From "FluWiki":
France
? The ethics of pandemics
http://www.ecdc.eu.int/Health_topics/influenza/news/news_Influenza_071108.html#Public1
ECDC - Influenza news 8th November 2007
Excerpt:
Public health developments
The ethics of pandemics ? Centre and Journal in France
The next pandemic will be different from those of the 20th century in that there will be more specific countermeasures and treatments available. There will be antivirals available, more intensive care and after some months specific pandemic vaccines. Hence some people who would have died in previous pandemics will now survive. However there will not be sufficient resources and facilities for all. For example some people with severe disease who might have been saved by a short course artificial ventilation will die because of finite resources. Also who should receive the first supplies of specific pandemic vaccine when it becomes available? The most vulnerable elderly, children or child-bearing women. Also is it right that H5N1 vaccines should be developed from viruses sources in poorer countries without then becoming available to the populations of those countries.<SUP>1</SUP> These issues move outside the area of technical medicine into that of ethics and even political considerations. In its self-assessments done with EU/EEA member states this is a topic that ECDC checks that countries have at least thought about. Specific work on the topic has been done by WHO and by certain EU member states.<SUP>2-4</SUP> A specialist centre in France the Espace ?thique de l'Assistance Publique H?pitaux de Paris (www.espace-ethique.org/fr/grippe.php) is very much involved in thought on pandemic's ethical issues in Europe and works closely with WHO Geneva. It has published two issues of a new journal on influenza pandemic ethics. The first issue is available in English as well as French.<SUP>5</SUP>
____________
ECDC:
Influenza news
<!-- HT link box start -->Influenza news
ECDC activities
Web links
Related topics
Avian influenza
Seasonal influenza
Pandemic influenza
Scientific Developments
Public health developments
Meetings and workshops
<HR>Epidemiological updates
Seasonal Influenza ? European Status
Text updated from: European Influenza Surveillance Scheme (EISS) Weekly Electronic Bulletin
Issue 239, Week 44 (29/10/2007-04/11/2007)
Low levels of influenza activity in Europe
Summary: Levels of influenza activity remain low in Europe, with 28 countries reporting no or only sporadic influenza activity this week. There has been no change in influenza activity in the last week, or since the start of the 2007-2008 season in week 40/2007, and seasonal influenza activity has not yet started in any part of Europe.
Epidemiological situation - week 44/2007: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low inall of the 28 countries providing these data. For the geographical spread indicator, sporadic influenza activity was reported in England, France and Scotland; the remaining 25 countries reported no activity.
Cumulative epidemiological situation - 2007-2008 season (week 40-44/2007): So far this season, the consultation rates for ILI and/or ARI across the whole of Europe have been at levels usually seen outside the winter period (i.e. below the national baseline threshold).
Virological situation - week 44/2007: The total number of respiratory specimens collected by sentinel physicians in week 44/2007 was 239, of which two (0.8%) were influenza virus positive (both influenza B viruses; reported by Poland). In addition, six influenza virus detections (five A and one B) were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals). The non-sentinel findings were reported by England (two A subtype H1), Scotland (one A not subtyped and one B), Sweden (one A not subtyped) and Switzerland (one A not subtyped).
Cumulative virological situation - 2006-2007 season (since week 40-44/2007): Based on (sub)typing data of all influenza virus detections since week 40/2007 (N=47; sentinel and non-sentinel data), 11 were A (not subtyped), 13 were A(H1), six were A(H3) and 17 were B. The influenza virus detections were reported by the following countries: Denmark (2), England (9), France (8), Germany (3), Hungary (1), Ireland (1), the Netherlands (3), Poland (2), Scotland (6), Slovakia (1), Spain (4), Sweden (5) and Switzerland (2).
Based on the antigenic and/or genetic characterisation of four influenza viruses, six were A/Solomon Island/3/2006 (H1N1)-like and one was B/Florida/4/2006-like (B/Yamagata/16/88 lineage).
Comment: Influenza activity in Europe remains low which is typical for this time of the year. There have been only sporadic laboratory confirmed cases of influenza since week 40/2007 and these have been reported across the whole of Europe: in Denmark, England, France, Germany, Hungary, Ireland, the Netherlands, Poland, Scotland, Slovakia, Spain, Sweden and Switzerland. For the whole of Europe, out of the three influenza viruses A(H1), A(H3) and B, no one group has yet emerged as the dominant virus.
Background: The Weekly Electronic Bulletin presents and comments influenza activity in the 30 European countries that are members of EISS. In week 43/2007, 28 countries reported clinical data and 27 countries reported virological data to EISS. 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).
Full interactive EISS bulletin including maps and graphs by country and informative links in the text
National/regional bulletins in Europe and other bulletins from around the world
Links to general information from EISS:
General information on EISS, including background, membership and information on citing the EISS bulletin
Definitions of epidemiological indicators used by EISS
? Back to top
AVIAN INFLUENZA ?HUMAN HEALTH ? INDONESIA
5 November 2007
The WHO reported this week that the Ministry of Health of Indonesia has announced another new case of human infection of H5N1 avian influenza. A 30-year-old female from the Tangerang Municipality, Banten Province developed symptoms on 23 October, was hospitalized on 31 October and died in an AI referral hospital on 3 November. The investigation found that there were poultry deaths in the case's neighborhood in the days prior to her onset of symptoms. The WHO report contains no mention of associated human cases. Of the 112 cases confirmed to date in Indonesia, 90 have been fatal.
WHO report on case in Indonesia (updated 5th November)
Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO (updated 5th November).
H5N1 avian influenza: timeline of major events (updated 19th October).
? Back to top
Scientific Developments
Duration of influenza A virus shedding in hospitalized patients and implications for infection control
Leekha S, et al.
Infect Control Hosp Epidemiol. 2007; 28: 1071-6
Description:the aim of this study was to assess the duration of Influenza A virus shedding at or beyond 7 days since the onset of Influenza Like Illness (ILI) symptoms. Patients were recruited among those admitted for ILI symptoms in a single hospital in Minnesota. If the first specimen collected was positive for Influenza A at PCR, sequential specimens were collected at days 2, 3, 5 and 7 since hospital admission (if still hospitalised). Throat swabs were tested using both PCR and cell cultures. Of 149 patients hospitalized with influenza A virus infection, 50 patients were enrolled in the study. Only patients hospitalized for >48 hours were included. Most patients were older (median age, 76 years), and almost all (96%) had underlying chronic medical conditions. Of 41 patients included in the final analysis, influenza A virus was detected in 22 (54%) by PCR and in 12 (29%) by culture methods at or beyond 7 days after symptom onset. The longest duration of virus shedding in this study was 14 days. All 12 patients identified by culture also had PCR results positive for influenza A virus. No significant differences in the duration of virus shedding were observed by influenza vaccination status and antiviral treatment received. The main conclusion of the study was that hospitalized patients with influenza A virus infection can shed detectable virus beyond the 5- to 7-day period traditionally considered the duration of infectivity.
ECDC comment (1/11/2007): This small study found that elderly individuals with pre-existing medical conditions and requiring hospitalization for influenza associated complication or severe manifestations, might shed influenza virus for longer than previously presumed. These findings are relevant to infection control since one interpretation is that hospital discharge or interruption of isolation measures (usually done after 5 days since symptom onset) might be premature for certain patients. In such cases, individuals who are still infectious may mix with other susceptible, and be responsible for outbreaks in hospitals, nursing homes, the community, etc.
However the results of this study should be interpreted with some caution. First of all findings cannot be generalised to all patients in hospital. The population included consisted of older subjects with pre-existing medical conditions who represent a selected groups at high risk of severe disease. These individuals might have impaired mechanisms for clearing the infection. In addition as was demonstrated for the case of another viral respiratory infection SARS with a similar reproductive number, a positive PCR tests does not necessarily mean infectiousness and risk to others.<SUP>1</SUP> The proportion of cultures still positive after 7 days since symptoms? onset was relatively low. To actually know that patients were infectious beyond 5 or 7 days it would need to be shown that infection took place beyond the period not just that some virus was being shed. In addition this study did not have the power (size of sample) to show the effectiveness of vaccination and antiviral treatment in reducing infectiousness and duration of virus shedding. Despite these limitations, this study demonstrates yet again that more research is needed to better understand dynamics of influenza virus transmission.<SUP>2</SUP> It also suggests that more specific recommendation might be needed for isolation of individuals known to be at higher risk of prolonged infectiousness as these might also be those more likely to transmit the infection in hospitals and other institutional settings.
? Back to top
Public health developments
The ethics of pandemics ? Centre and Journal in France
The next pandemic will be different from those of the 20th century in that there will be more specific countermeasures and treatments available. There will be antivirals available, more intensive care and after some months specific pandemic vaccines. Hence some people who would have died in previous pandemics will now survive. However there will not be sufficient resources and facilities for all. For example some people with severe disease who might have been saved by a short course artificial ventilation will die because of finite resources. Also who should receive the first supplies of specific pandemic vaccine when it becomes available? The most vulnerable elderly, children or child-bearing women. Also is it right that H5N1 vaccines should be developed from viruses sources in poorer countries without then becoming available to the populations of those countries.<SUP>1</SUP> These issues move outside the area of technical medicine into that of ethics and even political considerations. In its self-assessments done with EU/EEA member states this is a topic that ECDC checks that countries have at least thought about. Specific work on the topic has been done by WHO and by certain EU member states.<SUP>2-4</SUP> A specialist centre in France the Espace ?thique de l'Assistance Publique H?pitaux de Paris (www.espace-ethique.org/fr/grippe.php) is very much involved in thought on pandemic's ethical issues in Europe and works closely with WHO Geneva. It has published two issues of a new journal on influenza pandemic ethics. The first issue is available in English as well as French.<SUP>5</SUP>
USA National Influenza Vaccination Week
CDC announced the second annual National Influenza Vaccination Week (NIVW), taking place November 26 to December 2, 2007. NIVW serves to remind people who have not yet been vaccinated that the time to get a flu vaccine continues into winter ? through January or later, when the influenza season typically peaks. Throughout the week, CDC will be highlighting the importance of influenza vaccination for those people at high risk, their close contacts, and all those who want to be protected against influenza.
NIVW web page
NIVW Media Toolkit
NIVW educational materials
CDC flu website
? Back to top
Meetings and workshops
Intergovernmental Meeting on Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits, Geneva, 20?23 November 2007
This is the culmination of a series of high level meetings to reach international consensus on terms and conditions for sharing viruses between originating countries, WHO Collaborating Centres and third parties, and to revise the terms of reference of WHO Collaborating Centres.
Agenda and background information can be found at:
http://www.who.int/gb/pip/
? Back to top
3rd ESWI European Influenza Conference, Vilamoura, Portugal 14-17 September 2008.
The European Scientific Working group on Influenza (EWSI) - an independent group of European scientists promoting the study of influenza ? will hold its third European Influenza Conference in the autumn of 2008.
Preliminary conference information can be found at: http://www.eswi.org/Events.cfm
? Back to top
Contributions Requested The ECDC influenza project team very much welcomes potential contributions to this newsletter from EU/EEA member states particularly concerning public health developments and scientific published papers. This includes publications in non-English languages. These should be sent, preferably with a web-link, to Influenza@ecdc.europa.eu. If drawing to our attention a non-English language article for development, a short summary in English is appreciated. However, this is not essential because of its multi-national staff, ECDC can cope with most languages from within the EU.
France
? The ethics of pandemics
http://www.ecdc.eu.int/Health_topics/influenza/news/news_Influenza_071108.html#Public1
ECDC - Influenza news 8th November 2007
Excerpt:
Public health developments
The ethics of pandemics ? Centre and Journal in France
The next pandemic will be different from those of the 20th century in that there will be more specific countermeasures and treatments available. There will be antivirals available, more intensive care and after some months specific pandemic vaccines. Hence some people who would have died in previous pandemics will now survive. However there will not be sufficient resources and facilities for all. For example some people with severe disease who might have been saved by a short course artificial ventilation will die because of finite resources. Also who should receive the first supplies of specific pandemic vaccine when it becomes available? The most vulnerable elderly, children or child-bearing women. Also is it right that H5N1 vaccines should be developed from viruses sources in poorer countries without then becoming available to the populations of those countries.<SUP>1</SUP> These issues move outside the area of technical medicine into that of ethics and even political considerations. In its self-assessments done with EU/EEA member states this is a topic that ECDC checks that countries have at least thought about. Specific work on the topic has been done by WHO and by certain EU member states.<SUP>2-4</SUP> A specialist centre in France the Espace ?thique de l'Assistance Publique H?pitaux de Paris (www.espace-ethique.org/fr/grippe.php) is very much involved in thought on pandemic's ethical issues in Europe and works closely with WHO Geneva. It has published two issues of a new journal on influenza pandemic ethics. The first issue is available in English as well as French.<SUP>5</SUP>
____________
ECDC:
Influenza news
<!-- HT link box start -->Influenza news
ECDC activities
Web links
Related topics
Avian influenza
Seasonal influenza
Pandemic influenza
<!-- HT link box end -->Thursday 8th November 2007
Epidemiological updates Scientific Developments
Public health developments
Meetings and workshops
- Intergovernmental Meeting on Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits, Geneva, 20?23 November 2007
- 3rd ESWI European Influenza Conference, Vilamoura, Portugal 14-17 September 2008
<HR>Epidemiological updates
Seasonal Influenza ? European Status
Text updated from: European Influenza Surveillance Scheme (EISS) Weekly Electronic Bulletin
Issue 239, Week 44 (29/10/2007-04/11/2007)
Low levels of influenza activity in Europe
Summary: Levels of influenza activity remain low in Europe, with 28 countries reporting no or only sporadic influenza activity this week. There has been no change in influenza activity in the last week, or since the start of the 2007-2008 season in week 40/2007, and seasonal influenza activity has not yet started in any part of Europe.
Epidemiological situation - week 44/2007: For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low inall of the 28 countries providing these data. For the geographical spread indicator, sporadic influenza activity was reported in England, France and Scotland; the remaining 25 countries reported no activity.
Cumulative epidemiological situation - 2007-2008 season (week 40-44/2007): So far this season, the consultation rates for ILI and/or ARI across the whole of Europe have been at levels usually seen outside the winter period (i.e. below the national baseline threshold).
Virological situation - week 44/2007: The total number of respiratory specimens collected by sentinel physicians in week 44/2007 was 239, of which two (0.8%) were influenza virus positive (both influenza B viruses; reported by Poland). In addition, six influenza virus detections (five A and one B) were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals). The non-sentinel findings were reported by England (two A subtype H1), Scotland (one A not subtyped and one B), Sweden (one A not subtyped) and Switzerland (one A not subtyped).
Cumulative virological situation - 2006-2007 season (since week 40-44/2007): Based on (sub)typing data of all influenza virus detections since week 40/2007 (N=47; sentinel and non-sentinel data), 11 were A (not subtyped), 13 were A(H1), six were A(H3) and 17 were B. The influenza virus detections were reported by the following countries: Denmark (2), England (9), France (8), Germany (3), Hungary (1), Ireland (1), the Netherlands (3), Poland (2), Scotland (6), Slovakia (1), Spain (4), Sweden (5) and Switzerland (2).
Based on the antigenic and/or genetic characterisation of four influenza viruses, six were A/Solomon Island/3/2006 (H1N1)-like and one was B/Florida/4/2006-like (B/Yamagata/16/88 lineage).
Comment: Influenza activity in Europe remains low which is typical for this time of the year. There have been only sporadic laboratory confirmed cases of influenza since week 40/2007 and these have been reported across the whole of Europe: in Denmark, England, France, Germany, Hungary, Ireland, the Netherlands, Poland, Scotland, Slovakia, Spain, Sweden and Switzerland. For the whole of Europe, out of the three influenza viruses A(H1), A(H3) and B, no one group has yet emerged as the dominant virus.
Background: The Weekly Electronic Bulletin presents and comments influenza activity in the 30 European countries that are members of EISS. In week 43/2007, 28 countries reported clinical data and 27 countries reported virological data to EISS. 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).
Full interactive EISS bulletin including maps and graphs by country and informative links in the text
National/regional bulletins in Europe and other bulletins from around the world
Links to general information from EISS:
General information on EISS, including background, membership and information on citing the EISS bulletin
Definitions of epidemiological indicators used by EISS
? Back to top
AVIAN INFLUENZA ?HUMAN HEALTH ? INDONESIA
5 November 2007
The WHO reported this week that the Ministry of Health of Indonesia has announced another new case of human infection of H5N1 avian influenza. A 30-year-old female from the Tangerang Municipality, Banten Province developed symptoms on 23 October, was hospitalized on 31 October and died in an AI referral hospital on 3 November. The investigation found that there were poultry deaths in the case's neighborhood in the days prior to her onset of symptoms. The WHO report contains no mention of associated human cases. Of the 112 cases confirmed to date in Indonesia, 90 have been fatal.
WHO report on case in Indonesia (updated 5th November)
Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO (updated 5th November).
H5N1 avian influenza: timeline of major events (updated 19th October).
? Back to top
Scientific Developments
Duration of influenza A virus shedding in hospitalized patients and implications for infection control
Leekha S, et al.
Infect Control Hosp Epidemiol. 2007; 28: 1071-6
Description:the aim of this study was to assess the duration of Influenza A virus shedding at or beyond 7 days since the onset of Influenza Like Illness (ILI) symptoms. Patients were recruited among those admitted for ILI symptoms in a single hospital in Minnesota. If the first specimen collected was positive for Influenza A at PCR, sequential specimens were collected at days 2, 3, 5 and 7 since hospital admission (if still hospitalised). Throat swabs were tested using both PCR and cell cultures. Of 149 patients hospitalized with influenza A virus infection, 50 patients were enrolled in the study. Only patients hospitalized for >48 hours were included. Most patients were older (median age, 76 years), and almost all (96%) had underlying chronic medical conditions. Of 41 patients included in the final analysis, influenza A virus was detected in 22 (54%) by PCR and in 12 (29%) by culture methods at or beyond 7 days after symptom onset. The longest duration of virus shedding in this study was 14 days. All 12 patients identified by culture also had PCR results positive for influenza A virus. No significant differences in the duration of virus shedding were observed by influenza vaccination status and antiviral treatment received. The main conclusion of the study was that hospitalized patients with influenza A virus infection can shed detectable virus beyond the 5- to 7-day period traditionally considered the duration of infectivity.
ECDC comment (1/11/2007): This small study found that elderly individuals with pre-existing medical conditions and requiring hospitalization for influenza associated complication or severe manifestations, might shed influenza virus for longer than previously presumed. These findings are relevant to infection control since one interpretation is that hospital discharge or interruption of isolation measures (usually done after 5 days since symptom onset) might be premature for certain patients. In such cases, individuals who are still infectious may mix with other susceptible, and be responsible for outbreaks in hospitals, nursing homes, the community, etc.
However the results of this study should be interpreted with some caution. First of all findings cannot be generalised to all patients in hospital. The population included consisted of older subjects with pre-existing medical conditions who represent a selected groups at high risk of severe disease. These individuals might have impaired mechanisms for clearing the infection. In addition as was demonstrated for the case of another viral respiratory infection SARS with a similar reproductive number, a positive PCR tests does not necessarily mean infectiousness and risk to others.<SUP>1</SUP> The proportion of cultures still positive after 7 days since symptoms? onset was relatively low. To actually know that patients were infectious beyond 5 or 7 days it would need to be shown that infection took place beyond the period not just that some virus was being shed. In addition this study did not have the power (size of sample) to show the effectiveness of vaccination and antiviral treatment in reducing infectiousness and duration of virus shedding. Despite these limitations, this study demonstrates yet again that more research is needed to better understand dynamics of influenza virus transmission.<SUP>2</SUP> It also suggests that more specific recommendation might be needed for isolation of individuals known to be at higher risk of prolonged infectiousness as these might also be those more likely to transmit the infection in hospitals and other institutional settings.
- World Health Organization. Consensus Document on the epidemiology of severe acute respiratory syndrome. WHO/cds/csr/gar/2003.11 (October 17th 2003).
http://www.who.int/csr/sars/en/WHOconsensus.pdf - Influenza and Eurosurveillance Editorial Teams, European Centre for Disease Prevention and Control. Influenza transmission: research needs for informing infection control policies and practice
http://www.eurosurveillance.org/ew/2007/070510.asp#1
? Back to top
Public health developments
The ethics of pandemics ? Centre and Journal in France
The next pandemic will be different from those of the 20th century in that there will be more specific countermeasures and treatments available. There will be antivirals available, more intensive care and after some months specific pandemic vaccines. Hence some people who would have died in previous pandemics will now survive. However there will not be sufficient resources and facilities for all. For example some people with severe disease who might have been saved by a short course artificial ventilation will die because of finite resources. Also who should receive the first supplies of specific pandemic vaccine when it becomes available? The most vulnerable elderly, children or child-bearing women. Also is it right that H5N1 vaccines should be developed from viruses sources in poorer countries without then becoming available to the populations of those countries.<SUP>1</SUP> These issues move outside the area of technical medicine into that of ethics and even political considerations. In its self-assessments done with EU/EEA member states this is a topic that ECDC checks that countries have at least thought about. Specific work on the topic has been done by WHO and by certain EU member states.<SUP>2-4</SUP> A specialist centre in France the Espace ?thique de l'Assistance Publique H?pitaux de Paris (www.espace-ethique.org/fr/grippe.php) is very much involved in thought on pandemic's ethical issues in Europe and works closely with WHO Geneva. It has published two issues of a new journal on influenza pandemic ethics. The first issue is available in English as well as French.<SUP>5</SUP>
- European Centre for Disease Prevention and Control. Interim ECDC Scientific and Public Health Briefing: Sharing influenza Virus Samples ? September 2007. Available from: http://www.ecdc.eu.int/pdf/ECDC_influenza_briefing.pdf
- World Health Organization. Addressing Ethical Issues in Pandemic Influenza Planning
http://www.who.int/ethics/influenza_project/en/ - UK Committee on Ethical Aspects of Pandemic Influenza (CEAPI)
http://www.dh.gov.uk/en/PandemicFlu/DH_065163 - Finland. Ministry of Social Affairs and Health. Finland prepares for influenza pandemic. (Press release)
http://www.stm.fi/Resource.phx/publishing/documents/6783/index.htx - Espace ?thique de l'assistance publique h?pitaux de paris Plate-forme veille & reflexion Pandemie grippale, ethique, societejournal pandemiques / pandemics
http://www.espace-ethique.org/fr/grippe.php
USA National Influenza Vaccination Week
CDC announced the second annual National Influenza Vaccination Week (NIVW), taking place November 26 to December 2, 2007. NIVW serves to remind people who have not yet been vaccinated that the time to get a flu vaccine continues into winter ? through January or later, when the influenza season typically peaks. Throughout the week, CDC will be highlighting the importance of influenza vaccination for those people at high risk, their close contacts, and all those who want to be protected against influenza.
NIVW web page
NIVW Media Toolkit
NIVW educational materials
CDC flu website
? Back to top
Meetings and workshops
Intergovernmental Meeting on Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits, Geneva, 20?23 November 2007
This is the culmination of a series of high level meetings to reach international consensus on terms and conditions for sharing viruses between originating countries, WHO Collaborating Centres and third parties, and to revise the terms of reference of WHO Collaborating Centres.
Agenda and background information can be found at:
http://www.who.int/gb/pip/
? Back to top
3rd ESWI European Influenza Conference, Vilamoura, Portugal 14-17 September 2008.
The European Scientific Working group on Influenza (EWSI) - an independent group of European scientists promoting the study of influenza ? will hold its third European Influenza Conference in the autumn of 2008.
Preliminary conference information can be found at: http://www.eswi.org/Events.cfm
? Back to top
Contributions Requested The ECDC influenza project team very much welcomes potential contributions to this newsletter from EU/EEA member states particularly concerning public health developments and scientific published papers. This includes publications in non-English languages. These should be sent, preferably with a web-link, to Influenza@ecdc.europa.eu. If drawing to our attention a non-English language article for development, a short summary in English is appreciated. However, this is not essential because of its multi-national staff, ECDC can cope with most languages from within the EU.