Giuseppe
Emeritus
EISS - Bulletin Review: Issue N? 303 - Seasonal influenza activity in Europe continues to be low and declining but human infections with a novel influenza virus were reported
EISS - Weekly Electronic Bulletin Week 17 : 20/04/2009-26/04/2009 01 May 2009, Issue N? 303 - Seasonal influenza activity in Europe continues to be low and declining but human infections with a novel influenza virus were reported
Summary:
In week 17/2009, influenza activity remained at baseline levels, with sentinel virus detections being low, in almost all countries and regions of Europe. Only the Russian Federation reported a medium intensity of clinical activity. During the past week cases of infection with novel influenza A (H1N1) virus were reported. The World Health Organisation has raised the pandemic alert level. For further details please see the WHO website (click here).
Epidemiological situation - week 17/2009:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were medium in six of seven regions of the Russian Federation, and low in the other 32 countries that reported this indicator.
For the geographical spread indicator, local influenza activity was reported in the Russian Federation and sporadic or no activity in the other 31 countries. Definitions for the epidemiological indicators can be found here.
Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-17/2009):
Consultation rates for ILI and/or ARI rose above baseline levels as of week 49/2008 in most western and central European countries following a general west to east progression. High influenza intensity, again with peak activity following a general west to east progression, has been reported in 15 countries since week 51/2008. 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. In most countries in western and central Europe the seasonal epidemic appears to be over, with consultation rates for ILI and/or ARI having returned to baseline levels. In Eastern Europe, including the Russian Federation, influenza activity has passed its peak and is declining. Five countries experienced only sporadic influenza activity during the season: Bulgaria, Cyprus, Kazakhstan, Montenegro and Scotland.
Virological situation - week 17/2009:
The total number of respiratory specimens collected by sentinel physicians in week 17/2009 was 329, of which 24 (7.3%) were positive for influenza virus: five type A (one subtype H3, one subtype H1N1 and three not subtyped) and 19 type B. In addition, 84 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 58 type A (26 subtype H3, four subtype H1 and 28 not subtyped) and 26 type B.
Cumulative virological situation - 2008-2009 season (weeks 40/2008-17/2009):
Of 30575 virus detections (sentinel and non-sentinel) since week 40/2008, 25674 (84%) were type A (11659 subtype H3, 1383 subtype H1 and 12632 not subtyped) and 4901 (16%) were type B. Based on the antigenic and/or genetic characterisation of 3642 influenza viruses reported to EISS up to week 17/2009, 2519 (69%) were reported as A/Brisbane/10/2007 (H3N2)-like, 163 (5%) as A/Brisbane/59/2007 (H1N1)-like, 37 (1%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 923 (25%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) (click here). More detailed antigenic and genetic analyses have shown that B/Victoria/2/87 lineage viruses resembled either B/Malaysia/2506/2004-like or B/Brisbane/60/2008-like, the prototype vaccine strain recommended by WHO for inclusion in the 2009-10 vaccine (WER 2009; 84(9): 65-76 (click here)).
Influenza isolates from 20 countries were assessed for antiviral drug susceptibility.
All influenza A(H3N2) viruses tested were sensitive to oseltamivir and zanamivir, but resistant to M2 inhibitors.
Ninety-eight percent of influenza A(H1N1) viruses analysed were resistant to oseltamivir while all those tested against zanamivir were sensitive.
One A(H1N1) virus was M2 inhibitor resistant, but sensitive to the neuraminidase inhibitors.
The small number of influenza B viruses analysed were sensitive to oseltamivir and zanamivir (click here).
Comment:
Influenza activity in Europe is coming to an end, with most influenza virus detections having occurred between weeks 48/2008 and 15/2009 (a 20 week period) (click here ). Influenza activity has returned to baseline levels for most countries in Europe.
A new A(H1N1) subtype influenza virus strain with pandemic potential has emerged triggering vigorous public health actions. For more information please go to the dedicated web pages of ECDC (click here) or WHO (click here).
European Member States have been requested to continue to perform seasonal influenza surveillance until further notice. As of week 18/2009, countries are able to report detections of the new virus to the EISS platform.
Influenza A has been the dominant virus type circulating in Europe, and the majority of these were characterised antigenically and/or genetically as A(H3N2). Of the influenza B viruses that were antigenically and/or genetically characterised the majority were B/Victoria lineage. With the exception of these B/Victoria lineage viruses, 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. The mismatch of these B/Victoria/2/87 lineage viruses with the current vaccine is unlikely to be of public health significance because of limited circulation of influenza B viruses and the dominant circulation of influenza A(H3N2) viruses which matched the strain included in the vaccine. From a public health perspective, the vaccine used this season is therefore expected to have been effective.]
Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS. Of these countries, 27 reported both clinical and virological data, six reported virological data only and five reported clinical data only to EISS in week 17/2009. The spread of influenza viruses 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. To view national/regional bulletins in Europe and other bulletins from around the world, please click here.
Maps
[Not Represented - MSIOH]
Table and graphs (where available)
[Intensity / Geographic Spread / Sentinel swabs / Percentage positive / Dominant type / ILI per 100,000 / ARI per 100,000 / Virology graph and pie chart (not represented MSIOH)]
Intensity:
percentage of sentinel swabs that tested positive for influenza A or B
Dominant type:
this assessment is based on data from sentinel and non-sentinel sources
ARI:
acute respiratory infection
ILI:
influenza-like illness
Population:
per 100,000 population
-
<cite cite="http://www.eiss.org/cgi-files/bulletin_v2.cgi">EISS - Bulletin Review</cite>Summary:
In week 17/2009, influenza activity remained at baseline levels, with sentinel virus detections being low, in almost all countries and regions of Europe. Only the Russian Federation reported a medium intensity of clinical activity. During the past week cases of infection with novel influenza A (H1N1) virus were reported. The World Health Organisation has raised the pandemic alert level. For further details please see the WHO website (click here).
Epidemiological situation - week 17/2009:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were medium in six of seven regions of the Russian Federation, and low in the other 32 countries that reported this indicator.
For the geographical spread indicator, local influenza activity was reported in the Russian Federation and sporadic or no activity in the other 31 countries. Definitions for the epidemiological indicators can be found here.
Cumulative epidemiological situation - 2008-2009 season (weeks 40/2008-17/2009):
Consultation rates for ILI and/or ARI rose above baseline levels as of week 49/2008 in most western and central European countries following a general west to east progression. High influenza intensity, again with peak activity following a general west to east progression, has been reported in 15 countries since week 51/2008. 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. In most countries in western and central Europe the seasonal epidemic appears to be over, with consultation rates for ILI and/or ARI having returned to baseline levels. In Eastern Europe, including the Russian Federation, influenza activity has passed its peak and is declining. Five countries experienced only sporadic influenza activity during the season: Bulgaria, Cyprus, Kazakhstan, Montenegro and Scotland.
Virological situation - week 17/2009:
The total number of respiratory specimens collected by sentinel physicians in week 17/2009 was 329, of which 24 (7.3%) were positive for influenza virus: five type A (one subtype H3, one subtype H1N1 and three not subtyped) and 19 type B. In addition, 84 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 58 type A (26 subtype H3, four subtype H1 and 28 not subtyped) and 26 type B.
Cumulative virological situation - 2008-2009 season (weeks 40/2008-17/2009):
Of 30575 virus detections (sentinel and non-sentinel) since week 40/2008, 25674 (84%) were type A (11659 subtype H3, 1383 subtype H1 and 12632 not subtyped) and 4901 (16%) were type B. Based on the antigenic and/or genetic characterisation of 3642 influenza viruses reported to EISS up to week 17/2009, 2519 (69%) were reported as A/Brisbane/10/2007 (H3N2)-like, 163 (5%) as A/Brisbane/59/2007 (H1N1)-like, 37 (1%) as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 923 (25%) as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage) (click here). More detailed antigenic and genetic analyses have shown that B/Victoria/2/87 lineage viruses resembled either B/Malaysia/2506/2004-like or B/Brisbane/60/2008-like, the prototype vaccine strain recommended by WHO for inclusion in the 2009-10 vaccine (WER 2009; 84(9): 65-76 (click here)).
Influenza isolates from 20 countries were assessed for antiviral drug susceptibility.
All influenza A(H3N2) viruses tested were sensitive to oseltamivir and zanamivir, but resistant to M2 inhibitors.
Ninety-eight percent of influenza A(H1N1) viruses analysed were resistant to oseltamivir while all those tested against zanamivir were sensitive.
One A(H1N1) virus was M2 inhibitor resistant, but sensitive to the neuraminidase inhibitors.
The small number of influenza B viruses analysed were sensitive to oseltamivir and zanamivir (click here).
Comment:
Influenza activity in Europe is coming to an end, with most influenza virus detections having occurred between weeks 48/2008 and 15/2009 (a 20 week period) (click here ). Influenza activity has returned to baseline levels for most countries in Europe.
A new A(H1N1) subtype influenza virus strain with pandemic potential has emerged triggering vigorous public health actions. For more information please go to the dedicated web pages of ECDC (click here) or WHO (click here).
European Member States have been requested to continue to perform seasonal influenza surveillance until further notice. As of week 18/2009, countries are able to report detections of the new virus to the EISS platform.
Influenza A has been the dominant virus type circulating in Europe, and the majority of these were characterised antigenically and/or genetically as A(H3N2). Of the influenza B viruses that were antigenically and/or genetically characterised the majority were B/Victoria lineage. With the exception of these B/Victoria lineage viruses, 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. The mismatch of these B/Victoria/2/87 lineage viruses with the current vaccine is unlikely to be of public health significance because of limited circulation of influenza B viruses and the dominant circulation of influenza A(H3N2) viruses which matched the strain included in the vaccine. From a public health perspective, the vaccine used this season is therefore expected to have been effective.]
Background:
The Weekly Electronic Bulletin presents and comments on influenza activity in the 53 countries that report to EISS. Of these countries, 27 reported both clinical and virological data, six reported virological data only and five reported clinical data only to EISS in week 17/2009. The spread of influenza viruses 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. To view national/regional bulletins in Europe and other bulletins from around the world, please click here.
Maps
[Not Represented - MSIOH]
Table and graphs (where available)
[Intensity / Geographic Spread / Sentinel swabs / Percentage positive / Dominant type / ILI per 100,000 / ARI per 100,000 / Virology graph and pie chart (not represented MSIOH)]
- Albania / Low / None / 0 / 0% / None / 0.0 / 298.6
- Austria / ... / ... / 31 / 0% / None / ... / ...
- Belgium / Low / None / 0 / 0% / None / 13.1/ 881.9
- Bulgaria / Low / None / 0 / 0% / None / 0.0 / 538.7
- Croatia /... / ... / 24 / 0% / None / ... / ...
- Czech Republic / Low / Sporadic / 17 / 5.9% / None / 12.5 / 715.1
- Denmark / Low / None / 0 / 0% / None / 6.9 / 0.0
- England / Low / Sporadic / 3 / 0% / None / 4.0 / 540.4
- Estonia / Low / Sporadic / 8 / 50.0% / Type B / 13.1 / 318.1
- Finland / Low / Sporadic / 17 / 5.9% / None / 0.0
- Georgia / ... / ... / 5 / 80.0% / Type B / ... / ...
- Germany /... / ... / 6 / 0% / None / ... / ...
- Greece / Low / Sporadic / 0 / 0% / None / 42.6 / 0.0
- Hungary / Low / None / 5 / 0% / None / 35.4 / 0.0
- Ireland / Low / None / 0 / 0% / None / 1.7 / 0.0
- Israel / Low / None /... / ... / 3.7 / 0.0
- Italy / Low / Sporadic / 0 / 0% / None / 41.9 / / 0.0
- Kazakhstan / ... / ... / 178 / 2.8% / Type A / ... / ...
- Kyrgyzstan / ... / ... / 4 / 25.0% / None / ... / ...
- Latvia / Low / Sporadic / 0 / 0% / None / 0.9 / 624.8
- Lithuania / Low / Sporadic / 3 / 0% / None / 0.1 / 340.6
- Luxembourg / Low / Sporadic / 1 / 0% / None / ... / ...
- The former Yugoslav Republic of Macedonia / Low / ... / ... / ... / 0.0
- Netherlands / Low / None / 1 / 0% / None / 0.0 / 0.0
- Northern Ireland / Low / None / 0 / 0% / None / 10.9 / 0.0
- Norway / Low / None / 0 / 0% / Type B / 23.8 / 0.0
- Poland / Low / None / ... / ... / ... / 13.3 / 0.0
- Portugal / Low / None / 0 / 0% / None / 1.7 / 0.0
- Romania / Low / Sporadic / 10 / 70.0% / Type B / 0.0 / 805.9
- Russian Federation / Medium / Local / 0 / 0% / Type A / 0.0 / 544.9
- Scotland / Low / None / ... / ... / ... / 0.7 / 0.0
- Serbia / Low / None / 0 / 0% / None / 23.0 / 0.0
- Slovakia / Low / Sporadic / 0 / 0% / None / 108.3 / 1140.3
- Slovenia / Low / Sporadic / 1 / 0% / Type B / 0.0 / 726.4
- Spain / Low / None / 0 / 0% / None / 6.7 / 0.0
- Sweden / Low / None / 0 / 0% / Type A and B / 0.0 / 0.0
- Switzerland / Low / Sporadic / ... / ... / ... / 2.0 / 0.0
- Ukraine / Low / Sporadic / 15 / 6.7% / Type A / 0.0 / 350.8
- Wales / Low / None / ... / ... / ... / 1.1 / 0.0
- Europe / ... / ... / 327 / 7.3%
Intensity:
- Low = no influenza activity or influenza activity at baseline level;
- Medium= usual levels of influenza activity;
- High = higher than usual levels of influenza activity;
- Very high = particularly severe levels of influenza activity.
percentage of sentinel swabs that tested positive for influenza A or B
Dominant type:
this assessment is based on data from sentinel and non-sentinel sources
ARI:
acute respiratory infection
ILI:
influenza-like illness
Population:
per 100,000 population
-
