Seasonal Flu 2008 - 2009

HenryN · Dec 19, 2008

Re: Seasonal Flu 2008 - 2009

<TABLE border=1><CAPTION>INFLUENZA VIRUSES ISOLATED BY
WHO/NREVSS Collaborating Laboratories
2008 - 2009 Season </CAPTION><TBODY><TR><TH id=header1 width=70>Week</TH><TH id=header2 width=90>A(H1)</TH><TH id=header3 width=70>A(H3)</TH><TH id=header4 width=70>A(Unk)</TH><TH id=header5 width=70>B </TH><TH id=header6 align=right>Total # Tested</TH><TH id=header7 align=right>% Positive</TH></TR><TR><TD align=right headers=header1>40 </TD><TD align=right headers=header2>2 </TD><TD align=right headers=header3>0 </TD><TD align=right headers=header4>9 </TD><TD align=right headers=header5>6 </TD><TD align=right headers=header6>2557 </TD><TD align=right headers=header7>0.66 </TD></TR><TR><TD align=right headers=header1>41 </TD><TD align=right headers=header2>4 </TD><TD align=right headers=header3>4 </TD><TD align=right headers=header4>6 </TD><TD align=right headers=header5>6 </TD><TD align=right headers=header6>2585 </TD><TD align=right headers=header7>0.77 </TD></TR><TR><TD align=right headers=header1>42 </TD><TD align=right headers=header2>13 </TD><TD align=right headers=header3>3 </TD><TD align=right headers=header4>15 </TD><TD align=right headers=header5>6 </TD><TD align=right headers=header6>2713 </TD><TD align=right headers=header7>1.36 </TD></TR><TR><TD align=right headers=header1>43 </TD><TD align=right headers=header2>22 </TD><TD align=right headers=header3>0 </TD><TD align=right headers=header4>24 </TD><TD align=right headers=header5>14 </TD><TD align=right headers=header6>3086 </TD><TD align=right headers=header7>1.94 </TD></TR><TR><TD align=right headers=header1>44 </TD><TD align=right headers=header2>11 </TD><TD align=right headers=header3>1 </TD><TD align=right headers=header4>21 </TD><TD align=right headers=header5>4 </TD><TD align=right headers=header6>3262 </TD><TD align=right headers=header7>1.13 </TD></TR><TR><TD align=right headers=header1>45 </TD><TD align=right headers=header2>27 </TD><TD align=right headers=header3>3 </TD><TD align=right headers=header4>23 </TD><TD align=right headers=header5>10 </TD><TD align=right headers=header6>3840 </TD><TD align=right headers=header7>1.64 </TD></TR><TR><TD align=right headers=header1>46 </TD><TD align=right headers=header2>27 </TD><TD align=right headers=header3>2 </TD><TD align=right headers=header4>18 </TD><TD align=right headers=header5>10 </TD><TD align=right headers=header6>3608 </TD><TD align=right headers=header7>1.58 </TD></TR><TR><TD align=right headers=header1>47 </TD><TD align=right headers=header2>16 </TD><TD align=right headers=header3>0 </TD><TD align=right headers=header4>33 </TD><TD align=right headers=header5>20 </TD><TD align=right headers=header6>3979 </TD><TD align=right headers=header7>1.73 </TD></TR><TR><TD align=right headers=header1>48 </TD><TD align=right headers=header2>23 </TD><TD align=right headers=header3>2 </TD><TD align=right headers=header4>45 </TD><TD align=right headers=header5>20 </TD><TD align=right headers=header6>3913 </TD><TD align=right headers=header7>2.3 </TD></TR><TR><TD align=right headers=header1>49 </TD><TD align=right headers=header2>23 </TD><TD align=right headers=header3>3 </TD><TD align=right headers=header4>47 </TD><TD align=right headers=header5>12 </TD><TD align=right headers=header6>3869 </TD><TD align=right headers=header7>2.2 </TD></TR><TR><TD align=right headers=header1>50 </TD><TD align=right headers=header2>28 </TD><TD align=right headers=header3>3 </TD><TD align=right headers=header4>48 </TD><TD align=right headers=header5>24 </TD><TD align=right headers=header6>2949 </TD><TD align=right headers=header7>3.49 </TD></TR></TBODY></TABLE>
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HenryN · Dec 19, 2008

Re: Seasonal Flu 2008 - 2009

2008-2009 Influenza Season Week 50 ending December 13, 2008
(All data are preliminary and may change as more reports are received.)
Synopsis:

During week 50 (December 7-13, 2008), a low level of influenza activity was reported in the United States.

One hundred three (3.5%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
One pediatric influenza-associated death was reported.
The proportion of outpatient visits for influenza-like illness (ILI) was below the national baseline. The Mountain region reported ILI above their region-specific baseline.
Three states reported local influenza activity; the District of Columbia, Puerto Rico and 36 states reported sporadic influenza activity; and 11 states reported no influenza activity.

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

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

Region

</TH><TH noWrap align=middle width=300 colSpan=3>Data for current week</STRONG></TH><TH noWrap align=middle width=276 colSpan=5>Data cumulative for the season</TH></TR><TR vAlign=top><TH align=middle width=72>Out-patient ILI*</TH><TH align=middle width=72>% positive for flu?</TH><TH align=middle width=96>Number of jurisdictions reporting regional or widespread activity?</TH><TH noWrap align=middle width=48>A (H1)</TH><TH noWrap align=middle width=48>A (H3)</TH><TH align=middle width=60>A Unsub-typed</TH><TH noWrap align=middle width=48>B</TH><TH align=middle width=72>Pediatric Deaths</TH></TR><TR><TD align=left width=85>Nation</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>3.5 % </TD><TD noWrap align=middle width=96>0 of 51 </TD><TD noWrap align=middle width=48>196</TD><TD noWrap align=middle width=48>21</TD><TD noWrap align=middle width=60>289</TD><TD noWrap align=middle width=48>132</TD><TD noWrap align=middle width=72>1</TD></TR><TR><TD align=left width=85>New England</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.7 % </TD><TD noWrap align=middle width=96>0 of 6</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>1</TD><TD noWrap align=middle width=60>8</TD><TD noWrap align=middle width=48>1</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>Mid-Atlantic</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>1.1 % </TD><TD noWrap align=middle width=96>0 of 3</TD><TD noWrap align=middle width=48>11</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>4</TD><TD noWrap align=middle width=48>3</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>East North Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>6.5 % </TD><TD noWrap align=middle width=96>0 of 5</TD><TD noWrap align=middle width=48>12</TD><TD noWrap align=middle width=48>2</TD><TD noWrap align=middle width=60>4</TD><TD noWrap align=middle width=48>6</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>West North Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.4 % </TD><TD noWrap align=middle width=96>0 of 7</TD><TD noWrap align=middle width=48>4</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>7</TD><TD noWrap align=middle width=48>5</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>South Atlantic</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>2.2 % </TD><TD noWrap align=middle width=96>0 of 9</TD><TD noWrap align=middle width=48>9</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>75</TD><TD noWrap align=middle width=48>47</TD><TD noWrap align=middle width=72>1</TD></TR><TR><TD align=left width=85>East South Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>0.4 % </TD><TD noWrap align=middle width=96>0 of 4</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>0</TD><TD noWrap align=middle width=48>1</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>West South Central</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>4.9 % </TD><TD noWrap align=middle width=96>0 of 4</TD><TD noWrap align=middle width=48>32</TD><TD noWrap align=middle width=48>0</TD><TD noWrap align=middle width=60>107</TD><TD noWrap align=middle width=48>52</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>Mountain</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>3.3 % </TD><TD noWrap align=middle width=96>0 of 8</TD><TD noWrap align=middle width=48>6</TD><TD noWrap align=middle width=48>12</TD><TD noWrap align=middle width=60>22</TD><TD noWrap align=middle width=48>6</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>Pacific</TD><TD noWrap align=middle width=72>Normal</TD><TD noWrap align=middle width=72>3.8 % </TD><TD noWrap align=middle width=96>0 of 5</TD><TD noWrap align=middle width=48>122</TD><TD noWrap align=middle width=48>6</TD><TD noWrap align=middle width=60>62</TD><TD noWrap align=middle width=48>11</TD><TD noWrap align=middle width=72>0</TD></TR></TBODY></TABLE>
* Elevated means the % of visits for ILI is at or above the national or region-specific baseline
? National data is for current week; regional data is for the most recent three weeks.
? Includes all 50 states and the District of Columbia
U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C. report to CDC the number of respiratory specimens tested for influenza each week. Results of these tests performed during the current week and cumulative totals for the season are summarized in the table below.
<TABLE class=table cellSpacing=0 cellPadding=3 align=center border=0><TBODY><TR><TH align=left width=200></TH><TH noWrap align=middle width=140>Week 50 </TH><TH noWrap align=middle width=140>Cumulative for the Season</TH></TR><TR><TD align=left width=200>No. of specimens tested</TD><TD noWrap align=middle width=140>2,949</TD><TD noWrap align=middle width=140>36,361</TD></TR><TR><TD align=left width=200>No. of positive specimens (%)</TD><TD noWrap align=middle width=140>103 (3.5%)</TD><TD noWrap align=middle width=140>638 (1.8%)</TD></TR><TR><TD align=left colSpan=3>Positive specimens by type/subtype</TD></TR><TR><TD align=left width=170> Influenza A</TD><TD noWrap align=middle width=140>79 (76.7%)</TD><TD noWrap align=middle width=140>506 (79.3%)</TD></TR><TR><TD align=left width=170> A (H1)</TD><TD noWrap align=middle width=140>28 (35.4%)</TD><TD noWrap align=middle width=140>196 (38.7%)</TD></TR><TR><TD align=left width=170> A (H3)</TD><TD noWrap align=middle width=140>3 (3.8%)</TD><TD noWrap align=middle width=140>21 (4.2%)</TD></TR><TR><TD align=left width=170> A (unsubtyped)</TD><TD noWrap align=middle width=140>48 (60.8%)</TD><TD noWrap align=middle width=140>289 (57.1%)</TD></TR><TR><TD align=left width=170> Influenza B</TD><TD noWrap align=middle width=140>24 (23.3%)</TD><TD noWrap align=middle width=140>132 (20.7%)</TD></TR></TBODY></TABLE>
Thirty-five states from all nine surveillance regions have reported laboratory-confirmed influenza this season with three states accounting for 483 (75.7%) of the 638 reported influenza viruses.
<CENTER>

View WHO-NREVSS Regional Bar Charts| View Chart Data | View Full Screen </CENTER>Antigenic Characterization:

CDC has antigenically characterized 69 influenza viruses [49 influenza A (H1), seven influenza A (H3) and 13 influenza B viruses] collected by U.S. laboratories since October 1, 2008.
All influenza A (H1) viruses were characterized as A/Brisbane/59/2007-like, the influenza A (H1N1) component included in the 2008-09 influenza vaccine, and five of the seven influenza A (H3) viruses were characterized as A/Brisbane/10/2007-like, the influenza A (H3N2) components included in the 2008-09 influenza vaccine.
Influenza B viruses currently circulating can be divided into two antigenically distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. Four influenza B viruses were characterized as B/Florida/04/2006-like, belonging to the B/Yamagata lineage, the influenza B component of the 2008-09 influenza vaccine. The remaining nine viruses belong to the B/Victoria lineage. Eight of the nine viruses belonging to the B/Victoria lineage were from one state.
Data on antigenic characterization should be interpreted with caution given that:

Few U.S. isolates are available for testing because of limited influenza activity thus far.
The majority of viruses antigenically characterized to date come from only two states and may not be nationally representative.
Antigenic characterization data is based on hemagglutination inhibition (HI) testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination.

Annual influenza vaccination is expected to provide the best protection against those virus strains which are most similar to the vaccine strains, but can also provide at least partial protection against strains that are related, but antigenically distinct from vaccine strains. Limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages, as is seen with the two lineages of influenza B viruses.
Antiviral Resistance:

Since October 1, 2008, 50 influenza A (H1N1), eight influenza A (H3N2), and 20 influenza B viruses from 15 states have been tested for resistance to the two groups of influenza antiviral drugs: neuraminidase inhibitors (oseltamivir and zanamivir) and the adamantanes (amantadine and rimantadine); however, 55% of the viruses tested were from only two states. The results of antiviral resistance testing performed on these viruses are summarized in the table below.
<TABLE class=table cellSpacing=0 cellPadding=3 align=center border=0><TBODY><TR><TH align=left width=200></TH><TH noWrap align=middle width=140>Isolates tested </TH><TH noWrap align=middle width=200 colSpan=2>Resistant Viruses, Number (%)</TH><TH noWrap align=middle width=140>Isolates tested </TH><TH noWrap align=middle width=140>Resistant Viruses, Number (%)</TH></TR><TR><TD align=left width=200></TD><TD noWrap align=middle width=100></TD><TD noWrap align=middle width=100>Oseltamivir</TD><TD align=left width=100>Zanamivir</TD><TD noWrap align=middle width=140></TD><TD noWrap align=middle width=140>Adamantanes</TD></TR><TR><TD align=left width=200>Influenza A (H1N1)</TD><TD noWrap align=middle width=100>

50

</TD><TD noWrap align=middle width=100>49 (98%)</TD><TD align=left width=100>

0 (0)

</TD><TD noWrap align=middle width=140>50</TD><TD noWrap align=middle width=140>0 (0%) </TD></TR><TR><TD align=left width=200>Influenza A (H3N2)</TD><TD noWrap align=middle width=100>

8

</TD><TD noWrap align=middle width=100>0 (0)</TD><TD align=left width=100>

0 (0)

</TD><TD noWrap align=middle width=140>8</TD><TD noWrap align=middle width=140>8 (100%)</TD></TR><TR><TD align=left width=200>Influenza B</TD><TD noWrap align=middle width=100>

20

</TD><TD noWrap align=middle width=100>0 (0)</TD><TD align=left width=100>

0 (0)

</TD><TD noWrap align=middle width=140>N/A*</TD><TD noWrap align=middle width=140>N/A*</TD></TR></TBODY></TABLE><SUP>*The adamantanes are not effective against influenza B viruses.</SUP>

With low levels of influenza activity thus far in the 2008-09 season in the United States, overall numbers of virus specimens and the number of states that have submitted specimens for testing is limited. The limited data on antiviral resistance, as well as the uncertainty regarding which influenza virus types or subtypes will predominate during the season, make it too early to make an accurate determination of the prevalence of influenza viruses resistant to oseltamivir or the adamantanes (amantadine and rimantadine) nationally or regionally at this time. CDC has solicited a representative sample of viruses from WHO collaborating laboratories in the United States, and more specimens are expected as influenza activity increases.
Pneumonia and Influenza (P&I) Mortality Surveillance

During week 50, 6.8% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below the epidemic threshold of 7.3% for week 50.
<CENTER>

View Full Screen</CENTER>Influenza-Associated Pediatric Mortality

One influenza-associated pediatric death was reported to CDC from Florida during week 50. This death occurred during week 49 (the week ending December 6, 2008). This was the first reported influenza-associated pediatric death that occurred during the current season.
<CENTER>

View Full Screen</CENTER>Influenza-Associated Hospitalizations

Laboratory-confirmed influenza-associated hospitalizations are monitored in two population-based surveillance networks: the Emerging Infections Program (EIP) and the New Vaccine Surveillance Network (NVSN).
No influenza-associated hospitalizations have been reported from the New Vaccine Surveillance Network this season.
During October 1 ? December 6, 2008, preliminary laboratory-confirmed influenza-associated hospitalization rates reported by the EIP for children aged 0-4 years and 5-17 years were 0.24 per 10,000 and 0.01 per 10,000, respectively. For adults aged 18-49 years, 50-64 years, and = 65 years, the rates were 0.02 per 10,000, 0.03 per 10,000, and 0.09 per 10,000, respectively.
<CENTER>

View Full Screen</CENTER>Outpatient Illness Surveillance:

During week 50, 1.3% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is less than the national baseline of 2.4%. On a regional level, the percentage of visits for ILI ranged from 0.4% to 2.2%. One region (Mountain) reported 1.6% of outpatient visits for ILI, which is above their region-specific baseline of 1.5%, while the remaining eight regions reported percentages of visits for ILI below region-specific baseline levels.
<CENTER>

View Sentinel Providers Regional Charts | View Chart Data |View Full Screen
</CENTER>Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists:

During week 50 the following influenza activity was reported:

Local influenza activity was reported by three states (Hawaii, Texas, and Virginia).
Sporadic activity was reported in the District of Columbia, Puerto Rico, and 36 states (Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Dakota, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Washington, and Wisconsin).
No influenza activity was reported in 11 states (Alabama, Kentucky, Louisiana, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, Tennessee, West Virginia, and Wyoming).

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A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
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HenryN · Dec 19, 2008

Re: Seasonal Flu 2008 - 2009

Overall influenza activity in Canada remains low; localized activity reported in a region in British Columbia
During week 50, influenza activity in Canada remained low overall with the majority of the influenza surveillance regions still reporting no activity. Fifteen regions (in BC, AB, ON & QC ) reported sporadic influenza activity and one region in BC (Fraser) reported localized activity this week (see map). Thirty specimens tested positive for influenza in Canada this week (percentage positive = 1.8%; 30/1,671) (see table). The majority of influenza virus detections to date this season were influenza A viruses (59% or 71/120). In week 50, the ILI consultation rate was 16 ILI consultations per 1,000 patient visits (see ILI graph), and is below the expected range for this week. The sentinel response rate was 61%. One outbreak of influenza was reported in a school in BC this week.

Antigenic Characterization:
Since 1 September 2008, the NML has antigenically characterized 16 influenza viruses: 1 influenza A/Brisbane/59/2007(H1N1)-like (from NS), 2 influenza A/Brisbane/10/2007(H3N2)-like (from BC & ON), 3 influenza B/Florida/4/2006-like (from ON and AB) and 10 B/Malaysia/2506/2004-like (from ON and AB). A/Brisbane/59/2007(H1N1), A/Brisbane/10/2007(H3N2) and B/Florida/4/2006 are the influenza A and influenza B components recommended for the 2008-09 influenza vaccine. B/Malaysia/2506/2004 was the influenza B component for the 2007-2008 season vaccine (see pie chart).
Antiviral Resistance:
Results from the NML:
Since the start of the season, the NML has tested 8 influenza A isolates (3 H1N1 and 5 H3N2) for amantadine resistance. All of the H1N1 isolates were susceptible; however all of the H3N2 isolates were resistant to amantadine (resistance = 100% or 5/5). The resistant isolates were from ON, AB and BC.
The NML has also tested 16 influenza isolates (3 A/H1N1, 2 A/H3N2 & 11 B) for oseltamivir (Tamiflu) resistance. All of the A/H3N2 and B isolates were sensitive; however all of the A/H1N1 isolates were resistant to oseltamivir due to the H274Y mutation (resistance = 100% or 3/3). The resistant isolates were from NS and BC.
All 12 influenza isolates (1 A/H1N1, 2 A/H3N2 & 9 B) tested for zanamivir resistance to date were sensitive to zanamivir.
Oseltamivir resistance findings from Provincial laboratories:
To date this season, 19 influenza isolates in BC have been sub-typed as A/H1 and were assessed genotypically for oseltamivir resistance using an SNP assay. Fourteen isolates tested positive for the H274Y mutation, while the other 5 were indeterminate. These specimens were from community-based cases of ILI; none were associated with an outbreak.
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 47 to 48, the level of overall influenza activity in the world remained low with sporadic activity observed in some countries.

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

CDC: During week 49, a low level of influenza activity was reported in the United States. Three states reported local influenza activity however the majority reported either no activity or sporadic activity. Of the 2,585 specimens tested this week for influenza viruses, 72 (2.8%) were positive. Since 1 October 2008, the CDC has antigenically characterized 36 influenza viruses: 20 influenza A(H1) (all A/Brisbane/59/2007-like), 3 A(H3) (all A/Brisbane/10/2007-like) and 13 influenza B (4 were B/Florida/04/2006-like belonging to the B/Yamagata lineage and the other 9 belonged to the B/Victoria lineage). Since 1 October, 2008, 68 influenza viruses (46 A(H1N1), 7 A (H3N2), and 15 B) have been tested for resistance to neuraminidase inhibitors. Of the A(H1N1) viruses tested, 98% (45/46) were resistant to oseltamivir however all were sensitive to zanamivir. All of the A(H3N2) and B viruses tested were sensitive to both oseltamivir and zanamivir. The CDC tested 30 influenza A viruses (25 H1, 5 H3) for amantadine resistance: all of the H1N1 viruses were sensitive to amantadine however all the H3N2 viruses were resistant.

<A href="http://www.cdc.gov/flu/weekly/" target=_blank rel=x><ACRONYM title="Centers for Disease Control and Prevention ">CDC</ACRONYM>

EISS: In week 50, influenza activity reached medium intensity in several European countries and has been reported as increasing in several others. There is currently widespread activity in England (UK) and Portugal and outbreaks were reported in France and Spain. Most of the influenza virus detections so far have been for influenza A viruses of which the majority were A(H3). Of the 26 A(H3N2) isolates that were also tested for adamantanes susceptibility, all were resistant. Of the 20 A(H1N1) virus isolates tested for resistance against neuraminidase inhibitors, 19 were resistant to oseltamivir (resistance=95%), but all were sensitive to zanamivir.

<A href="http://www.eiss.org/cgi-files/bulletin_v2.cgi" target=_blank rel=x><ACRONYM title=" European Influenza Surveillance Scheme">EISS</ACRONYM>

Human Avian Influenza: Since 12 December 2008, the WHO has reported two new cases of human H5N1 avian influenza infection. The first case was a 19-year-old male from Kendal Province, Cambodia who developed symptoms on 28 November and is currently hospitalized. The second case was a 16-year-old female from Assuit Governorate, Egypt who developed symptoms on 8 December, was hospitalized on 11 December and died on 15 December.

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

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

<TABLE id=fluwatchtable cellSpacing=0 cellPadding=2 width="100%" border=1><TBODY><TR class=bg-colour-blue vAlign=top><TD class=alignCenter rowSpan=3>Province of
reporting
laboratories </TD><TD class=alignCenter vAlign=bottom colSpan=4>Report Period:
December 7, 2008 to December 13, 2008</TD><TD class=alignCenter vAlign=bottom colSpan=4>Season to Date:
August 24, 2008 to December 13, 2008</TD></TR><TR class=bg-colour-blue><TD class=alignCenter rowSpan=2>Total #
Influenza
Tests </TD><TD class=alignCenter colSpan=3># of Positive Tests </TD><TD class=alignCenter rowSpan=2>Total #
Influenza
Tests</TD><TD class=alignCenter colSpan=3># of Positive Tests </TD></TR><TR class=bg-colour-blue vAlign=top><TD class=alignCenter vAlign=center>Influenza A</TD><TD class=alignCenter vAlign=center>Influenza B</TD><TD class=alignCenter vAlign=center>Total </TD><TD class=alignCenter vAlign=center>Influenza A</TD><TD class=alignCenter vAlign=center>Influenza B</TD><TD class=alignCenter vAlign=center>Total </TD></TR><TR><TD class=bg-colour-blue>NL
</TD><TD class=alignCenter>21</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>124</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD></TR><TR><TD class=bg-colour-blue>PE
</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>38</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD></TR><TR><TD class=bg-colour-blue>NS
</TD><TD class=alignCenter>21</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>210</TD><TD class=alignCenter>1</TD><TD class=alignCenter>0</TD><TD class=alignCenter>1</TD></TR><TR><TD class=bg-colour-blue>NB
</TD><TD class=alignCenter>27</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>148</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD></TR><TR><TD class=bg-colour-blue>QC
</TD><TD class=alignCenter>590</TD><TD class=alignCenter>3</TD><TD class=alignCenter>0</TD><TD class=alignCenter>3</TD><TD class=alignCenter>5077</TD><TD class=alignCenter>34</TD><TD class=alignCenter>2</TD><TD class=alignCenter>36</TD></TR><TR><TD class=bg-colour-blue>ON
</TD><TD class=alignCenter>254</TD><TD class=alignCenter>0</TD><TD class=alignCenter>2</TD><TD class=alignCenter>2</TD><TD class=alignCenter>6134</TD><TD class=alignCenter>6</TD><TD class=alignCenter>5</TD><TD class=alignCenter>11</TD></TR><TR><TD class=bg-colour-blue>MB
</TD><TD class=alignCenter>52</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>711</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD></TR><TR><TD class=bg-colour-blue>SK
</TD><TD class=alignCenter>111</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>1118</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD><TD class=alignCenter>0</TD></TR><TR><TD class=bg-colour-blue>AB
</TD><TD class=alignCenter>550</TD><TD class=alignCenter>5</TD><TD class=alignCenter>12</TD><TD class=alignCenter>17</TD><TD class=alignCenter>6315</TD><TD class=alignCenter>9</TD><TD class=alignCenter>41</TD><TD class=alignCenter>50</TD></TR><TR><TD class=bg-colour-blue>BC
</TD><TD class=alignCenter>45</TD><TD class=alignCenter>8</TD><TD class=alignCenter>0</TD><TD class=alignCenter>8</TD><TD class=alignCenter>498</TD><TD class=alignCenter>21</TD><TD class=alignCenter>1</TD><TD class=alignCenter>22</TD></TR><TR><TD class=bg-colour-blue>Canada
</TD><TD class=alignCenter>1671</TD><TD class=alignCenter>16</TD><TD class=alignCenter>14</TD><TD class=alignCenter>30</TD><TD class=alignCenter>20373</TD><TD class=alignCenter>71</TD><TD class=alignCenter>49</TD><TD class=alignCenter>120</TD></TR></TBODY></TABLE>

Specimens from NT, YT, and NU are sent to reference laboratories in other provinces.
Note: Cumulative data includes updates to previous weeks; due to reporting delays, the sum of weekly report totals do not add up to cumulative totals.
Abbreviations: Newfoundland/Labrador (NL), Prince Edward Island (PE), New Brunswick (NB), Nova Scotia (NS), Quebec (QC), Ontario (ON), Manitoba (MB), Saskatchewan (SK), Alberta (AB), British Columbia (BC), Yukon (YT), Northwest Territories (NT), Nunavut (NU)
Respiratory virus laboratory detections in Canada, by geographic regions, are available weekly on the following website:
<http://www.phac-aspc.gc.ca/bid-bmi/dsd-dsm/rvdi-divr/index-eng.php>

Number of influenza surveillance regions? reporting widespread or localized influenza activity, Canada, by report week, 2008-2009 (N=54)

? sub-regions within the province or territory as defined by the provincial/territorial epidemiologist. Graph may change as late returns come in.

<TABLE width="100%"><TBODY><TR vAlign=top align=middle><TD colSpan=2>Influenza Activity Level by Provincial and Territorial
Influenza Surveillance Regions, Canada,
December 7, 2008 to December 13, 2008 (Week 50)

</TD></TR><TR vAlign=top align=middle><TD class=alignCenter>

</TD><TD><TABLE cellSpacing=0 cellPadding=1 border=0><TBODY><TR><TD align=middle><TABLE class=border-lite cellSpacing=1 cellPadding=1><TBODY><TR align=middle><TD>No Data </TD><TD>

</TD></TR><TR align=middle><TD>No Activity</TD><TD>

</TD></TR><TR align=middle><TD>Sporadic Activity</TD><TD>

</TD></TR><TR align=middle><TD>Localized Activity</TD><TD>

</TD></TR><TR align=middle><TD>Widespread
Activity</TD><TD>

</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>
Note: Influenza activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates (see graphs and tables) and outbreaks. Please refer to detailed definitions. For areas where no data is reported, late reports from these provinces and territories will appear on the FluWatch website. Select single maps by report week to get this updated information.
<http://dsol-smed.phac-aspc.gc.ca/dsol-smed/fluwatch/fluwatch.phtml?lang=e>
Click on the map to view provinces/territories and maps for other weeks.

Influenza tests reported and percentage of tests positive, Canada, by report week, 2008-2009

Percent positive influenza tests, compared to other respiratory viruses, Canada, by reporting week, 2008-2009

Influenza strain characterization, Canada, cumulative, 2008-2009 influenza season by the Respiratory Viruses Section at the National Microbiology Laboratory
[N=16]

{Strain characterization, number identified, per cent of total number}
NACI recommends that the trivalent vaccine for the 2008-2009 season in Canada contain A/Brisbane/59/2007 (H1N1)-like virus; an A/Brisbane/10/2007 (H3N2)-like virus; and a B/Florida/4/2006-like virus.

Influenza-like illness (ILI) consultation rates, Canada, by report week,
2008-2009 compared to 1996/97 through to 2006/07 seasons

Note: No data available for mean rate in previous years for weeks 19 to 39 (1996-1997 through 2002-2003 seasons).

Number of New Outbreaks in Long Term Care Facilities, Canada, by Report Week, 2008-2009

Please note that the above graphs may change as late returns come in.
Single Maps | Dual Maps | Animated Maps | FluWatch Reports
Definitions for the 2008-2009 season

http://www.phac-aspc.gc.ca/fluwatch/08-09/w50_08/index-eng.php

HenryN · Dec 19, 2008

Re: Seasonal Flu 2008 - 2009

however all of the A/H1N1 isolates were resistant to oseltamivir due to the H274Y mutation (resistance = 100% or 3/3). The resistant isolates were from NS and BC.

http://www.phac-aspc.gc.ca/fluwatch/08-09/w50_08/index-eng.php

HenryN · Dec 19, 2008

Re: Seasonal Flu 2008 - 2009

Commentary at

http://www.recombinomics.com/News/12200801/H274Y_Canada_100.html

AlaskaDenise · Dec 20, 2008

Re: Seasonal Flu 2008 - 2009

niman said:
Commentary at

http://www.recombinomics.com/News/12200801/H274Y_Canada_100.html

Commentary

H1N1 Tamiflu Resistance at 100% in Canada
Recombinomics Commentary 01:07
December 20, 2008

however all of the A/H1N1 isolates were resistant to oseltamivir due to the H274Y mutation (resistance = 100% or 3/3). The resistant isolates were from NS and BC.

The above comments from the week 50 influenza report from Canada indicate H1N1 oseltamivir resistance in Canada is currently at 100%. Although only three isolates have been tested, it is a marked improvement over the one tested at the beginning of the season. The isolates are from the opposite ends of Canada, and match the results in the United States, where 49/50 H1N1 isolates have H274Y.

The United States has issued an advisory to physicians, describing the high levels of resistance in seasonal flu, since the vast majority of flu in the US currently is influenza A and the vast majority of influenza A is H1N1.

The resistance levels in H1N1 in Europe are also near 100% in England, at at 100% in Scotland, Norway, and Austria, although the number of samples tested remain low. However, in Europe most of the influenza A is H3N2, which is sensitive, so an advisory in Europe has not been issued to physicians, although England did put out a report on the high frequency in H1N1.

The levels of resistance in North America and Europe suggest that the resistance levels in H1N1 are not likely to change this season.

.

Commonground · Dec 20, 2008

Re: Seasonal Flu 2008 - 2009

UK: Doctors hit by flu virus fears

Dec 19 2008 By Debbie Wood

A flu type virus has led to a surge in telephone calls to GPs and emergency services across the region.

Medical staff at doctors surgeries across Solihull have witnessed a rocketing number of enquiries, averaging 20 to30 per day relating to the virus which causes a cold and chest pains among all ages during the past week.

In addition, West Midlands Ambulance Service based in Dudley, took an estimated 2,146 calls during last Saturday (December 13) alone, representing a 30 per cent increase for the same period last year.

Dr Patrick Brooke, medical director for Solihull NHs Care Trust in Union Road, is urging people with colds and flu-like symptoms to seek the right treatment for their illness and not to use the Accident and Emergency departments of Solihull Hospital.

?There has been a tremendous health service response to this unprecedented demand,? he said. ?GPs and community services staff have made a concerted effort to deal with the high level of demand and help to relieve the pressure on local hospitals.

?One of the main problems recently is a flu-like illness, the Norovirus which causes respiratory problems, sickness and diarrhoea. This has hit old people particularly hard. While NHS staff are always there to help, there is a lot people can do for themselves and their families to avoid becoming ill or having accidents.?

Any members of the public with flu-like symptoms are advised to take plenty of rest, consume hot drinks and plenty of fluid, wear extra layers of warm clothing, stay at home, wash their hands regularly and use their local GP or pharmacy for treatment and advice.

Shiloh · Dec 20, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://www.telegraph.co.uk/health/h...gripped-by-worst-flu-outbreak-since-2000.html

Britain gripped by worst flu outbreak since 2000
Britain is in the grip of the worst flu outbreak for eight years, with emergency services fearing they will be "swamped" by calls when GP surgeries close for Christmas.
By Laura Donnelly, Health Correspondent
Last Updated: 4:20PM GMT 20 Dec 2008

This week?s official flu figures are expected to show a further surge in the number of people infected.

With most GPs surgeries shut for four days over the Christmas period, experts said the remaining medical services would become stretched to breaking point by the weekend.

Accident and Emergency doctors said the chaos in their departments was already reminiscent of scenes from the last big NHS winter crisis, at the turn of the millenium, when crematoriums were forced to work around the clock to cope with the 22,000 people who died.

The latest figures show the number of flu infections running at 40 per 100,000 - the highest level at this point in the year since the winter of 2000-1, when flu rates went on to reach epidemic proportions.

Dozens of hospitals have closed wards or stopped admitting emergency patients as they battle with the rising number of admissions linked to flu and the vomiting bug norovirus. Record numbers of 999 calls have left emergency services struggling to cope, with ambulances queuing outside hospitals who are unable to take patients quickly enough.

John Heyworth, president of the College of Emergency Medicine, said Accident and Emergency departments and ambulance services were already overstretched, with patients facing long waits in ambulances and on trolleys.

?The system simply does not have enough capacity to cope with the pressure it is under, and we expect this to keep getting worse over Christmas, and then over the next three to four weeks,? he said.

The A&E consultant at Southampton General Hospital said: ?Already we have got scenes where patients are waiting hours in A&E, or on trolleys in corridors because there are not enough beds to admit them. Outside the hospitals, ambulances are backed up, and can?t unload patients because the departments aren?t able to cope with them.

?The ambulance service and A&E departments are already inundated with patients and we fear we will soon be swamped,? he added.

Mr Heyworth described current pressures as ?very reminiscent? of the crisis in the NHS over the millenium.

?What is really frustrating about this, is that these pressures are predictable,? he said. ?The reason the service struggles to cope is because bed numbers have been cut to a minimum?.

After the 1999/2000 winter crisis, the Government pledged to increase the number of hospital beds by 7,000. In fact, the number of beds has fallen by 13,000 since then.

Meanwhile, hospitals are continuing to carry out thousands of operations in a desperate attempt to meet a Government deadline at the end of this month.

The British Medical Association said ?inflexible targets? which mean patients must be treated within 18 weeks of referral, by the end of this month, meant hospitals had failed to create enough slack in the system to cope with the growing crisis.

Jim Wardrope, an A&E consultant at Sheffield Northern General Hospital, said: ?We are currently at a stage where we have severe and sustined pressures and we are really worried about the four day weekend around Christmas. Some places will run some extra services out of hours, but the reality is we do not have a national plan to deal with this.?

The national director for the ambulance service has already begged the public not to call 999 or visit A&E unless they have a genuine emergency, urging people to call NHS Direct, visit their pharmacy or try a walk-in centre if they need advice.

Ambulance staff said changes to the running of GP services, which mean most surgeries no longer responded to calls in the evenings and weekends, with the work ?outsourced? to private companies, had left the public confused about who to contact if they needed to see a doctor when their local surgery was shut.

Sam Oestreicher, UNISON National Officer for Ambulance workers, said: ?The four day weekend is a real concern; a lot of people don?t know how to access care when their GP surgery is shut, but the one number they do know is 999, so it is very hard to keep the pressure off the ambulances?.

On Thursday the health secretary Alan Johnson insisted that the increase in sickness was ?pressure we can cope with.?

He was responding to comments from Peter Bradley, the national director of ambulance services, who told The Daily Telegraph that the emergency system was ?struggling to cope? with demand.

Latest figures show that the London Ambulance Service, where he is chief executive, experienced its busiest week in its history, with more than 20,000 calls in the week ending last Sunday, while calls in the West Midlands rose by 30 per cent, compared with the same period last year.

St George?s Hospital in London, Leighton Hospital in Cheshire, and Norfolk and Norwich Hospital have all stopped receiving emergency patients as pressures mounted over the past fortnight, due to rising emergencies and outbreaks of the vomiting bug.

Dozens more hospitals have closed wards and cancelled scheduled operations

Shiloh · Dec 21, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://www.dailymail.co.uk/news/art...inter-flu-crisis-NHS-deluged-emergencies.html

Red Cross to answer 999 calls in winter flu crisis as NHS is deluged by emergencies

By Lucy Ballinger
Last updated at 1:14 AM on 22nd December 2008

Volunteers from the Red Cross and St John Ambulance are being sent to 999 calls as the ambulance service is hit by a deluge of emergencies.

Crews are faced with the worst flu outbreak for ten years, the winter vomiting bug and a wave of alcohol-related injuries from the Christmas party season.

In desperation they have turned to the charities to help them with the massive influx of calls.

The Red Cross, more usually linked to disasters in the Third World, has been called in to help with non-life-threatening calls.

And St John Ambulance, which deals with any call-up to the most serious kind, says it is being forced to provide three times the cover it normally does at this time of year.

Even firemen in some areas are poised to give emergency assistance while patients wait for ambulances to arrive.

Peter Bradley, the national director of ambulance services, said services in England the week before last was their busiest ever, with a 30 per cent rise in some areas during the ten days up to the middle of last week.

He said it was due to the coldest start to a winter for 30 years causing a sharp increase in falls and breathing problems, combined with outbreaks of flu and the winter vomiting bug norovirus.

'It is absolutely horrendous. Hospitals are full and A&E departments are struggling,' he said.

St John Ambulance chief commissioner of operations Harry Dymond said: 'We are probably operating in every county in England. If not every one, then certainly the vast majority. Huge numbers of vehicles are helping, with up to ten being used in many counties.

'Most of the crews will be dealing with emergency calls in the same way as any other normal ambulance crew. This can mean going to any type of call including the most serious heart attacks.

'We expect to have to help out well into next year. In many areas we have already been asked to help through to the middle of January.'

He added that this year ambulance services were under extra pressure to meet new Government response time targets set this spring.

Last Friday over-indulgence at office celebrations saw London Ambulance service receive 4,549 calls, which they said was 'extremely busy' compared with a normal day's average of 3,500 calls.

Geoff Martin from Health Emergency, which represents paramedics, said: 'We have got a combination of flu and norovirus and cold weather, and it has led to absolute chaos.

'The services are trying to muddle through and that is the problem. The problem has been compounded by the target-obsessed Government.

'To use these volunteer organisations is a measure of how desperate the situation is. We have the emergency services for a reason. There is no substitute for those trained professionals, it is not their fault but this is a dire situation.'

The Red Cross has 300 ambulances across Britain who are on stand-by all year for emergencies, but are very rarely needed.

A Red Cross spokesman said: 'We provide support to the emergency services as needed, this includes helping some ambulance services with lower category calls.

'All our ambulances are fully equipped, and the crews are fully trained.'

Neil Cook, director of operations for the east Hampshire ambulance area, said: 'I've been in this job for 25 years and I can't remember it ever being this bad.

'The increase in call outs is putting us under incredible strain.'

Ambulance service managers are urging patients to think carefully before dialling 999 - as they could be diverting an ambulance from a life-threatening emergency.

Michelle Ullett, from South Central Ambulance Service, which covers Hampshire, said: 'In some cases people don't know where else to turn and think dialling 999 is their only alternative.

'There are a lot of people who do not need an ambulance but may need some other form of NHS treatment from places such as their GP, NHS Direct, minor injuries or walk-in centres or out-of-hours service.'

tropical · Dec 22, 2008

Re: Seasonal Flu 2008 - 2009

#209:

"Ambulance service managers are urging patients to think carefully before dialling 999 - as they could be diverting an ambulance from a life-threatening emergency."

The above is a product of an "one-number-for-all-emergencies", which is not bad if covered with enaugh real-time specialistics phone-call "judge it" staff and enaugh inner channels, and emergency vehicles/dr/staff,
but if not,
the outcome can be dificultly and serious for the people who need realy an express life-save ambulance without the need for other kind of specialists but doctors (heart, ...),
if they can't get the vehicle/dr./staff/em.treatment because the lines are occupated by un-neccessary urgent calls evaluations or team interventions.

Two diferent main call numbers - one for the suspected vital urgent emergency calls only,
and another for the rest of potential emergencies?

Shiloh · Dec 22, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://www.independent.co.uk/life-s...ults-suffer-most-in-flu-outbreak-1208498.html

Young adults suffer most in flu outbreak
Older people more likely to be vaccinated, experts say

By Steve Connor, Science Correspondent
Tuesday, 23 December 2008

Young adults are being struck down with the flu at three times the rate of their parents' generation, figures from heath watchdogs reveal.

For every 100,000 people aged 15 to 44 in England, 54.4 of them have the flu, compared with 18 cases among the same number of people aged over 65.

Doctors have been diagnosing more cases of flu during this year's lead-up to Christmas than they have done during the past 10 pre-Christmas periods. The overall rate stands at 39 cases of influenza per 100,000 people within the general population, the government's Health Protection Agency said.

The number of flu cases reported to GPs has already breached the minimum "baseline" figure that marks the point at which the outbreak is defined as seasonal but it is still well short of the 200 cases per 100,000 that turn an outbreak into an epidemic.

Health experts said the rise in cases among the young, particularly in southern England, was in part due to the fact that many had not received the flu vaccine to protect them against the different strains of the illness.

And they said that flu outbreaks often affected certain demographics differently. They suggested that young working people suffering from the early symptoms of flu stay at home, rather than risk spreading the virus through their workplace.

Even with flu-sufferers staying at home, the working population is still likely to experience an increase in the number of cases of flu.

The current outbreak is likely to reach its peak across all age groups within the next three to four weeks, said Douglas Fleming, the director of the Birmingham Research Unit of the Royal College of General Practitioners.

"We expect to see an increase in the number of cases within that age group, but also possibly in other age groups as well," Dr Fleming said.

"There is often a tendency for the virus to affect one age group more than another.

"The reason has a lot to do with the amount of mixing within any given age group, but it is also connected with the properties of the virus.

"We expect to see a figure that is much higher within this young-adult age group when the latest figures come in this week."

The flu epidemic in the winter of 1999-2000 mainly affected older people while the epidemic in 1989 mostly affected younger age groups, Dr Fleming said. "We are now looking at a maximum impact on the working age groups."

Richard Pebody, the head of infectious disease surveillance at the Health Protection Agency, said: "There is higher activity in the working-age group. Often we see one age group or other being more affected, so it is not unusual.

"The simple message is, if you do get flu it's best to stay at home to avoid spreading the virus in the office."

Scientists said that the H3N2 strain of the influenza virus was causing the current flu outbreak.

The outbreak began in central England and has since spread to the rest of the country.

The flu vaccine, which is offered free to everyone over the age of 65, covers the H3N2 strain, in addition to two other flu viruses.

The low incidence of flu in people over 65 indicates that the vaccine is limiting the spread of the virus. However, 27 per cent of over 65s have not been vaccinated against the illness.

In the under 65s, certain high-risk groups such as people with asthma or heart disease are also offered the flu vaccine for free, although only about four in 10 people within these high-risk groups have taken up the offer.

Shiloh · Dec 23, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://www.liverpoolecho.co.uk/live...es-stretched-by-flu-outbreak-100252-22536760/

City?s health services stretched by flu outbreak
Dec 23 2008 by Caroline Innes, Liverpool Echo

HEALTH services are being stretched because of a flu outbreak in Liverpool, where cases are four times the national average.

Infection rates have more than trebled in the last week.

The national flu rate is 26 per 100,000 of the population ? compared with about 103 per 100,000 in Liverpool.

Last week the ECHO revealed Liverpool?s biggest hospital was gripped by an outbreak.

More than 1,000 members of staff were given emergency flu jabs at the Royal Liverpool and Broadgreen hospitals to fight the virus.

The trust confirmed more than 14 patients at the Royal tested positive for influenza.

Liverpool primary care trust today urged everyone eligible to get the flu vaccination to help stop it spreading.

Public health consultant for Liverpool PCT Dr Emer Coffey said: ?There is a lot more flu around now in Liverpool compared with this time last year, and it is having a huge impact on demand for health services.

?Flu can be a nasty illness for older people and those with chronic medical problems.

?The flu jab is recommended for people aged 65 or over, as well as those of any age, with chronic medical problems, such as heart or chest conditions, diabetes, asthmatics on steroids, liver or kidney diseases, stroke or those who have weak immune systems.

?It is also recommended for people living in care homes.

?If you are eligible, but have not had a chance to get your free flu jab yet, you should make an appointment with your GP to get the jab.?

For most people flu is miserable, lasts a week or so but is not life-threatening.

But the elderly and people with underlying medical problems can suffer serious illnesses.

Parents of children and young people with underlying health problems also need to ensure the youngsters are protected against the virus.

Dr Coffey added: ?There is also plenty individuals can do to prevent the virus spreading.

?We recommend you ?catch it, bin it and kill it?.

?Always carry tissues with you. Cover your nose and mouth when you sneeze. Bin the tissues after single use and wash your hands immediately and at regular intervals.?

Giuseppe · Dec 24, 2008

Re: Seasonal Flu 2008 - 2009

United Kingdom: Flu outbreak is worst for eight years - The Guardian

Flu outbreak is worst for eight years

* Sarah Boseley, health editor
* The Guardian, Wednesday 24 December 2008

Britain is in the grip of a flu outbreak greater than anything seen in the last eight years, with soaring numbers of people falling ill, new figures show.

The last big flu outbreak occurred in 1999/2000, when 22,000 people died, which is 10 times the average for a winter flu season.

The latest figures from the Royal College of GPs show 69 cases of flu in 100,000 population for this week. In the last two weeks, the rate has climbed steeply, from 28 in 100,000 two weeks ago, to 40 last week and now 69.

The rise is across all regions of the UK and all age groups, but it appears to be the young and middle-aged adults who are hit hardest. The rate has soared to 80 in 100,000 in the 15 to 44 age group and to 76 among 45 to 64-year-olds. These tend to be more socially active people - teenagers, young adults and workers who refuse to stay home when they feel ill.

The worsening outbreak will cause problems for the health service over the Christmas break, especially combined with the spread of the vomiting bug norovirus. These highly transmittable diseases are hitting hard at a time when GP practices will be closed and hospital staff reduced because of the holiday.

"If you have norovirus on the ward, you have to close it down and clean it," said Professor Steve Field, a Birmingham GP who is chairman of the Royal College of GPs. "And at the same time you are getting more frail and elderly people getting bronchitis and pneumonia."

Even last week, flu was having an impact on the functioning of the NHS. David Nicholson, the NHS chief executive, said across England the number of 999 calls was 7% higher than last year and admissions to hospital through A&E departments were 4% up, because of more cases of flu and breathing problems. London, the West Midlands and south-west were under the most pressure, he said.

Older people are being hit less hard by flu at the moment because of the good take-up rate of the vaccine among the over-65s. The rate is now 45 in 100,000 in that age group. However, there are concerns about many others under the age of 65 who are considered to be at risk of the complications of flu, which can be serious and in some cases life-threatening.

Campaigns from the Department of Health have been urging those at risk of complications to have a flu vaccination for several months. But while 72% of the over-65s have had the jab, only 42% of younger people considered to be at risk have come forward.

Around 4 million people under 65 risk becoming seriously ill with the complications of flu, such as bronchitis and pneumonia. They include people whose immune systems are in some way compromised, those with asthma, serious kidney and liver complaints and diabetes.

Professor Field said he was also concerned about those in the older age group who have not been vaccinated. Although the rate was 72% overall, it was patchy, he said. "This is going to be around for a while, so it is well worth getting vaccinated."

This year, the strain of flu that is doing the damage - H3N2, or Brisbane flu after the city where it was first identified - is one of the three included in the vaccination, so anybody who has a jab is well-protected.

The HPA said the figures looked worse because the last three years have been quiet. But an early rise did not necessarily mean a continuing rise in the numbers falling ill.

"It may continue on up and it may go down," said the spokeswoman. Other countries in Europe are not yet seeing a rise in cases.

She stressed that those who get ill should stay at home and not spread the infection around the workplace. "If you are sick, don't even bother. Just stay home and get better or you will just infect the rest of your team," she said.

The steady upward trend in flu cases is matched by the number of people going to see their GP for common colds, which hit 300 in 100,000 last week - up from an average of 200 a week earlier in the month.

Professor Field said the current outbreak was still well short of an epidemic. The outbreak in 1999/2000 hit a peak of 220 cases per 100,000 and was classified officially as an epidemic by the Department of Health.

The current trend is a very steep and sudden rise in cases, but it is always possible that it will peak early and start to go back down.

"You can't assume anything," he said. "Some of them do go down." He would expect a drop in cases in the next week or so anyway because fewer GPs are working and recording case numbers.
-

<cite cite="http://www.guardian.co.uk/society/2008/dec/24/health-flu-outbreak">Flu outbreak is worst for eight years | Society | The Guardian</cite>

Giuseppe · Dec 24, 2008

Re: Seasonal Flu 2008 - 2009

ITALY: INFLUENZA, 2008-2009 SEASON; EPIDEMIC SURVEILLANCE UPDATE, data from CIRI (Dec 24 2008)

Global Trend for Influenza-Like Illness Morbidity incidence among population.

Data and graphs compiled by CIRI.

Data refers to the ILI incidence for current epidemic surveillance season and are divided by season, surveillance week, class ages.

<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>

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</td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From TABLES</td></tr></tbody></table>
Updated at: 12-24-2008 H 10:44:03am (GMT+1)

[WEEK / particpant GPs / outpatients / CASES: 0-4 / 5-14 / 15-65 / +65 / CUM. INCIDENCEx1000 inhab.]

2008-42 / 391 / 510721 / 141 / 0,67 / 0,23 / 0,29 / 0,16 / 0,28
2008-43 / 386 / 509332 / 133 / 0,76 / 0,34 / 0,25 / 0,14 / 0,26
2008-44 / 405 / 535482 / 147 / 0,81 / 0,16 / 0,29 / 0,16 / 0,27
2008-45 / 408 / 536770 / 177 / 1,16 / 0,36 / 0,3 / 0,18 / 0,33
2008-46 / 394 / 516856 / 177 / 0,66 / 0,45 / 0,36 / 0,15 / 0,34
2008-47 / 411 / 541846 / 272 / 1,76 / 0,56 / 0,47 / 0,26 / 0,5
2008-48 / 419 / 553235 / 337 / 1,93 / 0,57 / 0,6 / 0,31 / 0,61
2008-49 / 411 / 542423 / 409 / 2,74 / 1,09 / 0,68 / 0,31 / 0,75
2008-50 / 408 / 537826 / 480 / 3,35 / 1,32 / 0,82 / 0,28 / 0,89
* 2008-51 / 348 / 462055 / 562 / 4,99 / 2,13 / 1,02 / 0,53 / 1,22

RED figures indicate an increasing incidence, while BLUE ones indicate a decreasing incidence.

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HenryN · Dec 24, 2008

Re: Seasonal Flu 2008 - 2009

http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1230105661596

Neuraminidase inhibitor susceptibility testing on 73 A (H3) isolates since week 40/08 showed that all are sensitive to
oseltamivir and zanamivir but resistant to amantadine. Both of the two influenza B isolates tested since week 40/08
are sensitive to oseltamivir and zanamivir

. Twenty-nine of 30 A (H1) specimens tested in the same time frame are
resistant to oseltamivir but sensitive to zanamivir and amantadine. The majority of these oseltamivir-resistant viruses
come from the south west of England. Two influenza A (H1) isolates have been found to be resistant to oseltamivir in

Scotland this season, one of which has been confirmed by CfI.

Giuseppe · Dec 24, 2008

Re: Seasonal Flu 2008 - 2009

CIDRAP >> Surging flu cases may herald tough season in England

Surging flu cases may herald tough season in England

Robert Roos * News Editor
Dec 24, 2008 (CIDRAP News) ?

While the US influenza season has started slowly, cases are surging in England, raising concern that the country could have its toughest season since 1999-2000.

In England and Wales last week, about 68.5 people per 100,000 saw a general practitioner for influenza-like illness (ILI), a 73% increase over the 39.5 per 100,000 the week before, according to the latest weekly report from the Royal College of General Practitioners (RCGP). A BBC News report said the number also is 73% higher than the same week a year ago.

Dr. Douglas Fleming, director of the RCGP Research Unit in Birmingham, said the increase was significant, according to BBC News. "In the past 10 years, the only substantial outbreak was in 1999-2000," he said. "I think we could be looking at something that approaches that this year.

"The RCGP report says ILI visit rates of 30 to 100 per 100,000 population per week are "usual when influenza viruses are circulating," rates above 100 are above average, and rates exceeding 200 are "exceptional." The RCGP data are drawn from about 85 general practitioner clinics around the country, representing an at-risk population of about 840,000.

ILI rates rose in all age-groups and regions in the week of Dec 15 to 21, the RCGP report says. The highest rates were seen among 15- to 44-year-olds, with 79.7 cases per 100,000, and 45- to 64-year-olds, with 75.6 cases. The 65-and-older group had 44.7 cases per 100,000, which was more than double the 18 cases seen the week before.

The BBC report said experts believe the unusually cold weather might have contributed to the surge in cases.

British public health officials define a flu epidemic as an ILI rate of 200 per 100,000, according to the BBC story. The last time that happened in England was in 1989-90, the report said.

"That one caught everyone a bit off guard but there's been a big push on flu vaccination since then," virologist John Oxford of Queen Mary's School of Medicine and Dentistry in London told the BBC.

Oxford and others quoted in the story urged people to get a flu shot if they haven't done so yet.

David Salisbury, director of immunization at the UK Department of Health, told the BBC, "We have had a very unusual run of winters with almost no flu, so we should not be surprised that here is a winter with more flu. It is very difficult to predict what makes the change winter to winter."

In contrast to the situation in England, flu activity in the United States has remained low so far this season, according to the latest report from the Centers for Disease Control and Prevention, issued Dec 19. The report, for the week that ended Dec 13, said only three states?Texas, Virginia, and Hawaii?were reporting local flu activity. Thirty-six states reported sporadic cases and 11 states were reporting none.

Google Flu Trends, a Web site that estimates US flu activity from the volume of Internet searches for flu information, currently shows "moderate" activity only in Hawaii, Maryland, and Virginia, with the rest of the country having low activity.

See also:
RCGP report for Dec 15 to 21 http://www.rcgp.org.uk/pdf/pr_RCGP_Weekly_Report_Wk51 _2008_.pdf
RCGP report for Dec 8 to 14 http://www.rcgp.org.uk/pdf/RCGP Weekly Report Wk50 2008.pdf
CDC flu surveillance update http://www.cdc.gov/flu/weekly/
Google Flu Trends http://www.google.org/flutrends/
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<cite cite="http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/dec2408england.html">CIDRAP >> Surging flu cases may herald tough season in England</cite>

HenryN · Dec 25, 2008

Re: Seasonal Flu 2008 - 2009

<TABLE cellSpacing=0 cellPadding=0 width=782 border=0><TBODY><TR><TD align=middle width=780 bgColor=#0063c8 height=1>[FONT=Arial, Helvetica, sans-serif][SIZE=-1]EISS - Weekly Electronic Bulletin [/SIZE][/FONT]</TD><TD width=1 bgColor=black height=1>