Giuseppe
Emeritus
Re: Seasonal Flu 2008 - 2009
EISS - Weekly Electronic Bulletin Week 8 - 27 February 2009, Issue N? 294 - Influenza activity increasing in central and eastern Europe while continuing to decrease in western Europe
EISS - Weekly Electronic Bulletin Week 8 - 27 February 2009, Issue N? 294 - Influenza activity increasing in central and eastern Europe while continuing to decrease in western Europe
EISS - Weekly Electronic Bulletin Week 8 : 16/02/2009-22/02/2009 - 27 February 2009, Issue N? 294 - Influenza activity increasing in central and eastern Europe while continuing to decrease in western Europe
-- Summary:
In week 08/2009, influenza activity remained little changed across Europe compared to last week. Most countries in central Europe continue to report medium intensity activity, and activity is low but increasing in eastern Europe.
Influenza activity is generally declining in western Europe.
Influenza A(H3) continues to be the predominant circulating virus although the proportion of influenza B virus detections continues to increase.
All the A(H3N2) viruses tested for antiviral resistance were resistant to M2 inhibitors but susceptible to neuraminidase inhibitors.
-- Epidemiological situation - week 08/2009:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were high in Slovakia for the first time this season, medium in 20 countries, and low in the other twelve countries that reported this indicator.
The majority of countries reporting increasing trends for the intensity indicator in week 08/2009 were located in central and eastern Europe, while most countries in western Europe reported unchanged or decreasing intensity compared to the previous week. There has been a sharp increase in consultation rates in Greece where influenza virus type B is now the dominant type and influenza A detections continue to decrease.
For the geographical spread indicator, widespread influenza activity was reported in nine countries, regional activity in nine countries, local activity in six countries and sporadic or no activity in the remaining ten countries.
-- Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-08/2009):
Since week 49/2008 consultation rates for ILI and/or ARI rose above baseline levels in most western and central European countries following a general west to east progression. High influenza intensity, again following a general west to east progression, has been reported in 13 countries since week 51/2008, but intensity has declined in all but Slovakia.
Generally, the highest consultation rates have been in the 0-4 and 5-14 age groups, but Ireland, UK, Norway and Romania have reported their highest ILI consultation rates in the 15-64 age group.
-- Virological situation - week 08/2009:
The total number of respiratory specimens collected by sentinel physicians in week 08/2009 was 1960, of which 518 (26%) were positive for influenza virus: 349 type A (133 subtype H3, 9 subtype H1 and 207 not subtyped) and 169 type B.
In addition, 674 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 584 type A (150 subtype H3, 61 subtype H1 and 373 not subtyped) and 90 type B.
A total of 13 countries reported that influenza virus type B, generally in combination with influenza virus type A subtype H3, was dominant in week 08/2009.
-- Cumulative virological situation - 2008-2009 season (weeks 40/2008-08/2009):
Of 20698 virus detections (sentinel and non-sentinel) since week 40/2008, 19280 (93%) were type A (7843 subtype H3, 703 subtype H1 and 10734 not subtyped) and 1418 (7%) were type B.
Based on the antigenic and/or genetic characterisation of 2784 influenza viruses, 2441 (87.7%) were reported as A/Brisbane/10/2007 (H3N2)-like, 117 (4.2%) as A/Brisbane/59/2007 (H1N1)-like, 28 (1.0%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 198 (7.1%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) .
Twelve countries have reported antiviral susceptibility data.
All influenza A(H3N2) viruses tested were sensitive to oseltamivir (324) and zanamivir (303), but resistant to M2 inhibitors (198).
Ninety-eight percent of influenza A(H1N1) viruses analysed (150/153) were resistant to oseltamivir, but all those tested against zanamivir and M2 inhibitors were sensitive. The small number of influenza B viruses analysed (27) were sensitive to oseltamivir and zanamivir.
-- Comment:
Influenza activity continued to decline in western Europe and has continued to increase in several countries in central (Greece and Slovakia) and eastern (Lithuania, Russia and Ukraine) Europe, following a general west-to-east trend.
For Russia as a whole, influenza activity is increasing; by region, influenza activity is increasing in all regions except the Far East where it appears to be declining. Activity has decreased to baseline levels in countries that experienced the influenza epidemic first this season (Ireland, Portugal, the UK).
Whilst A(H3N2) continues to be the dominant influenza virus circulating in the Europe region, the proportion of type B influenza virus detections per week continues to show a rising trend, with an increasing number of countries reporting type B as the dominant or co-dominant virus type.
Antigenic and/or genetic characterisation indicates that, with the exception of the B/Victoria lineage viruses (7.1% of the viruses subjected to antigenic and/or genetic characterisation), the viruses circulating are similar to the three components - A(H1N1), A(H3N2) and B/Yamagata lineage - included in the 2008/2009 Northern Hemisphere influenza vaccine.
-- Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS.
Of these countries, 32 reported both clinical and virological data, four reported virological data only and two reported clinical data only to EISS in week 08/2009. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by the network under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) and the WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
-- Other bulletins:
The EISS bulletin is prepared using reports from GP consultations and other sources, depending on individual country arrangements. It is important to recognise that different health care systems and types of measurement should also be considered when assessing the impact of influenza.
-- Map
The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.
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Europe Year 2009 / Week 8
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 inSouth-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).
-- Network comments (where available)
- Italy. During this week, the number of influenza positive samples remarkably decreased. Only 5 type A influenza viruses (3 H3 and 2 H1) were isolated.
- The former Yugoslav Republic of Macedonia. Mandatory reporting
- Russian Federation. 12 (66.7%) strains of influenza A(H1N1) virus from 16 viruses of this subtype isolated earlier in Vladivostok and analyzed during week 8 appeared to be resistant to oseltamivir.
- Serbia. All B viruses detected in week 8. originated from the southern parts of Serbia. In additions to A (H3) viruses detected up to now, the number of type B viruses continues to show rising trends, from north to south part of country.
- Switzerland. Influenza activity is now decreasing in Switzerland. Influenza B viruses started to predominate now.
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<cite cite="http://www.eiss.org/cgi-files/bulletin_v2.cgi">EISS - Bulletin Review</cite>-- Summary:
In week 08/2009, influenza activity remained little changed across Europe compared to last week. Most countries in central Europe continue to report medium intensity activity, and activity is low but increasing in eastern Europe.
Influenza activity is generally declining in western Europe.
Influenza A(H3) continues to be the predominant circulating virus although the proportion of influenza B virus detections continues to increase.
All the A(H3N2) viruses tested for antiviral resistance were resistant to M2 inhibitors but susceptible to neuraminidase inhibitors.
-- Epidemiological situation - week 08/2009:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were high in Slovakia for the first time this season, medium in 20 countries, and low in the other twelve countries that reported this indicator.
The majority of countries reporting increasing trends for the intensity indicator in week 08/2009 were located in central and eastern Europe, while most countries in western Europe reported unchanged or decreasing intensity compared to the previous week. There has been a sharp increase in consultation rates in Greece where influenza virus type B is now the dominant type and influenza A detections continue to decrease.
For the geographical spread indicator, widespread influenza activity was reported in nine countries, regional activity in nine countries, local activity in six countries and sporadic or no activity in the remaining ten countries.
-- Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-08/2009):
Since week 49/2008 consultation rates for ILI and/or ARI rose above baseline levels in most western and central European countries following a general west to east progression. High influenza intensity, again following a general west to east progression, has been reported in 13 countries since week 51/2008, but intensity has declined in all but Slovakia.
Generally, the highest consultation rates have been in the 0-4 and 5-14 age groups, but Ireland, UK, Norway and Romania have reported their highest ILI consultation rates in the 15-64 age group.
-- Virological situation - week 08/2009:
The total number of respiratory specimens collected by sentinel physicians in week 08/2009 was 1960, of which 518 (26%) were positive for influenza virus: 349 type A (133 subtype H3, 9 subtype H1 and 207 not subtyped) and 169 type B.
In addition, 674 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 584 type A (150 subtype H3, 61 subtype H1 and 373 not subtyped) and 90 type B.
A total of 13 countries reported that influenza virus type B, generally in combination with influenza virus type A subtype H3, was dominant in week 08/2009.
-- Cumulative virological situation - 2008-2009 season (weeks 40/2008-08/2009):
Of 20698 virus detections (sentinel and non-sentinel) since week 40/2008, 19280 (93%) were type A (7843 subtype H3, 703 subtype H1 and 10734 not subtyped) and 1418 (7%) were type B.
Based on the antigenic and/or genetic characterisation of 2784 influenza viruses, 2441 (87.7%) were reported as A/Brisbane/10/2007 (H3N2)-like, 117 (4.2%) as A/Brisbane/59/2007 (H1N1)-like, 28 (1.0%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 198 (7.1%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) .
Twelve countries have reported antiviral susceptibility data.
All influenza A(H3N2) viruses tested were sensitive to oseltamivir (324) and zanamivir (303), but resistant to M2 inhibitors (198).
Ninety-eight percent of influenza A(H1N1) viruses analysed (150/153) were resistant to oseltamivir, but all those tested against zanamivir and M2 inhibitors were sensitive. The small number of influenza B viruses analysed (27) were sensitive to oseltamivir and zanamivir.
-- Comment:
Influenza activity continued to decline in western Europe and has continued to increase in several countries in central (Greece and Slovakia) and eastern (Lithuania, Russia and Ukraine) Europe, following a general west-to-east trend.
For Russia as a whole, influenza activity is increasing; by region, influenza activity is increasing in all regions except the Far East where it appears to be declining. Activity has decreased to baseline levels in countries that experienced the influenza epidemic first this season (Ireland, Portugal, the UK).
Whilst A(H3N2) continues to be the dominant influenza virus circulating in the Europe region, the proportion of type B influenza virus detections per week continues to show a rising trend, with an increasing number of countries reporting type B as the dominant or co-dominant virus type.
Antigenic and/or genetic characterisation indicates that, with the exception of the B/Victoria lineage viruses (7.1% of the viruses subjected to antigenic and/or genetic characterisation), the viruses circulating are similar to the three components - A(H1N1), A(H3N2) and B/Yamagata lineage - included in the 2008/2009 Northern Hemisphere influenza vaccine.
-- Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS.
Of these countries, 32 reported both clinical and virological data, four reported virological data only and two reported clinical data only to EISS in week 08/2009. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by the network under the aegis of the European Centre for Disease Prevention and Control in Stockholm (Sweden) and the WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
-- Other bulletins:
The EISS bulletin is prepared using reports from GP consultations and other sources, depending on individual country arrangements. It is important to recognise that different health care systems and types of measurement should also be considered when assessing the impact of influenza.
-- 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 Drop Box</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 Drop Box</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 Drop Box</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 Drop Box</td></tr></tbody></table>Europe Year 2009 / Week 8
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 inSouth-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).
-- Network comments (where available)
- Italy. During this week, the number of influenza positive samples remarkably decreased. Only 5 type A influenza viruses (3 H3 and 2 H1) were isolated.
- The former Yugoslav Republic of Macedonia. Mandatory reporting
- Russian Federation. 12 (66.7%) strains of influenza A(H1N1) virus from 16 viruses of this subtype isolated earlier in Vladivostok and analyzed during week 8 appeared to be resistant to oseltamivir.
- Serbia. All B viruses detected in week 8. originated from the southern parts of Serbia. In additions to A (H3) viruses detected up to now, the number of type B viruses continues to show rising trends, from north to south part of country.
- Switzerland. Influenza activity is now decreasing in Switzerland. Influenza B viruses started to predominate now.
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</th> <th colspan="2" align="center" width="200" nowrap="nowrap">Resistant Viruses,
