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A TIME'S MEMORY - Flu, Bugs & Other Accidents Blog - Year: XV

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14 Nov 2008

EISS - Weekly Electronic Bulletin Week 45 : 03/11/2008-09/11/2008 - 14 November 2008, Issue N. 279 Continuing low levels of influenza activity in Europe - more countries reporting virus detections

EISS - Weekly Electronic Bulletin Week 45 : 03/11/2008-09/11/2008 - 14 November 2008, Issue N. 279 Continuing low levels of influenza activity in Europe - more countries reporting virus detections

§ Summary:

Levels of influenza activity were low in all European countries reporting data in week 45/2008.

Since week 40/2008, sporadic laboratory-confirmed cases of influenza have been reported from 15 countries across Europe.

§ Epidemiological situation - week 45/2008:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low in all the 26 countries providing data.

For the geographical spread indicator, sporadic influenza activity was reported in England, Ireland, Northern Ireland, Norway and Portugal and no activity in 21 countries.

§ Cumulative epidemiological situation - 2008-2009 season (weeks 40-45/2008):

So far this season, the consultation rates for ILI and/or ARI are at levels usually seen outside the winter period (i.e. below the national baseline threshold).

§ Virological situation - week 45/2008:

The total number of respiratory specimens collected by sentinel physicians in week 45/2008 was 273, of which 17 (6.2%) were influenza virus positive; 16 type A (12 subtype H3, one subtype H1 and three not subtyped), and one type B.

In addition, 24 influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals); 22 type A (two subtype H1 and 20 not subtyped), and two type B.

Detection of influenza viruses was reported from ten countries across Europe, which, with two exceptions, were located along the western borders of Europe (England, Ireland, Northern Ireland, Norway, Portugal, Romania, Spain, Sweden, Switzerland, Wales).

§ Cumulative virological situation - 2008-2009 season (weeks 40-45/2008):

Of virus detections since week 40/2008, (N=125, sentinel and non-sentinel data), 111 were type A (39 subtype H3, 15 subtype H1 and 57 not subtyped), and 14 were type B.

Based on the antigenic and/or genetic characterisation of 23 influenza viruses, six were reported as A/Brisbane/59/2007 (H1N1)-like, 14 as A/Brisbane/10/2007 (H3N2)-like, one as B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and two as B/Malaysia/2506/2004-like (B/Victoria/2/87 lineage).

Analyses of antiviral susceptibility by genetic or phenotypic methods have been reported for nine influenza viruses, five A(H1N1) and three A(H3N2) from the UK and one A(H1N1) from Norway.

Five of the six A(H1N1) viruses were shown to be resistant to oseltamivir (4 from the UK and 1 from Norway) and one to be sensitive; all those tested against zanamivir (4) and amantadine (2) were shown to be sensitive.

The two A(H3N2) viruses tested against amantadine were shown to be resistant; all three A(H3N2) viruses were shown to be sensitive to oseltamivir and zanamivir.

§ Comment:

An increasing number of countries reported sporadic influenza virus detection compared to previous weeks, although this was not accompanied by significant increases in consultation rates.

Most of the countries (11/15) in which influenza viruses have been detected since week 40/2008 are located along the western borders of Europe.

The majority (89%; 111/125) of virus detections have been type A and 72% (39/54) of those subtyped were shown to be H3. It is too soon, however, to conclude which virus type or subtype may become dominant in Europe this season.

Similarly, limited data are available on antiviral resistance and although most (5/6) of the A(H1N1) viruses analysed to date are oseltamivir-resistant it is too early to comment on the resistance pattern for Europe as a whole.

Whilst influenza activity in Europe is currently low, reports of RSV (respiratory syncytial virus), a respiratory virus with clinical symptoms similar to influenza, are increasing in several countries in Europe that report RSV detections to EISS, notably for the UK (e.g. England and Northern Ireland), Ireland and the the Netherlands. The increase in RSV detections at this time of the year is a normal phenomenon in these countries.

§ Background:

The Weekly Electronic Bulletin presents and comments on influenza activity in the 30 European countries that are members of EISS.

In week 45/2008, 26 countries reported clinical data and 24 countries reported virological data to EISS.

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

§ Map

The map presents the intensity of influenza activity and the geographical spread as assessed by each of the networks in EISS.



Europe Year 2008 / Week 45

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 in South-Western Finland (the health-care district serves 54,000 inhabitants i.e. approximately onepercent of the Finnish population).

§ Network comments (where available)

- Norway
One case of influenza A detected by a laboratory in Northern Norway

- Spain
Sporadic AH3 isolates in the North of Spain
EISS - Bulletin Review
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