Seasonal Flu 2008 - 2009

Commonground · Aug 29, 2008

Re: Seasonal Flu 2008 - 2009

FLU IN TASMANIA

Public health authorities are waiting on test results to show the reason for a spike in flu-like illness affecting Lauderdale Primary School in Southern Tasmania.

A number of viruses to blame for flu outbreak

Tasmania's Health Department says a number of viruses have caused the high level of absenteesim at Lauderdale Primary School in the state's south.

Influenza A and B are among the viruses that have been identified.

More than half of Lauderdale Primary's students didn't make it to school yesterday - 300 all up, out of an enrolment of 530.

20 staff were also off sick, including one who was admitted to hospital.

The Health Department says test results showing the presence of the two influenza viruses confirm the outbreak is typical for this time of year.

But Dr Avner Misrachi says the number is relatively high, and has advised those struck down to stay home.

Those unaffected should follow basic hygiene guidelines, or be vaccinated.

The Department yesterday rejected requests from parents to temporarily close the Lauderdale school.

http://www.abc.net.au/news/stories/2008/08/29/2350589.htm

HenryN · Aug 29, 2008

Re: Seasonal Flu 2008 - 2009

<CENTER>LAUDERDALE FLU RESULTS
<HR class=text noShade SIZE=1></CENTER>
The Public and Environmental Health Service today said test results have shown that influenza B has been identified as affecting the Lauderdale Primary School and probably other viruses are also active at the school

Senior Medical Advisor, Dr Avner Misrachi, said results received by the Department indicated a range of different respiratory viruses have been circulating among the Hobart community and the Eastern shore and these included both influenza A and influenza B

?This confirms that, although the numbers of people who have become ill are relatively high, this outbreak is typical for this time of year.

?Seasonal influenza can affect between 10% and 30% of the community each winter and outbreaks are common.?

Dr Misrachi said the test results did not change the advice to the school and the wider community about the flu.

?The main symptoms are sudden onset of fever, chills, dry cough, extreme tiredness and body aches.

?Parents should keep unwell children at home and adults who become ill also should stay home.

?Flu spreads easily and can cause serious illness and hospitalisation, especially for older people and people with chronic illnesses.

?It?s important that people affected stay home until they are fully recovered, so they don?t spread the disease to others.?

Dr Misrachi said influenza was largely vaccine preventable and people who had not been vaccinated should see their doctor.

?The flu vaccine is still available but it takes around two weeks to be fully effective.

?There are also a number of other steps people can take to protect themselves and others from flu.

?Wash your hands often with soap and water or alcohol rubs, especially before touching your face or anything that goes in your mouth. This is because the virus can be picked up unknowingly on your hands.

?Always cover your cough or sneeze with a tissue or your elbow if you don?t have a tissue. Throw dirty tissues in the bin straight away.?
http://www.media.tas.gov.au/release.php?id=24649

HenryN · Aug 29, 2008

Re: Seasonal Flu 2008 - 2009

New H1N1 sequences from Guatamala look like Tamiflu resistant (only HA sequences released).

<TABLE cellPadding=0 width="100%"><TBODY><TR><TD style="WHITE-SPACE: nowrap" vAlign=top width="20%">CY034621</TD><TD vAlign=top align=left>

Reports<SCRIPT language=JavaScript1.2></SCRIPT> </TD><TD vAlign=top align=right>

</TD></TR><TR><TD style="PADDING-LEFT: 2.8em" vAlign=top align=left colSpan=3>Influenza A virus (A/Guatemala/AF1995/2008(H1N1)) segment 4 sequence
gi|197323089|gb|CY034621.1|[197323089] </TD></TR></TBODY></TABLE>

HenryN · Aug 29, 2008

Re: Seasonal Flu 2008 - 2009

Guatemala and Honduras isolates do not have the South African cluster.

Shiloh · Aug 29, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://warrnambool.yourguide.com.au...t-pneumonia-hits-14-in-past-week/1258133.aspx

AU: Flu epidemic alert Pneumonia hits 14 in past week
ANDREW THOMSON
30/08/2008 4:00:00 AM
SOUTH-WEST residents have been warned of a late influenza epidemic.

In the past week, 14 people under the age of 30 have been treated for pneumonia at South West Healthcare Warrnambool hospital's emergency department.

City council medical officer of health Dr John Philpot said yesterday a strain of flu, which had hit Melbourne, was ``coming this way''. ``I would not be surprised if the flu hit town soon,'' he said.

He said that although there had not been a flu outbreak around Warrnambool this winter, the district had been rife with colds, coughs and sore throats ``It's been a miserable winter with a lot of bugs going about, mostly colds and viruses,'' he said.

South West Healthcare spokeswoman Suzan Morey said although patient numbers with flu-like symptoms had not increased, the severity of cases was worse than normal.

``In the past week we have treated an average of two people a day with pneumonia (secondary bacterial infection). And each of these 14 patients was less than 30 years of age,'' she said.

The Department of Human Services told The Standard official numbers of flu this year were well down on last year. At this time last year there were 794 cases compared with 397 this year. Last year's total figures were boosted by a severe August-September flu outbreak with 1206 cases for the two months.

Dr Philpot said it was not too late to be vaccinated. He said those most at risk included the elderly and those with chronic medical illnesses.

Meanwhile, Dr Philpot said he had not heard reports of Warrnambool school-aged children being struck down with a stomach bug for weeks.

It has been reported that three children in one street have had the illness which includes headaches and a sore stomach. One child has been off school for seven weeks and another for five.

Shiloh · Sep 1, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://www.abc.net.au/news/stories/2008/09/01/2352442.htm

AU: Flu outbreak causes delays at RHH

The Royal Hobart Hospital is having trouble coping with an outbreak of influenza

About 30 staff are sick and elective surgery has been cancelled.

The hospital's acting chief executive officer, Doctor Tony Bell says it is a difficult period with higher levels of flu-like symptoms in both staff and the community.

"We had a very busy weekend with a lot of attendances, over 140 patients through on Sunday, and today we've had four highly qualified nurses off in the morning and three on the afternoon shifts which has left the Emergeny Department short of staff," said Doctor Bell.

tropical · Sep 1, 2008

Re: Seasonal Flu 2008 - 2009

#46: "About 30 staff are sick and elective surgery has been cancelled.
That's why the health staff must be all vaccinated before the flu season.

#45: "``In the past week we have treated an average of two people a day with pneumonia (secondary bacterial infection). And each of these 14 patients was less than 30 years of age,'' she said."
Can the standard pneumo vaccine prevent that pneumonia if taken previously?

#41: "The Department yesterday rejected requests from parents to temporarily close the Lauderdale school."
Unbelievable how the burocrates can be so unsensitive with others health.
Why this overhelming need to impose the openess of an contagious school environment - will they produce new scientifical breaches just this month ...

Shiloh · Sep 1, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://orange.yourguide.com.au/news...a-epidemic-northing-to-sneeze-at/1260399.aspx

AU: Influenza epidemic northing to sneeze at
BY TRACEY PRISK
2/09/2008 11:11:00 AM

A chronic flu epidemic is still raging through Orange district schools causing attendance figures in some institutions to drop by one third.

Over the last three weeks, students of all ages have been struck down by symptoms of sneezing, coughing and in some cases severe stomach cramps and vomiting.

James Sheahan Catholic High School?s student welfare officer Paul McKie confirmed that one third of the students at the school were ill last week with the flu.

?I hope that the worst is over and that we have turned a corner,? said Mr McKie.

?I have been teaching for 35 years and this is the worst epidemic I can remember.?

According to Mr McKie, teachers have also been forced to cover their colleagues? lessons as the flu spread through the pupils and teaching staff.

?We really have had a snowball effect,? said Mr McKie.

According to the assistant principal of St Mary?s Primary School Robyn Doyle, many teachers have reported attendance levels hovering at 50 per cent.

?Last week one of my year two classes had 10 of its 25 pupils away from school as a result of the flu,? said Mrs Doyle.

?The children seemed to go down quickly and the symptoms are quite severe.

?Often there is a lot of dizziness and fainting.?

With many teachers also forced to stay home due to their own illness or to care for their own sick children, finding casual teachers has also been difficult.

At one stage last week, half the teachers working at St Mary?s were casuals.

?Parents have been great although in the end we don?t expect them to be able to keep their children at home, we just cope with it.?

Kinross Wolaroi School?s boarders have also been hit hard by the flu with 60 to 70 of the school?s live-in student population of 300 struck down.

Most of the ill students left the school and returned home to recuperate which has helped quell the infection rates.

According to school spokesperson Kate McCarthy this year?s rate of infection has been particularly high compared to past years with a large proportion of the school?s day students also suffering as a result of the flu.

Public schools have also felt the impact of the virus.

Most public schools in Orange have reported a higher than usual number of students with illness being kept home by parents and more teachers than normal taking sick leave.

Shiloh · Sep 3, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://www.canberratimes.com.au/new...us-stretching-hospitals-to-limit/1262620.aspx

AU: 'Nasty virus' stretching hospitals to limit
BY DANIELLE CRONIN
HEALTH REPORTER
4/09/2008 12:00:00 AM

Critical staffing shortages meant nurses were unable to meet demand for health care in the ACT, the nurses' union warned yesterday.

Australian Nursing Federation ACT secretary Colleen Duff called for ''immediate decisive action'' to boost staffing levels.

ACT Health Minister Katy Gallagher said that the spread of respiratory illnesses including influenza was increasing the strain on the ACT hospital system.

''There is also a really nasty virus going around at the moment that is knocking people out for 10 days,'' she said yesterday.

''It's when those people get a secondary infection such as pneumonia or ... chest infections or throat infections that they need antibiotics urgently and they are being admitted to hospital.''

She had received no reports about deaths caused by this ''nasty virus''.

Ms Duff said, ''The ANF does not believe that it the responsibility of clinical nurses to prop up the system by working unsafe levels of overtime and going without adequate rest and meal breaks.''

Ms Gallagher conceded nurses were working extremely hard to cope with an influx of patients into the public hospital system.

Almost 1070 patients had been treated at Canberra Hospital's emergency department in a week about 150 more patients than usual.

''There's more nurses on duty than ever before ... and more beds opened and that's just to try to deal with the demand,'' she said.''But all my advice from management is that yes the staff are tired because this is the second week of high level activity but the staff are not working to dangerous levels.''

Ms Duff said the federation had received complaints from its members for the past month.

''The ANF has been notified by members working at both Calvary Health Care and the Canberra Hospital that critical staffing shortages exist or that the clinical demands for health care cannot be met by the nurses currently available,'' she said.

''The ANF demands that ACT Health, Calvary Health Care, Mental Health ACT and the ACT Government take immediate and decisive action to provide sufficient staffing levels, based on the professional judgment of clinical bedside nurses, and triage service delivery across the ACT and south-east region to prioritise needs and determine the level of service that can be safely managed.''

The union would distribute critical incident forms to nurses so they could ''inform the health bureaucracy of these critical staffing shortfalls and requests them to take responsibility for the safe provision of health care within their facilities''.

Ms Gallagher said she ''really appreciated'' the efforts of staff.

''I'm happy to work with the ANF to do anything more that we can to either support staff or change practice or whatever,'' she said.

Ms Gallagher urged people with minor illnesses to stay away from hospital emergency departments, which were ''busier than ever''.

''Of course anybody who requires urgent attention or in the case of accidents, please come to the emergency department,'' she said.

''[But] coughs, colds and sore throats do not generally need that sort of urgent attention.''

People with minor ailments were encouraged to contact Health Direct on 1800 022 222, the Canberra After-Hours Locum Medical Service on 1300 422 567 or their GP

tropical · Sep 4, 2008

Re: Seasonal Flu 2008 - 2009

#48:
"According to Mr McKie, teachers have also been forced to cover their colleagues’ lessons as the flu spread through the pupils and teaching staff."

We can see how would be the pandemic working policy "at work".
Schools as spreading vectors (to "immunize" by illness the humans without vaccines) ...

#49:
"''It's when those people get a secondary infection such as pneumonia or ... chest infections or throat infections that they need antibiotics urgently and they are being admitted to hospital.''"

The standard procedure is to got the antibiotic and stay home.
The above "admitted to hospital" means probably that those additional infections are now much worst than usual.

HenryN · Sep 4, 2008

Re: Seasonal Flu 2008 - 2009

Flu season taking its toll: Gallagher

September 4, 2008 - 7:27AM
Source: ABC

<TABLE class=bpnArticleImg cellSpacing=0 cellPadding=0 width="10%" align=left border=0><TBODY><TR><TD>

</TD></TR><TR><TD vAlign=top align=left>Ms Gallagher says more beds have been made available.
Photo: ABC News
</TD></TR></TBODY></TABLE>ACT Health Minister Katy Gallagher says the Government is doing all it can to cope with increased demand on the hospital system due to winter illness.
The Australian Nursing Federation says staff shortages are at critical levels and compromising patient safety.
The ANF says the issue came to a head yesterday after its members made eight complaints in one day about unsafe situations.
Ms Gallagher says the past fortnight has been the busiest this year for the Canberra Hospital and she acknowledges staff are making a big effort.
"Yes staff are tired, yes staff are working to an enormous capacity but at the moment we're not seeing the trends that you would see if a work force was under enormous stress," she said.
"But I'm not discounting that either.
"I have to say that the health work force rise to the challenge every year and this is our peak period."
Ms Gallagher says more than 1,000 people presented to the Canberra Hospital's emergency department over a seven day period last week.
She says more beds have been made available and elective surgery has been cancelled to help deal with the problem.
"On the hour, every hour, every day the hospital is meeting to talk about what's going on, looking at what we do on shifts, looking at how we staff beds, looking at how the work force is feeling, everything that can be done is being done," she said.
Ms Gallagher says she is open to any ideas from the ANF and cost is not an issue.
"Absolutely anything that they can give us as a suggestion for the way to manage this we will look at seriously," she said.
"We have everything in place that we can do.
"No staff are being required to work and people can say no to work but it's true that we have more beds open than ever before and that's really because of the demand we're seeing."

http://www.bigpond.com/news/national/content/20080904/2354861.asp

tropical · Sep 4, 2008

Re: Seasonal Flu 2008 - 2009

"Ms Gallagher says she is open to any ideas from the ANF and cost is not an issue."

Well, if money cost is not an issue, than hire additionaly health workers part time, or at predefinite time, if not full time.

Shiloh · Sep 4, 2008

Re: Seasonal Flu 2008 - 2009

Source: http://www.geelongadvertiser.com.au/article/2008/09/05/17979_news.html

AU: Flu outbreak strains emergency department
Joel Cresswell
September 5th, 2008

AN unexpected influenza strain has swept through Geelong and blown out waiting times at the hospital emergency department, Barwon Health says.

Barwon Health said reports of 20-hour waits in the hospital's ED were due to a "strain of influenza not covered by this year's vaccine".

"Consequently, the Geelong Hospital is experiencing a period of high demand and high acuity," the Barwon Health statement said.

Barwon Health could not confirm the strain's identity late yesterday, but said it caused respiratory problems, particularly among older people.

Dr Mark Kennedy, of Corio Medical Clinic, one of the city's largest, said his clinic had noticed increasing influenza infections over the past three weeks.

But he said the infections were not in patients who had received this year's vaccine.

Patients contacted the Geelong Advertiser this week with reports of up to 21 people waiting in emergency department cubicles for transfer into the hospital.

Karen, who did not want her surname used, said her mother went to the emergency department with breathing complaints at 4.15pm on Tuesday.

She was not moved to a hospital bed until noon on Wednesday.

Karen said her 80-year-old mum waited 14 hours in a cubicle between her diagnosis and subsequent admission to a hospital bed.

A second woman with a fracture, who did not want to be named, said she waited 12 hours before she was booked in for surgery at a later date and sent home.

The Department of Human Services reported 31 influenza cases to September 1 this year, down from 48 in the severe 2007 flu season.

Statewide, there have been 538 flu cases to September this year compared with 897 in 2007.

tropical · Sep 5, 2008

Re: Seasonal Flu 2008 - 2009

Thanks Shiloh.

"Barwon Health said reports of 20-hour waits in the hospital's ED were due to a "strain of influenza not covered by this year's vaccine".
"Consequently, the Geelong Hospital is experiencing a period of high demand and high acuity," the Barwon Health statement said.
Barwon Health could not confirm the strain's identity late yesterday, but said it caused respiratory problems, particularly among older people. ...
But he said the infections were not in patients who had received this year's vaccine."

Two contradictory statements.

Do anibody know the label of that problematical strain there and if it was included in the South flu vaccine 07-08, and also, if it was included to be produced in the new North flu vaccine 08-09?

"Patients contacted the Geelong Advertiser this week with reports of up to 21 people waiting in emergency department cubicles for transfer into the hospital.
... went to the emergency department with breathing complaints at 4.15pm on Tuesday.
She was not moved to a hospital bed until noon on Wednesday.
... her 80-year-old mum waited 14 hours in a cubicle between her diagnosis and subsequent admission to a hospital bed.
A second woman with a fracture, who did not want to be named, said she waited 12 hours before she was booked in for surgery at a later date and sent home."

That shamefully practice of not giving a first doctor's look at the emergency with an preliminary aid in a real time (15 min.-1/2h) to old patients who can, because of the age and the chronical cardio/pulmo illnesses, have potentialy deadly outcomes, is obviously worldwide omnipresent.

If not a VIP, you can wait ...

That's why the emergency must be phisicaly divided into 2(or3) separate autonomous health teams - one for the enaugh strong, the second one for the elderly, baby's - or pediatric the third.
If somebody objected that's not enaugh employers, start to hire jang doctors on practice to do the first preliminary look and giving medical aid to the entering at risk patients.
If that's not enaugh because of any money-bla reason, I bet that every patient would be glade to pay an additional ticket if this way we save in time lives of the realy "emergency" patients.

HenryN · Sep 5, 2008

Re: Seasonal Flu 2008 - 2009

The vaccine in the southern hemisphere this season did not change H1N1, which is a mismatch.

[FONT=Verdana, Arial, Helvetica, sans-serif]It is recommended that vaccines to be used in the 2008 season (southern hemisphere winter) contain the following:[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]? an A/Solomon Islands/3/2006 (H1N1)-like virus*;
? an A/Brisbane/10/2007 (H3N2)-like virus;
? a B/Florida/4/2006-like virus[/FONT]
*A/Solomon Islands/3/2006 is a current vaccine virus

It is recommended that vaccines for use in the 2008-2009 influenza season (northern 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.#

* A/Brisbane/10/2007 is a current southern hemisphere vaccine virus.
# B/Florida/4/2006 and B/Brisbane/3/2007 (a B/Florida/4/2006-like virus) are current southern hemisphere vaccine viruses.

tropical · Sep 5, 2008

Re: Seasonal Flu 2008 - 2009

Thank you Dr. Niman for the help.

Now we can only crossfingers that the actual nasty seasonal flu version in Ausi is:
— an A/Brisbane/59/2007 (H1N1)-like virus;
(?)
___
From your previous thread:
"... there have been an increasing number of recent viruses of the alternative B lineage (B/Victoria-lineage) found recently in Australia and New Zealand. Some of these cases were found at the World Youth Day in Sydney where there were also outbreaks of A(H1) and A(H3) viruses during this week in mid July. Recently cases of A(H1) viruses that are resistant to oseltamivir have been detected in Australia (but not in NZ) with 8 detected in WYD samples and 2 from other parts of Australia. Oseltamivir resistant viruses have also predominated in South Africa during the 2008 winter season...."

HenryN · Sep 5, 2008

Re: Seasonal Flu 2008 - 2009

tropical said:
Thank you Dr. Niman for the help.

Now we can only crossfingers that the actual nasty seasonal flu version in Ausi is:
? an A/Brisbane/59/2007 (H1N1)-like virus;
(?)
___
From your previous thread:
"... there have been an increasing number of recent viruses of the alternative B lineage (B/Victoria-lineage) found recently in Australia and New Zealand. Some of these cases were found at the World Youth Day in Sydney where there were also outbreaks of A(H1) and A(H3) viruses during this week in mid July. Recently cases of A(H1) viruses that are resistant to oseltamivir have been detected in Australia (but not in NZ) with 8 detected in WYD samples and 2 from other parts of Australia. Oseltamivir resistant viruses have also predominated in South Africa during the 2008 winter season...."

H274Y is on Brisbane/59, but was already changing in South Africa several months ago, so the new vacine in the north will have limited utility.

Giuseppe · Sep 5, 2008

Re: Seasonal Flu 2008 - 2009

[EISS, EUROPEAN UNION, SEASONAL INFLUENZA, UPDATES] EISS - Inter-season Electronic Bulletin - Week 35 : 25/08/2008-31/08/2008 - 05 September 2008, Issue N? 271 - Sporadic laboratory confirmed cases of influenza in Europe (http://www.eiss.org/cgi-files/bulletin_v2.cgi)

? Summary:

Influenza virus detections occur sporadically in Europe. One detection was reported in week 34/2008, and another one in week 35/2008.

Out of 13 countries reporting the geographical spread indicator in week 34-35/2008, 12 countries reported no influenza activity and Switzerland reported sporadic activity.

In week 34-35/2008, only two influenza viruses were detected in Europe out of a total of 123 investigated specimens: one influenza A not subtyped virus in the Poland from a sentinel specimen and one influenza A not subtyped virus detected in Switzerland from a non-sentinel specimen.

There have been no reports of unusual influenza activity in Europe at a community level (i.e. in a region or local area such as a city, county or district) since week 16/2008.

? Background:

The Inter-season Electronic Bulletin presents and comments influenza activity based on virological data reported to EISS. In weeks 34/2008 and 35/2008, a total of 15 countries reported virological data to EISS. The Inter-season Electronic Bulletin will be published between week 21/2008 and week 39/2008.

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

? Graph

The graph presents the total number of specimens positive for influenza A and B viruses in Europe during the inter-season period.

? Map

The map presents the geographical spread as assessed by each of the networks in EISS.

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

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.

-

-------

Giuseppe · Sep 5, 2008

Re: Seasonal Flu 2008 - 2009

[ECDC, ANTIVIRALS, SEASONAL INFLUENZA, A/H1N1, UPDATES] Resistance to oseltamivir (Tamiflu) in some European influenza virus samples (http://ecdc.europa.eu/en/Health_topics/influenza/antivirals.aspx)

As the influenza season is over, all data on the WHO, ECDC and EISS web-sites will now be updated only monthly with the next update at the end of August. Data can be expected to change because of testing of specimens taken earlier in the season.

EU data updated 28th August ? Global data 20th August 2008 ? next update at the end of September

In late January 2008, antiviral drug susceptibility surveillance of seasonal influenza viruses was carried out in Europe (the EU-EEA-EFTA countries) by the EU-funded VIRGIL network. The National Influenza Centres revealed that some of the A (H1N1) viruses circulating this season (winter 2007-8) are resistant to the antiviral drug oseltamivir through mutation at position 274 in the viral neuraminidase gene.

Analysis of 2898 A(H1N1) viruses from 25 European (European Union, EEA/EFTA) countries isolated between November 2007 and late July 2008 (data archived on August 6th) showed that 704 were resistant to oseltamivir, but retained sensitivity to zanamivir and amantadine. The data are shown as a figure with a linked table.

The proportion of A(H1N1) viruses that are oseltamivir resistant varied significantly across Europe.

The highest proportion of resistant viruses to date have been in Norway where 184 (67%) of the 273 samples are resistant to oseltamivir, whereas no resistant viruses have been detected in five of the 25 countries. Due to back testing of specimens previously collected some results are now available.

What is new this month from EU countries are the first data for Estonia, where 3 of 7 A(H1N1) specimens show the marker for resistance.

Surveillance in previous years by the Virgil Project found <1% of circulating viruses to be resistant The predominant influenza A viruses in Europe in winter 07/08 were A(H1N1) viruses, antigenically similar to the A/Solomon Islands/3/2006 virus included in the 2007/08 N Hemisphere vaccine.

As the season progressed influenza B viruses started to circulate and then predominated.

There was only limited circulation of other influenza A in Europe. Further details on country to country virus distribution this season are available on the European Influenza Surveillance Scheme (EISS) weekly update as well as in Influenza News.

Following the observation of a high level of resistance to oseltamivir in the A(H1N1) viruses circulating in Norway, the Norwegian authorities notified their EU partners and the World Health Organization (WHO) of this situation at the end of January. The Norwegian Public Health Institute also published an advisory to doctors and the public.

The country with the second highest proportion is now Belgium (53%) followed by France with 231 (47%) of 496 specimens showing the marker for oseltamivir resistance. This is then followed by the Netherlands and Luxembourg with proportions of 27% and 26% respectively.

There is no evidence that the appearance of these new viruses are related to use of oseltamivir which is currently seemingly not widely prescribed in most European countries.

ECDC is now working with the manufacturer and national authorities to gather more information on routine oseltamivir use in Europe.

Experts from the European Centre for Disease Prevention and Control (ECDC), the European Commission, the European Influenza Surveillance Scheme and the World Health Organization (WHO) are currently assessing the significance of the data from the EISS VIRGIL network. An interim European risk assessment has been published by ECDC and comments on this are welcomed to influenza@ecdc.europa.eu.

Global surveillance started immediately after the detection in Europe and is being coordinated by WHO, and evidence has been found of similarly resistant viruses in North America and the Far East. All data including that on the WHO web-site are updated at monthly intervals at present.

The latest global data were posted on August 20th and now WHO is showing data separately for the 2007/8 winter season (Last Quarter 2007 to March 2008) and the 2008 season (Table 1 Second Quarter 2008 to August 20th).

At the global level the most recent notable finding was from South Africa where now all 107 influenza A/H1N1 specimens gathered since the start of the second Quarter 2008 showed the marker of resistance.

Their findings have been confirmed by WHO Collaborating Centres.

To date there have been 136 specimens influenza A/H1N1 specimens tested from WHO?s Africa Region but only nine of these have shown the markers of resistance apart from those from South Africa.

Other significant national proportions of A/H1N1 specimens for the Southern Hemisphere or Equatorial regions showing resistance for which there are data are from Australia (10 out of 10), Chile (4 out of 13), Argentina (2 out of 5) and the Hong Kong Region of China 97 out of 483 (17%). These are the first of these viruses reported from the Southern Cone of South America.

Looking back to the earlier period (Quarter 4 2007 to end of Quarter 1 2008 equivalent to the Northern Hemisphere winter season where there are data on more than 50 specimens the results are: the Russian Federation 45%, (58 of 128), Canada 26% (127 of 486), United States 12% (126 of 1026), Japan 3% (44 of 1652), Hong Kong 12% (98 of 797), Australia 4% (3 of 83), Madagascar (none of 59), Korea (none of 99%) and New Zealand (none of 88).

As well as the WHO monthly table. WHO is publishing less frequent analytic summaries on the WHO web-site. WHO also published regular summaries on influenza in the world. The last of these was published in late July.

These data are interesting because they firstly indicate that these A(H1N1) viruses are not going away and also that they seem to be following the pattern suggested for A(H3N2) viruses of spreading eventually to even the Southern Cone of South America.(1)

Although sporadic low level transmission of drug resistant viruses may have taken place since 1999 when the Neuraminidase Inhibitor drugs first were licensed, the 07/08 winter season is the first time there has been widespread and sustained transmission of such viruses in the community. Similar viruses have been seen before, but usually following treatment.

Such viruses previously have not been able to readily transmit and have rapidly disappeared.

Clinical experience in Norway and elsewhere suggests that people who become ill with an oseltamivir resistant strain of A(H1N1) have a similar spectrum of illness to those infected with ?normal? seasonal influenza A which can cause severe disease or death in vulnerable people (older people, those with debilitating illnesses and the very young).

This is now being investigated in national studies and international studies coordinated by ECDC.

At this stage the significance of these findings remains uncertain.

The emergence of drug resistance in the context of limited drug use is unexpected, and the extent of future circulation is difficult to predict.

ECDC, WHO, EISS, VIRGIL and authorities in the member states are undertaking intensive surveillance and progress will be reported through this and other relevant web-pages. A summary of the arrangements for the EU EEA & EFTA Countries is on the ECDC web-site this is also available in a pdf version as a briefing for policy makers in the EU and EEA/EFTA Member States.

(1) Russell C, Jones T, Barr I et al The global circulation of seasonal influenza A (H3N2) viruses Science 2008; 320 340-6.

Data were provided by the European Influenza Surveillance Scheme http://www.eiss.org/index.cgi and the VIRGIL Project http://www.virgil-net.org/ ECDC would like to thank all countries, virologists, clinicians and others for contributing data. Funding for the VIRGIL project comes from the European Union FP6 Research Programme
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HenryN · Sep 5, 2008

Re: Seasonal Flu 2008 - 2009

<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=content vAlign=top>1.</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>20</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>3</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>21</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>7</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>22</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>5</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>23</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>5</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>24</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>4</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>25</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>12</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>26</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>22</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>27</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>25</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>28</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>31</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>29</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>66</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>30</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>117</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>31</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>164</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>32</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>153</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>33</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>98</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>34</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>64</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>China</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>35</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>66</TD><TD class=content vAlign=top align=middle>view</TD></TR></TBODY></TABLE>

Seasonal Flu 2008 - 2009

Senior Moderator

Retired

Retired

Retired

Editor, Senior Moderator

Editor, Senior Moderator

Well-known member

Editor, Senior Moderator

Editor, Senior Moderator

Well-known member

Retired

Well-known member

Editor, Senior Moderator

Well-known member

Retired

Well-known member

Retired

Emeritus

Emeritus

Retired