H5N1

Flu News Europe, week 2

Via Flu News Europe, an excerpt from the week 2 update:

Week 02/2020 (6-12 January 2020) 

• Activity increased compared to week 01/2020, particularly in the southern part of the Region, with two Member States reporting high intensity and six reporting medium intensity. The remainder reported baseline or low intensity levels. 

• The percentage of samples from sentinel ILI surveillance patients that tested positive for influenza virus increased from 27% in the previous week to 40% this week. 

• The majority of reported influenza virus detections from sentinel ILI surveillance across the Region for week 02/2020 were type A (67%): this percentage has decreased from a high of 78% in week 49. The distribution of viruses detected varied between Member States and areas and within sub-regions. 

• Data from the 22 countries or regions reporting to the EuroMOMO project indicated that all-cause mortality was at expected levels for this time of the year. 

• ECDC published an Influenza virus characterization report, summarizing surveillance data in Europe through December 2019 

2019/20 season overview  

• For the Region as a whole, influenza activity commenced earlier than previous years. 

• Influenza activity in the European Region, based on sentinel sampling, first exceeded a positivity rate of 10% in week 47/2019 and has remained over 10% for 8 weeks. There has been an overall increasing trend in the weekly positivity rate for influenza virus detections among sentinel ILI surveillance patients, following a dip in week 52. 

• Type A viruses have dominated across the European Region, though several Member States and areas have reported influenza type B virus dominance or co-dominance of types A and B viruses. 

• In sentinel sources, both influenza A subtypes, A(H3N2) and A(H1N1)pdm09, are co-circulating and of the influenza B viruses, the vast majority (98%) have been B/Victoria lineage. 

• Influenzanet, which uses self-reported symptoms for ILI surveillance in the general population of European countries, is included in the bulletin as a pilot for the 2019/2020 season. 

• ECDC and WHO Regional Office published a joint Regional Situation Assessment for the 2019–2020 influenza season up to week 49/2019, which focused on disease severity and impact on healthcare systems to assist forward planning in Member States.

Case of seasonal reassortant A(H1N2) influenza virus infection, the Netherlands, March 2018

Via Eurosurveillance: Case of seasonal reassortant A(H1N2) influenza virus infection, the Netherlands, March 2018. The discussion section:

Human seasonal reassortant A(H1N2) influenza viruses harbouring the H1 from human seasonal A(H1N1) and seven segments from human seasonal influenza A(H3N2) virus have been detected before during an outbreak in China in 1988/89 and from 2000 to 2003 starting in Asia and spreading worldwide. However, the latter failed to co-circulate in the long term or to replace the A(H1N1) or A(H3N2) influenza viruses that were in circulation at the time. 

A sporadic case of seasonal reassortant A(H1N2) influenza virus harbouring the H1 from human influenza A(H1N1)pdm09 virus and the other seven segments from human seasonal influenza A(H3N2) virus was detected in India during the influenza pandemic in 2009. In a mixture of reassortants generated by in vitro coinfection with seasonal A(H1N1)pdm09 and A(H3N2) influenza viruses, sporadic virus with the current 2:6 constellation of genome segments was detected. Furthermore, in a transmission experiment with guinea pigs infected with this mixture of reassortant viruses, the influenza A(H1N2) virus with the NS segment from influenza A(H1N1)pdm09 virus was not detected in contact animals. 

In conclusion, this is the first time a seasonal reassortant A(H1N2) influenza virus with HA and NS from influenza A(H1N1)pdm09 virus and the other six segments of influenza A(H3N2) virus is reported in a human natural infection. The patient recovered fully and there is no evidence of extended spreading of the reassortant virus in humans. Published evidence indicates limited capacity for transmission of seasonal reassortant A(H1N2) influenza viruses. However, laboratories, especially national influenza centres, should stay vigilant for reassortant human seasonal influenza viruses with mixed genome segments from A(H1N1)pdm09 and A(H3N2) influenza viruses.

Canada: Nine children released from hospital after mystery illness on Alberta First Nation

Via CBC News: 9 children released from hospital after mystery illness on Alberta First Nation. Excerpt and then a comment:

Nine children have been released from hospital, while one remains in intensive care, two days after they were found on a Calgary-area First Nation with a mysterious illness.  

The children from Stoney Nakoda First Nation are now with relatives, according to a children's welfare representative. 

"They have been back in the community, placed in a home with a kinship group," said Trez McCaskill, director of Stoney Nakoda Child and Family Services.   

"We always hope to reunite the parents with the family. We'll be working with the family to address any concerns they might have." 

The children and two adults were found in a home on Wednesday, suffering from "influenza-like" symptoms, and were taken to hospital. A four-month-old baby was also found in the home and declared dead.   

Police and paramedics were responding to a report of children in medical distress. One of the children, a two-year-old, was found in serious condition.  

That child is the one still in hospital, McCaskill said.  

"A variety of common respiratory viruses were determined to be involved with those admitted to hospital," AHS said in the release. 

Alberta Health Services said Friday there's no ongoing health risk for the children or adults. The agency also said there was no health risk to the public. 

The agency said it was unable to comment on any patient's medical history or condition under the province's Health Information Act, and was also unable to comment on the child's death as it is under investigation by RCMP. 

Between the placement of the children in another home, and the involvement of the RCMP in the baby's death, this begins to look like suspected parental neglect—or the perennial problem on Canadian First Nations reserves, gross overcrowding in substandard housing. 

Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014

Via The Lancet Public Health: Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study. The summary:

Background 

Tuberculosis continues to disproportionately affect many Indigenous populations in the USA, Canada, and Greenland. We aimed to investigate whether population-based tuberculosis-specific interventions or changes in general health and socioeconomic indicators, or a combination of these factors, were associated with changes in tuberculosis incidence in these Indigenous populations. 

Methods 

For this population-based study we examined annual tuberculosis notification rates between 1960 and 2014 in six Indigenous populations of the USA, Canada, and Greenland (Inuit [Greenland], American Indian and Alaska Native [Alaska, USA], First Nations [Alberta, Canada], Cree of Eeyou Istchee [Quebec, Canada], Inuit of Nunavik [Quebec, Canada], and Inuit of Nunavut [Canada]), as well as the general population of Canada. 

We used mixed-model linear regression to estimate the association of these rates with population-wide interventions of bacillus Calmette-Guérin (BCG) vaccination of infants, radiographic screening, or testing and treatment for latent tuberculosis infection (LTBI), and with other health and socioeconomic indicators including life expectancy, infant mortality, diabetes, obesity, smoking, alcohol use, crowded housing, employment, education, and health expenditures.  

Findings 

Tuberculosis notification rates declined rapidly in all six Indigenous populations between 1960 and 1980, with continued decline in Indigenous populations in Alberta, Alaska, and Eeyou Istchee thereafter but recrudescence in Inuit populations of Nunavut, Nunavik, and Greenland. 

Annual percentage reductions in tuberculosis incidence were significantly associated with two tuberculosis control interventions, relative to no intervention, and after adjustment for infant mortality and smoking: BCG vaccination (–11%, 95% CI −6 to −17) and LTBI screening and treatment (–10%, −3 to −18). Adjusted associations were not significant for chest radiographic screening (–1%, 95% CI −7 to 5). 

Declining tuberculosis notification rates were significantly associated with increased life expectancy (–37·8 [95% CI −41·7 to −33·9] fewer cases per 100 000 for each 1-year increase) and decreased infant mortality (–9·0 [–9·5 to −8·6] fewer cases per 100 000 for each death averted per 1000 livebirths) in all six Indigenous populations, but no significant associations were observed for other health and socioeconomic indicators examined.  

Interpretation 

Population-based BCG vaccination of infants and LTBI screening and treatment were associated with significant decreases in tuberculosis notification rates in these Indigenous populations. These interventions should be reinforced in populations still affected by tuberculosis, while also addressing the persistent health and socioeconomic disparities.

Hong Kong: CHP investigates influenza A outbreak and influenza-like illness outbreak at two primary schools

Via the Centre for Health Protection: CHP investigates influenza A outbreak and influenza-like illness outbreak at two primary schools. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (February 5) investigating an influenza A outbreak at a primary school in Tai Po District and an outbreak of influenza-like illness at a primary school in Sai Kung District.      

The influenza A outbreak at a primary school in Tai Po District affected 20 students including 15 boys and five girls, aged 6 to 10. They have developed fever, cough and sore throat since January 19. Of the 15 patients who sought medical attention, one was discharged upon hospitalisation. All affected students are in stable condition.      

The nasopharyngeal aspirate of a patient tested positive for influenza A virus upon laboratory testing.        

For the outbreak of influenza-like illness at a primary school in Sai Kung District, it affected 27 students including 11 boys and 16 girls, aged 6 to 10. They have developed fever, cough and sore throat since January 19. All patients sought medical attention and one required hospitalisation. All affected students are in stable condition.  

Officers of the CHP have conducted site visits to both schools and advised the schools to adopt infection control measures against respiratory infections. The schools have been put under medical surveillance.

Flu News Europe, week 4

Excerpted from this week's Flu News Europe:

Week 4/2018 (22–28 January 2018) 

• Influenza activity was widespread in the majority of reporting countries and while activity was increasing, intensity in most countries was reported as low to medium. 

• Both influenza virus types A and B were co-circulating with a higher proportion of type B viruses. Different proportions of circulating influenza virus types and A subtypes were observed between countries in the Region. 

• Of the individuals sampled, on presenting with ILI or ARI to sentinel primary healthcare sites, 51.9% tested positive for influenza viruses, within the range observed in the previous 3 weeks (42–52%).

US: Worst flu season in nearly a decade

Credit: CDC

Via The New York Times: This Flu Season Is the Worst in Nearly a Decade. Excerpt:

This year’s flu season is now more intense than any since the 2009 swine flu pandemic and is still getting worse, federal health officials said on Friday.  

Nationally, the number of people who are falling ill with flu is still increasing. More worrying, the hospitalization rate — a predictor of the death rate — has just jumped, and is now on track to equal or surpass that of the 2014-2015 flu season.  

In that year, the Centers for Disease Control and Prevention estimates, 34 million Americans got the flu, 710,000 were hospitalized and about 56,000 people died.  

“We’ll expect something around those numbers,” Dr. Daniel B. Jernigan, director of the C.D.C.’s influenza division, said during a telephone news conference Friday. 

This week, the deaths of seven children were reported to the C.D.C., bringing this season’s total to 37. In 2014-2015, there were 148 pediatric deaths — which the agency tracks individually, not by estimates, as it does with death totals. 

It is too early to estimate how many children will die this season, Dr. Jernigan said, because the flu season still has weeks to run, and because the agency often does not learn of deaths — especially of children who die at home — until weeks after they occur.

More people fell ill during the 2009 “swine flu” pandemic, but that was a new virus. This year’s dominant virus, H3N2, has been circulating for 50 years — it emerged as the “Hong Kong flu” in 1968 — but it is usually the most lethal of the seasonal strains.

US: ‘Smart thermometers’ track flu season in real time

Via The New York Times: ‘Smart Thermometers’ Track Flu Season in Real Time. Excerpt:

A company making “smart thermometers” that upload body temperatures to its website claims to be tracking this year’s flu season faster and in greater geographic detail than public health authorities can.  

This year’s flu season — which the Centers for Disease Control and Prevention considers “moderately severe” — has left Missouri and Iowa the “sickest states in the country,” said Inder Singh, the founder of Kinsahealth.com.  

California has had its worst outbreak in five years, with nearly 1 percent of the state exhibiting flu symptoms on Jan. 2, he added. By contrast, New York, New England and the Southeast have had relatively mild seasons so far, but cases are rising and should peak in two weeks.  

Mr. Singh’s data paints a different picture from that of the C.D.C., which held a news conference Friday to announce that flu activity was “widespread” across the continental United States, which is unusual. (Hawaii’s outbreak is smaller, the agency said.) 

“There’s lots of flu in lots of places,” said Dr. Daniel B. Jernigan, director of the C.D.C.’s flu division.  

Hospitalization and death rates, though climbing, are still lower than was expected, Dr. Jernigan added, even though most of this season’s cases are H3N2, which is typically the most deadly seasonal strain.  

Although 20 children and teenagers have already died of flu or its consequences, the 2014-2015 season — the one this season most closely resembles — killed 148. (This year’s final death toll will not be known until summer, because the deaths from lingering pneumonia may occur as late as June.)  

The C.D.C. data comes from hospitals and clinics that report how many cases of “influenza-like illness” they treat. Delays can result if clinic statisticians are busy or if state health departments do not pass on the figures quickly. 

Kinsa, by contrast, is able almost instantly to spot fever spikes in states — or even in cities and neighborhoods. More than 500,000 households now own its smartphone-connected oral and ear thermometers, Mr. Singh said, and the company gets about 25,000 readings each day.

Canada: British Columbia Influenza Surveillance Bulletin, week 1

Via the BC Centre for Disease Control: British Columbia Influenza Surveillance Bulletin for week 1 (Dec. 31-Jan. 6). Excerpt:

During week 1 (December 31, 2017 to January 6, 2018), influenza activity remained elevated in BC. Although some surveillance indicators plateaued or decreased slightly in week 1, it is too early to determine if the seasonal peak has been reached. 

Influenza positivity at the BCCDC Public Health Laboratory remained above 40% in week 1. A mix of influenza types A and B continue to circulate in approximately equal proportions, with A(H3N2) remaining the dominant subtype among influenza A detections. 

 

Since our last bulletin, 29 new lab-confirmed outbreaks were reported; 26 from long-term care facilities (LTCFs) and three from acute care hospitals. Of the 29 outbreaks, 16 had influenza B detected, 11 had influenza A detected, and 2 had influenza A and B detected; of the 2 influenza A outbreaks with subtype information available, both were A(H3N2). 

Medical Services Plan (MSP) claims for influenza illness were stable around expected median levels for the province overall and in most regions, while sentinel ILI rates were significantly above 10-year historical averages.

Flu News Europe, week 1

An excerpt from the latest Flu News Europe:

Week 1/2018 (1–7 January 2018) 

• Influenza activity was increasing in countries in northern, southern and western Europe. 

• Both influenza type A and B viruses were co-circulating and different patterns of circulation were observed across countries in the Region. 

• Of the individuals sampled, on presenting with ILI or ARI to sentinel primary healthcare sites, 42% tested positive for influenza viruses, similar to the 44% in the previous week. 

• EuroMOMO data showed excess mortality in the elderly (>65 years of age) for the United-Kingdom (Scotland), Spain and Portugal. 

2017/18 season overview  

• From sentinel sources, a higher proportion of type B viruses compared to type A viruses has been detected. Of the type A detections, A(H1N1)pdm09 viruses have outnumbered A(H3N2) viruses. 

• For type B viruses from both sentinel and non-sentinel sources, B/Yamagata lineage viruses have greatly outnumbered those of the B/Victoria lineage. 

• While low in number, 64% of the genetically characterized A(H3N2) viruses belonged to clade 3C.2a, the vaccine virus clade as described in the WHO recommendations for vaccine composition for the northern hemisphere 2017–18, and 36% to clade 3C.2a1, with viruses in both clades being antigenically similar. 

• Based on data submitted to the EuroMOMO project there has, over the past weeks, been increased mortality among the elderly, notably in the southwest and the north of the British Isles.  

• An early risk assessment based on data from EU/EEA countries was published by ECDC on 20 December 2017. First detections indicated circulation of A(H3N2) and B/Yamagata viruses in the highest proportions. As the A(H3N2) subtype dominated last season, a high proportion of the population should be protected. 

Other news 

• The US CDC published a Health Alert Network (HAN) notice, regarding increased A(H3N2) activity that affects mostly people aged over 65 and younger children, leading to more hospitalizations and deaths. Based on the moderate vaccine effectiveness, detailed information on recommended antiviral treatment is provided. See full report here. 

• Additional information on global influenza activity is available from WHO’s biweekly global updates.