Thursday 14 December 2006
Contents
Epidemiological updates
Scientific advances
Meetings and workshops
Epidemiological updates¨
SEASONAL INFLUENZA – WEEKLY EISS UPDATE
The next EISS update for week 50 will be published on December 22nd
European Influenza Surveillance Scheme (EISS) Weekly Electronic Bulletin
Issue 205, Week 49: 04/12/2006-10/12/2006
Low levels of Influenza activity with sporadic cases of laboratory confirmed influenza in Europe
Summary: Clinical influenza activity in Europe remains at baseline levels. In the last three weeks (weeks 47-49) an increased number of laboratory confirmed cases of influenza have been reported for Europe as a whole. Since the start of the 2006-2007 season a total of 134 cases of influenza A and 12 cases of influenza B have been detected.
Epidemiological situation - week 49/2006: National network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were at a low level in 26 countries. Data from France, Luxembourg, Norway, Romania, Scotland and Switzerland indicated sporadic activity (isolated cases of laboratory confirmed influenza) whilst 22 countries reported no activity.
Cumulative epidemiological situation - 2006-2007 season (week 40-49/2006): So far this season, the consultation rates for ILI and/or ARI have been at baseline levels across the whole of Europe.
Virological situation - week 49/2006: The total number of respiratory specimens collected by sentinel physicians was 503, of which ten (2.0%) were positive for influenza virus. The positive specimens were collected in Austria (one), the Czech Republic (one), France (two), Luxembourg (one), Romania (one), Sweden (one) and Switzerland (three). In addition, 22 influenza virus positive specimens from non-sentinel sources (e.g. specimens collected in hospitals) were reported [Norway (five), France (two), Scotland (six), Sweden (eight) and Switzerland (one)].
All positive specimens except for one from Romania were influenza A.
Cumulative virological situation - 2006-2007 season (week 40-49/2006): Based on (sub)typing data of all influenza virus detections (N=146; sentinel and non-sentinel data), 87 (60%) were A (not subtyped), nine (6%) were A(H1) [of which three were A(H1N1)], 38 (26%) were influenza A(H3) [of which 18 were A(H3N2)] and 12 (8%) were B.
Based on the characterisation data of all influenza virus detections up to week 49/2006, 17 have been antigenically and/or genetically characterized (one in Austria, two in England, 12 in France, one in Luxembourg and one in Norway). Fourteen were A/Wisconsin/67/2005 (H3N2)-like (one from Austria, 11 from France, one from Luxembourg and one from Norway), two were A/New Caledonia/20/99 (H1N1)-like) (one from England and one from France) and one (from England) was A/California/7/2004 (H3)-like [a strain of the A(H3N2) virus that emerged during the 2004-2005 season, circulated during the 2005-2006 season, and is closely related to the A/Wisconsin/67/2005 (H3N2) reference virus].
Comment: Influenza activity in Europe remains at baseline levels. Although clinical influenza activity in Northern Ireland is increasing, there is no laboratory evidence for influenza infection in this country. Laboratory confirmed cases of influenza have been found sporadically throughout Europe since week 40/2006. However, from week 47 onwards the number of positive isolates per week has been increasing. So far this season, 92% of the virus isolates were influenza A.
Detections of the respiratory syncytial virus (RSV), a respiratory virus with clinical symptoms that are similar to influenza, have been gradually increasing in a number of European countries (e.g. in Czech Republic [second graph], England, France, Netherlands and Northern Ireland) whereas in Scotland RSV remains stable and in Ireland RSV is possibly over its peak.
Background: The Weekly Electronic Bulletin presents and comments influenza activity in 28 European countries that are members of EISS. In week 48/2006, 27 countries reported clinical data and 29 countries reported virological data. The spread of influenza virus strains and their epidemiological impact in Europe are being monitored by EISS in collaboration with the WHO Collaborating Centre in London (United Kingdom) and the European Centre for Disease Prevention and Control in Stockholm (Sweden).
Full EISS bulletin including maps and graphs by country
National/regional bulletins in Europe and other bulletins from around the world
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AVIAN INFLUENZA – ANIMAL HEALTH – POULTRY OUTBREAKS
Media Reports of H5N1 in South Korea
December 11 2006
Media reports indicate that the South Korean Ministry of Agriculture and Forestry has reported a new case of highly pathogenic avian influenza at poultry farm in the south western part of the country. The outbreak was reported to have killed about 1,000 quail at the farm in Gimje, 262 kilometers southwest of Seoul.
The case would be the third case reported in South Korea since Nov. 25, when an outbreak of highly pathogenic bird flu was confirmed, the firs
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Scientific Advances
SCIENTIFIC ADVANCES - PANDEMIC INFLUENZA - PREPAREDNESS
Modeling Community Containment for Pandemic Influenza- a letter report
Committee on Modeling Community Containment for Pandemic Influenza
Institute of Medicine of the National Academy of Science (US) 2006
Description: The ‘letter report’ paper published this week (December 11th) reports on the rapid conclusions from a panel of scientists and public health specialists that were convened by the United States Institute of Medicine at the request of its government to review: 1) the quality of current models on pandemic influenza and their usefulness in predicting the effects of containment policies on disease mitigation; (2) the available science and previous analyses of the efficacy of community mitigation approaches; and (3) the historical record of community interventions utilized during previous influenza pandemics and other relevant outbreaks. The paper discusses and summarises the effectiveness of intervention strategies in six key categories: infection control and prevention; antiviral use; patient management; contact management; community restrictions and risk communication. The Committee also identified nine key recommendations where further work is necessary to inform policy making in the area of pandemic preparedness planning and specifically how to respond to a pandemic when it occurs so as to minimize the damage.
ECDC comment (2006-12-13): A detailed comment on the paper will be provided next week.
Responses to influenza@ecdc.europa.eu
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SCIENTIFIC ADVANCES – SEASONAL INFLUENZA – VACCINATION
Hajj and the risk of influenza
Gatrad A et al
British Medical Journal (2006);333:1182-83
Influenza vaccine uptake among British Muslims attending Hajj, 2005 and 2006
Shafi S et al
British Medical Journal (2006) (Letters);333:1220
Description: An editorial on this week issue of the British Medical Journal states the potential risks that the next Hajj, the annual pilgrimage to Mecca, can pose in terms of facilitating the spread of influenza virus and promoting the emergence of a pandemic. Authors express concerns for the reported low adherence of pilgrims to the currently recommend vaccination against influenza for "high risk" individuals participating to the event, and suggest that mandatory influenza vaccination for all pilgrims should be considered. They also acknowledge that stockpiling and use of antivirals would be unpractical due to the lack of diagnostic testing facilities and to the cost of stockpiling sufficient supplies. Editorialists concludes that virological surveillance should be implemented urgently to identify newly emerging strains and suggest that WHO works with the Saudi authorities to minimise the risk of the influenza virus spreading among pilgrims.
ECDC Comment (2006-12-13): It is already the policy of the Saudi Arabian authorities to advise that pilgrims to Mecca are immunized against seasonal influenza. This editorial mentions some evidence that pilgrims are at somewhat higher risk of acquiring or suffering from seasonal influenza and the letter by Shafi et al indicates that this advice is not universally followed. However it is not clear that there is a good public health case for immunizing travellers to the Hajj beyond the usual risk groups (the elderly and those with chronic conditions). The editorial then goes on to confuse the risk from seasonal influenza and pandemic influenza and the risk of a pandemic emerging from the Hajj which immunization against seasonal influenza would do little to prevent. It should be noted that the case for supporting immunization of all pilgrims to the Hajj against Meningococcal infection, which is a mandatory visa requirement for pilgrims travelling to Saudi Arabia, is stronger than for influenza.
See also:
Hajj 2006: communicable disease and other health risks and current official
guidance for pilgrims.
Shafi S et al.
EuroSurveillance (2005);10:(12)
Responses to influenza@ecdc.europa.eu
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Meetings and workshops
3rd ECDC Regional Workshop on Pandemic Preparedness, Stockholm 4-6 December 2006.
The workshop was organized by ECDC in conjunction with Member States as part of a series of Regional workshops on Pandemic Influenza Preparedness which have the objectives to:
- bridge preparedness activities between the European region and review the results of the status report on pandemic preparedness to the Commission
- address operational issues (e.g. interoperability, health services preparedness, antivirals) of preparedness at a sub-regional level before the next main pandemic preparedness workshop that is planned for May 2007.
Two representatives for each of the 9 Countries (France, Germany, Italy, Lithuania, Poland, Greece, Portugal, Slovakia, and United Kingdom) which have already undergone the ECDC assessment on preparedness status were invited to participate. Italy, France and Greece could not attend.
Four focus areas on preparedness were identified in advance and specifically addressed by 4 invited experts. The selected focus areas were: 1) preparing hospitals for pandemics; 2) communication with health care workers; 3) delivery of antivirals; 4) interoperability.
MS representatives presented their status of preparedness relatively to the four focus areas, participated to working group discussions and shared constraints and limitations found when making their plans operational.
Conclusions have been drawn and priority actions at national and European level agreed within each focus area. The programme for the future Regional workshops will be announced in early 2007.
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International Conference on Avian and Pandemic Influenza, Bamako, Mali, West Africa. December 6-8th
The conference was a one year follow up to Beijing pledging conference. The Conference was supported by the European Union. Documents from the conference are starting to appear at the conference and UNDP websites. Especially recommended by the ECDC represenatatives is a talk by the United Nations Systems Influenza Coordinator Dr David Nabarro
Conference website
UNDP website
Speech by Dr Nabarro
For information on the EU support see: http://ec.europa.eu/comm/world/avian_influenza/index.htm
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