Seasonal Flu --- 2008 - 2009

[Dutchy]

Seasonal Influenza – European Status

Summary: Levels of influenza activity in Europe are low, with all countries reporting no or only sporadic influenza activity in week 41/2008.

There have been sporadic laboratory confirmed cases of influenza in weeks 40-41/2008: 12 cases of influenza A and one case of influenza B.

http://ecdc.europa.eu/en/Health_Topics/influenza/news/news_Influenza_081016.aspx#Seasonal

[Dutchy]

- snip -

Since September 30, 2007, WHO and NREVSS laboratories have tested a total of 218,493 specimens for influenza viruses and 39,407 (18.0%) were positive. Among the 39,407 influenza viruses, 28,091 (71.3%) were influenza A viruses and 11,316 (28.7%) were influenza B viruses. Eight thousand two hundred seventy-two (29.4%) of the 28,091 influenza A viruses have been subtyped: 2,173 (26.3%) were influenza A (H1) viruses and 6,099 (73.7%) were influenza A (H3) viruses.

During week 40, WHO and NREVSS laboratories reported 1,123 specimens tested for influenza viruses, eight of which were positive: five influenza A viruses that were not subtyped (Mountain, Pacific, South Atlantic and West South Central regions) and three influenza B virus (Mountain and South Atlantic regions).

http://www.cdc.gov/flu/weekly/fluactivity.htm

[Dutchy]

Low levels of influenza activity continue to be reported in Canada; no new
laboratory detections reported this week

During week 41, influenza activity in Canada remained low with the majority of the influenza surveillance regions reporting no activity and only six regions (in NS, QC, ON & AB) reported sporadic influenza activity (see map).

No specimens tested positive for influenza in Canada this week (percentage positive = 0%; 0/1,167) (see table).

In week 41, the ILI consultation rate was 18 ILI consultations per 1,000 patient visits (see ILI graph), and is within the expected range for this week. The sentinel response rate has been slowly increasing over the last
several weeks but remained low at 47% for this week.

Fluctuations in ILI consultation rates are expected during periods of low influenza activity and low sentinel participation. No new influenza outbreaks were reported in week 41.

Antigenic Characterization:

Since 1 September 2008, National Microbiology Laboratory (NML) has antigenically characterized three influenza viruses:
one influenza A/Brisbane/59/2007(H1N1)-like and two influenza B/Florida/4/2006 viruses, which are the influenza A(H1N1) and influenza B components recommended for the 2008-09 influenza vaccine.

Antiviral Resistance:

The testing results showed that the influenza A(H1N1) isolate was sensitive to amantadine, however, it was resistant to oseltamivir due to the H274Y mutation. Both of the influenza B viruses tested were found to be sensitive to oseltamivir.

http://www.phac-aspc.gc.ca/fluwatch/08-09/w41_08/pdf/fw2008-41-eng.pdf

credits Niman@FT

[drummagick]

Flu has been confirmed in North Central Washington. I am seeing my doc tomorrow and will probably ask for a flu shot.

Has anyone heard if the vaccine is a better match this year than last?

[Sysiphus]

Has anyone heard if the vaccine is a better match this year than last?

Supposedly, it's pretty close this year, but who really knows what will come down the pipe once flu season really hits.

[Auburn Boy]

Oh well,

THe longer H5N1 takes to become H2H, the longer it HAS to pick up full blown Tamiflu resistance..,

No silver lining to be seen there.

[Kassy]

Identification in the UK of the 1st oseltamivir-resistant influenza
A(H1N1) virus of the 2008/09 season
---------------------------

Since week 34/08, several sporadic, laboratory-confirmed influenza
infections have been detected in the United Kingdom (UK): isolates
have included influenza A(H3N2), A(H1N1) and influenza B.


The 1st oseltamivir resistant
influenza A(H1N1) for the 2008/09 season has also
been identified in the UK through the HPA
sentinel GP virological surveillance scheme. The
virus contains the H274Y mutation but remains
sensitive to zanamivir and amantadine, and is
antigenically similar to the H1N1 reference
strain A/Brisbane/ 59/2007, which is included in
this season's influenza vaccine. Antiviral
susceptibility tests on A(H3) isolates showed
that they are sensitive to oseltamivir and zanamivir.

With laboratory-confirmed sporadic influenza
infections of various strains in circulation at
the start of this autumn season, it is important
to emphasise that people in the defined influenza
risk groups should take up the recommendation of
influenza vaccination. It is too early in the
season to predict the course of the 2008/09
influenza season, and whether it will be
dominated by the circulation of H1N1, H3N2, or
influenza B. The Agency will be closely
monitoring the characteristics of circulating
isolates in order to determine the overall
prevalence of drug resistant influenza A and B isolates.

Influenza virus detections across Europe have
been low so far in the 2008/09 influenza season
(13 to date) and the above-mentioned H1N1
oseltamivir-resistant influenza isolate is, to
the Agency's knowledge, the 1st detected in
Europe. Influenza A oseltamivir resistance 1st
emerged last season with a number of circulating
influenza A(H1N1) isolates with the H274Y
mutation, which confers resistance to
oseltamivir, but not to zanamivir. By the end of
the 2007/08 season, 26 out of 33 reporting
European countries reported H1N1 oseltamivir
resistance ranging from 4 percent in Spain to 67
percent in Norway, with 11 percent (38/347) in
the UK [1,2].

The epidemiological evidence from the 2007/08 season suggested no
reported increase in morbidity associated with these confirmed
oseltamivir-resistant cases.

Reports between the 2nd quarter 2008 and September 2008 from WHO
showed high prevalence of resistance in the southern hemisphere with
100 percent (129/129) of H1N1 strains oseltamivir resistant in South
Africa, and 96 percent (25/26) strains in Australia [2].

http://www.promedmail.org/pls/otn/f?p=2400:1001:1016477867711879::NO::F2400_P1001_BA CK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,74516

[Dutchy]

USA : http://www.google.org/flutrends/

[Dutchy]

2008-2009 Influenza Season Week 46, ending November 15, 2008

(All data are preliminary and may change as more reports are received.)

Synopsis:

During week 46 (November 9-15, 2008), a low level of influenza activity was reported in the United States.

Sixteen (0.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, and reported to CDC/Influenza Division, were positive for influenza.

The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.

The proportion of outpatient visits for influenza-like illness (ILI) was below national and region-specific baseline levels.

Twenty-one states, the District of Columbia, and Puerto Rico reported sporadic influenza activity and 29 states reported no influenza activity.

One human infection with a novel influenza A virus was reported

Antiviral Resistance:

In the United States, two groups of antiviral drugs have been approved by Food and Drug Administration for use in treating or preventing influenza virus infections. These two groups of antiviral drugs are the neuraminidase inhibitors (oseltamivir and zanamivir) and the adamantanes (amantadine and rimantadine). A description of these drugs can be found at: http://www.cdc.gov/flu/protect/antiviral/index.htm.


Neuraminidase Inhibitor Antiviral Drugs: Since October 1, 2008, two influenza A (H1N1) viruses, four influenza A (H3N2) viruses, and five influenza B viruses have been tested for antiviral resistance. One of the two influenza A (H1N1) viruses was found to be resistant to oseltamivir. All the influenza A (H3N2) viruses and influenza B viruses tested retain their sensitivity to oseltamivir. All tested viruses retain their sensitivity to zanamivir.

In addition, CDC performed antiviral resistance testing on one influenza A (H1N1), three influenza A (H3N2), and four influenza B viruses collected during September. All tested viruses are sensitive to both oseltamivir and zanamivir.

Additional information on antiviral resistance can be found at: http://www.cdc.gov/flu/about/qa/antiviralresistance.htm.

Adamantane Antiviral Drugs: Three isolates from specimens collected during September were tested for adamantane resistance. The one influenza A (H1N1) virus tested and the two influenza A (H3N2) viruses tested were resistant to the adamantanes. The adamantanes are not effective against influenza B viruses.

Based on the level of oseltamivir resistance observed in only one influenza subtype, H1N1, and the persisting high levels of resistance to the adamantanes in H3N2 viruses, CDC continues to recommend the use of oseltamivir and zanamivir for the treatment or prevention of influenza in the United States. Use of amantadine or rimantadine is not recommended. Guidance on influenza antiviral use can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e717a1.htm

http://www.cdc.gov/flu/weekly/

[Dutchy]

Europe

Virological situation - week 46/2008: The total number of respiratory specimens collected by sentinel physicians in week 46/2008 was 451, of which 32 (7.1%) were positive for influenza virus: 29 type A (22 subtype H3 and seven not subtyped) and three type B. In addition, 30 influenza virus detections were reported from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals): 28 type A (six subtype H3 and 22 not subtyped) and two type B. Detection of influenza viruses was reported from 13 countries across Europe and included the first detections in Czech Republic, Hungary and Italy.

Cumulative virological situation 2008-2009 season (weeks 40-46/2008): Of 192 virus detections (sentinel and non-sentinel) since week 40/2008, 171 were type A (73 subtype H3, 15 subtype H1 and 83 not subtyped) and 21 were type B.

Based on the antigenic and/or genetic characterisation of 41 influenza viruses, three were reported as A/Brisbane/59/2007 (H1N1)-like, 35 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) (click here).

Analyses of antiviral susceptibility by genetic or phenotypic methods have been reported for 26 influenza viruses, 11 A(H1N1) and 15 A(H3N2) from England and one A(H1N1) from Norway. Eleven of the 12 A(H1N1) viruses were shown to be resistant to oseltamivir (10 from England and 1 from Norway) and one to be sensitive; all those tested against zanamivir (12) and amantadine (4) were shown to be sensitive. The six A(H3N2) viruses tested against amantadine were shown to be resistant; all 15 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 (12 versus five or less in previous weeks), although this was not accompanied by significant increases in overall consultation rates. The 18 countries that have detected influenza viruses since week 40/2008 are geographically distributed throughout Europe.

The majority (89%; 171/192) of virus detections up to week 46 have been type A, a percentage unchanged since week 45. The proportion of type A viruses subtyped as H3 has increased from 72% up to week 45 to 83% (73/88) at week 46. Although this represents an apparent increase in prevalence of the H3 subtype, it is too soon to conclude which virus type or subtype may become dominant in Europe this season.

Similarly, limited data from only two countries (England and Norway) are available for antiviral resistance and although most (11/12) of the A(H1N1) viruses analysed to date are oseltamivir-resistant, these represent very early-season isolates. It is too early to comment on the antiviral-resistance pattern for Europe as a whole.

Whilst influenza activity in Europe is currently low, reports of RSV (Respiratory Syncytial Virus which induces clinical symptoms similar to influenza) from countries in Europe that report RSV detections to EISS showed continued increases in the Netherlands and Northern Ireland). Increase in RSV detections at this time of the year is a normal phenomenon in these countries.

http://ecdc.europa.eu/en/health_content/episu/081121_EISS.aspx

[Dutchy]

CDC reports swine flu virus in Texas patient

Lisa Schnirring Staff Writer


Nov 24, 2008 (CIDRAP) – The Centers for Disease Control and Prevention (CDC), in its latest update on the nation's seasonal influenza activity, reported on a person who was infected with a swine influenza virus following several exposures to pigs, including a sick one.

The CDC said the patient was infected with a swine influenza A/H1N1 virus. Although human infections with swine flu viruses are uncommon, many years bring reports of isolated cases, the report said.

The Texas Department of State Health Services, in a flu surveillance activity report for the week ending Nov 15, said the patient got sick in mid October. His or her specimen was collected and the virus identified during routine influenza surveillance. Texas officials, who gave no details about the patient's illness, said their investigation found no illnesses in his or her household or close contacts.

According to the CDC's background information on swine flu, the agency receives about one human influenza isolate each year that tests positive for a swine influenza virus. H1N1 and H3N2 swine flu viruses are endemic in US pig populations.

In September, researchers from the CDC and public health officials from Wisconsin published a case report in Emerging Infectious Diseases on a healthy 17-year-old boy who had mild respiratory symptoms in December 2005, 3 days after helping his brother-in-law butcher pigs.

At an outpatient clinic a few days later, healthcare workers collected nasal wash specimens, which tested positive for influenza A and were forwarded to the Wisconsin State Laboratory of Hygiene. Though further testing isolated influenza A, the virus didn't match human H3 or H1 subtypes or the H5 avian subtype. CDC investigators sequenced the virus, identifying it as a swine influenza A (H1N1) triple reassortant virus, A/Wisconsin/87/2005 H1N1.

The report said that triple reassortant H1N1 subtypes are the predominant genotype in North American pigs and that human swine flu illnesses often mimic seasonal flu infections. The authors recommended that clinicians ask patients with unexplained influenza-like illnesses about exposure to animals, including pigs, and visits to petting zoos and county fairs.

Human infections with novel influenza A subtypes now are nationally notifiable diseases in the United States, the group reported. Though human-to-human swine flu transmission is rare, the CDC said human infections with swine H1N1 viruses should be investigated to ensure that they are not spreading among humans—as spread could represent a pandemic threat—and to monitor changes in circulating viruses.

In 1988, an H1N1 swine flu virus was found in a previously healthy 32-year-old pregnant woman who died 8 days after she was hospitalized for pneumonia, according to the CDC. Four days before she got sick she had visited a swine exhibit at a county fair where a flu-like illness was widespread among the pigs. Follow-up studies showed that 76% of swine exhibitors had antibodies to the swine flu virus, though no illnesses were reported. However, researchers found that one to three healthcare workers who had contact with the woman experienced mild flu symptoms with antibody evidence of swine flu exposure.

In December 2007, researchers reported that a new swine flu subtype found recently in Missouri pigs—H2N3—combined genes from avian and swine flu viruses, could cause experimentally induced infections in mice, and was transmissible in pigs and ferrets. The findings, which appeared in Proceedings of the National Academy of Sciences (PNAS), bolstered the theory that pigs can serve as a mixing vessel for flu viruses and a possible source for a human pandemic strain.

The CDC said swine flu outbreaks in pigs typically occur in late fall and winter months. The agency said seasonal influenza vaccines are likely to partially protect against swine H5N2 viruses, but not the H1N1 subtype.

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/nov2408swine-br.html

[Dutchy]

CDC sees early-season signs of Tamiflu resistance

Robert Roos News Editor


Dec 12, 2008 (CIDRAP News) – With this year's US influenza epidemic barely getting started, there are already signs of increased viral resistance to oseltamivir (Tamiflu), the most widely used antiviral drug, the Centers for Disease Control and Prevention (CDC) said today.

In its flu surveillance report for Nov 30 to Dec 6, released today, the CDC said 45 of 46 influenza A/H1N1 viruses tested so far have shown resistance to oseltamivir.

All the H1N1 viruses were susceptible to zanamivir (Relenza), the other antiviral drug in the neuraminidase inhibitor class, the agency reported.

All tested influenza A/H3N2 and B viruses were susceptible to both oseltamivir and zanamivir. Sixty-three percent of all the viruses tested came from only two states.

The CDC said all the H1N1 viruses also were susceptible to the adamantanes (amantadine and rimantadine), the older class of flu antivirals. However, 5 of 5 H3N2 viruses tested were resistant to the adamantanes (which do not work against type B viruses). The CDC has been recommending against using the adamantanes since January 2006 because of high resistance rates in H3N2 viruses.

With only three states reporting more than scattered flu cases so far, the CDC said it's too early to assess how common resistance to either class of drugs will be.

"Limited data on antiviral resistance, as well as the uncertainty regarding which influenza virus types or subtypes will circulate during the season, make it too early to make an accurate determination of the prevalence of influenza viruses' resistance to oseltamivir or the adamantanes . . . nationally or regionally at this time," the report said.

Increased H1N1 resistance to oseltamivir cropped up during the last flu season in the United States and a number of other countries. By the end of the season, 10.9% (106 of 969) of H1N1 viruses tested had shown the mutation associated with resistance, the CDC reported in May. All the isolates remained sensitive to zanamivir.

After the resistance problem emerged last winter, the World Health Organization said there was no evidence that the resistant H1N1 viruses caused more severe illness or spread more easily than susceptible H1N1 viruses.

In its update today, the CDC said only Hawaii, Massachusetts, and Texas reported local flu activity in early December. Another 24 states, with Washington, DC, and Puerto Rico, reported sporadic cases, and 23 states reported no flu activity.

In addition, only 1.3% of patient medical visits reported through the CDC's Outpatient Influenza-like Illness Surveillance Network were due to flu-like illness, which is well below the national baseline of 2.4%, the agency said.

The CDC said it has tested 36 isolates so far to determine how well they match up with the strains used in this year's flu vaccine. The 20 H1N1 and 3 H3N2 isolates tested were all found to be similar to the corresponding strains in the vaccine.

Of the 13 type B isolates tested, 4 belonged to the Yamagata lineage, the type used in the vaccine. However, the other 9 B isolates—8 of which were from one state—belonged to the Victoria lineage, the CDC said.

The agency said "limited to no protection" may be expected when the circulating and vaccine strains belong to different lineages. However, it said the data available so far must be interpreted cautiously because so few isolates were tested and most of them came from only two states. Also, the report said, the results may not correlate with clinical protection conferred by the vaccine because the testing involves ferret serum.

The B strain in the seasonal vaccine was changed from the Victoria lineage to the Yamagata lineage for this season. The switch was prompted by a mismatch last year, when most of the type B viruses in circulation were of the Yamagata lineage.

http://www.cidrap.umn.edu//cidrap/content/influenza/general/news/dec1208cdc.html

[Auburn Boy]

Alles still im westen!

CDC Weekly tracker indivates it's too early in the season to see any particular trends. The "pneumonia and influenza mortality" shows the season to be below epidemic levels and actually bleow the seasonal baseline.

http://www.cdc.gov/flu/weekly/fluactivity.htm

[Kassy]

Flu cases on the rise in England

Doctors are being advised to prescribe antiviral drugs for flu in response to increasing numbers of people falling ill with the virus.

Both NHS Direct and the Royal College of GPs have reported large increases in the number of people with influenza symptoms.

The Health Protection Agency have also reported 23 outbreaks in hospitals, schools and care homes.

But experts said the levels of flu were not unexpected for the time of year.

GP surveillance showed a 60% increase in influenza-like illness from 16.5 per 100,00 consultation to 27.6.

NHS Direct has also seen a big rise in calls about flu - with figures more than doubling in the past three months.

In the past week, the proportion of calls about colds or flu increased from 0.9% of the total to 1.2%.

There is currently no significant influenza activity in Scotland or Wales. Figures in Northern Ireland although low, have begun to rise.

Complications

The Health Protection Agency said the figures had tipped the threshold when they ask GPs to prescribe anti-retroviral drugs oseltamivir and zanamivir in people at risk of developing serious complications from flu infection, such as the elderly or those with underlying conditions like asthma or heart disease.

The drugs are only recommended when flu is known to be circulating

Dr Richard Pebody, a flu expert from the Health Protection Agency, said: "For most people, flu is miserable, lasting a week or so, but not life threatening.

"For those in at-risk groups, however, such as the elderly and patients with heart problems, diabetes or lung, liver or renal diseases, or those who have weak immune systems, it can be far more dangerous and can lead to more serious illnesses."

Symptoms of seasonal flu include sudden onset of headache, fever, and symptoms such as cough, sore throat, aching muscles and joints.

Dr Pebody said: "If you do get flu this year, our advice is to stay at home, rest, drink plenty of fluids and use over-the-counter remedies if they make you feel more comfortable.

He also advised the elderly and those with chronic illnesses, such as heart disease and diabetes to make sure they have had their flu vaccination.

"Antiviral drugs are only effective if taken within 48 hours of the onset of symptoms and may help limit the impact of some symptoms and reduce the potential for serious complications.

"However, it is difficult to avoid infection if there is a lot of flu circulating."

Flu expert Professor John Oxford, said rates of colds and flu had certainly started to go up but it was not unexpected for the time of year.

"It is not good news but these levels are normal around Christmas time.

"This is an advance warning for anyone who had not been vaccinated - there's a good vaccine supply this year so they should book an appointment with their GP."
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7780623.stm