r25c4 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11)>[FONT=Arial, Helvetica, sans-serif]2[/FONT]</TD><TD class=relative id=r25c5 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r25c6 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r25c7 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11) align=right>[FONT=Arial, Helvetica, sans-serif]171.5 [/FONT]</TD><TD class=relative id=r25c8 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r25c9 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11) align=right>[FONT=Arial, Helvetica, sans-serif]1584.4 [/FONT]</TD><TD class=relative id=r25c10 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r25c11 onmouseover=crossRow_over(25,11) onmouseout=crossRow_out(25,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r26c0><TD class=relative id=r26c1 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11)>[FONT=Arial, Helvetica, sans-serif]Slovenia[/FONT]</TD><TD class=relative id=r26c2 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r26c3 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r26c4 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11)>[FONT=Arial, Helvetica, sans-serif]3[/FONT]</TD><TD class=relative id=r26c5 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r26c6 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r26c7 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r26c8 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r26c9 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11) align=right>[FONT=Arial, Helvetica, sans-serif]775.3 [/FONT]</TD><TD class=relative id=r26c10 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r26c11 onmouseover=crossRow_over(26,11) onmouseout=crossRow_out(26,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r27c0><TD class=relative id=r27c1 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11)>[FONT=Arial, Helvetica, sans-serif]Spain[/FONT]</TD><TD class=relative id=r27c2 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r27c3 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r27c4 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11)>[FONT=Arial, Helvetica, sans-serif]30[/FONT]</TD><TD class=relative id=r27c5 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r27c6 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r27c7 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11) align=right>[FONT=Arial, Helvetica, sans-serif]14.1 [/FONT]</TD><TD class=relative id=r27c8 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r27c9 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r27c10 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r27c11 onmouseover=crossRow_over(27,11) onmouseout=crossRow_out(27,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r28c0><TD class=relative id=r28c1 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11)>[FONT=Arial, Helvetica, sans-serif]Sweden[/FONT]</TD><TD class=relative id=r28c2 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r28c3 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r28c4 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11)>[FONT=Arial, Helvetica, sans-serif]43[/FONT]</TD><TD class=relative id=r28c5 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11)>[FONT=Arial, Helvetica, sans-serif]2.3%[/FONT]</TD><TD class=relative id=r28c6 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11) noWrap>[FONT=Arial, Helvetica, sans-serif]Type A[/FONT]</TD><TD class=relative id=r28c7 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11) align=right>[FONT=Arial, Helvetica, sans-serif]1.3 [/FONT]</TD><TD class=relative id=r28c8 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r28c9 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r28c10 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r28c11 onmouseover=crossRow_over(28,11) onmouseout=crossRow_out(28,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r29c0><TD class=relative id=r29c1 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11)>[FONT=Arial, Helvetica, sans-serif]Switzerland[/FONT]</TD><TD class=relative id=r29c2 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r29c3 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r29c4 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11)>[FONT=Arial, Helvetica, sans-serif]2[/FONT]</TD><TD class=relative id=r29c5 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11)>[FONT=Arial, Helvetica, sans-serif]0%[/FONT]</TD><TD class=relative id=r29c6 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11) noWrap>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r29c7 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11) align=right>[FONT=Arial, Helvetica, sans-serif]9.0 [/FONT]</TD><TD class=relative id=r29c8 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r29c9 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11) noWrap>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r29c10 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r29c11 onmouseover=crossRow_over(29,11) onmouseout=crossRow_out(29,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r30c0><TD class=relative id=r30c1 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11)>[FONT=Arial, Helvetica, sans-serif]Wales[/FONT]</TD><TD class=relative id=r30c2 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11)>[FONT=Arial, Helvetica, sans-serif]Low[/FONT]</TD><TD class=relative id=r30c3 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11)>[FONT=Arial, Helvetica, sans-serif]None[/FONT]</TD><TD class=relative id=r30c4 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r30c5 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r30c6 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11) noWrap>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r30c7 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11) align=right>[FONT=Arial, Helvetica, sans-serif]1.0 [/FONT]</TD><TD class=relative id=r30c8 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r30c9 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11) align=right>[FONT=Arial, Helvetica, sans-serif]0.0 [/FONT]</TD><TD class=relative id=r30c10 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11)>[FONT=Arial, Helvetica, sans-serif](graphs)[/FONT]</TD><TD class=relative id=r30c11 onmouseover=crossRow_over(30,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(30,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR id=r31c0><TD class=relative id=r31c1 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11)>[FONT=Arial, Helvetica, sans-serif]Europe[/FONT]</TD><TD class=relative id=r31c2 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r31c3 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r31c4 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11)>[FONT=Arial, Helvetica, sans-serif]199[/FONT]</TD><TD class=relative id=r31c5 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11)>[FONT=Arial, Helvetica, sans-serif]2.0%[/FONT]</TD><TD class=relative id=r31c6 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11) noWrap>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r31c7 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11) align=right>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r31c8 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r31c9 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11) noWrap>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r31c10 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11)>[FONT=Arial, Helvetica, sans-serif][/FONT]</TD><TD class=relative id=r31c11 onmouseover=crossRow_over(31,11) style="BACKGROUND: #ffffff; CURSOR: hand" onmouseout=crossRow_out(31,11)>[FONT=Arial, Helvetica, sans-serif]Click here[/FONT]</TD><TR><TD bgColor=#808080 colSpan=14>
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</TD></TR><TR><TD colSpan=14>[FONT=Arial, Helvetica, sans-serif]Preliminary data[/FONT]</TD><TR><TD colSpan=14>[FONT=Arial, Helvetica, sans-serif]
Intensity: Low = no influenza activity or influenza activity at baseline level; Medium= usual levels of influenza activity; High = higher than usual levels of influenza activity; Very high = particularly severe levels of influenza activity.
Percentage positive: percentage of sentinel swabs that tested positive for influenza A or B
Dominant type: this assessment is based on data from sentinel and non-sentinel sources
ARI: acute respiratory infection
ILI: influenza-like illness
Population: per 100,000 population
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</TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD width=1 bgColor=black height=1>
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</TD><TD width=780 bgColor=#1d92ff height=5>
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</TD><TD width=780 bgColor=white><TABLE><TBODY><TR><TD>[FONT=Arial, Helvetica, sans-serif][SIZE=-1]<TABLE><TBODY><TR><TD>[FONT=Arial, Helvetica, sans-serif][SIZE=-2]The bulletin text was written by an editorial team at the European Centre for Disease Prevention and Control (ECDC) and the Community Network of Reference Laboratories for Human Influenza in Europe (CNRL). Team members are Flaviu Plata, Phillip Zucs and Bruno Ciancio from ECDC, and Adam, Meijer Rod Daniels Alan Hay and Maria Zambon from CNRL. The bulletin text was reviewed by Olav Hungnes (Norwegian Institute of Public Health, Oslo, Norway), and Anne Mazick (Statens Serum Institut, Copenhagen, Denmark) on behalf of the EISS members.

EISS is funded by the European Centre for Disease Prevention and Control. Specific projects within EISS are funded by F. Hofmann-La Roche Ltd. (Switzerland) and Sanofi Pasteur. Neither the European Centre for Disease Prevention and Control, F. Hofmann-La Roche Ltd. (Switzerland) or Sanofi Pasteur, nor any person acting on their behalf is liable for the use that may be made of the information contained in this bulletin. [/SIZE][/FONT]</TD></TR></TBODY></TABLE>[/SIZE][/FONT]</TD></TR></TBODY></TABLE></TD><TD width=1 bgColor=black height=1>
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</TD><TD align=middle width=780 bgColor=#0063c8>[FONT=Arial, Helvetica, sans-serif]EISS : Weekly Electronic Bulletin[/FONT]</TD></TR></TBODY></TABLE>
 
Re: Seasonal Flu 2008 - 2009

http://gamapserver.who.int/GlobalAtlas/DataQuery/viewData.asphttp://gamapserver.who.int/GlobalAtlas/DataQuery/viewData.asp<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=content><HR>
<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR title="Click on column header to change the sort order"><TD class=viewDataBorderTBLBold height=30></TD><TD class=viewDataBorderTBRBold>Country</TD><TD class=viewDataBorderBold>Subgroup</TD><TD class=viewDataBorderBold align=middle>Period</TD><TD class=viewDataBorderBold align=middle>Year</TD><TD class=viewDataBorderBold align=middle>Value</TD><TD class=viewDataBorderBold align=middle>Source</TD></TR><TR><TD class=categoryPath align=middle colSpan=7>Communicable Diseases -> Influenza -> Influenza viruses detected</TD></TR><TR><TD class=indicatorInfo align=middle colSpan=7>(Periodicity: Week, Applied Time Period: from 41/2008 to 42/2008)</TD></TR><TR><TD class=content vAlign=top>1.</TD><TD class=content vAlign=top width=161>Belgium</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>2.</TD><TD class=content vAlign=top width=161>Brazil</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>3.</TD><TD class=content vAlign=top width=161>Bulgaria</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>4.</TD><TD class=content vAlign=top width=161>Bulgaria</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>5.</TD><TD class=content vAlign=top width=161>Canada</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>6.</TD><TD class=content vAlign=top width=161>Chile</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>7.</TD><TD class=content vAlign=top width=161>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>9</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>8.</TD><TD class=content vAlign=top width=161>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>9.</TD><TD class=content vAlign=top width=161>Denmark</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>10.</TD><TD class=content vAlign=top width=161>Denmark</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>11.</TD><TD class=content vAlign=top width=161>France</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>12.</TD><TD class=content vAlign=top width=161>France</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>13.</TD><TD class=content vAlign=top width=161>Germany</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>14.</TD><TD class=content vAlign=top width=161>Germany</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>15.</TD><TD class=content vAlign=top width=161>Honduras</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>16.</TD><TD class=content vAlign=top width=161>Iran (Islamic Republic of)</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>17.</TD><TD class=content vAlign=top width=161>Iran (Islamic Republic of)</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>18.</TD><TD class=content vAlign=top width=161>Latvia</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>19.</TD><TD class=content vAlign=top width=161>Latvia</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>20.</TD><TD class=content vAlign=top width=161>Mongolia</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>21.</TD><TD class=content vAlign=top width=161>Mongolia</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>22.</TD><TD class=content vAlign=top width=161>Norway</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>23.</TD><TD class=content vAlign=top width=161>Norway</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>24.</TD><TD class=content vAlign=top width=161>Poland</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>25.</TD><TD class=content vAlign=top width=161>Poland</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>26.</TD><TD class=content vAlign=top width=161>Portugal</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>27.</TD><TD class=content vAlign=top width=161>Portugal</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>28.</TD><TD class=content vAlign=top width=161>Russian Federation</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>2</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>29.</TD><TD class=content vAlign=top width=161>Slovenia</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>30.</TD><TD class=content vAlign=top width=161>Slovenia</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>31.</TD><TD class=content vAlign=top width=161>South Africa</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>32.</TD><TD class=content vAlign=top width=161>Spain</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>33.</TD><TD class=content vAlign=top width=161>Spain</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>34.</TD><TD class=content vAlign=top width=161>Sweden</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>35.</TD><TD class=content vAlign=top width=161>Sweden</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>36.</TD><TD class=content vAlign=top width=161>Switzerland</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>37.</TD><TD class=content vAlign=top width=161>Switzerland</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>38.</TD><TD class=content vAlign=top width=161>United Kingdom of Great Britain and Northern Ireland</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>2</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>39.</TD><TD class=content vAlign=top width=161>United Kingdom of Great Britain and Northern Ireland</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>40.</TD><TD class=content vAlign=top width=161>United States of America</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>41.</TD><TD class=content vAlign=top width=161>United States of America</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>42</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>42.</TD><TD class=content vAlign=top width=161>Uruguay</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>41</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR></TBODY></TABLE><!-- END OF CONTENT -->
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Re: Seasonal Flu 2008 - 2009

Increasing frequency in Canada last season

http://www.who.int/csr/disease/influenza/Canada_2008_06_25.pdf

Reporting date: 8 May 2008
Over the 2007-2008 influenza season in the northern hemisphere, a total of 476 H1N1 viruses
were tested for oseltamivir resistance (H274Y) in Canada, of which 123 viruses (26%) were
found to be resistant.​
Table 1​
Month of sampling Sept
07
Oct
07
Nov
07
Dec
07
Jan
08
Feb
08
Mar
08
Apr
08
No.of H1N1 isolates
tested 1 1 18 114 153 126 56 7
No. (%) of viruses
resistant to
oseltamivir
0
(0%)
0
(0%)
0
(0%)
16
(14%)
26
(17%)
37
(29%)
38
(68%)
6
(86%)​
Influenza A(H3N2) viruses and B viruses have been also tested for oseltamivir susceptibility​
(Table 2 by Canadian province).
 
Re: Seasonal Flu 2008 - 2009

INFLUENZA A (H1N1) VIRUS, OSELTAMIVIR RESISTANCE (08): EUROPE
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 24 Oct 2008
Source: HPA Health Protection Report, vol.2, no. 43 [edited]
<http://www.hpa.org.uk/hpr/archives/2008/news4308.htm#ah1n1>


Identification in the UK of the 1st oseltamivir-resistant influenza
A(H1N1) virus of the 2008/09 season
---------------------------
Since week 34/08, several sporadic, laboratory-confirmed influenza
infections have been detected in the United Kingdom (UK): isolates
have included influenza A(H3N2), A(H1N1) and influenza B.

The 1st oseltamivir resistant
influenza A(H1N1) for the 2008/09 season has also
been identified in the UK through the HPA
sentinel GP virological surveillance scheme. The
virus contains the H274Y mutation but remains
sensitive to zanamivir and amantadine, and is
antigenically similar to the H1N1 reference
strain A/Brisbane/ 59/2007, which is included in
this season's influenza vaccine. Antiviral
susceptibility tests on A(H3) isolates showed
that they are sensitive to oseltamivir and zanamivir.

With laboratory-confirmed sporadic influenza
infections of various strains in circulation at
the start of this autumn season, it is important
to emphasise that people in the defined influenza
risk groups should take up the recommendation of
influenza vaccination. It is too early in the
season to predict the course of the 2008/09
influenza season, and whether it will be
dominated by the circulation of H1N1, H3N2, or
influenza B. The Agency will be closely
monitoring the characteristics of circulating
isolates in order to determine the overall
prevalence of drug resistant influenza A and B isolates.

Influenza virus detections across Europe have
been low so far in the 2008/09 influenza season
(13 to date) and the above-mentioned H1N1
oseltamivir-resistant influenza isolate is, to
the Agency's knowledge, the 1st detected in
Europe. Influenza A oseltamivir resistance 1st
emerged last season with a number of circulating
influenza A(H1N1) isolates with the H274Y
mutation, which confers resistance to
oseltamivir, but not to zanamivir. By the end of
the 2007/08 season, 26 out of 33 reporting
European countries reported H1N1 oseltamivir
resistance ranging from 4 percent in Spain to 67
percent in Norway, with 11 percent (38/347) in
the UK [1,2].

The epidemiological evidence from the 2007/08 season suggested no
reported increase in morbidity associated with these confirmed
oseltamivir-resistant cases.

Reports between the 2nd quarter 2008 and September 2008 from WHO
showed high prevalence of resistance in the southern hemisphere with
100 percent (129/129) of H1N1 strains oseltamivir resistant in South
Africa, and 96 percent (25/26) strains in Australia [2].

References
-------------
1. Centre for Disease Prevention and Control.
Antivirals and antiviral-resistant influenza ­
resistance to oseltamivir (Tamiflu) in some
influenza A(H1N1) virus samples. ECDC website
[online] September 2008 [cited 24 October 2008].
<http://ecdc.europa.eu/Health_topics/influenza/antivirals.html>

2. WHO. Epidemic and Pandemic Alert Response:
influenza A(H1N1) virus resistance to
oseltamivir. WHO website [online] 13 October 2008 [cited 24 October 2008].
<http://www.who.int/csr/disease/influenza/h1n1_table/en/index.html>

--
Communicated by:
ProMED-mail (ppromedmail.org>

[see al;so:
Influenza A (H1N1) virus, oseltamivir resistance (07): Europe 20080906.2783
Influenza A (H1N1) virus, oseltamivir resistance
(06): S. Hemisphere 20080825.2648
Influenza A (H1N1) virus, oseltamivir resistance
(05): China (HK) 20080203.0438
Influenza A (H1N1) virus, oseltamivir resistance (04): CA, USA 20080202.0428
Influenza A (H1N1) virus, oseltamivir resistance (03): corr. 20080203.0430
Influenza A (H1N1) virus, oseltamivir resistance (03) 20080201.0399
Influenza A (H1N1) virus, oseltamivir resistance (02): Europe 20080129.0371
Influenza A (H1N1) virus, oseltamivir resistance - Norway 20080128.0361
2007
----
Avian influenza, human (101): Indonesia, Tamiflu resistance 20070622.2021
Influenza B virus, neuraminidase inhibitor resistance 20070404.1143
Avian influenza, human (15): Egypt, drug resistance 20070119.0253
Avian influenza, human (15): Egypt, drug resistance 20070118.0238
2006
----
Avian influenza, human (162): oseltamivir resistance 20061010.2907
2005
----
Avian influenza, human - East Asia (203): Tamiflu resistance 20051222.3659
Influenza viruses, drug resistance (06) 20051016.3021
Influenza viruses, drug resistance (05) 20051015.3014
Influenza viruses, drug resistance (04) 20051015.2999
Influenza viruses, drug resistance (03) 20051007.2924
Influenza viruses, drug resistance (02): RFI 20051001.2878
Influenza viruses, drug resistance 20050930.2863
2004
----
Avian influenza A (H5N1) virus, drug resistance (02) 20040127.0316
Avian influenza A (H5N1) virus, drug resistance 20040125.0298
2001
----
Influenza virus, neuraminidase inhibitor resistance (02) 20010928.2372
Influenza virus, neuraminidase inhibitor resistance 20010926.2350]
..........................cp/ejp/jw
 
Re: Seasonal Flu 2008 - 2009

Commentary

First Confirmed H1N1 in CanadaTamiflu Resistant
Recombinomics Commentary 20:02
October 23, 2008

Since 1 September 2008, National Microbiology Laboratory (NML) has antigenically characterized three influenza viruses: one influenza A/Brisbane/59/2007(H1N1)-like and two influenza B/Florida/4/2006 viruses, which are the influenza A(H1N1) and influenza B components recommended for the 2008-09 influenza vaccine.

The testing results showed that the influenza A(H1N1) isolate was sensitive to amantadine, however, it was resistant to oseltamivir due to the H274Y mutation.

The above data from the most recent (week 41) report on seasonal flu in Canada indicates that the first confirmed influenza A case this season was H1N1 and was Tamiflu (oseltamivir) resistant. Data had been trickling in for influenza in the northern hemisphere this flu season. Several countries, including the US and Canada had high frequencies of H274Y in H1N1 isolates, but the above report is on the first Canadian isolate in the 2008/2009 season.

In the southern hemisphere, several countries (South Africa, New Zealand, New Caledonia) reported frequencies of 100%, raising concerns that H274Y was becoming fixed in human H1N1. The high levels in last season in the northern hemisphere was limited to clade 2B (Brisbane/59), as found in the isolate in Canada. H274Y was present in patients who had not recently taken Tamiflu, indicating the sub-clade with H274Y did not have a fitness penalty, and the increase to 100% levels indicated that the sub-clade had a selection advantage.

The early data from Canada supports concerns that the H274Y levels in H1N1 in the northern hemisphere will be close to 100% this season.



.
 
Re: Seasonal Flu 2008 - 2009

Commentary

First Confirmed H1N1 in United Kingdom is Tamiflu Resistant
Recombinomics Commentary 06:21
October 27, 2008

The 1st oseltamivir resistant influenza A(H1N1) for the 2008/09 season has also been identified in the UK through the HPA sentinel GP virological surveillance scheme.

Antiviral susceptibility tests on A(H3) isolates showed that they are sensitive to oseltamivir and zanamivir.

The above comments describe the first confirmed H1N1 isolate with H274Y in the UK this season. The comments on the lack of resistance in H3, suggests that the H1N1 isolate may be the first H1N1 tested in the UK. The finding of H274Y in the first H1N1 isolate(s) in the UK is similar to the results from Canada, which showed that the first confirmed influenza A case there this season was H1N1 with H274Y.

Last season H274Y was widespread in Europe and North America, but levels in most countries ranged form 10-65%. However, several countries in the southern hemisphere had H274Y levels at 100% in H1N1 isolates. The most dramatic was South Africa where 225/225 isolates had H274Y. Other countries at 100% were New Zealand and New Caledonia, with levels approaching 100% in Australia and the Philippines.

These high levels in the southern hemisphere raised concerns that similar levels would be seen in the 2008/2009 season in Europe and North America. The detection of H274Y in the first H1N1 isolate(s) in the UK increase those concerns.


.
 
Re: Seasonal Flu 2008 - 2009

CIDRAP >> Drug-resistant flu viruses cause growing concern

Drug-resistant flu viruses cause growing concern

Maryn McKenna * Contributing Writer
Oct 27, 2008 ? WASHINGTON, DC (CIDRAP News) ?

Health officials worldwide are becoming increasingly concerned about influenza viruses' resistance to antiviral drugs, which can shut down a flu infection or mitigate symptoms.


Flu antivirals are vital for reducing severe illness and death in average flu seasons and could be essential bulwarks against an influenza pandemic if one began.

There are currently only four antiviral drugs for flu, grouped into two classes, the adamantanes (amantadine and rimantadine) and the neuraminidase inhibitors (oseltamivir, or Tamiflu, and zanamivir, or Relenza).

Flu scientists have known since 2005 that seasonal flu viruses have become widely resistant to the adamantanes, with at least 90% of H3N2 strains and at least 15% of H1N1 strains impervious to the drugs.

That leaves only oseltamivir and the less widely used zanamivir as treatment options and has made oseltamivir the most commonly used influenza antiviral in the world.

But speaking at a major infectious-disease meeting here Sunday, Dr. Nila Dharan of the Centers for Disease Control and Prevention (CDC) disclosed that 12.6% (142 of 1,124) of H1N1 isolates sent to the CDC from around the United States during the 2007-08 season were resistant to oseltamivir, versus less than 1% before 2007.

And in a troubling addition, the CDC found that none of the patients who gave the isolates had taken oseltamivir, casting doubt on the widely held belief that oseltamivir resistance, when it occurs, is not transmissible. 1. (Dharan NJ, Gubareva L, Klimov A, et al. Oseltamivir-resistant influenza A [H1N1] in the United States, 2007-2008 [Abstract V-918])

The finding was announced on the second day of the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy, a 15,000-person gathering known as ICAAC, which this year is being held in conjunction with the 46th annual meeting of the Infectious Diseases Society of America.

It comes on the heels of an Oct 14 World Health Organization (WHO) announcement that during the southern hemisphere flu season this past summer, oseltamivir-resistant viruses were found in South Africa, Australia, Argentina, Chile, Kenya, New Caledonia, New Zealand, and Uruguay.

Last January, toward the end of the 2007-08 northern hemisphere flu season, the WHO reported that surveillance networks had found oseltamivir-resistant viruses in 9 out of 18 European countries surveyed, though the sample sizes were small.

Worrisomely, the mutation that confers resistance also appears in areas where seasonal flu co-exists with avian influenza H5N1.

"In the last year or so we have seen a massive increase in seasonal flu resistance to oseltamivir," Dr. Jeremy Farrar of the Oxford University Clinical Research Unit at Vietnam?s Hospital for Tropical Diseases said today at the conference. "In Ho Chi Minh City at the moment, 60% of seasonal flu isolates are drug-resistant."

Farrar was part of the treatment team for two Vietnamese H5N1 patients who were found to have the mutated virus in 2005 during treatment with oseltamivir and who died of the infection.

"There is a lot of concern about emerging resistance to oseltamivir," Dr. Trish Perl, director of hospital epidemiology and infection control at the Johns Hopkins Hospital in Baltimore, said at the meeting yesterday during a separate presentation on hospitals' pandemic preparations.

If a flu pandemic begins, she said, "We may not have the luxury of immunoprophylaxis. We may have to rely on basic infection control."

Protecting newborns from flu
In other news from the meeting, a study presented yesterday by Dr. Emmanuel Walter Jr. of Duke Children's Hospital suggested that newborn infants, who are too young to be safely vaccinated against flu, could be protected from the disease by vaccinating their mothers, fathers and siblings before mother and baby leave the hospital.

Vaccinating the family members creates a cocoon of immunity around newborns, who are at much higher risk than older children for potentially life-threatening flu complications.

The study was carried out at Durham (North Carolina) Regional Hospital. Researchers distributed educational information, set up a vaccination clinic, and compared the number of flu shots given to new mothers and family members over 5 months with the number given at Duke, where no program was in place.

The number of flu shots given rose 16% at Durham, and 40 percent of mothers agreed to be vaccinated. (Walter EB Jr, Swamy G, Allred N, et al. Influenza immunization of household contacts of newborns in the hospital setting [Abstract G1-1209])

High-dose flu shots for elderly
At the other end of the age spectrum, researchers funded by vaccine-maker Sanofi Pasteur reported that poor response to flu shots by the elderly could be improved by giving those over age 65 a much larger dose of the vaccine.

Dr. Ann Falsey of the University of Rochester School of Medicine and Dentistry and colleagues from St. Louis University and the St. Louis VA Medical Center gave a vaccine with four times the normal amount of hemagglutinin, a flu-virus protein, to 2,575 volunteers over age 65, and gave the normal vaccine to an additional 1,262 volunteers.

Four weeks after the shot, the high-dose volunteers showed twice the level of flu antibodies seen in the standard-dose volunteers. (Falsey AR, Capellan J, Yau E, et al. Improved immunogenicity after high dose compared to standard influenza vaccine in seronegative adults aged [at least] 65 Years [Abstract G-1191])

Testing nondrug flu defenses
In another study focused on prevention, University of Michigan researchers led by assistant professor of epidemiology Allison Aiello found that wearing standard surgical masks and regularly using an alcohol-based hand sanitizer can cut flu transmission in the community by up to 50%.

Participants were randomly assigned to a control group or to using a mask or mask plus hand sanitizer for 6 weeks in the 2006-07 flu season. Only those who used both the mask and the gel reported a drop in their rate of flu-like symptoms such as fever, chills, and body aches.

The researchers cautioned, though, that the results may not be robust because the 2006-07 season was relatively mild. They are currently computing results from the same intervention conducted in the 2007-08 season, which was more severe.

The study is the first prospective investigation to report that nonpharmaceutical interventions?a broad category that includes home quarantine and isolation, social distancing, and school closings?can play a role in reducing flu transmission. That could be an important finding in an influenza pandemic, when pharmaceutical measures such as vaccine and antivirals are expected to be in short supply. (Aiello AE, Murray G, Coulborn R, et al. Mask use reduces seasonal influenza-like illness in the community setting [Abstract V-924])

C difficile peak follows flu peak
And in an example of unintended consequences, Dr. Philip Polgreen of the University of Iowa reported a newly recognized statistical association between influenza outbreaks and the incidence of Clostridium difficile?associated disease, a severe diarrheal illness that can be drug-resistant and that occurs after antibiotics wipe out the normal bacterial inhabitants of the gut.

Using 8 years' worth of hospital discharge data, Polgreen plotted the monthly incidence of C difficile outbreaks in the United States and found that the disease routinely peaks within 2 months after the height of flu season. He theorizes that the outbreaks are the after-effect of antibiotics prescribed during flu season. The antibiotics may have been appropriately prescribed for secondary bacterial illnesses as well as inappropriately for viral symptoms that the drugs would not affect, he said. (Polgreen PM, Bohnett LC, Cavanaugh JE. A time series analysis of C. difficile and its seasonal association with influenza [Abstract K-502])

See also:
Oct 14 WHO report on H1N1 virus resistance to oseltamivir in the southern hemisphere in 2008 http://www.who.int/csr/disease/influenza/H1N1200801013.pdf
Nicoll A, Ciancio B, Kramarz P. Observed oseltamivir resistance in seasonal influenza viruses in Europe: interpretation and potential implications. Eurourveillance 2008 Jan 31;13(5) [Full text]
Deyde VM, Xu X, Bright RA, et al. Surveillance of resistance to adamantanes among influenza A(H3N2) and A(H1N1) viruses isolated worldwide. J Infect Dis 2007 Jul 15;196(2):249 (Full text)
de Jong MD, Tran TT, Truong HK, et al. Oseltamivir resistance during treatment of influenza A (H5N1) infection. N Engl J Med 2005 Dec 22;353(25):2667-72 [Full text]
Aug 25 CIDRAP News story "H1N1 viruses growing more resistant to Tamiflu" http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/aug2508tamiflu.html
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<cite cite="http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct2708resist.html">CIDRAP >> Drug-resistant flu viruses cause growing concern</cite>
 
Re: Seasonal Flu 2008 - 2009

EUROPEAN CENTRE OF DISEASES PREVENTION AND CONTROL (ECDC), INFLUENZA NEWS, EXCERPTS (10/30/2008)

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

Full texts at:
http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081030.aspx

* Scientific advances

-- SCIENTIFIC ADVANCES ? SEASONAL INFLUENZA - PREPARADNESS

- Can you predict the peak of seasonal influenza epidemics from early observations?

* Predictions by early indicators of the time and height of yearly influenza outbreaks in Sweden - Kuhlmann-Berenzon S. Linde A. at al - Scand J Public Health. 2008 Jul;36(5):475-82.

Description:
In this study, some statistical methods are described and applied to weekly national (Swedish) data from 1994 onwards concerning influenza-like illness (ILI) and confirmed laboratory diagnoses of influenza (LDI).

Both simple and more advanced rules for how to predict the timing and height of the peak of LDI are suggested. The predictions are made using covariates calculated from data in early LDI reports. The simple rules are based on the observed LDI values, while the advanced ones are based on smoothing by the statistical technique unimodal regression. The suggested predictors were evaluated by cross-validation and by application to the observed seasons.

The research suggested that the percentage of ILI was not a good predictor for LDI, however analyse on solely LDI, the time of the onset of outbreak (TO) and the initial slope (TD) showed the rule that the average time between onset (when the LDI exceed 10 in the first wee) and the peak is 8 weeks (with a median error of 0.9 weeks).

Furthermore linear regression fitted to HP and TO data suggested the rule that the predicted height of the peak is 500 ? 25 the time of outbreak (with a median error of 30% of the average HP)

In simple terms the finding was that in Sweden at least seasons that started early tended to be more intense (have higher peaks) than late ones.

ECDC Comment (30/10/08):
This study based on early indicator data from 8 seasons in Sweden shows that basic statistical methods may be useful in predicting the characteristic of seasonal epidemic and planning the public health response on it. Especially in intensifying vaccination campaigns it will be interesting to test this hypothesis to other countries and prospectively.

ECDC invites comment from other Member States on the method and its application in other counties influenza@ecdc.europa.eu. The influenza team also thank the Swedish State Epidemiologist Dr Annika Linde for drawing it to our attention.

* Public Health Developments

- Publication of the full report of the VENICE survey of seasonal influenza vaccination in Europe, 2006-7

Description:
Last week in influenza news it was noted that the VENICE group had publishing a peer-reviewed summary of their Europe wide survey of seasonal influenza policies, practices and performance. This week the full detailed report is published. The document is the result of a cross-sectional survey that was undertaken with all the European Union (EU) Member States, Norway and Iceland to describe seasonal influenza immunisation in the 2006-7 season, in particular to identify country-specific recommendations for risk groups, obtain vaccine uptake information and allow comparison with global recommendations.

A standardised questionnaire was completed electronically by each country?s project gatekeeper who are listed in the report.

Of the 29 countries surveyed, 28 recommended seasonal influenza vaccination for older age groups (22 for those aged > 65 years), and in one country (Austria) vaccine was recommended for all age groups. All countries recommended vaccinating patients with chronic pulmonary and cardiovascular diseases and most countries advised to immunise patients with haematologic or metabolic disorders (n=28), immunologic disorders (n=27) and renal disease (n=27), as well as residents of long-term care facilities (n=24).

Most countries recommended vaccination for staff in hospitals (n=25), long-term care facilities (n=25) and outpatient clinics (n=23), and one-third had such recommendations for workers in essential (n=10), military (n=10) and veterinary services (n=10) and poultry industry (n=13). Only eight countries recommended vaccine for pregnant women; and five advised to vaccinate children (with age limits ranging from 6 months to 5 years). Twenty countries measured influenza vaccine uptake among those aged > 65 years (range 1.8%-82.1%), seven reported uptake in healthcare workers (range 14%-48%) and seven assessed coverage in persons with underlying medical conditions (range 27.6%-75.2%).

The data provided by this study can assist EU states to assess and compare their influenza vaccination programme performance with other countries. The information provides a comprehensive overview of policies and programmes and their outcomes and can be used to inform joint discussions on how the national policies in the EU might be standardised in the future to achieve optimal coverage. Annual surveys could be used to monitor changes in these national policies. Enquiries and questions about the survey and its results should be made to the VENICE group.

* Meetings and workshops

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

This conference specifically considers the first World War and the start of the Spanish Influenza pandemic. Specifically did the war itself engender the emergence of this avian influenza A(H1N1)? Are there serious lessons from that pandemic to help today as we prepare for 21st century pandemics?

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

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

A web-site with registration details are at http://www.espace-ethique.org/fr/pandemic_ethics_november_2008.php

- European Scientific Conference on Applied Infectious Disease Epidemiology, Berlin 19-21 November 2008.

The second annual European Scientific Conference on Applied Infectious Disease Epidemiology ? ESCAIDE ? is fast approaching. The event is being held in Berlin from 19-21 November, and over 500 health experts from across Europe and beyond are expected to come together to share scientific knowledge and experience on all areas related to infectious disease epidemiology.

It is possible to register for the conference for a reduced fee of 100 Euros- the deadline for early registration is 1st October. It is also still possible to submit a ?late breaker abstract? to the conference- the deadline for submission is 29th September.

Details of the full conference programme, participant registration, and abstract submission can be found on the ESCAIDE website
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<cite cite="http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081030.aspx#oseltamivir">http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081030.aspx#oseltamivir</cite>
 
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