Thursday 25th January 2007
Public health guidance
Meetings and workshops
SEASONAL INFLUENZA– WEEKLY EISS UPDATE
The next EISS update for week 4 will be published on February 2nd 2007
Seasonal Influenza – European Status
Text adapted from: European Influenza Surveillance Scheme (EISS) Weekly Electronic Bulletin
Issue 211, Week 03 (15/01/2007-21/01/2007)
Influenza virus detections continue to increase in Europe
Summary: Influenza virus detections are currently increasing in Europe. The total number of positive specimens has steadily increased from less than 100 in week 50/2006 to 626 positive specimens in week 03/2007. Countries with increased levels of influenza activity are Greece, Luxembourg, the Netherlands, Northern Ireland, Scotland, Spain and Switzerland. In Scotland consultation rates for influenza-like illness peaked in week 02/2007 and now appear to be on the decline.
Epidemiological situation - week 03/2007: For the intensity indicator, the national network level of influenza-like illness (ILI) and/or acute respiratory infection (ARI) was medium in Greece, Luxembourg, the Netherlands, Northern Ireland, Scotland, Spain and Switzerland*, whilst it remained low in 18 other countries.
For the geographical spread indicator, regional activity was reported in four countries (the Czech Republic, Norway, Scotland and Spain), local activity in seven countries, sporadic activity in 12 countries and no activity in three countries (Hungary, Lithuania and Poland). Definitions for the epidemiological indicators can be found.
Cumulative epidemiological situation - 2006-2007 season (since week 40/2006): So far this season, the consultation rates for ILI and/or ARI have been at increased levels in Northern Ireland (since week 49/2006), and above the national baseline threshold in Greece (since week 01/2007), Scotland (since week 01/2007), Luxembourg (since week 02/2007), Spain (since week 02/2007), Switzerland (since week 03/2007) and the Netherlands. In the other countries influenza activity has remained at baseline levels.
Virological situation - week 03/2007: The total number of respiratory specimens collected by sentinel physicians was 1290, of which 320 (24.8%) were positive for influenza virus. Of these, 315 (98%) specimens tested positive for influenza A virus and five (2%) were influenza B. In addition, 306 specimens from non-sentinel sources (e.g. specimens collected for diagnostic purposes in hospitals) tested positive for influenza virus, of which 300 (98%) were influenza A and six (2%) influenza B.
Cumulative virological situation - 2006-2007 season (since week 40/2006): Based on (sub)typing data of all influenza virus detections (N=1881; sentinel and non-sentinel data), 1191 (63%) were type A not subtyped, 59 (3%) were type A subtype H1 [of which 28 were subtype H1N1], 583 (31%) were type A subtype H3 [of which 310 were subtype H3N2] and 48 (3%) were type B.
Based on the characterisation data of all influenza virus detections, 325 have been antigenically and/or genetically characterized: 250 were A/Wisconsin/67/2005 (H3N2)-like, 52 were A/California/7/2004 (H3N2)-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], 21 were A/New Caledonia/20/99 (H1N1)-like, one was B/Malaysia/2506/2004-like (the B/Victoria/2/87 lineage) and one was B/Jiangsu/10/2003-like (the B/Yamagata/16/88 lineage
Comment: Influenza virus detections are currently increasing in Europe. Whilst influenza activity appears to have peaked in Scotland, in most other European countries the epidemiological and/or virological indicators indicate it is increasing. Based on historical data, the consultation rates in Scotland were the highest observed in the last seven seasons but were not exceptionally high (for example, compared to the 1999-2000 season). It is expected that influenza activity will continue to increase in Europe in the coming weeks.
Background: The Weekly Electronic Bulletin presents and comments influenza activity in 29 European countries that are members of EISS. In week 03/2007, 26 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 interactive EISS bulletin including maps and graphs by country and informative links in the text
National/regional bulletins in Europe and other bulletins from around the world
Links to general information from EISS:
General information on EISS, including background, membership and information on citing the EISS bulletin
Definitions of epidemiological indicators used by EISS
* Erratum: The intensity of influenza activity in Slovenia was low and not medium in week 03/2007.
Seasonal influenza beginning in Europe: report from EISS
Arkema JMS et al
Eurosurveillance Weekly January 25th 2006
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AVIAN INFLUENZA – HUMAN HEALTH -OVERVIEW
Overall Situation (January 24th 2006)
Since 2003 and January 15th there have been 269 confirmed H5N1 human cases worldwide that have met WHO’s criteria and reported to WHO. Of these 163 (61%) are known to have died.
- In 2003-2005, human cases were reported from 5 countries: Vietnam (93), Thailand (22), Indonesia (19), China (9) and Cambodia (4). In 2006 retrospectively recognised isolated human cases that occurred in China (2003) and Indonesia (2005) were also reported to WHO.
- In 2006, 116 cases (80 fatal) were been reported from 9 countries: Azerbaijan (8 / of which 5 fatal), Cambodia (2/2), Djibouti (1), China (13/8), Egypt (18/10), Indonesia (56/46), Iraq(3/2), Turkey (12/4), Thailand (3/3). Vietnam reported no cases in 2006.
- In 2007: 6 cases (5 fatal) have been reported by 2 countries: Indonesia (5 / of which 4 fatal), Egypt (1/1).
The epidemiological situation of human H5N1 infections globally remains unchanged.
ECDC country updates
Cumulative number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO
Avian influenza update: Recent outbreaks of H5N1 in poultry worldwide
Influenza team, ECDC
Eurosurveillance Weekly January 25th 2006
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AVIAN INFLUENZA – HUMAN HEALTH - EGYPT
22 January 2007
The Egyptian Ministry of Health and Population announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 27-year-old woman from Beni Sweif Governate developed symptoms on 9 January 2007 and died in hospital on 19 January.
Initial investigations indicate the presence of sick and dead poultry at her residence in the days prior to the onset of illness.
Of the 19 cases confirmed to date in Egypt, 11 are known to have died.
Egypt situation summary
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AVIAN INFLUENZA – HUMAN HEALTH - INDONESIA
22 January 2007
The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 26-year-old woman from West Java Province developed symptoms on 11 January and died in hospital on 19 January. Initial investigations of the source of her infection indicate that the woman had been involved in the slaughter of sick chickens in the days prior to symptom onset.
Of the 80 cases confirmed to date in Indonesia, 62 are known to have died.
Indonesia situation summary
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AVIAN INFLUENZA – ANIMAL HEALTH – HUNGARY
24 January 2007
Infection with avian influenza A/H5 has been confirmed in a flock of over 3,000 geese in Csongràd County, south-east Hungary. Samples will now be sent to the Community Reference Laboratory for avian influenza in Weybridge to determine if it is the H5N1 virus. The Hungarian authorities have already culled the infected flock, in order to prevent the spread of the virus. A protection zone of 3 km radius and a surveillance zone of 10 km around the infected holding has been established.
This will be the first outbreak in Hungary since the summer of 2006 and only the sixth outbreak in poultry in the EU.
European Commission press release confirming HPAI H5 in Hungary
HPAI in Hungary - Ministry of Agriculture and Rural Development
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AVIAN INFLUENZA – ANIMAL HEALTH – SOUTH KOREA
24 January 2007
On the 21st January, South Korea reported to the OIE positive cases of H5N1 among poultry, including chickens and ducks in two provinces: CH'UNGCH'ONG-NAMDO (2 outbreaks) and in CHOLLA-BUKDO (3 outbreaks). Movement restrictions were applied to the affected farms and other farms within the 10-km-radius zone. The eggs laid and stored in the affected farm will be destroyed.
The 5th affected farm is located in the surveillance zone which had been established in Asan (Ch'ungch'ong-Namdo) due to the HPAI outbreak on 11 December 2006. The stamping-out of the susceptible animals reared in the 3-km-radius zone around the affected farm will be conducted.
Official report to OIE
There are media reports that specimens from healthy ducks in Viet Nam's southern Dong Thap province have tested positive to bird flu virus strain H5, in the 3 districts of Thanh Binh, Lap Vo and Thap Muoi, and Sa Dec town. The newspaper quoted the provincial Department of Agriculture and Rural Development as reporting.
The most recent official return from Viet Nam to the OIE (17 Jan 2007) reports that 52 outbreaks have been notified during this latest series of avian influenza outbreaks which began on 6th December 2006. The report to OIE does not provide information on species but it should be assumed that most if not all are domestic poultry.
According to the Vietnamese Department of Animal Health, as of 17 Jan 2007 these outbreaks are appearing in 41 communes in 19 districts of 7 provinces: Ca Mau, Bac Lieu, Hau Giang, Kien Giang, Vin Long, Soc Trang, Tra Vinh. The affected provinces are located in the Southern part of the country (see Map).
The Vietnamese authorities are reacting vigorously and with commendable transparency, on 16th January, the Prime Minister issued an official communication on avian influenza control and prevention. This followed a letter on !5th January from the Director of Department of Animal Health increasing the number of personnel available for emergency teams to control avian influenza on 15th January.
Provinces are continuing to carry out supplementary vaccination against AI. Information from the Department of Agriculture indicated that a total of around 2,100,000 poultry have been vaccinated, involving respectively approximately 300,000 and 1,800,000 chickens and ducks.
On January 18th WHO reported that samples from two patients in Egypt showed the presence of a genetic marker previously observed to be associated with some reduced susceptibility of influenza viruses to oseltamivir (Tamiflu). Both patients had been on treatment with oseltamivir, but only for two days before the clinical samples that yielded the viruses were taken. The two patients from whom samples were taken were a 16 year-old female and a 26 year-old male. They were a niece and uncle, respectively, who lived in the same house. In both cases treatment was initiated beyond 48 hours from symptoms onset. The girl died on 25 December and the man died on 28 December 2006.
This genetic marker of resistance had previously been identified in Viet Nam in one case in 2005. WHO pointed out in its report that these markers are not associated with any known change in the transmissibility of the virus between humans, that antiviral resistance is uncommon in Egypt and that the public health implications at this time are limited. Monitoring of the levels and type of antiviral resistance is important and carried out by an international collaboration with WHO.
As influenza viruses continuously change, mutations conferring antiviral resistance can emerge. There are various levels at which antiviral resistance can be detected or inferred:
It is important to appreciate that a virus may have genetic markers associated with resistance but still respond well to drugs in the laboratory. Equally a virus found to be resistant in the laboratory or in animals may still respond to antivirals given to patients.
The two patients who died in Egypt both started oseltamivir somewhat late and its considered unlikely that antiviral resistance contributed to their sad clinical outcome.
Though both WHO and ECDC feel there is no reason to change antiviral policies for H5N1 at present, there remains every reason for continuing to develop new drugs and to monitor resistance carefully on a routine basis in H5N1 and other influenza isolates from humans and animals.
Irrespective of the low public health relevance here the situation in Egypt is concerning because H5N1 is endemic in the poultry and there are many domestic flocks in close proximity to people.
This scientific conference on vaccination, co-organised by the OIE, FAO and the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe), and supported by the European Commission, aims to address the issue of global guidelines for vaccination in poultry with regard to international standards, regulations and the implementation of vaccination programmes. Delgates will also review the current methods and recent experiences in the use of vaccination as one of the tools to control and prevent losses due to avian influenza in poultry, and discuss the appropriate decision-making process for the implementation of a vaccination strategy.