Thursday 10th October 2007
Epidemiological updates
Scientific Developments
Public health developments
Meetings and workshops
Request for Contributions
Epidemiological updates
Seasonal Influenza – European Status
During the inter-season period over the summer, EISS produces a bulletin every two weeks as a low-level monitoring of human influenza activity in Europe. The next inter-season bulletin will be published on October 5th 2007
Text updated from: European Influenza Surveillance Scheme (EISS) Inter-season Electronic Bulletin
Issue 234, Week 37 (10/09/2007-16/09/2007)
A single laboratory confirmed case of influenza A in Europe in the last two weeks
Summary: In weeks 36/2007 and 37/2007, 13 countries reported on their virological situation. A single detection of influenza A was reported in England (Central) in week 36/2007. Consistent with the lack of detected viruses, none of 12 countries reporting on their epidemiological situation reported any influenza activity.
Since week 21/2007, a total of 21 positive specimens - 16 influenza A viruses and five influenza B viruses - have been reported to EISS (see graph and table for further details). Additionally, Finland reported one positive specimen (influenza B) in week 21/2007.
There have been no reports of unusual influenza activity in Europe at a community level (i.e. in a region or local area (such as a city, county or district)) since week 22/2007, when an outbreak of avian influenza A(H7N2) with transmission to humans was reported in the United Kingdom.
Background: The Inter-season Electronic Bulletin presents and comments influenza activity based on virological data reported to EISS. The Inter-season Electronic Bulletin will be published between week 21/2007 and week 39/2007.
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
» Back to top
AVIAN INFLUENZA – HUMAN HEALTH – INDONESIA
8th October
The WHO reported this week that the Ministry of Health in Indonesia has detected a new fatal case of human H5N1 infection. The case is of a 44-year-old female from Pekanbaru City in Riau Province who developed symptoms on 1 October and died on 6 October. The Indonesian authorities report that a team is currently investigating the case to determine the most likely source of infection. It is stated that all of the close contacts are being monitored but that they all remain healthy. I.e. there is no suggestion of person to person transmission.
Of the 108 cases confirmed to date in Indonesia, 87 have been fatal.
WHO report on case in Indonesia (updated 8th October)
Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO (updated 2nd October).
H5N1 avian influenza: timeline of major events (updated 11th September).
» Back to top
AVIAN INFLUENZA – ANIMAL HEALTH – GERMANY
3rd October
Only a small number of EU member states have been affected by A/H5N1 in birds in 2007, and there have been no reports of any human infection. The majority of the small number of cases in EU wild birds and domestic poultry have been reported in Germany. A recent presentation by the German Federal Ministry to a meeting of EU veterinary experts gives a useful summary of the three cases of A/H5N1 that have been identified in German domestic poultry during the year (the most recent was identified on 10th September), and includes both detailed maps of the locations, epidemiological information on possible source of introduction and also measures taken by the German authorities to control infection.
German presentation on the HPAI H5N1 situation in Bavaria, Germany to a meeting of EU veterinary experts in the Standing Committee on the Food Chain and Animal health (SCoFCAH) (3rd October).
» Back to top
Scientific Developments
Mutation identifed in H5N1 viral protein that may facilitate transmission- Growth of H5N1 influenza A viruses in the upper respiratory tract of mice.
Hatta M et al
PLoS Pathogens 2007; 3 (10) e113: P 1-6.
Description: In humans, receptors with good affinity for H5N1 virus are typically only found in the lower respiratory tract. The inability of H5N1 viruses to adhere to and replicate in the upper respiratory tract is seen as one of the barriers to the development of easy human to human transmission of H5N1 because this limits the levels of virus that can excreted by coughing and sneezing. The authors have identified a single amino acid change in a H5N1 viral protein that, when present, facilitates the virus' ability to infect and replicate in the cells of the upper respiratory system in non-human mammals (in this case in mice). The point mutation identified in the virus protein appears to alter the replication characteristics of viral particles allowing the virus to replication more easily at lower temperatures such as are seen in the upper respiratory tract, and in a wider range of cell types.
ECDC Comment (11/10/2007): This alteration of a single amino acid could be an important in the establishment of a strain on H5N1 that has the potential to be transmitted between humans, although there remain other biological barriers that an avian derived virus must overcome before it can be said to have true pandemic potential. The paper uses mice as a model of mammalian respiratory tract. The paper led to some speculation in the media that H5N1 is moving towards being more transmissible. That may be the case however it needs to also be appreciated that there is no evidence at present that the virus has changed or is changing its behaviour in terms of its ability to infect humans, its pathogenicity and crucially its ability or rather lack of ability to transmit on from person to person. In that sense the ECDC risk assessment statement of 2005 and 2006 still applies, namely these viruses currently remain “a group of influenza viruses of birds, poorly adapted to humans whom they find hard to infect except at high doses. They are dangerous as they are highly pathogenic in those few humans that do become infected, but then they generally do not transmit on to other humans.”(1)
1) ECDC Technical report: The Public Health Risk from Highly Pathogenic Avian Influenza Viruses Emerging in Europe with Specific Reference to type A/H5N1. Version June 2006. http://www.ecdc.eu.int/Health_topics/Avian_Influenza/pdf/060601_public_health_risk_HPAI.pdf
Comment to influenza@ecdc.europa.eu.
» Back to top
Public health developments
ECDC Guide to Public Health Measures to Reduce the Impact of Influenza Pandemics during Phase 6 - ‘The ECDC Menu’. Public Consultation Version. http://ecdc.europa.eu/Health_topics/Pandemic_Influenza/Guidance.aspx
Background
The ECDC has this week published an interim Guide to Public Health Measures to Reduce the Impact of Influenza Pandemics during Phase 6 - ‘The ECDC Menu’ The aim of the document is to present all the measures that European States and EU institutions individually or collectively could consider to reduce the impact of an influenza pandemic.
This includes a wide range of possible options (26 in all), including personal actions (hand-washing and mask wearing) and pharmaceutical interventions (antivirals, human avian influenza vaccines and late in the pandemic specific vaccines) as well as the so-called ‘social distancing’ (school closures, cancelling public meetings, restricting internal travel etc). As befits ECDC advisory mandate and reflecting the diversity of Europe (and pandemics) the document does not make any recommendations on what EU states should so. Rather it summarises the current status of public health and scientific information on what is known or can be said about the likely effectiveness, costs (direct and indirect), acceptability, public expectations and other more practical considerations.
Audience
The primary intended audience is those who develop policy and decision makers though secondary audiences are all those concerned with influenza the public and the media. The understanding by the latter of the measures and their limitations will be crucial to their successful application in a pandemic.
Scope – Phase 6 of a Pandemic
The document only applies to measures that would be taken during Phase 6 of a pandemic or when there are epidemics of seasonal influenza. It does not address the somewhat different circumstances of Phases 4 & 5, to the unique needs of the first emergence of a putative pandemic strain (the WHO Rapid Containment Strategy) or the complex planning and policy issues that arise over how to sustain key services in a pandemic.
Current WHO position on public health measures
With permission the version contains the current WHO position on the public health measures in Phases 4, 5 & 6 as published as an Annex to their 2005 global plan.
Consultation version- views requested
This is a public consultation version of this document.
Debate, comments and suggestions are all welcome to influenza@ecdc.europa.eu preferably with the subject title ECDC Pandemic Public Health Measures Menu before January 31st 2008. Substantive comments will be published along with ECDC responses.
Comment to influenza@ecdc.europa.eu.
» Back to top
Meetings and workshops
Perspectives in Interpandemic Influenza, Madrid, 12-14 October 2007.
The inaugural Congress on Perspectives in Interpandemic Influenza will take place 12-14 October 2007 in Madrid, Spain. This Congress aim’s to provide an update on the latest treatment and management options available for seasonal influenza. The agenda is focused on therapeutic approaches to patient care, and is targeted at health care professionals in the primary care sector. Conference website: Perspectives in Interpandemic Influenza
» Back to top
3rd ESWI European Influenza Conference, Vilamoura, Portugal 14-17 September 2008.
The European Scientific Working group on Influenza (EWSI) - an independent group of European scientists promoting the study of influenza – will hold its third European Influenza Conference in the Autumn of 2008.
Preliminary conference information can be found at: http://www.eswi.org/Events.cfm
» Back to top
Contributions Requested The ECDC influenza project team very much welcomes potential contributions to this newsletter from EU/EEA member states particularly concerning public health developments and scientific published papers. This includes publications in non-English languages. These should be sent, preferably with a web-link, to Influenza@ecdc.europa.eu. If drawing to our attention a non-English language article for development, a short summary in English is appreciated. However, this is not essential because of its multi-national staff, ECDC can cope with most languages from within the EU.