Rhiza Labs FluTracker Forum

Lisa Schnirring Staff Writer

Dec 22, 2010 (CIDRAP News) – The European Centre for Disease Prevention and Control (ECDC) today said flu transmission is increasing across the European Union (EU), led by a spike in the United Kingdom, and warned people in recommended groups to get vaccinated as soon as possible.

Dr Marc Sprenger, ECDC director, said in a press release that infections with 2009 H1N1 and influenza B viruses have produced some severe cases in the UK and that none of the people who died had been immunized with either the monovalent H1N1 or trivalent seasonal flu vaccine.

While acknowledging that national authorities vary in their flu prevention recommendations, Sprenger said vaccination is the most effective step and that groups targeted by countries for immunization should be vaccinated right away. He emphasized that this year's seasonal flu vaccine is a good match with circulating flu strains.

In a separate flu update, the ECDC said doctor's visits for flu-like illness are rising in 14 EU countries, with the 2009 H1N1 and influenza B predominating. Typically flu epidemics in the EU move from west to east, it said.

The ECDC said the UK experience so far suggests a flu season profile that is similar to what Southern Hemisphere countries such as New Zealand experienced this year and that seems consistent with patterns seen during the 2009 H1N1 pandemic. Most people have mild or no illness, with severe disease more common in people with underlying risk factors and in those younger than 65.

The agency said the UK flu experience so far should serve as a lesson for other countries bracing for an uptick in flu activity. For example, the UK has prepared intensive care units and extracorporeal membrane oxygenation (ECMO) services to handle more patients, emphasized seasonal flu vaccines for pregnant women and others at risk for flu complications, and advised doctors to prescribe antiviral medication for sick patients.

England's chief medical officer yesterday urged that existing antiviral recommendations be relaxed in England and Wales to allow general practitioners and other providers to prescribe them at their discretion, the UK's Royal College of General Practitioners (RCGP) said yesterday in a statement. The Health Protection Agency had recently issued new antiviral guidance that said the drugs should be prescribed to those in risk groups, ideally within 48 hours, and that prophylactic use in healthy people under age 65 is not recommended.

In other developments, Dr Steve Field, who recently chaired the RCGP, today raised concerns about the UK National Health Service's ability to handle the rapid spread of flu, given that so few people, including healthcare workers, have been immunized, the London-based Guardian reported.

Calling vaccine uptake "shockingly low," he said it was a mistake for the country not to have had a public awareness campaign to push the importance of seasonal flu vaccination, the Guardian reported. The story also said the Department of Health reported that more than 300 people are in critical care beds with flu.

Health officials countered that the outbreak was under control, according to the Guardian report. However, Dr Sally Davies, England's chief medical officer, said government curbs on media spending forced the Department of Health to depend on primary care trusts and general practitioners to highlight the importance of vaccination.

Dr Lindsey Davies, president of the UK Faculty of Public Health, said the lack of a national campaign could be contributing to low flu-vaccine uptake. "And that's regrettable," she said.

Start of the influenza season 2010-11
22 Dec 2010

ECDC
Through European surveillance and formal notification from the Community Network on surveillance and control of communicable diseases we are aware that influenza transmission is now picking up across the European Union. In particular, in the first affected country, the UK, there have been some cases of severely affected people due to influenza A (H1N1)2009 and B virus infections, with some fatalities. None of the fatal cases to date had a record of vaccination with the 2009 pandemic vaccine or the 2010 seasonal influenza vaccine. ECDC monitors the influenza situation across Europe and reports results through the Weekly Influenza Surveillance Overview (WISO).
During the influenza season - and especially while influenza cases are occurring in your community - citizens should adopt preventative measures recommended by their national authorities; these may include: personal hygiene measures and vaccination for those recommended. Vaccination is the most effective of these and it is ECDC advice that all those who are recommended to have the influenza vaccine by their national authorities should get vaccinated as soon as possible.

Virological analysis show that the 2010 trivalent seasonal influenza vaccines will protect against this season’s influenza viruses.

The proportion of the population immunised in 2010 will not be known for some time, however the most recent figures have ranged from nearly 80% to under 10% among older people and even lower rates among those in the risk groups (with pregnant women usually having the lowest coverage).

Vaccines and vaccination can be an emotive issue and citizens rightly ask for assurance that vaccines are both safe and effective. The scientific evidence shows that seasonal influenza vaccines are effective and very safe. They provide a protection of up to 80% against influenza on an individual basis. ECDC will continue to work closely with the European Medicines Agency (EMA) – which is the EU agency responsible for the regulation of medicines at European level, including vaccines – to ensure that the relevant information on safety and effectiveness is readily available to all who want or need it.

Start of the seasonal influenza epidemics 2010-11– EU/EEA countries
22 December 2010
EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL Start of the seasonal influenza epidemics 2010-11
2
This 2010-11 season may differ from the usual pattern, due to highly variable use of pandemic vaccines in 2009 with high coverage in some Nordic countries3.
This initial picture in the EU is consistent with the experience in some temperate countries in the southern hemisphere (e.g. New Zealand) in their 2010 winter (May to September)4.
As in some other influenza seasons, what the EU/EAA countries are experiencing is different from North America and Asia (so far dominated by influenza A(H3N2)5). But it is important to note that influenza can always surprise.
The experience in the United Kingdom: useful for other countries
The experience in the United Kingdom can give some important indications of what is most likely to occur soon in other EU/EEA countries, except those that had a high coverage with the pandemic vaccine in 2009 (such as Finland, Norway and Sweden).
According to the information provided by the Health Protection Agency (week 49 report)
 there has been considerable pressure on intensive care units and extra corporeal membrane oxygenation (ECMO) since early December 2010;
 community consultation rates crossed the epidemic threshold in weeks 48 and 49, but influenza rates in the community have been lower than would be expected from the observed pressure on intensive care units. This may reflect the fact that, similar to the situation during the pandemic but in contrast to previous seasonal influenzas, most people infected with the influenza A(H1N1)2009 virus experience only mild illness or no illness at all, but in a few the infection results in a very severe disease6
 The pattern of severe disease is similar to the that observed during the pandemic: ;
o most patients affected are under 65 years-old;
o most, but not all have risk factors (chronic disease or pregnancy);
o as of 16 December, 17 deaths have been reported including one pregnant woman;
o of the 14 fatal cases for whom vaccination records were available, none had had the 2009 pandemic vaccine or the 2010 seasonal vaccine, which is compatible with the fact that the vaccine is up to 80% effective;
 virological analysis of isolates from this season's severely affected cases has not revealed any observable difference to the influenza A(H1N1) viruses since 2009; it is therefore likely that the higher impact on hospitals simply reflects the effect of influenza B viruses present in addition to the A(H1N1) viruses;
3 Merecekiene J on behalf of the VENICE Consortium. Overview of pandemic A(H1N1) 2009 influenza vaccination in Europe. Preliminary results of survey conducted by VENICE, 2010 ESCAIDE Conference; Lisbon; 13 November 2010. http://ecdc.europa.eu/en/ESCAIDE/ESCAID ... ckiene.pdf
4 Likely scenarios and uncertainties in the 2010/2011 influenza season in Europe and beyond. ECDC Forward Look Risk Assessment. October 2010. http://www.ecdc.europa.eu/en/healthtopi ... luenza.pdf
5 World Health Organisation Influenza Update No 123. Geneva: WHO; 17 December 2010. http://www.who.int/csr/disease/influenz ... index.html
6 Miller E, Hoschler K, Hardelid P, Stanford E, Andrews N, Zambon M. Incidence of 2009 pandemic influenza A H1N1 infection in England: a cross-sectional serological study. Lancet, ;375(9720):1100-8. doi:10.1016/S0140-6736(09)62126-7 http://www.thelancet.com/journals/lance ... 40-6736(09)62126-7/fulltext
EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL Start of the seasonal influenza epidemics 2010-11
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 It is important to monitor the virology carefully and relate them to the clinical details, because an unexplained oseltamivir resistance has been noted in a very few cases.
Actions adopted in the United Kingdom
Actions recently adopted in the United Kingdom include:
 Preparing intensive care and ECMO services to accommodate more pressure;
 Emphasising seasonal immunisation especially for risk groups, i.e. pregnant women and those with chronic medical conditions7
 Advocating use of antivirals for people with possible influenza who are ill enough to be hospitalised and for ill patients seen in primary care, those who belong to a risk group and also others that doctors consider would benefit
8.
Further resources
 News item in Eurosurveillance
 Update on the ECDC website
 Statement on HPA website
 ECDC Seasonal Influenza Spotlight
 ECDC Forward Look Risk Assessment - October 2010
 Seasonal levels of influenza vaccination 2008/9 – VENICE Report
 Interim report of VENICE – ECDC survey of pandemic 2009 vaccine coverage levels
Updated Data Sources
 Weekly influenza surveillance overview – next published Thursday 23 December, 30 December (if there are new data), Friday 6 January and every Friday to week 20, 2011
 ECDC RSS Feed for the WISO, available for subscription here or via the listing of all ECDC RSS Feeds.
 Influenza section of the Health Protection Agency web-site
 World Health Organization (WHO) web-site seasonal influenza

EuroFlu – WHO Regional Office for Europe
Concerning clinical care and in addition to standing national guidelines
Below you will find a list of links to the WHO or United Kingdom resources. Please note, however, that these links are external to ECDC.

WHO: Clinical Care guidance Series for influenza
 UK: A summary of guidance for infection control in healthcare settings
UK Royal College of Anaesthetists
 . (please search for influenza)
 UK: Royal College of Obstetricians and Gynaecologists
 UK: Department of Health: clinical management guidelines including for pregnant women (updated December 2010)
 UK: Royal College of Paediatrics and Child Health UK: Intensive Care Society: for the update for December 2010, please click here.
7 Flu vaccination for pregnant women. UK Department of Health; 16 December 2010. http://www.dh.gov.uk/en/Publicationsand ... /DH_122856
8 Treatment guidelines for patients with influenza 2010/2011. UK Department of Health; 14 December 2010. http://www.dh.gov.uk/en/Publicationsand ... /DH_122682