2010

Kassy · 01-16-2011, 11:34 AM

A thread to collect the more general updates, like the WHO general update on seasonal influenza.

There are several other candidates like Eurosurveillance or some EU entity.

Edit: i mostly get them through ProMed and will post them here.

Quote:

Citing ProMED-mail
ProMED-mail reports are freely available for retransmission, on-line posting, or publication provided that ProMED-mail is cited as the source of the material.

http://www.promedmail.org/pls/apex/f...258783367:::::

Kassy · 01-16-2011, 11:34 AM

Who update via ProMed:

Archive Number 20110115.0171
Published Date 15-JAN-2011
Subject PRO/EDR> Influenza (05): WHO update 125

INFLUENZA (05): WHO UPDATE 125
******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

http://www.promedmail.org/pls/apex/f..._ID:1000,86668

Date: Fri 14 Jan 2011
Source: WHO Global Alert and Response (GAR) [summ., edited]
<http://www.who.int/csr/disease/influenza/2011_01_14_GIP_surveillance/en/index.html>

Influenza update 125 (14 Jan 2011) -- summary
---------------------------------------------
North America is continuing to report increases in influenza activity
primarily related to influenza A (H3N2) with lower numbers of influenza
type B. In the United Kingdom, severe and fatal cases are increased
compared with 2 weeks ago, associated predominantly with influenza A (H1N1)
2009 and less commonly with influenza type B. Currently, 25 per cent of
intensive care beds in the UK are occupied by influenza patients. Notably,
the chief medical officer has issued an alert to clinicians, warning of
increasing rates of bacterial infections often associated with influenza
(_S. pneumoniae_, Group A streptococcus, and meningococcus), though the
association with the current influenza circulation is still under
investigation. Severe disease associated with H1N1 (2009) and to a lesser
extent influenza type B is also being increasingly reported on the European
continent and areas of the Middle East. Tropical areas of the world and the
temperate countries of the Southern Hemisphere are currently reporting very
little influenza circulation.

Countries in the temperate zone of the Northern Hemisphere
----------------------------------------------------------
North America
Rates of influenza-like illness (ILI) and hospital admissions due to
influenza continue to increase in Canada. The rate of ILI reporting is
similar to influenza seasons prior to 2009. About 25 per cent of specimens
tested in Canada are positive for influenza and influenza type A makes up
about 98 per cent of influenza detections. Of the influenza type A viruses
characterized, 94 per cent are H3N2 and the other 6 per cent, H1N1 (2009).
In the United States (US), the proportion of outpatient visits due to ILI
decreased slightly in the last week, perhaps due to the holiday season, but
remains slightly above the epidemic threshold. 6 US states are reporting
high ILI activity. Rates of death due to pneumonia and influenza from a
sentinel surveillance system that includes data from 122 cities across the
country are below the epidemic threshold. About 20 per cent of clinical
specimens tested in the last week of 2009 were positive for influenza. In
contrast to the situation in Canada, about a third (34.1 per cent) of
influenza detections in the US are type B and two-thirds are type A. Of the
influenza type A viruses that have been sub-typed, 86 per cent are H3N2 and
the other 14 per cent are H1N1 (2009). As in previous weeks, all of the
influenza A and 91 per cent of the influenza type B viruses characterized
antigenically are of the same lineages as contained in the current seasonal
influenza vaccine.

Europe
The United Kingdom (UK) continues to report high rates of ILI and
influenza-related hospitalizations. Currently about 25 per cent of
intensive care beds are occupied by influenza cases and 112
influenza-related deaths have been reported. 95 of 100 fatal cases from
which the virus has been sub-typed have been H1N1 (2009) related and the
other 5, influenza type B. The majority of severe and fatal cases have been
between the ages of 15 and 64 years; only 16 per cent of fatal cases were
over the age of 64 years. 78 per cent of the fatal cases for which there
are data had an underlying risk condition. Of note, the chief medical
officer of the UK has issued an alert to clinicians noting recent increases
in some bacterial infections that are sometimes seen as co-infections with
influenza, particularly _S. pneumoniae_, invasive Group A streptococcus,
and meningococcal disease. The association of this increase with the
current influenza transmission is unclear and is under investigation. 2 per
cent (17/811) H1N1 (2009) viruses tested in the UK have been found to carry
the H275Y mutation which confers resistance to the antiviral drug
oseltamivir. Elsewhere in the European Region there have been increasing
numbers of hospitalized cases and deaths associated with influenza A (H1N1)
and influenza B virus infections in several countries. France, Portugal,
the Netherlands, and Denmark have all reported deaths and cases admitted to
intensive care. The percentage of intensive care beds occupied by influenza
cases in Denmark has reached 4 per cent, which is as high as it was during
the peak of the 2009/2010 influenza season. The pattern seen in severe
cases in continental Europe is similar to that seen in the UK primarily
affecting adults between the ages of 15 and 64 years with 60-80 per cent
reporting a history of underlying risk factors. In areas where H1N1 (2009)
and type B viruses are co-circulating in the community, H1N1 (2009) appears
to be disproportionately detected in the severe cases. Overall, 45 per cent
of specimens tested from sentinel sites in Europe were positive for
influenza virus, an increase from previous reports. 77 per cent of
influenza viruses were type A and 23 per cent, influenza type B. Of the 307
influenza A viruses that were sub-typed, 85 per cent were H1N1 (2009) 15
per cent were H3N2.

North Africa and the Middle East
Several countries of North Africa and the Middle East are also experiencing
increases in influenza activity. Morocco, Algeria, and Tunisia have had
modestly increased levels of influenza detections in the last 2 to 3 weeks.
Influenza type B has been the predominant virus reported with lesser
amounts of H1N1 (2009). Limited data suggests that H1N1 (2009) is
circulating in Egypt where 122 H1N1 (2009) related deaths have been
reported since October 2010. Iran and Pakistan have also had a steady
increase in influenza detection in the same period of time with the
majority of viruses being H1N1 (2009).

North Asia
The temperate areas of Asia, including Mongolia, northern China, the
Republic of Korea, and Japan have all reported slight increases in
respiratory disease activity in recent weeks. In Mongolia and northern
China, the increase in activity was associated with influenza A (H3N2),
which appears to have peaked around the 3rd week of December [2010].
However, in the Republic of Korea, very little H3N2 was detected; over 90
per cent of influenza viruses reported there were H1N1 (2009). Japan had
earlier detections of H3N2 coinciding with those of Mongolia and northern
China but more recently, H1N1 (2009) has become the predominant virus
detected there.

Countries in the tropical zone
------------------------------
Very little transmission of influenza viruses is currently being reported
in tropical regions of the world. Previously reported circulation of H3N2
in Paraguay, though still elevated, continues to decline. Elsewhere in the
topical areas of the Americas, levels of influenza detection are low. In
Asia, the previously reported surge in severe H1N1 (2009) related cases in
Sri Lanka is decreasing for the last 4 weeks. Other countries in the region
and extending into South East Asia report only small numbers of influenza
virus detections and no increases in respiratory disease activity. A
mixture of viruses is being reported with influenza type B and (H1N1) 2009
being the most common types in most countries. No new information is
available this week from sub-Saharan Africa. Madagascar, however, has been
experiencing moderate levels of circulation of H3N2 and lesser amounts of
influenza type B for several weeks.

Countries in the temperate zone of the Southern Hemisphere
----------------------------------------------------------
The countries of the southern temperate regions of the world have had very
little influenza transmission since the end of their winter season [2010].
Australia is the notable exception with persistence of small numbers of
H3N2 and influenza type B viruses.

Virological surveillance - FluNet reports
-----------------------------------------
During this reporting period (weeks 49 to 52 -- 6 Dec 2010-2 Jan 2011),
National Influenza Centres (NICs) from 71 countries, areas or territories
reported data to FluNet*. A total of 18 757 specimens were reported as
positive for influenza viruses, 14 423 (76.9 per cent) were typed as
influenza A and 4335 (23.1 per cent) as influenza B. Of the sub-typed
influenza A viruses reported, 53.2 per cent were influenza H1N1(2009) and
46.7 per cent were influenza A (H3N2).

Influenza virus detection by type/subtype in countries:
- Influenza H1N1 (2009): Algeria, Australia, Austria, Belgium, Bulgaria,
Cambodia, Cameroon, Canada, China, China Hong Kong SAR, Colombia, Croatia,
Czech Republic, Denmark, Ecuador, Ethiopia, Finland, France, Georgia,
Germany, Ghana, Hungary, Indonesia, Iran, Italy, Japan, Kenya, Lao People's
Democratic Republic, Latvia, Lithuania, Luxembourg, Madagascar, Malta,
Mexico, Morocco, Netherlands, Norway, Oman, Pakistan, Poland, Portugal,
Republic of Korea, Russian Federation, Senegal, Singapore, Slovakia,
Slovenia, South Africa, Spain, Sri Lanka, Sweden, Switzerland, Thailand,
Tunisia, Turkey, Ukraine, UK, and USA.

- Influenza A (H1N1) (old seasonal virus): Canada.

- Influenza A (H3N2): Algeria, Argentina, Australia, Austria, Belgium,
Bolivia, Cambodia, Canada, China, China Hong Kong SAR, Colombia, Cuba,
Denmark, Ecuador, France, French Guiana, Germany, Ghana, Guadeloupe,
Indonesia, Italy, Japan, Kenya, Lao People's Democratic Republic, Latvia,
Madagascar, Martinique, Mexico, Mongolia, Morocco, Norway, Paraguay,
Portugal, Republic of Korea, Russian Federation, Serbia, Singapore, Spain,
Thailand, Tunisia, Turkey, UK, and USA.

- Influenza B: Algeria, Argentina, Australia, Austria, Belarus, Belgium,
Bulgaria, Cambodia, Cameroon, Canada, Central African Republic, China,
China Hong Kong SAR, Costa Rica, Cuba, Denmark, Dominican Republic,
Finland, France, Germany, Georgia, Guadeloupe, Honduras, India, Indonesia,
Iran, Italy, Japan, Kenya, Kyrgyzstan, Lao People's Democratic Republic,
Latvia, Lithuania, Luxembourg, Madagascar, Malta, Mexico, Morocco,
Netherlands, Norway, Oman, Pakistan, Paraguay, Peru, Poland, Portugal,
Russian Federation, Singapore, Slovakia, Slovenia, South Africa, Spain, Sri
Lanka, Sweden, Switzerland, Thailand, Tunisia, Turkey, Ukraine, UK, and USA.

- No influenza activity reported: Albania, Armenia, Azerbaijan, Bangladesh,
Bosnia and Herzegovina, El Salvador, Greece, Romania, Rwanda, and Uruguay.

* Some NICs report to FluNet retrospectively leading to updates of previous
summary data.

The weekly update on oseltamivir resistance to influenza H1N1 (2009)
viruses can be accessed at
<http://www.who.int/csr/disease/influenza/2011_01_12_weekly_web_update_oseltamivir_resistanc e.pdf>.
Graphical presentation of some of the data contained in this report can be
accessed as follows:
- Map timeline for influenza activity
<http://www.who.int/csr/disease/influenza/2011_01_14_influenza_update_125_week_052_main.jpg> .

- Graph of the global circulation of influenza viruses
<http://www.who.int/csr/disease/influenza/2011_01_14_influenza_global_graphs_weeks_01_52.pdf >.

- Graph of northern hemisphere circulation of influenza viruses
<http://www.who.int/csr/disease/influenza/2011_01_14_influenza_northern_graphs_weeks_01_52.p df>.

- Graph of southern hemisphere circulation of influenza viruses
<http://www.who.int/csr/disease/influenza/2011_01_14_influenza_southern_graphs_weeks_01_52.p df>.

--
communicated by:
ProMED-mail rapporteur Marianne Hopp

[As of the week ending 14 Jan 2011 influenza activity in the northern
hemisphere has increased, particularly in Europe, with A (H1N1) and B
viruses predominating. In contrast in Asia and North America influenza A
(H3N2) and B viruses have predominated during the same period. Overall the
previous H1N1 seasonal strain has been largely replaced by the 2009
pandemic H1N1 strain. As in previous weeks, all of the influenza A viruses
and 91 per cent of the influenza type B viruses characterized antigenically
are of the same lineages as contained in the current seasonal influenza
vaccine.

In the Southern Hemisphere, with the exception of Australia, there has been
very little influenza transmission since the end of their winter season
(2010). - Mod.CP]

Kassy · 01-22-2011, 06:11 PM

Archive Number 20110121.0247
Published Date 21-JAN-2011
Subject PRO/EDR> Influenza (08): Europe]

INFLUENZA (08): EUROPE
**********************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 14 Jan 2011
Source: EuroFlu: Weekly Electronic Bulletin, Week 2: 10-16 Jan 2011 [edited]
<http://www.euroflu.org/cgi-files/bulletin_v2.cgi>

Continued slow increase in influenza activity across Europe
-----------------------------------------------------------
Summary
-------
- This issue is based on data reported in week 2/2011 by 46 Member
States in the WHO European Region.
- Influenza activity has progressed across the Region following a
west-to-east trend.
- 44 percent of sentinel specimens were positive for influenza.
- Pandemic influenza A(H1N1) 2009 remains the dominant virus,
particularly in the western part of the Region.
- Countries continue to report cases of severe disease caused mainly
by pandemic influenza A(H1N1) 2009 virus infections (see network comments).

Current situation - week 02/2011
--------------------------------
Of the 38 countries reporting on consultation rates for
influenza-like illness (ILI) and acute respiratory infection (ARI),
20 reported increases while 2 reported decreases. In the remaining 16
countries, consultation rates were largely unchanged. In general, the
highest consultation rates were reported for children aged 0-14
years. Information on the intensity of influenza activity was
available for 40 countries.

Most countries reported medium (24) or low (13) activity, while 1
(Luxembourg) reported very high influenza activity and 2 others
(Ireland and Norway) reported high activity. Influenza was reported
to be widespread in 15 countries, regional in 7 countries and local
in 7 countries; 11 countries reported no or sporadic activity.
Influenza levels were highest in the western part of the Region. Of
the 23 countries reporting on the impact of influenza on health care
systems, 19 described it as low overall. Ireland reported severe
impact on its health care capacity, while 3 other countries (Estonia,
Georgia and Israel) reported moderate impact.

Virological situation - week 2/2011
-----------------------------------
Pandemic influenza A(H1N1) 2009 continued to predominate in western
and northern Europe, while influenza A and B mainly co-dominated in
the eastern part of the Region. Influenza B was reported to be
dominant in a few countries.

Sentinel physicians collected 2886 respiratory specimens, of which
1263 (44 percent) were positive for influenza virus: 912 (72 percent)
were influenza A and 351 (28 percent) were influenza B. Of the
influenza A viruses, 813 were subtyped: 769 (95 percent) as pandemic
A(H1) and 44 (5 percent) as A(H3). In the 24 countries testing 20 or
more sentinel specimens, influenza positivity ranged from 12 percent
to 76 percent, with a median of 44 percent (mean: 43 percent).

In addition, 4515 non-sentinel specimens were reported positive for
influenza: 3183 (70 percent) influenza A and 1332 (30 percent)
influenza B. Of the influenza A viruses, 1875 were subtyped: 1842 (98
percent) as pandemic A(H1) and 33 (2 percent) as A(H3). In addition,
20 countries reported circulation of respiratory syncytial virus.

Since week 40/2010, 620 influenza viruses have been characterized
antigenically: 361 were A(H1) pandemic A/California/7/2009
(H1N1)-like; 184 were B/Brisbane/60/2008-like (B/Victoria/2/87
lineage); 62 were A(H3) A/Perth/16/2009 (H3N2)-like; and 13 were
B/Florida/4/2006-like (B/Yamagata/16/88 lineage).

Based on the genetic characterization of 62 influenza viruses, 41
belonged to the pandemic A/California/7/2009 A(H1N1) clade; 9
belonged to the A(H3) clade represented by A/Perth/16/2009; 5
belonged to the subgroup represented by A/Hong Kong/2121/2010 in the
A/Victoria/208/2009 A(H3) clade; 1 belonged to the A(H3) clade
represented by A/Victoria/208/2009; 4 belonged to the
B/Bangladesh/3333/2007 clade (Yamagata lineage); 1 belonged to the
B/Florida/4/2006 clade (Yamagata lineage), and 1 to the
B/Brisbane/60/2008 clade (Victoria lineage).

Cumulative virological update - weeks 40/2010-2/2011
----------------------------------------------------
A total of 22 579 influenza virus detections were reported, of which
16 055 (71 percent) were influenza A and 6524 (29 percent) influenza
B. Of the influenza A viruses, 9866 were subtyped: 9327 (95 percent)
as pandemic influenza A(H1), 537 (5 percent) as influenza A(H3) and 2
(less than 1 percent) as influenza A(H1).

Comment
-------
ILI and ARI consultation rates continue to rise, following a
west-to-east progression across the Region. However, several
countries are reporting low influenza activity, mainly in the central
part of the Region. In week 2/2011, 44 percent of sentinel samples
tested positive for influenza, similarly to previous weeks. Pandemic
influenza A(H1N1) 2009 remains the dominant virus in circulation in
most countries.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[As in the previous week about half (44 percent) of respiratory
infections could be attributed to influenza virus infection,
respiratory syncytial virus possibly being a significant minor
component. ILI and ARI consultation rates continue to rise, following
a west-to-east progression across the Region. However, several
countries are now reporting low influenza activity,

Overall, of the influenza positives, 71 percent were influenza A and
(29 percent) influenza B. Of the influenza A viruses, 95 percent were
identified as pandemic influenza A(H1), 5 percent as influenza A(H3)
and less than 1 percent were similar to the previous seasonal
influenza A(H1) outbreak strain.

Maps displaying the qualitative indicators of influenza activity
(intensity, trend, geographical spread and impact) and the dominant
virus as assessed by each of the countries can be viewed by accessing
the original document via the URL at the head of this report. - Mod.CP]

http://www.promedmail.org/pls/apex/f..._ID:1010,86752

Kassy · 01-25-2011, 04:46 PM

http://uk.reuters.com/article/idUKLD...MktRpt&rpc=401

Very general article on flu in Europe, guess that qualifies. It's an ECDC report. European Centre for Disease Prevention and Control.

Didn't even know we had that.

Kassy · 01-29-2011, 04:21 AM

Archive Number 20110128.0337
Published Date 28-JAN-2011
Subject PRO/EDR> Influenza (09): WHO update 126

INFLUENZA (09): WORLD HEALTH ORGANISATION UPDATE 126
************************************************** **
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 28 Jan 2011
Source: World Health Organisation (WHO), Global Alert and Response,
Influenza [abbrev., edited]
<http://www.who.int/csr/disease/influenza/2011_01_28_GIP_surveillance/en/index.html>

Influenza Update Number 126
---------------------------
Summary
-------
Influenza transmission in North America appears to be levelling off or
decreasing according to several national influenza indicators, though
not all regions have experienced a peak yet. Influenza activity in
North America has been related primarily to influenza A (H3N2) virus
with some co-circulation of influenza type B in the United States
(U.S.). Influenza transmission in the United Kingdom (U.K.),
predominantly related to influenza A (H1N1) 2009, is now decreasing.
Influenza activity on the European continent is increasing,
particularly in the west, and countries are increasingly reporting
severe and fatal cases.

Severe cases have been reported in association with all three
influenza viruses, H1N1 (2009), influenza A (H3N2), and influenza type
B, but H1N1 (2009) appears to be disproportionately over-represented
among severe cases when compared to the distribution of viruses in the
community. The large majority of the viruses characterized from North
America and Europe continue to be of the same lineages as those found
in the current seasonal trivalent vaccine. Transmission in Northern
Africa and Northern Asia has peaked recently and is declining. In the
tropics, several countries of southern Asia have seen increasing
trends recently mainly due to H1N1 (2009). Other tropical areas of the
world and the temperate countries of the Southern Hemisphere are
currently reporting very little influenza circulation.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
Several national-level indicators of influenza transmission indicate
that influenza may be levelling off or decreasing in North America;
however, there are many areas that have not yet experienced widespread
circulation and some that are now reporting increases in activity.
Rates of influenza-like illness (ILI) and hospital admissions due to
influenza have decreased nationally in the last 2 weeks in Canada,
though one region of Ontario has reported an increased rate. The
national rate of ILI reporting is similar to influenza seasons prior
to 2009. About 23 percent of specimens tested in Canada are positive
for influenza, which is slightly decreased from recent weeks.
Influenza type A accounts for 98 percent of influenza viruses
detected. Of the influenza type A viruses characterized, 91 percent
are H3N2 and the 16 percent, H1N1 (2009); the H1N1 (2009) proportion
is increased from 6 percent in week 52.

In the United States (U.S.), several influenza activity indicators
have also decreased nationally, though the proportion of outpatient
visits due to ILI remains slightly above the epidemic threshold. Rates
of death reported due to pneumonia and influenza from a sentinel
surveillance system that includes data from 122 cities across the
country are below the epidemic threshold. About 26 percent of clinical
specimens tested in week 2 of 2011 were positive for influenza, a
slight increase from the 20 percent reported previously. The
proportion of the detections accounted for by influenza type B
decreased to 15 percent of the samples tested, from 26 percent of
influenza isolates in previous weeks. Of the influenza type A viruses
that have been sub-typed, 74 percent are H3N2 and the other 26
percent are H1N1 (2009) which is an increase in the proportion of H1N1
(2009) in comparison to earlier weeks.

As in previous weeks, all of the influenza A and 92 percent of the
influenza type B viruses characterized antigenically are of the same
lineages as contained in the current trivalent seasonal influenza
vaccine. In Mexico the percentage of samples positive for influenza
was 30 percent with around 60 percent influenza type B and 30 percent
H3N2. Based on the proportion of samples testing positive, influenza
activity in Mexico appears to be decreasing.

Influenza transmission continues to increase in Europe, particularly
in the West. In the United Kingdom, where intensive care units have
been stressed by the numbers of severe influenza cases, activity has
peaked and the number of severe cases is now declining. Many countries
of Western Continental Europe are now reporting significant numbers of
severe and fatal cases of influenza though intensive care units (ICU)
have not yet been stressed to the degree seen in the UK. In Denmark,
the proportion of patients in ICU due to influenza infection rose from
4 percent 2 weeks ago to 9.5 percent in the past week. In France, 290
influenza cases have required intensive care management. Notably, 41
percent of ICU cases in France were found to not have pre-existing
underlying risk conditions, a higher proportion than seen in the UK,
and 58 percent are between the ages of 15 and 64 years. Similar to
observations in the U.K., only 8 percent of severe cases in France had
been vaccinated against influenza.

Of the samples tested from sentinel sites across Europe 43 percent
were positive for influenza, unchanged for the last 2 weeks. The
dominant strain in Europe is currently H1N1 (2009), with a few
countries reporting co-circulation of influenza type B. Norway is a
notable exception with predominance of influenza type B. Of influenza
viruses that have been subtyped, 72 percent were type A and 28 percent
type B. Of the type A viruses subtyped, 95 percent were H1N1 (2009)
and 5 percent influenza A (H3N2). H1N1 (2009) appears to be
over-represented in severe cases compared to frequency with which it
is detected in the community. For example, in France of the ICU cases
for which subtype data are available, 90 percent were found to have
H1N1 (2009) or unsubtyped influenza A, 1 percent influenza A (H3N2)
and only 8 percent influenza type B.

A similar disparity between mild and severe cases was earlier noted in
the U.K. As in North America, viruses that were antigenetically
characterized in Europe were nearly all of the same lineages as those
in the current trivalent seasonal influenza vaccine, with only a small
number of influenza B viruses of the Yamagata lineages detected.

Several countries of North Africa and the Middle East are also
experiencing increases in influenza activity. Morocco, Algeria, and
Tunisia have had modestly increased levels of influenza detections in
the last 2 to 3 weeks. Influenza type B has been the predominant virus
reported with lesser amounts of H1N1 (2009). Limited data suggests
that H1N1 (2009) is circulating in Egypt where 122 H1N1 (2009) related
deaths have been reported since October 2010. Iran and Pakistan have
also had a steady increase in influenza detection in the same period
of time with the majority of viruses being H1N1 (2009).

Influenza transmission in North Africa and the Middle East appears to
have peaked overall, though data from Tunisia, Morocco and Pakistan
suggest an increasing trend. H1N1 (2009) is the predominant virus in
the area, with the exception of Algeria which has reported a
predominance influenza type B in recent weeks. However, the proportion
of influenza type B in Algeria is declining with increasing detections
of H1N1 (2009). Transmission in Egypt peaked in late December 2010 or
early January, along with the rest of the region, and the weekly
reporting of fatal cases is declining.

Influenza transmission in the temperate areas of Asia, including
Mongolia, northern China, the Republic of Korea, and Japan has
recently peaked and is now declining. There were some differences
noted in the predominant viruses detected in countries of the area.
Mongolia and northern China reported a predominance influenza A
(H3N2), which appears to have peaked around the 3rd week of December
at which time increasing numbers of H1N1 (2009) viruses began to be
detected. The Republic of Korea, in contrast, experienced peak of
transmission coinciding with the peak in northern China, but over 90
percent of influenza viruses reported there were H1N1 (2009).
Transmission in Japan began with a predominance of H3N2, with a peak
that coincided with the rest of temperate Asia, but more recently H1N1
(2009) has become the predominant virus detected there though overall
levels of detection are declining.

Countries in the tropical zone
------------------------------
The most active area of transmission in tropical regions of the world
is in Asia. In tropical areas of the Americas, reports indicate very
little transmission of influenza viruses. Previously reported active
circulation of H3N2 in Paraguay, continues to decline. The few viruses
detected in the area otherwise are a mixture of influenza type B and
(H1N1) 2009. In sub-Saharan Africa, available data indicate little
activity in most countries. Madagascar, however, still has moderate
levels of circulation of mainly H3N2 virus.

In Asia, Singapore and Hong Kong report crossing their epidemic
threshold of respiratory disease activity with the largest fraction of
samples tested being H1N1 (2009) and an increase in H1N1 (2009)
positive samples is also reported from Southern China. Data from South
East Asia indicate only small numbers of influenza virus detections
and no increases in respiratory disease activity.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
The countries of the southern temperate regions of the world have had
very little influenza transmission since the end of their winter
season. Australia, however, continues to report out-of-season
transmission of small numbers of H3N2 and influenza type B viruses.

Virological surveillance
------------------------
During weeks 1 to 2, influenza activity in parts of the northern
hemisphere continued to increase, in particular in Europe with A(H1N1)
and B viruses predominating. In Asia influenza A(H1N1) and A(H3N2)
predominated and in the North Americas A(H3N2) and B viruses co-
circulated.

FluNet reports
--------------
During weeks 1 to 2 (02 Jan 2011 to 15 Jan 2011), National Influenza
Centres (NICs) from 74 countries, areas or territories reported data
to FluNet. A total of 21 104 specimens were reported as positive for
influenza viruses, 16 586 (78.6 percent) were typed as influenza A,
4518 (21.4 percent) as influenza B. Of the sub-typed influenza A
viruses reported, 74.5 percent were influenza H1N1(2009) and 25.4
percent were influenza A(H3N2). The proportion of H1N1(2009) compared
to A(H3N2) reported to FluNet increased markedly compared to December.

Influenza virus detection by type/subtype in countries, areas or territories
----------------------------------------------------------------------------

- Influenza H1N1 (2009): Albania, Algeria, Australia, Austria,
Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Cameroon, Canada,
Chile, China, Croatia, Czech Republic, Denmark, Egypt, Finland,
France, France French Guiana, France Guadeloupe, Georgia, Germany,
Greece, Hungary, Iceland, India, Iran, Italy, Japan, Kenya, Latvia,
Lithuania, Luxembourg, Malta, Mauritius, Mexico, Mongolia, Morocco,
Netherlands, Norway, Oman, Pakistan, Poland, Portugal, Republic of
Korea, Russian Federation, Serbia, Singapore, Slovenia, South Africa,
Spain, Sri Lanka, Sweden, Switzerland, Togo, Tunisia, Turkey, Ukraine,
United Kingdom of Great Britain and Northern Ireland, United States of
America.

- Influenza A(H3N2): Albania, Australia, Canada, Chile, China, Costa
Rica, Cuba, Denmark, Dominican Republic, France, France Guadeloupe,
France Martinique, Germany, Ghana, Greece, Honduras, Iceland, Italy,
Japan, Kenya, Lao People's Democratic Republic, Madagascar, Mexico,
Mongolia, Morocco, Norway, Poland, Republic of Korea, Romania, Russian
Federation, Serbia, Singapore, South Africa, Spain, Sweden, Turkey,
United Kingdom of Great Britain and Northern Ireland, United States of
America.

- Influenza B: Albania, Algeria, Armenia, Australia, Austria, Belarus,
Belgium, Bosnia and Herzegovina, Cambodia, Cameroon, Canada, China,
Costa Rica, Denmark, Dominican Republic, El Salvador, Finland, France,
Georgia, Germany, Ghana, Greece, Honduras, Hungary, Iceland, India,
Iran (Islamic Republic of), Italy, Japan, Kenya, Kyrgyzstan, Lao
People's Democratic Republic, Latvia, Lithuania, Luxembourg,
Madagascar, Malta, Mexico, Morocco, Netherlands, Norway, Oman, Poland,
Portugal, Romania, Russian Federation, Singapore, Slovenia, South
Africa, Spain, Sri Lanka, Sweden, Switzerland, Tunisia, Turkey,
Ukraine, United Kingdom of Great Britain and Northern Ireland and
United States of America.

- No influenza activity reported: Afghanistan, Angola, Azerbaijan,
Central African Republic, Ethiopia or Slovakia.

The weekly update on oseltamivir resistance to influenza H1N1 (2009)
viruses can be accessed at
<http://www.who.int/csr/disease/influenza/2011_01_28_weekly_web_update_oseltamivir_resistanc e.pdf>. For this reporting period (12- 26 Jan 2011), 21 new cases of influenza H1N1 (2009) viruses carrying the H275Y substitution have been reported1. It brings the cumulative total to 340 so
far.

Graphical presentation of some of the data contained in this report
can be accessed as follows:

- Graph of the global circulation of influenza viruses
<http://www.who.int/csr/disease/influenza/2011_01_28_influenza_global_circulation.pdf>.

- Graph of northern hemisphere circulation of influenza viruses
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>.

- Graph of southern hemisphere circulation of influenza viruses
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[As of 28 Jan 2011, of the samples tested from sentinel sites across
Europe, 43 percent were positive for influenza, unchanged for the last
2 weeks. The dominant strain in Europe is currently H1N1 (2009), with
a few countries reporting co-circulation of influenza type B. In
contrast, the predominant virus in North America has been influenza
(H3N2) virus with some co-circulation of influenza type B.

Influenza H1N1 (2009) appears to be disproportionately
over-represented among severe cases when compared to the distribution
of viruses in the community. The large majority of the viruses
characterized from North America and Europe continue to be of the same
lineages as those found in the current seasonal trivalent vaccine.

Influenza transmission continues to increase across Europe. In the
United Kingdom, however, where intensive care units have been stressed
by the numbers of severe influenza cases, activity has peaked and the
number of severe cases is now declining. - Mod.CP]

[see also:
http://www.promedmail.org/pls/apex/f..._ID:1000,86866

Kassy · 02-13-2011, 06:06 PM

Archive Number 20110212.0482
Published Date 12-FEB-2011
Subject PRO/EDR> Influenza (14): WHO update 127

INFLUENZA (14): WORLD HEALTH ORGANIZATION UPDATE 127
************************************************** ***
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 11 Feb 2011
Source: World Health Organization (WHO), CSR, Influenza [abbrev.,
edited]
<http://www.who.int/csr/disease/influenza/2011_02_11_GIP_surveillance/en/index.html>

WHO update number 127
---------------------
Summary
-------
Influenza activity is increasing on the European continent,
particularly in the central, south and eastern part.

In the tropics, several countries of southern Asia have seen a recent
increase in influenza virus transmission mainly due to influenza
A(H1N1) 2009 virus. Other tropical areas of the world and the
temperate countries of the southern hemisphere are currently reporting
very little influenza circulation.

Influenza transmission in North America, notably in the United States
of America (USA) has increased this week with a slight increase of
(H1N1) 2009 compared to earlier weeks.

Transmission in most of northern Africa and the Middle East has
peaked recently and is declining. Some countries in northern Asia are
seeing an increase in (H1N1) 2009 transmissions and some are seeing an
increase in influenza-like illness (ILI) activity.

The majority of the viruses characterized from North America and
Europe are closely related to the vaccine viruses for the current
seasonal vaccines.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
Europe
------
Overall, influenza transmission continues to be high and is
increasing in Europe while the countries in the north are starting to
show decreasing trends. Of the samples tested from sentinel sites
across Europe 46 per cent were positive for influenza virus (43-44 per
cent in the previous weeks). The dominant influenza virus in Europe is
still (H1N1) 2009. Of influenza viruses detected, 65 per cent were
type A and 35 per cent type B (72 per cent A and 28 per cent B in the
last update). Of the type A viruses subtyped, 94 per cent were (H1N1)
2009 and 6 per cent influenza A(H3N2). In the western European
countries, hospital admissions due to influenza are declining while
the eastern countries report an increase. From the western countries,
severe cases are in 15 to 64 year old age range, a substantial
proportion (43 per cent) are not in the known higher risk groups and
most are due to (H1N1) 2009 virus infection. For example, in France,
of the cases admitted to intensive care units and for which subtype
data are available, 90 per cent were found to have (H1N1) 2009 virus
or unsubtyped influenza A, 8 per cent influenza type B and only 1 per
cent influenza A(H3N2), while in the community 43 per cent of the
detected viruses are influenza type B and 7 per cent A(H3N2). A
similar disparity between mild and severe cases was earlier noted in
the United Kingdom.

Characterized viruses in Europe were nearly all antigenically closely
related to the current seasonal influenza vaccine viruses, with only a
small number of influenza B viruses of the Yamagata lineages
detected.

North America
-------------
Influenza transmission continued this week across North America, with
increasing trends in the USA but declining in Canada. In Canada
influenza virus detections in most parts of the country have declined,
except in the Atlantic provinces. Other influenza activity indicators
are either decreasing or stable compared to earlier weeks. About 18
per cent of specimens tested in Canada are now positive for influenza;
influenza type A accounts for 95 per cent, a decrease from previous
weeks related to a slight increase of influenza type B detections. Of
the influenza type A viruses characterized, 87 per cent are A(H3N2)
and 13 per cent are (H1N1) 2009.

In the USA, influenza activity increased. The proportion of
outpatient visits for influenza-like illness increased to 4.0 per cent
from 2.9 per cent in 2 weeks, which is above the national baseline of
2.5 per cent. Pneumonia and influenza deaths from 122 cities across
the country are currently at 8.5 per cent of total mortality, slightly
above the epidemic threshold and increased from 2 weeks ago (7.5 per
cent). About 33 per cent of clinical specimens tested are positive for
influenza, an increase from the 26 per cent reported previously.
Influenza type B accounted for 18 per cent of detections. Of the
influenza type A viruses, 63 per cent are influenza A(H3N2) and 37 per
cent are (H1N1) 2009. This represents a further increase in the
proportion of (H1N1) 2009 in comparison to earlier weeks.

In Mexico the percentage of samples positive for influenza was 18 per
cent, about half influenza type B and half influenza A(H3N2). Based on
the proportion of samples tested positive, influenza activity in
Mexico appears to be declining.

All of the influenza A viruses from Canada and the USA, and more than
90 per cent of the influenza type B viruses that have been
antigenically characterized are closely related to the current
seasonal influenza vaccine viruses.

North Africa and the Middle East
--------------------------------
Influenza transmission in North Africa and the Middle East appears to
have peaked overall, though Algeria is showing an increase. In
Pakistan, Iran, and Oman the percentage of samples tested positive for
influenza was still rather high (range 28 per cent to 70 per cent).
(H1N1) 2009 and type B viruses are co-circulating in nearly equal
distribution.

Northern Asia
-------------
The influenza-like illness activity has been variable in the
different countries in northern Asia. A number of countries already
went through a peak of influenza activity, and most of these were
predominated by A(H3N2), notably northern China and Mongolia, while
the Republic of Korea has had a (H1N1) 2009 season which peaked around
week 52 of 2010. In recent weeks, however, Mongolia and northern China
are reporting an increase in (H1N1) 2009 detections, although without
a significant increase in the ILI indicator. Japan is reporting a
sharp increase of ILI activity, but does not report as many positive
detections of influenza viruses as in previous weeks.

Countries in the tropical zone
------------------------------
The most active area of transmission in tropical regions of the world
continues to be in Asia. In tropical areas of the Americas, reports
continue to indicate very little transmission of influenza viruses. In
sub-Saharan Africa, available data indicate little activity in most
countries. Madagascar, however, shows an increase in influenza
activity with a mixture of influenza B and A(H3N2) circulating. In
tropical Asia, Singapore and China, Hong Kong Special Administrative
Region report respiratory disease activity above their epidemic
thresholds with (H1N1) 2009 virus accounting for about 90 percent of
the samples tested. An increase in (H1N1) 2009 positive samples is
also reported from southern China. Data from South East Asia indicate
only small numbers of influenza virus detections and no increases in
respiratory disease activity.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
The countries in the southern temperate regions of the world continue
to have very little influenza transmission since the end of their
winter season. Australia, however, continues to report out-of-season
transmission of influenza A(H3N2) at low level.

Virological surveillance
------------------------
During weeks 3 to 4, widespread outbreaks of laboratory confirmed
influenza A(H1N1) 2009, A(H3N2) and B viruses continued to be reported
in many parts of the northern hemisphere. In general (H1N1) 2009 and B
viruses predominated in Asia and Europe. In the North Americas A(H3N2)
activity remained high but A(H1N1)2009 activity increased.

FluNet reports
--------------
During weeks 3 to 4 (16 Jan 2011 to 29 Jan 2011), National Influenza
Centres (NICs) from 78 countries, areas or territories reported data
to FluNet. A total of 24 543 specimens were reported as positive for
influenza viruses, 19 078 (77.7 per cent) were typed as influenza A
and 5464 (22.3 per cent) as influenza B. Of the sub-typed influenza A
viruses reported, 77.6 per cent were (H1N1) 2009 and 22.4 per cent
were (H3N2).

Influenza virus detection by type/subtype in countries, areas or
territories:

* Influenza H1N1 (2009): Albania, Algeria, Australia, Austria,
Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Cameroon, Canada,
Chile, China, Costa Rica, Croatia, Cuba, Czech Republic, Denmark,
Egypt, Estonia, Finland, France, France - French Guiana, France -
Guadeloupe, France - Martinique, Georgia, Germany, Greece, Hungary,
Iceland, Iran, Italy, Jamaica, Japan, Kenya, Lao People's Democratic
Republic, Latvia, Lithuania, Luxembourg, Madagascar, Mongolia,
Morocco, Netherlands, Norway, Oman, Pakistan, Poland, Portugal,
Republic of Korea, Romania, Russian Federation, Serbia, Singapore,
Slovakia, Slovenia, South Africa, Spain, Sri Lanka, Sweden,
Switzerland, Thailand, Tunisia, Turkey, Ukraine, United Kingdom of
Great Britain and Northern Ireland and United States of America.

* Influenza A(H3N2): Albania, Australia, Austria, Brazil, Canada,
China, Costa Rica, Cuba, Czech Republic, Denmark, France, France -
Guadeloupe, France - Martinique, Ghana, Greece, Hungary, Italy, Japan,
Madagascar, Mexico, Mongolia, Morocco, Republic of Korea, Russian
Federation, Serbia, Singapore, Slovenia, Spain, Sweden, Thailand,
Turkey, United Kingdom of Great Britain and Northern Ireland and
United States of America.

* Influenza B: Albania, Algeria, Armenia, Australia, Austria,
Belarus, Belgium, Brazil, Bulgaria, Cambodia, Cameroon, Canada, China,
Costa Rica, Czech Republic, Denmark, Estonia, Finland, France, France
- Guadeloupe, France - Martinique, Georgia, Germany, Ghana, Greece,
Honduras, Hungary, Iceland, India, Iran, Italy, Japan, Kenya,
Kyrgyzstan, Lao People's Democratic Republic, Latvia, Lithuania,
Luxembourg, Madagascar, Mexico, Morocco, Netherlands, Norway, Oman,
Poland, Portugal, Romania, Russian Federation, Serbia, Singapore,
Slovakia, Slovenia, Spain, Sri Lanka, Sweden, Switzerland, Thailand,
Tunisia, Turkey, Ukraine, United Kingdom of Great Britain and Northern
Ireland and United States of America.

* No influenza activity reported: Afghanistan, Angola, Austria,
Azerbaijan, Bangladesh, Central African Republic, Cote d'Ivoire,
Dominican Republic, El Salvador, Ethiopia, Mauritius and Senegal.

The weekly update on oseltamivir resistance to influenza H1N1 (2009)
viruses can be accessed at:
<http://www.who.int/csr/disease/influenza/2011_02_11_weekly_web_update_oseltamivir_resistanc e.pdf>.

For this reporting period (26 Jan - 09 Feb 2011), 30 new cases of
influenza A(H1N1) 2009 viruses carrying the H275Y substitution have
been reported. It brings the cumulative total to 370 so far.

--
communicated by:
ProMED-mail rapporteur Marianne Hopp

[Graphical presentation of some of the data contained in this report
can be accessed as follows:
- Graph of the global circulation of influenza viruses:
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>
- Graph of northern hemisphere circulation of influenza viruses:
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>.
- Graph of southern hemisphere circulation of influenza viruses:
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>.
- Mod.CP]

[see also:
http://www.promedmail.org/pls/apex/f..._ID:1000,87058

Kassy · 02-19-2011, 04:28 AM

Archive Number 20110218.0533
Published Date 18-FEB-2011
Subject PRO/EDR> Influenza (16): Europe update

INFLUENZA (16): EUROPE UPDATE
*****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 18 Feb 2011
Source: WHO Regional Office for Europe, EuroFlu: Weekly Electronic
Bulletin [edited]
<http://www.euroflu.org/cgi-files/bulletin_v2.cgi>

Influenza activity peaking in the WHO European Region
-----------------------------------------------------

Summary
-------
- This issue is based on data reported in week 6/2011 [7-13 Feb 2011]
by 45 Member States in the WHO European Region.
- Clinical activity has apparently moved past peak in 24 countries of
the Region.
- 44 percent of sentinel specimens from patients with influenza-like
illness (ILI) and/or acute respiratory infections (ARI), and 39
percent of specimens from sentinel severe acute respiratory infection
(SARI) patients were positive for influenza.
- 97 percent of antigenically characterized viruses from the
2010/2011 influenza season are similar to the viruses included in the
2010/2011 northern hemisphere influenza vaccines.

Current situation -- week 6/2011 [7-13 Feb 2011]
------------------------------------------------
During week 6/2011, 2 countries (Georgia and Luxembourg) and the
Siberian region of the Russian Federation reported very high intensity
of influenza activity; 8 countries reported high intensity; 28
reported medium intensity; and 11 countries, low intensity. 23
countries reported widespread activity. Of the 26 countries reporting
on the impact of influenza on health care systems, 1 (Georgia)
reported severe impact; 14 countries reported moderate impact; and 11,
low impact.

Of the 41 countries reporting on consultation rates for ILI and ARI,
8 (Albania, Belarus, the Czech Republic, Iceland, Kazakhstan, Moldova,
Serbia, and Slovakia) reported increases while 6 (Ireland, Israel,
Malta, Norway, Spain, and the UK (England)) reported decreases.
Influenza activity has apparently passed its peak in 24 countries in
the Region. In general, the highest consultation rates were reported
for children aged 0-4 and 5-14 years.

WHO/Europe received sentinel surveillance data on hospitalized SARI
cases from 9 countries (Armenia, Georgia, Kazakhstan, Kyrgyzstan,
Romania, the Republic of Moldova, the Russian Federation, Serbia and
Ukraine). Sentinel SARI hospitalizations are at the highest levels
observed for the season so far in Georgia and Serbia. In Georgia,
however, outpatient clinical consultation rates declined from week 5
[31 Jan-6 Feb 2011] to week 6 [7-13 Feb 2011], while the relative
percentage of both SARI and ILI specimens testing positive for
influenza B increased. Sentinel SARI hospitalizations in Kazakhstan,
Kyrgyzstan, Romania, and the Russian Federation have declined somewhat
from observed peaks in weeks 3-5 [17 Jan-6 Feb 2011], but remain
notably elevated above pre-season levels, with 30-50 percent of
sentinel SARI specimens testing positive for influenza in each of
these countries. Sentinel SARI admissions in the Republic of Moldova
and Ukraine are at levels below prior peaks. Nevertheless, a
significant percentage of sentinel SARI specimens continue to test
positive for influenza, and the proportion of influenza A detections
in sentinel SARI specimens in Ukraine increased in week 6.

Virological situation -- week 6/2011 [7-13 Feb 2011]
----------------------------------------------------
Pandemic influenza A(H1N1) 2009 was reported to be dominant in 14
countries and co-dominant with influenza B in 12 countries. Influenza
B was dominant in 7 countries. During the past few weeks, the
predominance of influenza B viruses has increased in countries in
Western Europe, which had predominantly pandemic A(H1N1) viruses
circulating at the start of their season. In a number of eastern
European countries, the predominance has now shifted from influenza B
viruses to pandemic influenza A(H1N1) 2009 viruses.

Sentinel physicians collected 3109 respiratory specimens, of which
1373 (44 percent) were positive for influenza virus: 712 (52 percent)
were influenza A and 661 (48 percent) were influenza B. Of the
influenza A viruses, 647 were subtyped: 606 (94 percent) as pandemic
A(H1) and 41 (6 percent) as A(H3). In the 31 countries testing 20 or
more sentinel specimens, influenza positivity ranged from 9 percent to
91 percent, with a median of 46 percent (mean: 48 percent). In
addition, 6739 non-sentinel specimens were reported positive for
influenza: 5050 (75 percent) influenza A and 1689 (25 percent)
influenza B. Of the influenza A viruses, 4526 were subtyped: 4445 (98
percent) as pandemic A(H1) and 81 (2 percent) as A(H3). Out of 320
sentinel SARI specimens collected during week 6/2011, 125 (39 percent)
tested positive for influenza: 81 (65 percent) were influenza A; 44
(35 percent) were influenza B. Of the influenza A viruses, 59 were
subtyped: 58 (98 percent) as pandemic A(H1), and 1 (2 percent) as
A(H3). Of the 7 countries testing 10 or more sentinel SARI specimens,
the percentage of specimens testing positive for influenza ranged from
29 percent (Kazakhstan) to 55 percent (Republic of Moldova) with a
median of 44 percent (mean: 43 percent).

Respiratory syncytial viruses (RSV) were detected in 16 countries; 14
of these reported fewer detections in week 6/2011 than during
previously observed peaks of RSV activity.

Cumulative virological update -- weeks 40/2010-6/2011 [4 Oct 2010-13
Feb 2011]
------------------------------------------------------------------------------
A total of 55 529 influenza virus detections were reported during
this period, of which 39 778 (72 percent) were influenza A and 15 751
(28 percent) were influenza B. Of the influenza A viruses, 29 727 were
subtyped: 28 492 (96 percent) as pandemic influenza A(H1), 1234 (4
percent) as influenza A(H3), and 1 as influenza A(H1).

From week 40/2010 [4-10 Oct 2011] to week 6/2011 [7-13 Feb 2011], 756
out of 3058 sentinel SARI specimens (25 percent) tested positive for
influenza. Of these influenza viruses, 345 (46 percent) were influenza
A and 411 (54 percent) influenza B. Of the influenza A viruses, 246
were subtyped: 230 (93 percent) as pandemic influenza A(H1) and 16 (7
percent) as influenza A(H3).

Since week 40/2010, 1818 influenza viruses have been characterized
antigenically: 1043 were A(H1) pandemic A/California/7/2009
(H1N1)-like; 626 were B/Brisbane/60/2008-like (B/Victoria/2/87
lineage); 93 were A(H3) A/Perth/16/2009 (H3N2)-like; 55 were
B/Florida/4/2006-like (B/Yamagata/16/88 lineage); and 1 was
B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage). Based on the
genetic characterization of 311 influenza viruses, 147 belonged to the
pandemic A/California/7/2009 A(H1N1) clade; 7 belonged to the pandemic
A/Christchurch/16/2010 A(H1) clade; 23 belonged to the pandemic A/Hong
Kong/2213/2010 A(H1) clade; 25 were reported as A(H1) pandemic not
attributed to group category but belonging to the recently emerged
A/England/142/2010 subgroup characterized by S185T substitution in the
HA; 9 belonged to the A(H3) clade represented by A/Perth/16/2009; 6
belonged to the A(H3) clade represented by A/Victoria/208/2009; 20
belonged to the subgroup represented by A/Hong Kong/2121/2010 in the
A/Victoria/208/2009 A(H3) clade; 8 belonged to the
B/Bangladesh/3333/2007 clade (Yamagata lineage); and 66 to the
B/Brisbane/60/2008 clade (Victoria lineage).

Since week 40/2010, 5 countries (Ireland, Italy, Norway, Spain, and
the UK) have screened 801 viruses for susceptibility to the
neuraminidase inhibitors oseltamivir and zanamivir. The UK analysed
most of the viruses screened (671). Out of the total of 738 isolates
of pandemic influenza A(H1N1) 2009 viruses that were tested, 710 were
sensitive to both inhibitors and 28 viruses (3.8 percent) carried the
NA H275Y mutation. These 28 viruses were resistant to oseltamivir but
remained sensitive to zanamivir. One influenza A(H3N2) virus was
tested and found to be sensitive to both inhibitors. All of the 61
influenza B viruses tested for susceptibility to oseltamivir and the
62 tested for susceptibility to zanamivir were found to be sensitive.
All 35 pandemic influenza A(H1N1) 2009 viruses and 2 A(H3N2) viruses
that were screened for susceptibility to adamantanes were found to be
resistant.

Comment
-------
ILI and ARI clinical consultation rates and the percentage of
sentinel specimens testing positive for influenza remain high in the
WHO European Region, particularly in the central, eastern and
south-eastern parts. Influenza activity is generally progressing in a
west-to-east manner across the Region, with pandemic influenza A(H1N1)
2009 circulation decreasing in the western part and increasing in the
central and eastern parts. Influenza B is becoming relatively more
predominant in countries where the circulation of pandemic influenza A
(H1N1) 2009 is decreasing. This pattern is also apparent in sentinel
SARI hospitalizations, which are associated with both influenza A and
influenza B infections. Currently 97 percent of antigenically
characterized viruses from the 2010/2011 influenza season are similar
to the viruses recommended for inclusion in the 2010/2011 northern
hemisphere influenza vaccines.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[In brief: influenza activity is generally progressing in a
west-to-east manner across the Region, with pandemic influenza A(H1N1)
2009 circulation decreasing in the western part and increasing in the
central and eastern parts. Influenza activity has passed its peak in
24 countries in 41 countries of the Region. In general, the highest
consultation rates were reported for children aged 0-4 and 5-14 years.
Influenza B is becoming relatively more predominant in countries where
the circulation of pandemic influenza A (H1N1) 2009 is decreasing. In
contrast, in a number of eastern European countries, the predominance
has now shifted from influenza B viruses to pandemic influenza A(H1N1)
2009 viruses. This pattern is markedly different from that observed
currently in North America (see Influenza (15): USA update
20110217.0523). To what extent this reflects differences in patterns
of vaccine uptake remains to be analysed.

The original text is supplemented by tabulated data and a map
illustrating the qualitative indicators of influenza activity
(intensity, trend, geographical spread, and impact) and the dominant
virus as assessed by each of the countries. - Mod.CP]

[see also:

http://www.promedmail.org/pls/apex/f..._ID:1000,87134

Kassy · 03-14-2011, 05:09 PM

Archive Number 20110314.0819
Published Date 14-MAR-2011
Subject PRO/EDR> Influenza (21): WHO update

INFLUENZA (21): WHO UPDATE
**************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 11 Mar 2011 [available 14 Mar 2011]
Source: WHO Global Alert and Response (GAR) [summ., edited]
<http://www.who.int/csr/disease/influenza/latest_update_GIP_surveillance/en/index.html>

Influenza update 129 (11 Mar 2011)
----------------------------------
Summary
-------
Overall, the influenza season of the northern hemisphere appears to
be peaking or in decline in most areas, though with continuing active
circulation particularly in North America and Eastern Europe.
Influenza A(H3N2) comprises the largest proportion of influenza
detections in North America. Although influenza A(H1N1)2009 has been
the most commonly detected virus in Europe and northern Asia influenza
type B has been increasing in Europe and is now the more common virus
seen in many countries. The large majority of the viruses
characterized are closely related to the vaccine strains included in
the current seasonal vaccines. A small number of influenza type B of
the Yamagata lineage are reported in North America and Europe, making
up about 5 to 7 percent of B viruses detected.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
North America
Influenza activity has remained elevated in much of North America
though many indicators are beginning to show a leveling off or
decrease in activity.
In Canada, increases of influenza activity have been seen in Quebec
and British Columbia but is declining in many other regions of the
country. The influenza-like illness (ILI) consultation rate increased
to 36.5 consultations per 1000 patients from 29.3 the previous week
but has been relatively stable overall and is within the expected
range for this time of year. The proportion of clinical specimens
testing positive for influenza (18 percent in week 8 [21-27 Feb 2011])
has continued to decline in recent weeks since peaking in week 52 of
2010 [27 Dec 2010-2 Jan 2011]. Influenza A(H3N2) remains the most
commonly detected virus in Canada accounting for 86 percent of
influenza A viruses for which subtyping was performed. Although
influenza A(H1N1)2009 has been increasingly detected in recent weeks,
during week 8 H1N1(2009) decreased to 7 percent of subtyped viruses.
Influenza B detections accounted for the remaining 12 percent of
viruses subtyped.
In the United States of America, during week 8 [21-27 Feb 2011], ILI
activity remained above baseline nationally but has decreased from
previous weeks. Deaths attributed to pneumonia and influenza reported
through the 122 Cities Mortality Reporting System remain at the
epidemic threshold for the 5th consecutive week. The proportion of
specimens testing positive for influenza viruses (28 percent in week
8) have declined for the 2nd consecutive week. Of the viruses for
which subtype information is available, 49 percent were influenza
A(H3N2), 34 percent were influenza B, and 17 percent were influenza
A(H1N1)2009.
In both Canada and the United States, more than 99 percent of H3N2
and H1N1(2009) viruses characterized are antigenically similar to the
strain contained in the current trivalent seasonal influenza vaccine.
Of the influenza B viruses characterized, more than 90 percent are of
the Victoria lineage contained in the current vaccine, with another
5-7 percent from the Yamagata lineage.
Influenza activity in Mexico peaked in mid-December 2010 and activity
there is currently very low associated primarily with influenza type
B.

Europe
Influenza activity is decreasing in the majority of the European
countries, more notably in the west. A majority of countries in Europe
are reporting decreasing rates of consultation for ILI and acute
respiratory infections (ARI).
In Western Europe the number of influenza infections with severe
outcome also has declined but remained high in Greece. Sentinel
surveillance for severe acute respiratory infections (SARI) indicates
declining trends in south eastern part of the European Region
(Kazakhstan, Kyrgyzstan, and the Republic of Moldova) while increasing
numbers of SARI hospitalizations are reported in Romania, the Russian
Federation, and Ukraine. The overall percentage of sentinel specimens
testing positive for influenza in the whole of Europe, 36 percent of
525 specimens collected, is also declining in comparison with previous
weeks.
Influenza type B now makes up more than half of all influenza viruses
detected (51 percent). Of the influenza A viruses subtyped: 95 percent
were influenza A(H1N1)2009 and 5 percent were influenza A(H3N2). For
severe cases, some differences are noted between the countries of the
European Economic Area (EEA) and the rest of the Europe Region. Data
from 11 countries of the EEA indicate that H1N1 (2009) is much more
commonly detected in severe cases than in outpatients.
For 8 countries from Central Asia and Eastern Europe, however, the
proportions of viruses detected in 206 sentinel SARI specimens were
similar to those from ILI cases with 48 percent testing positive for
influenza, 54 percent of which were influenza A and 46 percent
influenza B. 92 percent of influenza A viruses tested from SARI cases
were H1N1 (2009) and 8 percent influenza A(H3N2).
Similar to North America, nearly all influenza A viruses
characterized this season in Europe have been antigenically similar to
the H1N1 and H3N2 strains included in the current trivalent seasonal
influenza vaccine. Approximately 93 percent of influenza type B
viruses characterized are also of the same lineage as those in the
current vaccine (Victoria) with the remainder being of the Yamagata
lineage.

North Africa and the Middle East
Influenza activity in North Africa and the Middle East remains low in
the countries where data are available. Most countries continue to
have limited co-circulation of influenza A(H1N1)2009 and influenza B.

North Asia
Overall, influenza activity in the temperate zone of Asia has
continued to decrease or remained stable at low level, with the
majority of cases involving influenza A(H1N1)2009. Northern China,
Japan, Republic of Korea, and Mongolia have all reported declining
levels of ILI in recent weeks. In northern China, influenza activity
has remained below the level seen during the previous two seasons, and
the proportion of specimens testing positive for influenza has
decreased to 13 percent.

Countries in the tropical zone
------------------------------
Influenza activity remains low throughout the tropical zone and the
most common subtype detected is influenza A(H1N1)2009.
Influenza activity is sporadic in regions of Central America, the
Caribbean, and the Andean Region, with influenza A and B
co-circulating.
In sub-Saharan Africa, available data indicate little activity in
most countries.
In Madagascar activity has peaked around week 5 of 2011 and now has a
low level of activity with influenza A(H3N2 ) and type B
co-circulating.
A low level of influenza activity continues in much of tropical Asia,
though at declining rates. In southern China, during 14-20 Feb 2011,
influenza activity has decreased slightly and remains below the level
seen last season, and similar to the level seen 2 seasons ago. During
this time period, 28 percent of the 981 specimens tested were positive
for influenza. Of these, 78 percent were influenza A and 22 percent
influenza B. Of the 274 influenza A detections: 94 percent were
influenza A(H1N1)2009, and 2 percent were influenza A(H3N2). In Hong
Kong Special Administrative Region, influenza activity continues to
decrease. Influenza A(H1N1)2009 made up approximately 90 percent of
the 372 viruses subtyped during week 9 [28 Feb-6 Mar 2011], with the
remaining viruses being influenza A(H3N2) and influenza B.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
Most countries in the southern temperate regions of the world
continue to have very little influenza transmission since the end of
their winter season. Australia continues to detect low, persistent
numbers of influenza A(H3N2).

Virological surveillance
------------------------
During weeks 7 to 8 [14-27 Feb 2011], regional and widespread
outbreaks of laboratory confirmed influenza A(H1N1)2009, A(H3N2), and
B viruses continued to be reported in many parts of Asia, Europe, and
north Americas while activity deceased in some countries. Influenza
A(H1N1)2009 viruses predominated in China, while both A(H1N1) 2009 and
B viruses co-circulated in many European countries. In the United
States of America, influenza A(H1N1)2009, A(H3N2) and B viruses
co-circulated, while in Canada, the predominant viruses were still
influenza A(H3N2). The number of laboratory confirmed influenza
positive specimens remained low in the southern hemisphere. The vast
majority of antigenically characterized viruses from the 2010-2011
influenza season remain similar to the viruses WHO recommended for the
2010-2011 northern hemisphere influenza vaccines.

FluNet reports
--------------
During weeks 7 to 8 [14 -27 Feb 2011], National Influenza Centres
(NICs) from 71 countries, areas or territories reported data to
FluNet. A total of 23 736 specimens were reported as positive for
influenza viruses, 17 762 (74.8 percent) were typed as influenza A,
5974 (25.2 percent) as influenza B. Of the sub-typed influenza A
viruses reported, 80 percent were influenza A(H1N1)2009 and 20 percent
were influenza A(H3N2).

Influenza virus detection by type/subtype in countries, areas, or
territories:
- Influenza A(H1N1)2009: Albania, Algeria, Armenia, Australia,
Austria, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Cambodia,
Canada, China, Croatia, Czech Republic, Denmark, Ecuador, Egypt,
Estonia, Finland, France, France - Martinique, Georgia, Germany,
Ghana, Greece, Hungary, Iceland, India, Iran, Italy, Japan,
Kyrgyzstan, Lao People's Democratic Republic, Latvia, Luxembourg,
Mexico, Mongolia, Netherlands, Norway, Pakistan, Poland, Portugal,
Republic of Korea, Romania, Russian Federation, Serbia, Singapore,
Slovakia, Slovenia, Spain, Sri Lanka, Sweden, Switzerland, Thailand,
Tunisia, Turkey, Ukraine, UK, and USA.

- Influenza A(H1N1) (old seasonal virus): no report.

- Influenza A(H3N2): Albania, Australia, Austria, Brazil, Canada,
China, Cuba, Czech Republic, Denmark, France, France - Martinique,
Georgia, Germany, Ghana, Italy, Jamaica, Japan, Madagascar, Mexico,
Mongolia, Norway, Paraguay, Republic of Korea, Russian Federation,
Serbia, Singapore, Spain, Sweden, Turkey, Ukraine, and USA.

- Influenza A(H5): Cambodia and Egypt.

- Influenza B: Albania, Algeria, Armenia, Austria, Belarus, Belgium,
Bulgaria, Cambodia, Canada, China, Costa Rica, Cuba, Czech Republic,
Denmark, Estonia, Finland, France, Georgia, Germany, Ghana, Greece,
Hungary, Iceland, Iran, Italy, Jamaica, Japan, Kyrgyzstan, Lao
People's Democratic Republic, Latvia, Lithuania, Luxembourg,
Madagascar, Mexico, Netherlands, Norway, Pakistan, Poland, Romania,
Russian Federation, Serbia, Slovakia, Slovenia, Spain, Sri Lanka,
Sweden, Switzerland, Thailand, Tunisia, Turkey, Ukraine, UK, and USA.

- No influenza activity reported: Afghanistan, Azerbaijan,
Bangladesh, Central African Republic, Chile, Colombia, France - French
Guiana, France - Guadeloupe, Honduras, Panama, or Uruguay.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Graphical representation of some of the data contained in this
report, which readers are recommended to consult, can be accessed as
follows:

- Global circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_03_11_influenza_global_circulation.pdf>

- Northern hemisphere circulation of influenza viruses (real-time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>

- Southern hemisphere circulation of influenza viruses (real-time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>

- The weekly update on oseltamivir resistance to influenza
A(H1N1)2009 viruses can be accessed at
<http://www.who.int/csr/disease/influenza/2011_03_11_weekly_web_update_oseltamivir_resistanc e.pdf>.

In brief: the influenza season of the northern hemisphere appears to
be peaking or in decline in most areas, though with continuing active
circulation particularly in North America and Eastern Europe. In
Western Europe the number of influenza infections wit severe outcome
also has declined. Most countries in the southern temperate regions of
the world continue to have very little influenza transmission

Although influenza A(H1N1)2009 has been the most commonly detected
virus in Europe and northern Asia influenza type B has been increasing
in Europe and is now the more common virus seen in many countries.

The vast majority of antigenically characterized viruses from the
2010-2011 influenza season remain similar to the viruses WHO
recommended for the 2010-2011 northern hemisphere influenza vaccines.
Although influenza A(H1N1)2009 has been the most commonly detected
virus in Europe and northern Asia, Influenza type B has been
increasing in Europe and is now the more common virus seen in many
countries. - Mod.CP]

[see also:
Influenza (20): H2N2 pandemic potential 20110311.0787
Influenza (19): Europe update 20110304.0709
Influenza (18): WHO update 20110225.0629]
.................................................c p/mj/dk
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http://www.promedmail.org/pls/apex/f..._ID:1000,87561

Kassy · 03-27-2011, 03:04 PM

Archive Number 20110326.0957
Published Date 26-MAR-2011
Subject PRO/EDR> Influenza (25) - WHO Update

INFLUENZA (25): WORLD HEALTH ORGANISATION UPDATE
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 25 Mar 2011
Source: World Health Organisation (WHO), Global Aleert and Response,
Influenza [abbr., edited]
<http://www.who.int/csr/disease/influenza/latest_update_GIP_surveillance/en/index.html>

WHO Update number 130 - Influenza update - 25 Mar 2011
------------------------------------------------------
Summary
-------
Influenza activity in most areas of the northern hemisphere temperate
regions appears to have peaked and is declining. Although the level of
pneumonia and influenza mortality in the United States of America
(USA) is above the epidemic threshold and many states still are
reporting on widespread activity, most indicators on influenza
activity in North America are indicating decreasing influenza
activity. As activity in the Americas declines, influenza A(H1N1)2009
has increased proportionately and now accounts for 38 percent of all
virus detections. In Europe the peak has been passed in most countries
and all countries now report medium or low influenza activity. Cases
of Severe Acute Respiratory Infections in Europe are decreasing but
still above baseline in some parts of Eastern Europe. Influenza
viruses in Europe continue to be primarily influenza A(H1N1)2009,
about 70 percent of all viruses characterized, and influenza type B,
making up about 28 percent of all viruses. Data from parts of Northern
Africa show that there is ongoing community transmission of both
influenza A(H1N1l)2009 and influenza type B in Tunisia and Algeria.
The large majority of the viruses characterized are closely related to
the vaccine strains included in the current seasonal vaccines. Viruses
which have been characterized antigenically continue to be largely
related to the lineages found in the current trivalent seasonal
vaccine except for a small number of influenza B viruses of the
Yamagata lineage.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
North America: Influenza activity in North America is decreasing in
both Canada and the USA. In Canada, most regions report either
declining or stable activity. The influenza like-illness (ILI)
consultation rate fell from 37.4 to 25.3 per 1000 patient visits in
epidemiological week 10 and is now below the expected rate for this
time of year. New hospitalizations with laboratory-confirmed influenza
among both adults and children also declined in the same period. Since
the beginning of the season, 93 percent of all influenza viruses have
been type A. Of the influenza A viruses subtyped, 86 percent have been
influenza A(H3N2). Detections of influenza type B have been increasing
proportionately since late January and now accounts for 28 percent of
all influenza positive specimens. Seventy-eight percent of 185 fatal
influenza cases reported from nine provinces and territories were in
patients aged 65 years or older. 91 percent of the subtyped influenza
A viruses in the fatal adult cases have been H3N2, and less than 3
percent influenza type B. In the USA, the ILI consultation rate fell 3
percent but is still above the national baseline. Reported deaths due
to pneumonia and influenza from the 122 city surveillance system also
remain above the epidemic threshold for this time of the year. During
epidemiological week 10, 11 children were reported to have died of
influenza related illness, making a total of 71 pediatric deaths since
October 2010. The overall proportion of samples testing positive for
influenza in week 10 has decreased from 27 percent to 21 percent.
Virus detections in the USA were primarily H3N2 and type B early in
the season, however, the proportion of detections due to influenza
A(H1N1)2009 have steadily increased and now account for 43 percent of
all the subtyped influenza A viruses. Mexico reports a low number of
influenza virus detections, with influenza type B as the most frequent
virus.

Europe: All influenza indicators in Europe continue to decline since
the last report. 37 of the 53 Member States in the WHO European Region
have passed a peak of the ILI or Acute Respiratory Illness (ARI)
surveillance in recent weeks. All countries reported either medium or
low influenza activity, and only Bulgaria reported increased activity.
Cases of Severe Acute Respiratory Infections (SARI) in the European
Economic Area (EEA) peaked at the end of December 2010 but still
remain above pre-season levels in the Eastern European countries
(Georgia, the Republic of Moldova, Romania, Serbia and Ukraine). In
the EEA, the most frequently reported risk factor for severe influenza
infections is obesity. In week 10 the proportion of samples testing
positive for influenza among sentinel doctors was 46 percent. Of all
influenza virus detections that were reported this season, 72 percent
were influenza A and 28 percent were influenza B. Of the influenza A
viruses that were subtyped 97 percent were influenza A(H1N1)2009 and 3
percent were influenza A(H3N2). Since week 40, 2010, and similar to
North America, nearly all influenza A viruses characterized this
season in Europe have been antigenically similar to the H1N1 and H3N2
strains included in the current trivalent seasonal influenza vaccine.
Approximately 93 percent of influenza type B viruses characterized are
also of the same lineage as those in the current vaccine (Victoria)
with the remainder being of the Yamagata lineage.

North Africa and the Middle East: Influenza activity in North Africa
and the Middle East is moderate with influenza A(H1N1)2009 and
influenza B viruses co-circulating. The number of confirmed cases in
Algeria has increased over the last several weeks, with nearly 60
cases of influenza A(H1N1)2009 reported during 7-12 March. Tunisia has
had continued activity during the last few weeks with nearly 30 cases
of co-circulating influenza A(H1N1)2009 and influenza B reported. In
the Middle East, influenza activity in Oman and Iran remain moderate
with approximately 50 confirmed influenza cases in each country, while
the number of confirmed cases in Pakistan has decreased to less than
20.

Northern Asia: Overall, influenza activity in northern Asia continues
to decline. In north China, ILI activity has remained low and below
the activity level observed during the last three seasons. ILI
activity in Japan has seen a slight increase after several weeks of
decreasing activity. The proportion of ILI patients has remained
stable in the Republic of Korea after a declining trend seen over the
last several weeks. The majority of cases involve influenza
A(H1N1)2009, with influenza A(H3N2) and influenza B circulating in
lower numbers.

Countries in the tropical zone
------------------------------
Influenza activity in the tropics remains low in most areas with
co-circulation of influenza B and influenza A(H1N1)2009. For the most
part, sporadic activity is reported in regions of Central America, the
Caribbean and the Andean Region. However, in Guatemala, the proportion
of positive respiratory viruses among the tested samples has increased
to 37 percent during 28 Feb - 4 Mar 2011, compared to 6 percent in the
previous week. In Ecuador, the percentage of samples positive for
respiratory viruses increased slightly from the previous week to
approximately 30 percent. In Sub-Saharan Africa, limited available
data indicate low levels of co-circulating influenza A and influenza B
viruses. However, influenza activity has been increasing in Kenya,
with 17 influenza B cases, 11 influenza A(H1N1)2009 cases, and 1
influenza A(H3N2) case during epidemiological week 10, compared to a
total of 18 cases the previous week. Madagascar also reports low level
persistent activity primarily associated with influenza type B.
Influenza activity in tropical Asia remains low with the majority of
cases involving influenza B and influenza A(H1N1)2009. In south China,
the percent ILI of sentinel hospital visits decreased to 3 percent
during week 10 from 3.3 percent the previous week. This is lower than
the level seen during the 2008-2009 and 2009-2010 seasons (3.4 percent
and 3.3 percent respectively).

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
Influenza activity remains low in most regions in the temperate zone
of the southern hemisphere. However, Australia reports persistent
low-level of out-of-season influenza activity, primarily in the
northern tropical areas of the country. Influenza A(H3N2) is the
predominant virus in Australia.

Virological surveillance
------------------------
During weeks 9 to 10, laboratory detections of influenza A(H1N1)2009,
A(H3N2) and B viruses continued to be reported in many parts of Asia,
Europe and North Americas, though virus activity in general was low.
In the northern hemisphere and tropical regions, a general decline in
activity was observed for both H1N1 (2009) and B viruses that
co-circulated in some countries. In Europe, decreased activity was
observed for both H1N1 (2009) and B viruses that co-circulated. In
Asia, influenza A(H1N1)2009 viruses continued to predominate, while
influenza B viruses were slightly predominant in Africa with
co-circulation of A(H3N2) viruses. In the United States of America,
influenza A(H1N1)2009, A(H3N2) and B viruses co-circulated, while in
Canada, the predominant viruses continued to be influenza A(H3N2). In
the southern hemisphere, influenza activity was low with
influenzaA(H1N1)2009, A(H3N2) and B viruses detected in few countries.
The vast majority of characterized viruses from the 2010-2011
influenza season remain antigenically similar to the viruses WHO
recommended for the 2010-2011 northern hemisphere influenza vaccines.

FluNet reports
--------------
During weeks 9 to 10 (27 February 2011 to 12 March 2011), National
Influenza Centres (NICs) from 71 countries, areas or territories
reported data to FluNet. A total of 13 496 specimens were reported as
positive for influenza viruses, 9379 (69.5 percent) were typed as
influenza A and 4117 (30.5 percent) as influenza B. Of the sub-typed
influenza A viruses reported, 76.7 percent were influenza A(H1N1)2009
and 23.3 percent were influenza A(H3N2).

Influenza virus detection by type/subtype in countries, areas or
territories (as of 22 Mar 2011):

-- Influenza A(H1N1)2009: Albania, Algeria, Argentina, Armenia,
Australia, Austria, Belarus, Bosnia and Herzegovina, Bulgaria,
Cameroon, Canada, China, Croatia, Cuba, Czech Republic, Denmark,
Estonia, Finland, France, France - French Guiana, France - Martinique,
Georgia, Germany, Ghana, Greece, Hungary, Iran (Islamic Republic of),
Italy, Jamaica, Japan, Kenya, Lao People's Democratic Republic,
Latvia, Lithuania, Luxembourg, Madagascar, Mali, Mongolia, Morocco,
Netherlands, Norway, Poland, Portugal, Romania, Russian Federation,
Rwanda, Serbia, Slovakia, Slovenia, Spain, Sri Lanka, Sweden,
Switzerland, Tunisia, Turkey, Ukraine, United Kingdom of Great Britain
and Northern Ireland, United Republic of Tanzania, United States of
America, Viet Nam.

-- Influenza A(H1N1) (old seasonal virus): no report.

-- Influenza A(H3N2): Australia, Brazil, Canada, China, Cuba,
Ecuador, Ethiopia, France, France - French Guiana, Germany, Greece,
Guatemala, Iran (Islamic Republic of), Italy, Japan, Kenya,
Kyrgyzstan, Madagascar, Morocco, Norway, Paraguay, Russian Federation,
Rwanda, Serbia, Spain, Sweden, Turkey, United Republic of Tanzania,
United States of America, Viet Nam.

-- Influenza B: Albania, Australia, Austria, Belarus, Belgium,
Brazil, Bulgaria, Cambodia, Canada, China, Costa Rica, Croatia, Czech
Republic, Denmark, Estonia, Finland, France, France - French Guiana,
Georgia, Germany, Ghana, Greece, Hungary, Iceland, Iran (Islamic
Republic of), Italy, Jamaica, Japan, Kenya, Kyrgyzstan, Lao People's
Democratic Republic, Latvia, Lithuania, Luxembourg, Madagascar,
Mexico, Mongolia, Morocco, Netherlands, Nicaragua, Norway, Poland,
Romania, Russian Federation, Serbia, Slovakia, Slovenia, Spain, Sri
Lanka, Sweden, Switzerland, Tunisia, Turkey, Ukraine, Unite Kingdom of
Great Britain and Northern Ireland, United Republic of Tanzania,
United States of America, Viet Nam.

-- No influenza activity reported: Afghanistan, Azerbaijan, Central
African Republic, Colombia, Dominican Republic, El Salvador, Ethiopia,
France - Guadeloupe, Honduras, India, Mauritius, South Africa,
Uganda.

(The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every 2 weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance Network) and
influenza reports from WHO Regional Offices and Member States.
Completeness can vary among updates due to availability and quality of
data available at the time when the update is developed.)

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Graphical representation of some of the data contained in this
report, which readers are recommended to consult, can be accessed as
follows

- Global circulation of influenza viruses
<http://www.who.int/csr/disease/influenza/2011_03_25_influenza_global_circulation.pdf>

- Northern hemisphere circulation of influenza viruses
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>

- Southern hemisphere cirulation of influenza viruses
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>

- Weekly update on oseltamivir resistance to influenza A/(H1N1)
virus
<http://www.who.int/csr/disease/influenza/2011_03_25_weekly_web_update_oseltamivir_resistanc e.pdf>.

For the reporting period (09 - 23 Mar 2011), 10 new cases of
influenza A(H1N1)2009 viruses carrying the H275Y substitution have
been reported. It brings the cumulative total to 431 so far. - Mod.CP]

[see also:
http://www.promedmail.org/pls/apex/f..._ID:1000,87741

Kassy · 04-08-2011, 03:47 PM

Archive Number 20110408.1103
Published Date 08-APR-2011
Subject PRO/AH/EDR> Influenza (28): Europe update

INFLUENZA (28): EUROPE UPDATE
*****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 8 Apr 2011
Source: WHO Regional Office for Europe, EuroFlu: Weekly Electronic
Bulletin [summ., edited]
<http://www.euroflu.org/cgi-files/bulletin_v2.cgi>

Influenza activity continuing to decline in the WHO European Region
-------------------------------------------------------------------

Summary
-------
- This issue is based on data reported in week 13/2011 [28 Mar-3 Apr
2011] by 47 Member States in the WHO European Region.
- Clinical consultation rates for influenza-like illness (ILI) and/or
acute respiratory infections (ARI) continue to decline in 35
countries, and are lower than previously observed peaks in 38
countries.
- Sentinel surveillance for hospitalised severe acute respiratory
infections (SARI) in 10 countries suggests that SARI hospitalizations
have also passed previous peaks in each of these countries.
- 18 percent of sentinel specimens from patients with ILI or ARI, and
15 percent of specimens from sentinel SARI patients tested positive
for influenza, a decline from recent weeks.
- Influenza B now represents a large majority of influenza detections
from sentinel sites in the Region.

Current situation -- week 13/2011 [28 Mar-3 Apr 2011]
-----------------------------------------------------
Of the 42 countries reporting on the intensity of respiratory disease
activity, 38 reported a low intensity and 5 reported a medium
intensity. Of 43 countries reporting on the geographical spread of
influenza, 31 reported none or sporadic activity. Local activity was
reported in 6 countries, while 5 reported regional activity, and one
(Croatia) reported widespread activity. The impact of influenza on
health care systems was reported to be low in 22 and moderate in 2 of
the 24 countries reporting on this indicator.

Trends in clinical and virological data suggest declining influenza
activity in the Region. Clinical consultation rates for influenza-like
illness (ILI) and/or acute respiratory infection (ARI) activity
continue to decline in 35 countries, and are lower than previously
observed peaks in 38 countries. In addition, of the 17 countries
indicating a baseline threshold for influenza activity, all reported
ILI or ARI clinical consultation rates to be below the seasonal
threshold. Declining trends in influenza positivity rates can also be
observed in 16 of the 18 countries that have reported consistently on
this indicator. Data from sentinel hospital-based surveillance for
SARI were reported from 10 countries: Albania, Armenia, Georgia,
Kazakhstan, Romania, the Republic of Moldova, the Russian Federation,
Serbia, and Ukraine. Sentinel SARI hospitalizations have declined to
levels below previous peaks in all of these countries. This has been
accompanied by concurrent declines in the percent of sentinel SARI
specimens testing positive for influenza. There has also been a
decrease in the relative percentage of sentinel SARI hospitalisations
in persons over age four years. Although Kyrgyzstan reported an
increase in sentinel SARI hospitalizations during the current week, no
sentinel specimens from these patients were reported to be positive
for influenza, and this increase was mostly the result of recent
hospitalisations in the 0-4 age group. Further information on the
sentinel SARI surveillance systems represented in the EuroFlu bulletin
can be found in the "Overview of sentinel SARI systems in EuroFlu".

Virological situation -- week 13/2011 [28 Mar-3 Apr 2011]
---------------------------------------------------------
Pandemic influenza A(H1N1) 2009 was reported to be dominant in 2
countries and co-dominant with influenza B in 3 countries. Influenza B
was reported to be dominant in 10 countries.

Sentinel physicians collected 590 respiratory specimens, of which 106
(18 percent) were positive for influenza virus: 18 (17 percent) were
influenza A and 88 (83 percent) were influenza B. Of the influenza A
viruses, 15 were subtyped: 15 (100 percent) as pandemic A(H1). In the
12 countries testing 20 or more sentinel specimens, influenza
positivity ranged from 0 percent to 50 percent, with a median of 11
percent (mean: 20 percent). In addition, 587 non-sentinel specimens
were reported positive for influenza: 315 (54 percent) influenza A and
272 (46 percent) influenza B. Of the influenza A viruses, 261 were
subtyped: 247 (95 percent) as pandemic A(H1) and 14 (5 percent) as
A(H3).

Sentinel hospitals participating in SARI surveillance (10 countries)
collected 113 sentinel SARI specimens of which 17 (15 percent) were
positive for influenza (compared to 25 percent positive in week
12/2011 [21-27 Mar 2011]). Among the 5 countries testing 10 or more
sentinel SARI specimens, the percentage testing positive for influenza
ranged from 0 percent in Kyrgyzstan to 30 percent in Georgia (median:
8 percent, mean: 13 percent).

Cumulative virological update -- weeks 40/2010-13/2011 [4 Oct 2010-3
Apr 2011]
------------------------------------------------------------------------------
A total of 82 150 influenza virus detections were reported during
this period, of which 58 399 (71 percent) were influenza A and 23 751
(29 percent) were influenza B. Of the influenza A viruses, 46 551 were
subtyped: 44 879 (96 percent) as pandemic A(H1), 1671 (4 percent) as
influenza A(H3) and 1 as influenza A(H1).

From week 40/2010 [4-10 Oct 2011] through week 13/2011 [28 Mar-3 Apr
2011], 1521 of 5343 sentinel SARI specimens (28 percent) tested
positive for influenza. Of these influenza viruses, 863 (57 percent)
were influenza A, and 658 (43 percent) influenza B. Of the influenza A
viruses, 684 were subtyped: 632 (92 percent) as pandemic A(H1) and 52
(8 percent) as influenza A(H3).

Since week 40/2010, 4443 influenza viruses have been characterized
antigenically: 2262 were A(H1) pandemic A/California/7/2009
(H1N1)-like; 1865 were B/Brisbane/60/2008-like (B/Victoria/2/87
lineage); 150 were A(H3) A/Perth/16/2009 (H3N2)-like; 164 were
B/Florida/4/2006-like (B/Yamagata/16/88 lineage), and 2 were
B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage). Based on the
genetic characterization of 550 influenza viruses, 160 belonged to the
pandemic A/California/7/2009 A(H1N1) clade; 10 belonged to the
pandemic A/Christchurch/16/2010 A(H1) clade; 46 belonged to the
pandemic A/Hong Kong/2213/2010 A(H1) clade; 124 belonged to the
recently emerged A/England/142/2010 subgroup characterized by S185T
substitution in the HA; 12 belonged to the A(H3) clade represented by
A/Perth/16/2009; 7 belonged to the A(H3) clade represented by
A/Victoria/208/2009; 30 belonged to the subgroup represented by A/Hong
Kong/2121/2010 in the A/Victoria/208/2009 A(H3) clade; 19 belonged to
the B/Bangladesh/3333/2007 clade (Yamagata lineage); and 142 to the
B/Brisbane/60/2008 clade (Victoria lineage).

Since week 40/2010, 9 countries (Denmark, Germany, Ireland, Italy,
Netherlands, Norway, Spain, Switzerland, and the UK) have screened
2407 viruses for susceptibility to the neuraminidase inhibitors
oseltamivir and zanamivir. The UK analysed most of the viruses
screened (1672). Out of the 2069 pandemic A(H1N1) 2009 viruses that
were tested, 1978 were sensitive to both inhibitors and 91 viruses
(4.4 percent) carried the NA H275Y mutation. These 91 viruses were
resistant to oseltamivir but remained sensitive to zanamivir. 4
influenza A(H3N2) viruses were tested and found to be sensitive to
both inhibitors. All of the 338 influenza B viruses tested for
susceptibility to oseltamivir and the 328 tested for susceptibility to
zanamivir were found to be sensitive. All 178 pandemic influenza
A(H1N1) 2009 viruses and 2 A(H3N2) viruses that were screened for
susceptibility to adamantanes were found to be resistant.

Comment
-------
Trends in clinical and virological data suggest that influenza
activity is substantially declining across the WHO European Region.
Recent declines in clinical indicators have been observed in nearly
all countries, and many are below seasonal thresholds for influenza
activity. The percent of sentinel ILI, ARI, and SARI specimens that
have tested positive for influenza, and the circulation of pandemic
influenza A(H1N1) 2009 relative to influenza B has also declined
during recent weeks.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The EuroFlu website features an interactive map presenting
qualitative indicators of influenza activity (intensity, trend,
geographical spread, and impact) and the dominant virus as assessed by
each of the countries. This information can be accessed by clicking on
the individual countries in the map and readers are recommended to
make use of this facility. In addition, clicking on France, the
Russian Federation, Turkey, and UK (England) will provide regional
data for these countries.

Interestingly the cumulative data for the winter season (weeks
40/2010-13/2011) reveal that only just over one quarter of the cases
of severe acute respiratory illness could be attributed to influenza
virus infection. - Mod.CP]

[see also:

http://www.promedmail.org/pls/apex/f..._ID:1000,87934

Kassy · 04-30-2011, 02:12 PM

Archive Number 20110430.1336
Published Date 30-APR-2011
Subject PRO/EDR> Influenza (33): Europe update

INFLUENZA (33): EUROPE UPDATE
*****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 29 Apr 2011
Source: WHO Regional Office for Europe, EuroFlu: Weekly Electronic
Bulletin [summ., edited]
<http://www.euroflu.org/cgi-files/bulletin_v2.cgi>

Influenza activity has returned to "out of season" levels in most
countries of the WHO European Region
----------------------------------------------------------------------
Summary
-------
- This issue is based on data reported in week 16/2011 [18-24 Apr
2011] by 45 [of the 53] Member States in the WHO European Region.

- Consultation rates for influenza-like illness (ILI) and acute
respiratory infection (ARI) activity are below baseline thresholds or
at pre-season levels in most countries.

- Hospitalizations for severe acute respiratory infection (SARI)
continue to decline in most countries with sentinel hospital-based
surveillance for SARI.

- 5 percent of sentinel specimens from patients with ILI or ARI, and
3 percent of specimens from sentinel SARI patients, tested positive
for influenza.

Current situation -- week 16/2011 [18-24 Apr 2011]
--------------------------------------------------
During week 16/2011 [18-24 Apr 2011], 35 countries reported low
intensity of respiratory-disease activity and 2 (Armenia and the
Russian Federation), medium intensity. ILI or ARI consultation rates
have returned to pre-season levels or are below the national baseline
thresholds in all but one (Azerbaijan) of the 36 countries reporting
epidemiological data this week. Among the 37 countries reporting on
the geographical spread of influenza, 35 reported no or sporadic
activity. Armenia reported local spread, and Georgia, regional spread.
The impact of influenza on health care systems was low in all but one
(Armenia) of the 20 countries reporting on this indicator.

Data on sentinel hospital-based surveillance for SARI were reported
in 10 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, Malta, the
Republic of Moldova, Romania, the Russian Federation, Serbia, and
Ukraine. SARI hospitalizations are declining overall and are back to
pre-season levels in Kazakhstan, Romania, Serbia, and Ukraine. In
Georgia, SARI hospitalizations have increased over the last 3 weeks;
this is driven by increases in hospitalizations in the group aged 0 to
4, however, and no sentinel SARI specimens tested positive for
influenza in the country during week 16. Further information on the
sentinel SARI surveillance systems represented in the EuroFlu bulletin
can be found in the "Overview of sentinel SARI systems in EuroFlu"
[<http://www.euroflu.org/documents/EuroFlu_Overview_of_SARI_Surveillance_Systems.pdf>].

Virological situation -- week 16/2011 [18-24 Apr 2011]
------------------------------------------------------
Influenza B virus was dominant in 3 countries, and co-dominant with
pandemic influenza A(H1N1) 2009 in 2 others. Ukraine reported pandemic
influenza A(H1N1) 2009 virus to be dominant.

Sentinel physicians collected 162 respiratory specimens, of which 8
(5 percent) were positive for influenza virus: 3 (38 percent) were
influenza A and 5 (62 percent) were influenza B. 2 of the 3 influenza
A viruses were subtyped: both were pandemic A(H1). In the 2 countries
testing 20 or more sentinel specimens, influenza positivity ranged
from 3 percent to 5 percent. In addition, 140 non-sentinel specimens
were reported positive for influenza: 63 (45 percent) influenza A and
77 (55 percent) influenza B. Of the influenza A viruses, 54 were
subtyped: 51 (94 percent) as pandemic A(H1) and 3 (6 percent) as
A(H3).

Sentinel hospitals participating in SARI surveillance in 10 countries
collected 64 specimens from SARI patients of which 2 (3 percent) were
positive for influenza.

Cumulative virological update -- weeks 40/2010-16/2011 [4 Oct 2010-24
Apr 2011]
----------------------------------------------------------------------
A total of 77 462 influenza virus detections was reported during this
period, of which 54 949 (71 percent) were influenza A and 22 513 (29
percent) were influenza B. Of the influenza A viruses, 46 281 were
subtyped: 44 542 (96 percent) as pandemic A(H1) and 1739 (4 percent)
as A(H3).

From week 40/2010 through week 16/2011 [18-24 Apr 2011], 1533 out of
5525 sentinel SARI specimens (28 percent) tested positive for
influenza: 872 (57 percent) were influenza A and 661 (43 percent)
influenza B. Of the influenza A viruses, 691 were subtyped: 638 (92
percent) as pandemic A(H1) and 53 (8 percent) as influenza A(H3).

Since week 40/2010, 4515 influenza viruses have been characterized
antigenically: 2329 were A(H1) pandemic A/California/7/2009
(H1N1)-like; 1860 were B/Brisbane/60/2008-like (B/Victoria/2/87
lineage); 151 were A(H3) A/Perth/16/2009 (H3N2)-like; 173 were
B/Florida/4/2006-like (B/Yamagata/16/88 lineage); and 2 were
B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage). Based on the
genetic characterization of 585 influenza viruses, 166 belonged to the
pandemic A/California/7/2009 A(H1N1) clade; 10 belonged to the
pandemic A/Christchurch/16/2010 A(H1) clade; 46 belonged to the
pandemic A/Hong Kong/2213/2010 A(H1) clade; 136 belonged to the
recently emerged A/England/142/2010 subgroup characterized by S185T
substitution in the HA; 12 belonged to the A(H3) clade represented by
A/Perth/16/2009; 5 belonged to the A(H3) clade represented by
A/Victoria/208/2009; 29 belonged to the subgroup represented by A/Hong
Kong/2121/2010 in the A/Victoria/208/2009 A(H3) clade; 20 belonged to
the B/Bangladesh/3333/2007 clade (Yamagata lineage); and 161 to the
B/Brisbane/60/2008 clade (Victoria lineage).

Since week 40/2010, 9 countries (Denmark, Germany, Ireland, Italy,
Netherlands, Norway, Spain, Switzerland, and the UK) have screened
3519 viruses for susceptibility to the neuraminidase inhibitors
oseltamivir and zanamivir. The UK analysed most of the viruses
screened (1672). Of the 3164 pandemic A(H1N1) 2009 viruses that were
tested, 3072 were sensitive to both inhibitors and 92 viruses (2.9
percent) carried the NA H275Y mutation. These 92 viruses were
resistant to oseltamivir but remained sensitive to zanamivir. 9
influenza A(H3N2) viruses were tested and found to be sensitive to
both inhibitors. All of the 346 influenza B viruses tested for
susceptibility to oseltamivir and the 340 tested for susceptibility to
zanamivir were found to be sensitive. All 197 pandemic influenza
A(H1N1) 2009 viruses and 10 A(H3N2) viruses that were screened for
susceptibility to adamantanes were found to be resistant.

Comment
-------
Influenza activity has returned to pre-season levels in most
countries across the WHO European Region. At present, a very low
percentage (less than 5 percent) of sentinel ILI/ARI and SARI
specimens is testing positive for influenza.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[In brief: influenza has returned to pre-seasonal levels throughout
most of Europe. During the course of the epidemic 3 (possibly 4)
distinct clades of influenza A(H1N1) 2009 virus, 3 of influenza A (H3)
virus, and 2 of influenza B virus have been recognised. Which of these
clades will predominate in any subsequent outbreak cannot be predicted
at this stage.

The EuroFlu website features an interactive map presenting
qualitative indicators of influenza activity (intensity, trend,
geographical spread, and impact) and the dominant virus as assessed by
each of the countries. This information can be accessed by clicking on
the individual countries in the map and readers are recommended to
make use of this facility. In addition, clicking on France, the
Russian Federation, Turkey, and UK (England) will provide regional
data for these countries. - Mod.CP]

[see also:

http://www.promedmail.org/pls/apex/f..._ID:1000,88253

Kassy · 05-07-2011, 04:32 PM

Archive Number 20110506.1402
Published Date 06-MAY-2011
Subject PRO/EDR> Influenza (35): WHO update

INFLUENZA (35): WHO UPDATE
**************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 6 May 2011
Source: WHO Global Alert and Response (GAR), influenza update
[edited]
<http://www.who.int/csr/disease/influenza/latest_update_GIP_surveillance/en/index.html>

Influenza update 133 [6 May 2011]
---------------------------------
Summary
-------
- Worldwide influenza activity is currently low.
- Influenza activity across the entire temperate Northern Hemisphere
is generally back to baseline or pre-seasonal levels
- As levels of influenza activity decrease, influenza type B has
become more commonly detected compared to influenza A viruses across
the Northern Hemisphere temperate areas and in much of the tropics.
- Transmission in tropical areas of the world is also generally low
with some transmission reported in countries of Sub-Saharan Africa
with a mixture of viruses and slight predominance of influenza type
B.
- In the temperate areas of the southern hemisphere the influenza
season has not yet started.
- Nearly all influenza A viruses tested continue to be antigenically
similar to those found in the current trivalent vaccine. More than 90
percent of the influenza type B viruses are also of the lineage found
in the vaccine (Victoria lineage); however, a small number of B
viruses of the Yamagata lineage are also being reported.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
North America
[North America circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_05_06_influenza_north_america_circulation_mai n.pdf>]

Influenza activity continued to decline both in Canada and the USA.
In Canada the influenza-like illness (ILI) consultation rate has
decreased. Both adult and pediatric hospitalizations with influenza
were similar to previous weeks. Most provinces and territories report
no or sporadic activity though there has been a slight increase in
reported influenza outbreaks, primarily in the Atlantic provinces. The
overall proportion of samples testing positive for influenza during
week 16 was 7.2 percent (1.9 percent influenza A, 5.3 percent
influenza B), which represents a continued decreased from previous
weeks. In the USA, the proportion of outpatient ILI visits was 1.3
percent, which is below the national baseline. Laboratory-confirmed
influenza-associated hospitalizations and deaths have decreased and
were almost back to pre-seasonal levels; however the percentage of all
deaths due to pneumonia and influenza reported from the 122 cities
surveillance system remained at or above the epidemic threshold for
the 13th consecutive week. The percentage of specimens testing
positive for influenza declined further from previous weeks to 4.3
percent, with 43 percent due to influenza B. Of the influenza A
positive samples, 64 percent were influenza A(H3N2), 26 percent
unsubtyped, and 10 percent influenza A(H1N1)2009. In Mexico the
percentage specimen testing positive for influenza increased slightly
from 9 percent to 14 percent. This increase was primarily H1N1 (2009)
related and follows a recent report of an H1N1 (2009) outbreak in the
northern state of Chihuahua.

Europe
------
[South west Europe circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_05_06_influenza_south_west_europe_circulation _main.pdf>]

ILI activity was below baseline or at pre-seasonal levels in most
countries. There was a further decrease in SARI [severe acute
respiratory infection] hospitalizations in countries with SARI
sentinel surveillance. Georgia is an exception with an increase mainly
in the 0-4 year old age group, but none of the specimens tested were
positive for influenza. The numbers of ILI and SARI samples that
tested positive for influenza further decreased to 5 percent and 3
percent respectively. Of the few influenza samples that tested
positive, 55 percent were due to influenza B, and 35 percent due to
influenza A(H1N1)2009.

North Africa and the Middle East
--------------------------------
Influenza activity continued to decline, with very low numbers of
influenza type B and H1N1 (2009) reported in Algeria, Tunisia, and the
Islamic Republic of Iran.

Northern Asia
-------------
[Eastern Asia circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_05_06_influenza_eastern_asia_circulation_main .pdf>]

In temperate areas of Asia, influenza activity was also low and
primarily associated with influenza B and a smaller proportion of
influenza A(H3N2). In Northern China, ILI activity remained low with
3.2 percent of visits to sentinel hospitals being for ILI, which is
noted to be below that observed during the previous 3 seasons. The
proportion of specimens testing positive for influenza was 5 percent
and all were due to influenza B. ILI activity was also declining in
Mongolia and no influenza virus was detected. In the Republic of
Korea, ILI activity remained low with low level of circulation of
influenza A(H3N2) and influenza type B. In Japan, where ILI activity
remained low, of the 184 influenza viruses detected during the month,
1 percent were influenza A(H1N1)2009, 40 percent were influenza
A(H3N2) and 59 percent were influenza type B.

Countries in the tropical zone
------------------------------
Influenza activity in the tropical zones is generally low. In
sub-Saharan Africa, Ghana and Kenya both report ongoing transmission
of a mix of H1N1 (2009) and influenza type B. Madagascar reports
decreasing detections of influenza viruses which have been a mix of
influenza type B and H3N2 with type B slightly more common. In
tropical countries of Asia, ILI activity has been low and the few
viruses detected have been a mixture of primarily H1N1 (2009) and
influenza type B.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------------------------
Influenza activity has not increased in the temperate zone of the
southern hemisphere. Australia continues to report on low but
decreasing levels of influenza, primarily A(H3N2) viruses primarily in
tropical and subtropical areas of the country.

Source of data
--------------
The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every 2 weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance Network) and
influenza reports from WHO Regional Offices and Member States.
Completeness can vary among updates due to availability and quality of
data available at the time when the update is developed.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Additional graphical presentation of these data, which readers are
recommended to consult, can be accessed as follows.
- Global circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_05_06_influenza_global_circulation.pdf>
- Northern hemisphere circulation of influenza viruses (real-time):
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>
- Southern hemisphere circulation of influenza viruses (real-time):
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>
- More charts (real-time)
<http://www.who.int/csr/disease/influenza/influenzanetwork/flunet/charts/en/index.html>
- The WHO Influenza map library
<http://gamapserver.who.int/mapLibrary/app/searchResults.aspx>

The current situation is that the northern hemisphere winter
influenza epidemic is now virtually over, and the southern hemisphere
epidemic has yet to begin. - Mod.CP]

[see also:

http://www.promedmail.org/pls/apex/f..._ID:1000,88343

Kassy · 05-08-2011, 04:28 PM

Archive Number 20110507.1411
Published Date 07-MAY-2011
Subject PRO/EDR> Influenza (36): Europe update

INFLUENZA (36): EUROPE UPDATE
*****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 6 May 2011
Source: WHO Regional Office for Europe, EuroFlu: Weekly Electronic
Bulletin [summ., edited]
<http://www.euroflu.org/cgi-files/bulletin_v2.cgi>

Influenza season ending in the WHO European Region
--------------------------------------------------
Summary
-------
- This issue is based on data reported in week 17/2011 [25 Apr-1 May
2011] by 44 Member States in the WHO European Region.
- Consultation rates for influenza-like illness (ILI) and acute
respiratory infection (ARI) are now at pre-season levels in all
countries.
- Sentinel-hospital surveillance data for severe acute respiratory
infection (SARI) from 7 countries shows that SARI hospitalizations
have declined to levels observed at the beginning of the season.
- Less than 2 percent of sentinel specimens from patients with ILI or
ARI, and 2 percent of specimens from sentinel SARI patients tested
positive for influenza.

Current situation -- week 17/2011 [25 Apr-1 May 2011]
-----------------------------------------------------
During week 17/2011 [25 Apr-1 May 2011], all but one country
(Armenia) reported low influenza activity. ILI or ARI consultation
rates either continued to decline further or were at very low levels
in all of the 36 countries reporting clinical data this week. Among 39
countries reporting on the geographical spread of influenza, 37
reported no or sporadic activity. Armenia and Lithuania reported local
spread, and Georgia, regional activity. The impact of influenza on
health care systems was low in 20 and moderate in 2 of the 22
countries reporting on this indicator.

A total of 7 countries reported data from sentinel hospital-based
surveillance systems for SARI: Armenia, Kazakhstan, the Republic of
Moldova, Romania, the Russian Federation, Serbia, and Ukraine. SARI
hospitalizations have returned to pre-season levels in these countries
and, although influenza detections have been reported from sentinel
sites in recent weeks, the percentage of samples testing positive is
very low.

Further information on the sentinel SARI surveillance systems
represented in the EuroFlu bulletin can be found in the "Overview of
sentinel SARI systems in EuroFlu."
[<http://www.euroflu.org/documents/EuroFlu_Overview_of_SARI_Surveillance_Systems.pdf>].

Virological situation -- week 17/2011 [25 Apr-1 May 2011]
---------------------------------------------------------
Sentinel physicians collected 136 respiratory specimens, of which
only 2 (2 percent) were positive for influenza virus: 1 was pandemic
A(H1) and 1 was influenza B. One country, the Russian Federation,
tested 20 or more sentinel specimens, and influenza was detected in 2
percent of the samples. In addition, 70 non-sentinel specimens were
reported positive for influenza: 37 (53 percent) influenza B and 33
(47 percent) influenza A. Of the influenza A viruses, 25 were
subtyped: 21 (84 percent) as pandemic A(H1) and 4 (16 percent) as
A(H3).

Sentinel hospitals participating in SARI surveillance collected 41
respiratory specimens, of which 1 (2 percent) was positive for
influenza. Only the Russian Federation tested more than 10 sentinel
SARI specimens, finding 1 positive specimen, to yield a 3 percent
positivity in the country.

Cumulative virological update -- weeks 40/2010-17/2011 [4 Oct 2010-1
May 2011]
----------------------------------------------------------------------
A total of 83 369 influenza virus detections were reported during
this period, of which 59 075 (71 percent) were influenza A and 24 294
(29 percent) were influenza B. Of the influenza A viruses, 47 068 were
subtyped: 45 311 (96 percent) as pandemic A(H1) and 1757 (4 percent)
as influenza A(H3).

From week 40/2010 to week 17/2011 [25 Apr-1 May 2011], 1540 out of
5622 sentinel SARI specimens (27 percent) tested positive for
influenza. Of these influenza viruses, 876 (57 percent) were influenza
A and 664 (43 percent) influenza B. Of the influenza A viruses, 696
were subtyped: 643 (92 percent) as pandemic A(H1) and 53 (8 percent)
as influenza A(H3).

Since week 40/2010, 5250 influenza viruses have been characterized
antigenically: 2622 were A(H1) pandemic A/California/7/2009
(H1N1)-like; 2255 were B/Brisbane/60/2008-like (B/Victoria/2/87
lineage); 197 were B/Florida/4/2006-like (B/Yamagata/16/88 lineage);
174 were A(H3) A/Perth/16/2009 (H3N2)-like; and 2 were
B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage). Based on the
genetic characterization of 607 influenza viruses, 169 belonged to the
pandemic A/California/7/2009 A(H1N1) cluster; 10 belonged to the
pandemic A/Christchurch/16/2010 A(H1) cluster; 46 belonged to the
pandemic A/Hong Kong/2213/2010 A(H1) cluster; 142 belonged to the
recently emerged A/England/142/2010 subgroup characterized by S185T
substitution in the HA; 12 belonged to the A(H3) clade represented by
A/Perth/16/2009; 5 belonged to the A(H3) clade represented by
A/Victoria/208/2009; 29 belonged to the subgroup represented by A/Hong
Kong/2121/2010 in the A/Victoria/208/2009 A(H3) clade; 23 belonged to
the B/Bangladesh/3333/2007 clade (Yamagata lineage); and 171 to the
B/Brisbane/60/2008 clade (Victoria lineage).

Since week 40/2010, 9 countries (Denmark, Germany, Ireland, Italy,
the Netherlands, Norway, Spain, Switzerland, and the UK) had screened
3533 viruses for susceptibility to the neuraminidase inhibitors
oseltamivir and zanamivir. The UK analysed most of the viruses
screened (1672). Of the 3169 pandemic A(H1N1) 2009 viruses that were
tested, 3077 were sensitive to both inhibitors and 92 viruses (2.9
percent) carried the NA H275Y mutation. These 92 viruses were
resistant to oseltamivir but remained sensitive to zanamivir. 18
influenza A(H3N2) viruses were tested and found to be sensitive to
both inhibitors. All of the 346 influenza B viruses tested for
susceptibility to oseltamivir and the 340 tested for susceptibility to
zanamivir were found to be sensitive. All 197 pandemic influenza
A(H1N1) 2009 viruses and 10 A(H3N2) viruses that were screened for
susceptibility to adamantanes were found to be resistant.

Comment
-------
ILI and ARI consultation rates are low throughout the WHO European
Region. The great majority of countries is reporting no or sporadic
influenza activity and the percentage of sentinel ILI, ARI, and SARI
samples testing positive for influenza has declined to pre-season
levels.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The EuroFlu website features an interactive map presenting
qualitative indicators of influenza activity (intensity, trend,
geographical spread, and impact) and the dominant virus as assessed by
each of the countries. This information can be accessed by clicking on
the individual countries in the map and readers are recommended to
make use of this facility. In addition, clicking on France, the
Russian Federation, Turkey, and UK (England) will provide regional
data for these countries.

The 2010/2011 winter influenza season in the European Region has
virtually ended. All but one (Armenia) of the 39 reporting countries
have reported no or low influenza activity. Among the 39 countries
reporting on the geographical spread of influenza, 37 reported no or
sporadic activity. Armenia and Lithuania reported local spread, and
Georgia, regional activity.

Consequently for the present ProMED-mail will discontinue reproducing
the EuroFlu Weekly Electronic Bulletin. - Mod.CP]

http://www.promedmail.org/pls/apex/f..._ID:1000,88354

Kassy · 05-22-2011, 03:55 PM

Archive Number 20110521.1536
Published Date 21-MAY-2011
Subject PRO/AH/EDR> Influenza (37): WHO update

INFLUENZA (37): WHO UPDATE
**************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 20 May 2011
Source: WHO Global Alert and Response (GAR), influenza update
[edited]
<http://www.who.int/csr/disease/influenza/latest_update_GIP_surveillance/en/index.html>

Influenza update 134 [20 May 2011]
----------------------------------
Summary
-------
- The influenza season is largely finished in the temperate countries
of the northern hemisphere with transmission now either undetectable
or at very low levels in most areas.

- A few tropical countries are experiencing low grade transmission
including the Dominican Republic, Venezuela (influenza A(H1N1)2009),
and Jamaica (influenza type B) in the Americas; and Rwanda (influenza
A(H3N2) and Madagascar (influenza type B) in Sub-Saharan Africa.

- The influenza season has not yet started in the temperate countries
of the southern hemisphere. Australia has reported a small increase in
reports of influenza-like illness, however actual detections of
influenza virus have decreased in most jurisdictions in recent weeks,
including in the northern tropical states.

- A summary review of the northern hemisphere 2010/11 winter
influenza season will be published in the World Health Organization's
Weekly Epidemiological Report on 26 May 2011.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
North America

[North America circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_05_20_influenza_north_america_circulation_mai n.pdf>]

Influenza activity in both USA and Canada has now largely returned to
baseline levels. Rates of influenza-like illness, reports of influenza
related deaths, and influenza related hospitalizations all continue to
decrease in both countries, though some localized activity persists in
the Canadian provinces of Nova Scotia and Newfoundland. The percentage
of respiratory specimens testing positive for influenza virus is low,
5 percent in Canada and less than 2 percent in the USA, and are
predominantly influenza type B.

Europe, North Africa, and the Middle East

Influenza activity across Europe and northern Africa has also
returned to very low levels. Consultations for influenza-like illness
(ILI) and acute respiratory infection (ARI) are at very low levels in
Europe and half of countries reported no influenza activity. Only 2
percent and 4 percent of respiratory samples tested positive for
influenza from sentinel ILI and severe acute respiratory infection
(SARI) cases, respectively, in Europe. Little or no influenza activity
is being detected in reporting countries of North Africa and the
Middle East. Of the small numbers of viruses being detected in Europe,
North Africa, and the Middle East, influenza type B is the most common
type.

[Eastern] Asia

[Eastern Asia circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_05_20_influenza_eastern_asia_circulation_main .pdf>]

No notable influenza activity is being reported from Mongolia,
northern China, the Republic of Korea, or Japan. Rates of ILI and
detections of influenza viruses are all quite low; 3 percent of all
outpatient visits were due to ILI in northern China, which is below
that observed in the previous 3 seasons. Most influenza viruses
detected in the area are influenza type B (all 12 viruses in northern
China and 60 percent of 415 viruses in Japan).

Countries in the tropical zone
------------------------------
Very little influenza activity is being reported across the tropical
regions. In the Americas, the Dominican Republic has been reporting
low numbers of influenza A(H1N1)2009 for the last 5 weeks. Jamaica has
also experienced low numbers of persistent influenza type B
transmission for several weeks, though in both of these countries
numbers have recently decreased. Previously noted influenza
A(H1N1)2009 circulation in Venezuela peaked in late March [2011] and
has now returned to very low levels. Several countries in the tropical
areas of Central and South America are now reporting an increase of
respiratory infection activity related to respiratory syncytial virus
transmission. In Sub-Saharan Africa, the previously reported
transmission of influenza A(H1N1)2009 and influenza type B in Ghana
and Kenya is subsiding. Rwanda has experienced recent active
transmission of influenza A(H3N2) over the past 10 to 12 weeks and
Madagascar reports persisting transmission of primarily influenza type
B with fewer numbers of H3N2. In tropical areas of Asia, very low
numbers of influenza viruses are being reported with below baseline
rates of ILI, where these data are available.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
[Southern hemisphere circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_05_20_influenza_southern_hemisphere_circulati on_main.pdf>]

The influenza season has not yet started in the temperate countries
of the southern hemisphere. Australia, which had previously observed
higher than expected numbers of influenza virus detections, most
notably in the northern states of Queensland and the Northern
Territories, reports that detections of virus have been decreasing in
most jurisdictions in recent weeks. ILI reports in Australia have
increased slightly but are still low. The majority of virus detections
in Australia over the summer have been H3N2, though in the past one
week H1N1 (2009) and influenza type B have become relatively more
common.

Source of data
--------------
The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every 2 weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance Network) and
influenza reports from WHO Regional Offices and Member States.
Completeness can vary among updates due to availability and quality of
data available at the time when the update is developed.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Additional graphical presentation of these data, which readers are
recommended to consult, can be accessed as follows.
- Update on oseltamivir resistance in influenza A(H1N1)2009 viruses
<http://www.who.int/csr/disease/influenza/2011_05_20_weekly_web_update_oseltamivir_resistanc e.pdf>
- Global circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_05_20_influenza_global_circulation.pdf>
- Northern hemisphere circulation of influenza viruses (snapshot)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>
- Southern hemisphere circulation of influenza viruses (snapshot)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>
- WHO Influenza map library
<http://gamapserver.who.int/mapLibrary/app/searchResults.aspx>

The current situation remains that the northern hemisphere winter
influenza epidemic is now virtually over, and the southern hemisphere
epidemic has yet to begin. - Mod.CP]

[see also:

http://www.promedmail.org/pls/apex/f..._ID:1000,88519

gsgs · 05-27-2011, 02:53 PM

charts ILI, by country
some ARE, flu-A,flu-B,RSV
Europe, season 2010/2011

http://magictour.free.fr/panflu/eue20c.JPG

Sweden and Norway were higly vaxed in 2009/10
they had much flu-B now
pH1N1 went West-East in Europe

no flu other than pH1N1 in 2009/10
almost no H3 in Europe in 2010/11, but much in USA (why ?)

I'd like to see a list by country or region :
(estimates are OK)

% ILI-visits 2009/10,
% ILI-visits 2010/11
% vaccinated in 2009/10 (Pandemrix)
% vaccinated in 2010/11 (trivalent)
% flu-B in 2010/11
week of peak in 2009/10
week of peak in 2010/11

Kassy · 06-08-2011, 12:53 PM

Archive Number 20110608.1743
Published Date 08-JUN-2011
Subject PRO/EDR> Influenza (39): WHO update

INFLUENZA (39): WHO UPDATE
**************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 3 Jun 2011
Source: WHO Global Alert and Response (GAR), influenza update
[edited]
<http://www.who.int/csr/disease/influenza/latest_update_GIP_surveillance/en/index.html>

Influenza update 135 [3 Jun 2011]
---------------------------------
Summary
-------
- The influenza season has finished in the temperate countries of the
northern hemisphere with only sporadic influenza virus detections
occurring.

- Transmission in tropical countries of the Americas and sub-Saharan
Africa has continued to decline.

- South Africa has reported an increase in influenza virus
detections, primarily influenza A(H1N1)2009, consistent with the start
of their winter influenza season. Seasonal transmission does not
appear to have started in other temperate countries of the southern
hemisphere.

- A summary review of the northern hemisphere winter influenza season
is now available as a WER [Weekly Epidemiological Record, at
<http://www.who.int/wer/2011/wer8622/en/index.html>] or as an expanded
online version [at
<http://www.who.int/csr/disease/influenza/2010_2011_GIP_surveillance_seasonal_review/en/index.html>].

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
Northern hemisphere circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_06_03_influenza_northern_hemisphere_circulati on_main.pdf>

Influenza transmission in all reporting countries in the temperate
regions of the northern hemisphere has now subsided to very low,
intra-seasonal levels. Sporadic detections of influenza viruses have
been reported in many countries across the northern temperate zone but
no active community transmission has been noted

Countries in the tropical zone
------------------------------
Very little influenza activity has been reported since the last
update in tropical areas [see ProMED-mail post: Influenza (37): WHO
update 20110521.1536], though some localized transmission has been
noted.

Transmission has continued to occur in the Dominican Republic, all
influenza A(H1N1)2009, and Jamaica, primarily influenza type B with
smaller numbers of H1N1 (2009), but the numbers of cases are low and
decreasing in both countries. An unconfirmed media account has
reported that new cases of H1N1 (2009) were detected in Bolivia in
late May 2011 along with an increase in severe respiratory infections.
Many countries of the northern, tropical areas of South America report
large numbers of respiratory disease in children, including hospital
admissions for pneumonia, related to respiratory syncytial virus [see
ProMED-mail post Respiratory syncytial virus - Chile: (Santiago)
20110603.1699].

Transmission in the tropical areas of sub-Saharan Africa has largely
subsided to very low levels, including previously noted active
transmission in Kenya and Ghana. Madagascar has continued to report
small numbers of influenza type B, influenza A(H3N2), and influenza
A(H1N1) 2009. Only sporadic detections of influenza viruses have been
reported in the tropical countries of Asia.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
South America

[Text for the South America section appears to have been omitted from
the WHO text. - Mod.CP]

Southern Africa

South Africa circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_06_03_influenza_south_africa__circulation_mai n.pdf>

The National Institute for Communicable Diseases in South Africa has
reported an increase in influenza viruses over the last 4 to 5 weeks
consistent with the start of the influenza season. The large majority
of viruses isolated have been influenza A(H1N1)2009 with a very small
number of influenza A(H3N2).

Australia and New Zealand and South Pacific

Oceania Melanesia and Polynesia (snapshot)
<http://www.who.int/csr/disease/influenza/2011_06_03_influenza_oceania_melanesia_circulation _main.pdf>

The influenza season does not appear to have started yet in either
Australia or New Zealand. Although Australia had previously noted
unusual out-of-season influenza virus transmission, rates of detection
have recently decreased and levels of influenza-like illness (ILI)
have remained low in the majority of surveillance systems reporting.
New Zealand has reported sporadic detections of influenza viruses,
primarily H1N1 (2009) and influenza B, however weekly consultation
rates for ILI have remained below baseline nationally.

Source of data
--------------
The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every 2 weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance Network) and
influenza reports from WHO Regional Offices and Member States.
Completeness can vary among updates due to availability and quality of
data available at the time when the update is developed.

See also the following maps and graphs:
- Global circulation of influenza viruses
<http://www.who.int/csr/disease/influenza/2011_06_03_influenza_global_circulation.pdf>
- Northern hemisphere circulation of influenza viruses (real time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>
- Southern hemisphere circulation of influenza viruses (real time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>
and
- Weekly update on oseltamivir resistance of influenza A (H1N1) 2009
virus
<http://www.who.int/csr/disease/influenza/2011_06_03_weekly_web_update_oseltamivir_resistanc e.pdf>

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[see also:
http://www.promedmail.org/pls/apex/f..._ID:1000,88795

Kassy · 06-24-2011, 12:48 PM

Archive Number 20110623.1921
Published Date 23-JUN-2011
Subject PRO/EDR> Influenza (42): WHO update

INFLUENZA (42): WHO UPDATE
**************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 17 Jun 2011
Source: WHO Global Alert and Response (GAR), influenza update
[edited]
<http://www.who.int/csr/disease/influenza/latest_update_GIP_surveillance/en/index.html>

Influenza update 136 [17 Jun 2011]
----------------------------------
Summary
-------
- The influenza season has finished in the temperate countries of the
northern hemisphere with only sporadic influenza virus detections
occurring.
- Transmission in tropical areas remains low with localized
circulation noted in the western and eastern regions of sub-Saharan
Africa and low level circulation in some countries of northern South
America.
- South Africa has reported a sharp increase in influenza-like
illness (ILI) and severe acute respiratory infection (SARI) rates,
primarily influenza A(H1N1)2009.
- Influenza activity remains low in other temperate countries of the
southern hemisphere.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
Northern hemisphere circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_06_17_influenza_northern_hemisphere_circulati on_main.pdf>

The influenza season has ended in the northern hemisphere. Although
sporadic detections of influenza viruses have been reported in many
countries across the northern temperate zone, no active community
transmission has been noted. Consultation rates for influenza-like
illness (ILI) and severe acute respiratory infection (SARI) are at low
levels and continue to decline in both the European and North American
regions. In North Africa influenza circulation remains low although
Egypt has reported 5 recent infections of the avian influenza A(H5N1)
virus with 3 deaths since May [2011].

Countries in the tropical zone
------------------------------
Influenza activity in tropical areas remains low with localized
transmission reported in some regions. Very low influenza activity was
reported across central and tropical South America. Low level
circulation of influenza type B and influenza A(H3N2) has been noted
in Brazil. Colombia and the Plurinational State of Bolivia have
reported a slight increase in influenza virus detection with low level
circulation of influenza A(H1N1)2009 in Colombia and A(H3N2) in the
Plurinational State of Bolivia. Colombia has also reported an
increased proportion of intensive care unit admission of SARI cases of
which children under the age of 5 contributed the highest proportion.
Notably, respiratory syncytial virus has been widely circulating in
Colombia in recent weeks.

Localized transmission has been noted across 4 countries in West
Africa with Ghana and Togo reporting the largest numbers of
laboratory-confirmed cases. In Ghana, the majority of the reported
cases were influenza A(H1N1)2009 with a smaller proportion of
influenza type B and even lower proportion of influenza A(H3N2). Togo
has reported transmission primarily with influenza type B. 2 other
West African countries, Nigeria and Cameroon, both reported detection
of influenza type B in modest numbers. In East Africa, Kenya has
reported co-circulation of A(H1N1)2009 and influenza type B while
Rwanda has reported transmission of A(H3N2).

Tropical Asian regions have also reported low influenza activity.
Thailand, the Lao People's Democratic Republic and the Philippines
have not detected any influenza virus since the last update. Influenza
type B is the most common virus detected in the southern region of
China, India, and Cambodia, though in very low numbers, while
influenza A(H1N1)2009 is more common in Viet Nam with 10 per cent of
ILI cases testing positive.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
South America

South American countries in the temperate region reported low numbers
of influenza viruses with ILI consultation rates similar to those
reported in the previous few weeks. Sporadic detection of influenza
A(H1N1)2009 virus has been reported in Uruguay and Chile.

Southern Africa

South Africa circulation of influenza viruses (snapshot)
<http://www.who.int/csr/disease/influenza/2011_06_17_influenza_southern_africa_circulation_m ain.pdf>

A sharp increase in ILI consultation rate has been noted by The
National Institute for Communicable Diseases in South Africa.
Influenza A(H1N1)2009 virus was the most common virus detected in the
ILI cases. The numbers of SARI cases admitted to hospital have also
increased and are also associated primarily with influenza
A(H1N1)2009. Influenza surveillance from Madagascar had a modest
increase in detections of influenza viruses. The proportion of
influenza A(H3N2) has decreased there while the proportion of
influenza type B seems to remain stable.

Australia and New Zealand and South Pacific

The influenza season does not appear to have started in either
Australia or New Zealand. Australia reported stable ILI consultation
rates below levels in 2008 and 2010 during the same period. The New
South Wales Department of Health has also indicated that the rate of
death associated with influenza and pneumonia remains below the
seasonal threshold for this period. New Zealand reported the national
ILI consultation rate below baseline activity. However, regional
differences are noted where the baseline level is exceeded by one
District Health Board from Northland. Influenza type B is the most
common virus detected recently in New Zealand, though the numbers are
quite small.

Source of data
--------------
The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every 2 weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance Network) and
influenza reports from WHO Regional Offices and Member States.
Completeness can vary among updates due to availability and quality of
data available at the time when the update is developed.

Maps and graphs
---------------
- Global circulation of influenza viruses
<http://www.who.int/csr/disease/influenza/2011_06_17_influenza_global_circulation.pdf>
- Northern hemisphere circulation of influenza viruses (real time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>
- Southern hemisphere circulation of influenza viruses (real time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>
- Weekly update on oseltamivir resistance in influenza A(H1N1)2009
viruses
<http://www.who.int/csr/disease/influenza/2011_06_17_weekly_web_update_oseltamivir_resistanc e.pdf>

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[The most notable feature of the current global situation is the
delayed appearance of the southern hemisphere winter influenza
epidemic. In contrast, in parts of South America (notably Colombia and
Chile) cases of respiratory syncytial virus infection in children have
occurred earlier and in greater number than usually observed. Probably
as a consequence there has been an increased proportion of intensive
care unit admissions of SARI cases of children under the age of 5. -
Mod.CP]

http://www.promedmail.org/pls/apex/f..._ID:1000,89050

[see also:

Kassy · 07-17-2011, 12:45 PM

Archive Number 20110716.2155
Published Date 16-JUL-2011
Subject PRO/EDR> Influenza (44): WHO update

INFLUENZA (44): WORLD HEALTH ORGANISATION UPDATE
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 15 Jul 2011
Source: World Health Organisation (WHO), Global Alert and Response,
Disease Outbreak News [edited]
<http://www.who.int/csr/disease/influenza/latest_update_GIP_surveillance/en/index.html>

Influenza Update number 138
---------------------------
Summary
-------
-- Influenza activity in the temperate regions of the northern
hemisphere remains at baseline inter-seasonal levels.
-- Countries in the tropical zone mostly report low influenza
activity but with some transmission reported in countries of the
Americas, western Africa, and southern Asia.
-- The influenza season is ongoing in South Africa though it appears
to have recently peaked. Some detailed preliminary information is now
available for severe cases in South Africa (see below). In Australia
the season appears to have started with notable increases in
influenza-like illness (ILI) consultations and confirmed cases. The
most common virus detected nationally in Australia is influenza
A(H1N1)2009, though this is not consistent in every state.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
-- Northern hemisphere circulation of influenza viruses (snapshot)
pdf, 109kb
<http://www.who.int/csr/disease/influenza/2011_07_15_influenza_northern_hemisphere_circulati on_main.pdf>

The influenza season in the northern hemisphere temperate areas has
ended. Nearly all of the countries of North America, Europe, northern
Africa and north Asia reported low or no influenza activity.

Countries in the tropical zone
------------------------------
Influenza activity in countries of tropical zone was low overall with
a few areas of active transmission, most notably in West Africa and
South Asia. In countries of the Caribbean Epidemiology Centre (CAREC)
countries, there was a small increase in the percent of severe acute
respiratory infection (SARI) admissions. No SARI deaths were reported
but approximately 3 percent of total hospitalizations were for SARI in
children between 6 to 48 months of age. In the Dominican Republic, the
percentage of samples testing positive for respiratory viruses
decreased slightly; influenza A(H1N1)2009 has been the primary virus
in circulation there since late March [2011]. No influenza virus
activity was reported in Central American countries. In Colombia,
there was low level co-circulation of influenza A(H1N1)2009 and
A(H3N2). In Brazil, there are reports of the increased number of
influenza cases especially in the south, southeast, and midwest of the
country. Influenza viruses including A(H1N1)2009 were identified in
circulation. In sub-Saharan Africa, influenza type B virus continues
to be predominant strain in both western and eastern Africa. Active
transmission of predominantly influenza B appears to be ongoing in
Ghana mixed with smaller numbers of influenza A(H1N1)2009. Much
smaller numbers of cases of influenza B reported in Nigeria and
Cameroon. Transmission in Kenya and Uganda has dropped to low levels
and the previously noted influenza A(H3N2) transmission in Rwanda has
also diminished to very low levels.

The overall influenza activity in the tropical Asia remained low with
some notable localized areas of transmission. Low numbers of influenza
A(H1N1)2009 viruses were reported from India associated with
unconfirmed media reports of cases occurring in the southern part of
the country. In Singapore ILI made up only 2 percent of polyclinic
attendances for acute respiratory illness, which is considered low,
however 51 percent of ILI cases tested positive for influenza virus in
the last 4 weeks. 83 percent of influenza viruses from ILI cases were
influenza A(H3N2); influenza A(H1N1)2009 and influenza B accounted for
11 percent and 6 percent of positive cases respectively.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
South America
-------------
Only low influenza activity was reported in the temperate regions of
South America. In Chile, ILI activity was less than [in] the previous
week, no deaths from influenza were reported, and influenza virus
detects were in low proportion compared to other respiratory viruses.
In Argentina, about 2 percent of respiratory specimens tested were
positive for influenza, mostly influenza A(H1N1)2009, but rates of ILI
are low. In Uruguay percent of SARI deaths among all deaths remained
stable and less than 5 percent. However, the percent of SARI
admissions to intensive care among all ICU admissions has been
trending upwards over the last month.

Southern Africa
---------------
-- South Africa circulation of influenza viruses (snapshot) pdf,
97kb. [This file currently not available. Can be access via the URL
for the complete document. - Mod.CP]

Influenza transmission in South Africa appears to have peaked and is
in early decline, though still quite active. Transmission in the
country has been primarily associated with influenza A(H1N1)2009,
which has accounted for more than 83 percent of influenza viruses in
ILI cases. Influenza A(H3N2) and type B have accounted for 7.5 percent
and 3.8 percent of viruses respectively in that group. Notably,
influenza type B has made up a larger proportion of cases with severe
infections admitted to hospital (17 percent of all influenza viruses
from SARI cases). Based on a preliminary analysis of case data by the
National Institute for Communicable Diseases, the case-fatality ratio
among influenza positive patients admitted to hospital in 2011 is less
than in the 2010 season when influenza B was the most common
circulating strain (3 percent vs. 9 percent respectively (p=0.06)).
The age distribution of severe cases has been similar this season as
compared to 2010; 37 percent of cases have been between the ages of 2
and 4 years (37 percent in 2010). Another 30 percent of severe cases
occurred in the age group from 25 to 44 years and only 19 percent of
cases were over the age of 45 years. Of the 4 influenza positive
patients enrolled into the SARI sentinel surveillance programme that
have died so far in 2011, 3 were positive for influenza A(H1N1)2009
and one was positive for influenza B.

Australia and New Zealand and South Pacific
-------------------------------------------
ILI consultations have continued to rise nationally in Australia
along with notifications of laboratory confirmed influenza, most
notably in South Australia, Queensland and New South Wales. The
distribution of virus types has varied somewhat between states.
Nationally, influenza A(H1N1)2009 has accounted for the majority of
virus detections; however, 85 percent of viruses detected in the state
of South Australia have been influenza B. These accounted for the
majority of influenza B virus reported from the country as a whole.
There numbers of confirmed cases of influenza reported through the
National Notifiable Disease Surveillance System is much higher than in
the same period of 2010 (5640 to date in 2011 vs. 1088 for the same
period of 2010).

In New Zealand, the rate of national ILI consultations has not
crossed the baseline levels although some of the districts were well
above the national average. For this week, influenza B virus was the
predominant strain followed by influenza A(H3N2) virus.

From the peer-reviewed literature:
----------------------------------
A recently published study assessed the frequency and distribution of
risk factors globally among influenza A(H1N1)2009 patients reported
during the pandemic. Risk factors were evaluated at 3 levels of
severity: hospitalization, intensive care admission, and death. The
study found that while the highest per capita risk of hospitalization
was among patients <5 years old and 5Â*--14 years old (relative risk
[RR] = 3.3 and 3.2, respectively, compared to the general population),
increasing age was associated with an increasing risk of severe
disease and death. Though infection rates were observed to be very low
in the oldest age group, as reflected in the proportion of
hospitalized cases in that group, their risk of death upon infection
was found to be higher than younger groups. The study demonstrated
that risk factors for severe influenza A(H1N1)2009 infection were
similar to those for seasonal influenza including many chronic medical
illness and pregnancy but also found some evidence to support obesity
as a risk for severe disease. The study reinforced the need to
identify and protect groups at highest risk of severe outcomes for
vaccination and early treatment. (Risk Factors for Severe Outcomes
following 2009 Influenza A(H1N1) Infection: A Global Pooled Analysis.
PLoS Med 8(7): e1001053. doi:10.1371/journal.pmed.1001053))

Source of data
--------------
The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every 2 weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance Network) and
influenza reports from WHO Regional Offices and Member States.
Completeness can vary among updates due to availability and quality of
data available at the time when the update is developed.

Maps and Graphs
---------------
Global circulation of influenza viruses
<http://www.who.int/csr/disease/influenza/2011_07_01_influenza_global_circulation.pdf>

Northern hemisphere circulation of influenza viruses (real time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>

Southern hemisphere circulation of influenza viruses (real time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>

Update on oseltamivir resistance in influenza A(H1N1)2009 viruses
<http://www.who.int/csr/disease/influenza/2011_07_15_weekly_web_update_oseltamivir_resistanc e.pdf>

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Overall the currently available influenza vaccine should provide
protection against infection by the influenza viruses circulating
during the course of the Southern hemisphere winter outbreak. -
Mod.CP]

[see also:

http://www.promedmail.org/pls/apex/f..._ID:1000,89369

Kassy · 09-11-2011, 11:48 AM

Archive Number 20110910.2758
Published Date 10-SEP-2011
Subject PRO/EDR> Influenza (53): WHO update

INFLUENZA (53): WORLD HEALTH ORGANISATION UPDATE
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 9 Sep 2011
Source: World Health Organisation (WHO), Influenza update 142
[edited]
<http://www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en/index.html>

WHO Influenza Update number 142
-------------------------------
Countries in the temperate zone of the northern hemisphere:
-----------------------------------------------------------
The countries in the northern hemisphere temperate zone are in their
inter-seasonal period for influenza. Nearly all of the countries in
this zone reported low or no influenza activity. Of interest, the USA
Centers for Disease Control and Prevention (CDC) has reported 4 cases
of swine influenza A(H3N2) virus in children in the states of Indiana
(1 case) and Pennsylvania (3 cases). The virus is similar to one that
has been circulating in swine since 1998 and which has been previously
identified in 8 human cases. The viral genome contains seven of the 8
gene segments from the circulating swine H3N2 viruses, including the
hemaglutinin and neuraminidase genes, however, it is unique in that it
contains one gene segment, the M gene, derived from the pandemic
influenza A(H1N1) virus. The swine H3N2 viruses have antigenic
cross-reactivity with human H3N2 viruses circulating in the 1990s. The
Indiana case did not have direct exposure to pigs but had contact with
a care-giver who did have recent swine contact. The 3 cases in
Pennsylvania had all recently visited a fair where swine were present.
The virus does not appear to have spread widely in humans; however,
investigations are ongoing.

For more information, see the CDC Morbidity and Mortality Weekly
Report, 9 Sep 2011 / 60(35);1213-1215; the Pennsylvania Department of
Health website; and the ProMED-mail archived posts listed below.

Countries in the tropical zone
------------------------------
Snapshot: Southern Asia circulation of influenza viruses pdf, 391kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_09_influenza_southern_asia_circulation_mai n.pdf>

In Central and tropical South America, several countries reported low
levels of influenza transmission. In the Dominican Republic, influenza
transmission continued to decrease from a peak in July [2011] with
influenza type B now the predominant influenza virus detected.
Influenza virus detections in Cuba have increased steadily over the
last 4 weeks, with influenza A(H3N2) accounting for the large
majority. Honduras has also reported increasing detections of
influenza A(H3N2) during the same period of time associated with and
increasing proportion of hospitalizations for severe acute respiratory
infection (SARI) and is higher than during the same period of 2010;
one SARI related death was reported over the last 2 reporting weeks.
Other Central American countries reported no or very low influenza
activity. In tropical South America, transmission in Brazil peaked in
late June or early July and has returned to low levels. Transmission
in Brazil was evenly distributed between influenza A(H1N1)2009 and
A(H3N2), with smaller amounts of influenza type B. A similar pattern
and time course was noted in Bolivia and Colombia.

Influenza activity in most of tropical Asia is now low. In southern
Asia India, Bangladesh, Thailand, and Singapore have recently reported
moderate influenza transmission, most of which has been influenza
A(H3N2) with very small numbers influenza type B. Transmission in
these countries appears to have peaked in mid July [2011], although
some low level transmission has continued recently. In South East
Asia, Viet Nam and Cambodia have had influenza A(H1N1)2009
transmission mixed with influenza type B. In both countries,
transmission appears to be declining since early August. Notably, the
severe viral pneumonia surveillance system has detected 27 cases (27
percent of all tested) that were positive for influenza virus. Of
these 27 positive samples, 26 (96 percent) were pA/H1N1 and 1 (4
percent) was type B influenza virus.

In sub-Saharan Africa, influenza transmission has continued in the
west though detection rates have decreased in Ghana and Togo since
peaking in mid July. Transmission in Cameroon has, however, has
continued to increase in recent weeks. In all 3 countries, virus
detections have been both influenza A(H1N1)2009 and type B in fairly
equal proportions. In eastern Africa, transmission in Kenya has been
continuous since the peak in March, though at much lower levels. Virus
detections there have been both influenza A(H1N1)2009 and influenza
type B.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
South America
-------------
Snapshot: Temperate South America circulation of influenza viruses
pdf, 389kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_09_influenza_temperate_south_america_circu lation_main.pdf>

In South America, the influenza season appears to have peaked and
several indicators suggest that the season has been mild in comparison
with previous years. In Chile, influenza-like illness (ILI) activity
has remained low in comparison to previous years with a peak of 7
consultations per 100 000 inhabitants. Admissions for respiratory
infections in children and the number of samples testing positive for
influenza have also remain low; although 2 deaths associated with
influenza A(H1N1)2009 were registered over the last 2 reporting weeks.
Influenza A(H1N1)2009 has accounted for the large majority of both ILI
and SARI cases in Chile this season. Virus detections and respiratory
disease activity in Chile appeared to level off in mid August. ILI,
pneumonia, and influenza virus detections in Argentina all peaked 3 to
4 weeks earlier in Argentina than in Chile. All 3 have been at
moderate levels compared to 5 year national averages. In contrast to
Chile, Argentina started the season with a predominance of influenza
A(H1N1)2009 but transitioned to a predominance of influenza A(H3N2) by
mid season in late July [2011] after which very little H1N1 was
detected. In Uruguay, respiratory disease activity also appears to
have leveled off in late July or early August. The proportions of SARI
hospitalizations and SARI ICU admissions were below 5 percent and 15
percent respectively and the proportion of SARI deaths decreased below
2 percent. The large majority of virus detections in Uruguay have been
H1N1 (2009) with smaller amounts of H3N2 early in the season.

Southern Africa
---------------
Snapshot: Southern Africa circulation of influenza viruses pdf, 384kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_09_influenza_southern_africa_circulation_m ain.pdf>

Influenza transmission in South Africa has remained at low level since
peaking in early June [2011].

Australia, New Zealand and South Pacific
----------------------------------------
Snapshot: Oceania Melanesia and Polynesia circulation of influenza
viruses pdf, 390kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_09_influenza_oceania_circulation_main.pdf>

The state of New South Wales, Australia, has reported an unusual
cluster of influenza cases infected with oseltamivir resistant
A(H1N1)2009 viruses in the Newcastle region. 25 influenza cases have
been identified over a 3 month period. The viruses all carry the H275Y
substitution, which is known to confer high level oseltamivir
resistance. In contrast, only 2 detections of viruses with this
genetic marker for oseltamivir resistance have been detected in the
country previously this year [2011], one in January and one in March.
The 1st resistant virus was detected in the Newcastle region in May,
the most recent in August; 14 percent of viruses from Newcastle tested
during that time have the H275Y substitution. Of 16 cases that have
been interviewed, none had previously been treated or exposed to
oseltamivir and 15 of the 16 live within a 50 kilometer [31 mile]
radius. The epidemiological picture is one of community transmission
of the resistant virus in a limited geographic area so far. Of note,
all of the resistant viruses are similar antigenically to the H1N1
strain contained in the current trivalent seasonal influenza vaccine,
indicating that vaccination would provide protection. The New South
Wales Health department is continuing to investigate.

Overall, influenza activity appears to have peaked in much of the
country, though regional increases are still being reported in some
areas. Specifically, influenza notifications have decreased in
Queensland, New South Wales (NSW), and South Australia, but other
states continue to report increases. The Influenza Complications Alert
Network sentinel hospital system in Victoria, South Australia, Western
Australia, and the Australia Capital Territory (ACT) reported 88
hospitalizations, including 7 intensive care unit (ICU) admissions,
associated with influenza since 1 May 2011. Over half of the
hospitalizations and 71 percent of ICU admissions have been associated
with influenza A(H1N1)2009 infection. The mean age of patients
hospitalized has been 47.3 years. The Australian Paediatric
Surveillance Unit reported 24 hospitalizations associated with severe
influenza complications in children from 1 Jul 2011 till 22 Aug 2011,
including 9 ICU admissions with the majority also associated with
influenza A(H1N1)2009; notably, more than one third of cases
hospitalized had chronic underlying conditions.

In 2011, 11 influenza associated deaths have been notified nationally
to date with a median age of 53 years. 8 of the cases were reported as
having an influenza A(H1N1)2009, 2 with influenza type B and one with
an un-subtyped influenza A infection. In NSW, the death registration
data up to 5 Aug 2011 was below the seasonal threshold for this period
with 1.8 pneumonia or influenza associated deaths per 100 000
population. The country continues to have some regional variation in
the predominant type or subtype of influenza virus being detected. In
recent weeks the proportion of influenza type B in South Australia has
continued to decline and currently represents a significant proportion
(43 percent) of influenza notifications, with the remainder being
mostly influenza A(H1N1)2009. The majority of Australian states and
territories now have influenza A(H1N1)2009 more commonly detected,
with co-circulation of influenza type B; however, in Tasmania
influenza type B accounts for the majority of influenza virus
detections and Western Australia is reporting a mix of mostly
influenza A(H1N1)2009, A(H3N2) and some influenza type B.

In New Zealand, the rate of national ILI consultations was 55.5 per
100 000 (210 ILI consultations) and remains stable around the seasonal
threshold level. Influenza type B virus accounts for the majority of
influenza viruses detected in New Zealand. In the Pacific Islands,
most countries reported low influenza activity with the exception of
Samoa, Tonga, the Solomon Islands and Kiribati. Samoa has experienced
an increase in ILI. Tonga, the Solomon Islands and Kiribati reported
sustained activity. Fiji reported fluctuating ILI activity, but the
level has declined over the past 5 weeks.

From the peer-reviewed literature
---------------------------------
Researchers in China have reported an association between the
occurrence of narcolepsy and respiratory disease. In a cross-sectional
retrospective ecological study examining the history of narcolepsy
onset in 629 patients (mostly children) diagnosed with narcolepsy in
Beijing, China between 1998 and 2010, researchers identified a
seasonal pattern in the onset, with highest observed incidence in
April to July. A 3 to 4 fold increase in even this peak incidence was
noted in 2010 (per a linear trend line fit to the past time series),
mirroring the reported increase in influenza cases from official
sources during the 2009/10 winter season. The majority of these 154
narcolepsy cases in 2010 were young children, and only 4 percent of
these cases reported receiving an H1N1 vaccination (using a
non-adjuvanted H1N1 monovalent vaccine). Finding, in their study, an
association between infection and narcolepsy, but not an association
with vaccination, the authors suggest that winter airway infections,
including influenza A and/or _S. pyogenes_ are the likely triggers for
narcolepsy. The authors felt that the 4-6 month delay between winter
airway infection and narcolepsy onset occurrence was consistent with
animal studies showing that approximately 80 percent cell loss is
required to exhibit symptoms; winter airway infections could initiate
or reactivate an immune response that leads to hypocretin cell loss
and narcolepsy in generally susceptible individuals.

Comment: While influenza is considered primarily a disease of the
respiratory tract, it is clear that it may on occasion cause disease
in other body systems, including the central nervous system. An
association between "winter airway infections" and neurological
complications was also noted in the years surrounding the 1918
pandemic and neurological complications have been reported in numerous
case series from seasonal influenza A(H3N2) epidemics and the 2009/10
influenza A(H1N1)2009 pandemic. Influenza infection has been linked to
cases of encephalopathy, seizures, and altered level of consciousness.
Neurological manifestations are occasionally the presenting illness
with influenza infection and likely occur more often in children and
adolescents.

Reference: Han, F., et al. Narcolepsy onset is seasonal and increased
following the 2009 H1N1 pandemic in China, 2011, Annals of Neurology.
doi: 10.1002/ana.22587(2011).

Source of data in this update
-----------------------------
The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every 2 weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance and Response
System) and influenza reports from WHO Regional Offices and Member
States. Completeness can vary among updates due to availability and
quality of data available at the time when the update is developed.

Maps and graphs
--------------
- Global circulation of influenza viruses (snapshot) pdf, 387kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_09_influenza_global_circulation.pdf>

- Northern hemisphere circulation of influenza viruses (real-time)

- Southern hemisphere circulation of influenza viruses (real-time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>

FluNet charts on circulation of influenza viruses (number of specimens
positive for influenza by subtypes) and graphs by country, area or
territory as well as by influenza transmission zone and WHO region are
available form the WHO Influenza Map Library.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Summary:
--------
- Countries in the temperate regions of the northern hemisphere
reported low or undetectable influenza activity. The United States of
America (USA) has recently reported 4 human cases of swine influenza
A(H3N2) containing a novel reassortment with an M gene derived from
influenza A(H1N1)2009.

- Influenza activity in the tropical zone was mostly low with the
exception of a few countries of the Americas (Cuba and Honduras),
Western Africa (Cameroon and Senegal), and Southern Asia (Bangladesh
and Thailand) that reported continued transmission.

- In South America the influenza season has been mild and has peaked
with variation in the predominant type and subtype of virus
circulating in different countries in the area. Influenza activity may
have peaked nationally in Australia, though regional increases are
still being reported. New South Wales, Australia, has recently
reported a cluster of 25 cases with oseltamivir-resistant influenza
A(H1N1)2009 virus infection. The cases occurred in a limited
geographic area but occurred over a 3 month period of time. Of note,
none of the cases interviewed had previously been exposed to
oseltamivir or had other risk factors previously associated with the
development of oseltamivir resistance. This represents the largest
cluster of oseltamivir resistant viruses to date and the most
persistent period of community transmission. Investigations are
ongoing to determine the full extent of spread of the virus.

Interested readers are recommended to view the the WHO maps and graphs
referenced above that provide a pain-free appreciation of the current
influenza situation. Currently there is no evidence suggesting the
appearance of a novel epidemic strains not containable by the
currently available vaccine. - Mod.CP]

[see also:

http://www.promedmail.org/pls/apex/f..._ID:1000,90195

Kassy · 09-24-2011, 08:44 AM

Archive Number 20110923.2884
Published Date 23-SEP-2011
Subject PRO/EDR> Influenza (56): WHO update

INFLUENZA (56): WORLD HEALTH ORGANISATION UPDATE
************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 23 Sep 2011
Source: World Health Organisation (WHO), Influenza [edited]
<http://www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en/index.html>

WHO Influenza Update number 143
-------------------------------
Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
The countries in the northern hemisphere temperate zone are in their
inter-seasonal period for influenza. Nearly all of the countries in
this zone reported low or no influenza activity.

Countries in the tropical zone
------------------------------
Southern Asia circulation of influenza viruses (snapshot) pdf, 389kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_23_influenza_southern_asia_circulation_mai n.pdf>

In Central and tropical South America, generally low levels of
influenza transmission are reported; RSV [respiratory syncytial virus]
continues to be the predominant virus in Central America and the
Caribbean since week 24. Cuba reports low level of circulation of
influenza A(H3N2) since week 29. Honduras has had recent circulation
of influenza A(H3N2), which peaked in mid August. The H3N2 circulation
there was associated with smaller amounts of influenza A(H1N1)2009 and
type B. Bolivia has reported sporadic detections of influenza
A(H1N1)2009 and influenza A(H3N2). The previously reported influenza
transmission in Colombia (H1N1 with smaller numbers of H3N2) and
Brazil (roughly equal numbers of H1N1, H3N2, and type B) has largely
finished.

In sub-Saharan Africa, some influenza transmission has continued in
the west, notably in Cameroon where transmission has been
predominantly influenza type B with smaller but increasing numbers of
influenza A(H1N1)2009 in the last weeks. In eastern Africa, continuous
transmission of a mixture of influenza type B, A(H3N2), and
A(H1N1)2009 since the peak of transmission in March are reported.
Transmission in Kenya has decreased with fewer positive samples for
influenza in recent weeks, which have been a mixture of influenza B,
A(H3N2), and A(H1N1)2009.

Influenza activity in most of tropical Asia has been active in
localized areas. Moderate transmission of primarily influenza A(H3N2)
was reported in India, Bangladesh, Singapore and Thailand, though
transmission in India has now peaked and returned to low levels. Small
numbers of influenza type B and H1N1(2009) have also been reported
from those countries. In contrast, Viet Nam continues to report
sustained transmission of predominantly influenza A(H1N1)2009 since
the beginning of 2011, which reached higher levels in mid August. 27
percent of severe viral pneumonias reported to Viet Nam's sentinel
surveillance system have been positive for influenza, 96 percent of
those influenza A(H1N1)2009. Lao People's Democratic Republic has
predominant transmission of influenza A(H3N2), though at low levels.
Cambodia reports a slight increase in the number of specimens positive
for influenza A(H1N1)2009 and influenza type B. In Singapore
influenza-like illness (ILI) made up only one percent of polyclinic
attendances for acute respiratory illness, which is considered low.
Influenza A(H3N2) constituted 69 percent of all the influenza virus
specimens collected in August 2011 followed by influenza type B at 20
percent and influenza A(H1N1)2009 at 6 percent.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------
South America
-------------
Temperate South America circulation of influenza viruses (snapshot)
pdf, 388kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_23_influenza_temperate_south_america_circu lation_main.pdf>

Lower levels of influenza activity were reported in the temperate
regions of South America, where the season appears to have peaked and
is declining. In Chile, influenza A(H1N1)2009 detections were
substantially lower than the past 4 weeks, ILI activity and
consultations for respiratory disease in emergency departments also
remained at low levels; 10 deaths from influenza A(H1N1)2009 were
reported in week 35, 9 of which had co-morbidities. The situation in
Argentina is similar with low and decreasing levels of ILI and severe
acute respiratory infection (SARI) activity and fewer samples testing
positive for influenza, with co-circulation of influenza A(H1N1) 2009
and influenza A(H3N2) among the subtyped influenza A viruses. In
Paraguay, the proportion of ILI consultations was slightly higher than
the previous week (about 9 percent) and the proportion of SARI
hospitalizations, SARI ICU admissions, and SARI related deaths were
below 5 percent, all either similar to or decreased from recent weeks;
in the samples tested, no influenza virus was detected. In Uruguay the
proportions of SARI hospitalizations and SARI deaths continues to
decline below five percent; the proportion of SARI ICU admissions also
continued to decrease (5 percent) after peaking in week 31.

Southern Africa
---------------
Southern Africa circulation of influenza viruses (snapshot) pdf,
386kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_23_influenza_southern_africa_circulation_m ain.pdf>

Influenza transmission in South Africa has continued at low levels
since peaking in early June. The influenza season was dominated by
influenza A(H1N1)2009 with smaller numbers of influenza type B and
some influenza A(H3N2). Notably, South Africa experienced a secondary
peak of influenza in late August primarily associated with influenza
A(H3N2) and B.

Australia, New Zealand and South Pacific
----------------------------------------
Oceania Melanesia and Polynesia circulation of influenza viruses
(snapshot) pdf, 389kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_23_influenza_oceania_circulation_main.pdf>

The weekly number of laboratory confirmed influenza notifications has
continued to decline in Queensland, New South Wales (NSW) and most
other states except the Northern Territory; but in many states these
notifications are still above the peak levels observed in 2010.

An additional 2 cases of oseltamivir resistant influenza A(H1N1)2009
have been reported in NSW associated with the previously reported
cluster of cases in that state. These new cases have no prior travel
history to the originally affected region of the state; all of the
viruses from the cluster were found to be sensitive to zanamivir and
without any antigenic changes that would have affected their
recognition by vaccine-induced antibodies. (see the Influenza Update
from 2 weeks ago for more details about this cluster). This represents
a wider area of spread of this cluster of viruses though the numbers
appear to be declining as the season in Australia wanes.

The majority of states and territories have reported mostly influenza
A(H1N1)2009 with co-circulation of influenza B; except in Tasmania and
NSW where influenza B predominates, and Western Australia reporting a
mix of influenza A(H1N1)2009, A(H3N2) and very little influenza B. By
2 Sep 2011, the National Notifiable Diseases Surveillance System
(NNDSS) had reported 19 987 confirmed cases of influenza of which the
peak this season was in the week ending 5 Aug 2011, with 1952 cases.
From 1 May to 1 Sep 2011, there were 118 influenza hospitalizations
(13 ICU admissions) in Victoria, South Australia, Western Australia
and the Australia Capital Territory. About 56 percent of the
hospitalizations and 77 percent of the ICU admissions were associated
with influenza A(H1N1)2009; mean age of the hospitalized patients was
46.6 years.

In New Zealand, the rate of national ILI consultations was 50.7 per
100 000, and is at or above baseline levels but has not reached high
levels in this season. Influenza type B virus accounts for a large
proportion of influenza viruses detected in New Zealand. In the
Pacific Islands, most countries reported low influenza activity, with
the exception of Samoa, Fiji, Solomon Islands, Marshall Islands, Tonga
and Kiribati.

Source of data
--------------
The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every 2 weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance and Response
System) and influenza reports from WHO Regional Offices and Member
States. Completeness can vary among updates due to availability and
quality of data available at the time when the update is developed.

Maps and graphs
---------------
-- Global circulation of influenza viruses (snapshot) pdf, 387kb
<http://www.who.int/influenza/surveillance_monitoring/updates/2011_09_23_influenza_global_circulation.pdf>

-- Northern hemisphere circulation of influenza viruses (real-time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Northern>

-- Southern hemisphere circulation of influenza viruses (real-time)
<http://gamapserver.who.int/gareports/Default.aspx?ReportNo=5&Hemisphere=Southern>

-- Influenza map library
<http://gamapserver.who.int/mapLibrary/app/searchResults.aspx>

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[In brief:
-- Influenza activity in the temperate regions of the northern
hemisphere remains low or undetectable.
-- Countries in the tropical zone mostly reported low influenza
activity but with some transmission reported in countries of the
Americas (Cuba, Honduras and Bolivia), western Africa (Cameroon), and
southern Asia (India, Thailand, Viet Nam and Singapore).
-- Transmission in South Africa has declined to low levels.
-- In Australia, the number of laboratory confirmed influenza
notifications is reported to be declining in Queensland, New South
Wales (NSW) and other states with the exception of the Northern
Territory. Oseltamivir-resistant (but sensitive to zanamivir)
influenza A(H1N1)2009 was identified in a cluster of cases in the
Newcastle region of New South Wales; no travel history was found among
the cases, and none have died.
-- ILI activity in New Zealand continues around national baseline
levels and the majority of viruses detected have been influenza B.

Interested readers are recommended to view the the WHO maps and graphs
referenced above that provide a pain-free appreciation of the current
influenza situation.

Currently there is no evidence suggesting the appearance of a novel
epidemic strains not containable by the currently available vaccine. -
Mod.CP]

[see also:
http://www.promedmail.org/pls/apex/f..._ID:1000,90384

Kassy · 11-21-2011, 03:47 PM

Published Date: 2011-11-18 17:46:41
Subject: PRO/EDR> Influenza (67): WHO update
Archive Number: 20111118.3403

INFLUENZA (67): WORLD HEALTH ORGANISATION UPDATE
************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 18 Nov 2011
Source: WHO [edited]
http://www.who.int/influenza/surveil.../en/index.html

WHO update number 147
---------------------

Summary
-------
-- Influenza activity in the temperate regions of the northern
hemisphere remains low or undetectable, though a recent outbreak of
influenza A(H3N2) in a seniors lodge has been reported in Alberta,
Canada.
-- Significant influenza activity was reported in only a few countries
of the tropical zone including Nicaragua in the Americas, Cameroon in
central Africa, and Cambodia in South East Asia.
-- Transmission in the temperate countries of the southern hemisphere
has returned to intra-seasonal levels, with some persistence of
influenza A(H3N2) in Australia.

Countries in the temperate zone of the northern hemisphere
----------------------------------------------------------
The influenza season has not yet started in the northern hemisphere
temperate zone, though some activity has been reported in a few areas.
The majority of the countries in this zone reported low or no
influenza activity in recent weeks. In Canada, one
laboratory-confirmed influenza A(H3) outbreak was reported in a
seniors lodge in Calgary, Alberta, in week 44. It is the 1st outbreak
due to influenza reported in Canada this season. In Europe, a number
of countries including France, Norway, Sweden, Finland, the Czech
Republic, and parts the western Russian Federation have reported

Countries in the tropical zone
------------------------------
-- Southern Asia circulation of influenza viruses (snapshot) pdf,
393kb
http://www.who.int/influenza/surveil...ion_mai n.pdf

Tropical countries of the Americas
----------------------------------
In the tropical countries of the Americas, generally low levels of
influenza transmission were reported with the exception of Nicaragua
where sharp increases in the numbers of influenza A(H1N1)pmd09 virus
detections began in late September. Most cases reported in the country
were in Managua, where 14 individuals with H1N1pdm infection were
hospitalized. Much smaller numbers of influenza A(H3N2) have also been
detected in the country. Transmission of H3N2 has decreased to low
levels in El Salvador and Honduras after peaking in September.

Sub-Saharan Africa
------------------
In sub-Saharan Africa, influenza transmission has generally remained
low with the exception of Cameroon. In Cameroon, influenza type B
transmission began in June and appears to be declining since peaking
in early September and corresponded to a parallel rise in
influenza-like illness (ILI) cases. Transmission of H1N1pdm, which
began about 6 weeks after type B, appears to be peaking now coincident
with a rise in H3N2 detections. Notably, more than 75 percent of the
ILI cases reported through the sentinel surveillance system in
Cameroon have been children under the age of 5 years.

Tropical Asia
-------------
Influenza transmission in tropical Asia is active in localized areas.
Cambodia and Lao People's Democratic Republic report high level
transmission of a mixture of H1N1pdm and influenza type B (Cambodia)
and H1N1pdm (Lao People's Democratic Republic) in the end of October.
65 percent of ILI cases from sentinel sites in Cambodia tested
positive, primarily of influenza type B (60 percent) and influenza
A(H1N1)pdm09, with a small number of influenza A(H3N2). Viet Nam, in
contrast, has continued to report sustained transmission of H1N1pdm
for most of the year with a slight nadir occurring in June. Other
countries of southern Asia reported small numbers of both H3N2 and
influenza type B.

Countries in the temperate zone of the southern hemisphere
----------------------------------------------------------

South America
-------------
Temperate South America circulation of influenza viruses (snapshot)
pdf, 393kb
http://www.who.int/influenza/surveil...ation_main.pdf

In the temperate regions of South America influenza transmission has
declined to intra-seasonal levels and the season appears to be largely
over. Low or no influenza transmission is reported in all countries.

Southern Africa
---------------
Southern Africa circulation of influenza viruses (snapshot) pdf,
387kb
http://www.who.int/influenza/surveil...ion_m ain.pdf

South Africa experienced a 2nd peak of influenza transmission this
season between late August and late October of influenza virus type B
and A(H3N2), which followed an earlier peak of influenza A(H1N1)pdm09.
This was manifested in the number of patients and virus detection rate
of Severe Acute Respiratory Infections (SARI). Transmission of all
influenza viruses has since declined to low levels.

Australia, New Zealand and South Pacific
----------------------------------------
Oceania Melanesia and Polynesia circulation of influenza viruses
(snapshot) pdf, 390kb
http://www.who.int/influenza/surveil...ation_main.pdf

Influenza activity is now at intra-seasonal levels in Australia and
New Zealand, though low-level transmission of H3N2 appears to be
ongoing in the former.

The Global Influenza Programme monitors influenza activity worldwide
and publishes an update every two weeks. The updates are based on
available epidemiological and virological data sources, including
FluNet (reported by the Global Influenza Surveillance and Response
System) and influenza reports from WHO Regional Offices and Member
States. Completeness can vary among updates due to availability and
quality of data available at the time when the update is developed.

Maps and graphs
---------------
Global circulation of influenza viruses (snap shot)
http://www.who.int/influenza/surveil...irculation.pdf

Northern hemisphere circulation of influenza viruses (real time)
http://gamapserver.who.int/gareports...phere=Northern

Southern hemisphere circulation of influenza viruses (real time)
http://gamapserver.who.int/gareports...phere=Southern

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Interested readers are recommended to access the diagrams referenced
above to gain a rapid appreciation of the current influenza situation.
Other maps and graphs (real time) are available at the WHO website.

Globally influenza transmission remains low or undetectable. Atypical
features were a sharp increase in the numbers of influenza
A(H1N1)pmd09 virus infections beginning in late September in
Nicaragua, and a 2nd peak of influenza transmission in South Africa
between late August and late October involving influenza viruses type
B and A(H3N2), which followed an earlier peak of influenza
A(H1N1)pdm09. - Mod.CP]

See Also

http://www.promedmail.org/?p=2400:1000