Ukraine hit by pandemic, as influenza activity continues to rise in most countries in the WHO European Region
Key points: week 44/2009
- This report is based on material received from 40 of the 53 Member States in the WHO European Region and includes an overview of the situation in Ukraine.
- On average, 45% of specimens collected from sentinel sources in the Region were positive for influenza virus.
- The incidence of clinical respiratory illness has increased in 17 countries over the past three weeks, and for seven of these the proportion of sentinel specimens testing positive for influenza this week was 20% or greater.
- Pandemic (H1N1) 2009 was dominant in 28 countries and accounted for 99% of influenza A virus subtype detections.
- From 27 October to 4 November, 11 countries reported a total of 47 deaths involving laboratory-confirmed cases of pandemic (H1N1) 2009 virus infection. Nevertheless, the majority of pandemic cases have resolved without complications.
On Monday, 2 November, a team of nine experts – from WHO, the European Centre for Disease Prevention and Control (ECDC), and the United Nations Children’s Fund (UNICEF) – arrived in Ukraine to investigate high levels of acute respiratory illness (ARI). The team was dispatched at the request of the Ministry of Health of Ukraine. The experts were briefed in Kyiv before heading to the western city of Lviv and other affected areas.
Preliminary reports indicate that the rapidly evolving situation in the country is mainly related to pandemic (H1N1) 2009 influenza. The results received from the examination of samples submitted earlier by national laboratories in Kyiv to the WHO collaborating centre for reference and research on influenza in London, United Kingdom, continue to confirm cases of pandemic (H1N1) 2009 virus infection. At this stage, however, other causes for clusters of respiratory illnesses cannot be ruled out.
On 4 November, the Minister of Health of Ukraine reported 70 deaths, 235 patients in a critical condition and more than 250 000 cases of influenza-like illness (ILI). Lviv is one of the most affected regions, with more than 100 000 people reportedly sick with ILI. WHO/Europe regularly issues updated information on the situation in Ukraine on its web site.
Current situation: week 44/2009
17 countries have reported increases in ILI and/or ARI consultations (defined as countries with increases in the previous three weeks). These increases have been particularly notable in the group aged 5–14 years. In 7 of these countries (Belgium, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom (Northern Ireland)), the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens: 20). In Norway, ILI consultation rates are above the maximum rates recorded in four previous seasons. To lessen the burden on physicians and improve the accessibility of antiviral drugs (oseltamivir and zanamivir), the Norwegian Government has made them available as over-the-counter medications (see press release in Norwegian).
The intensity of clinical activity was described as very high in Iceland and Ireland for the second week in a row, and in the Russian Federation (Urals region) for the first time. Eight countries described high clinical activity: Belarus, Bulgaria, the Netherlands, Norway, Italy, Russian Federation (far eastern, Siberian, north-western and central regions), Sweden and the United Kingdom (Northern Ireland). The clinical incidence of ILI and/or ARI was reported as widespread in 11 countries: Belgium, Iceland, Ireland, Israel, Italy, the Netherlands, Norway, the Russian Federation, Spain, Sweden and most of the United Kingdom (England, Wales, Northern Ireland). Ukraine reported medium intensity, regional clinical incidence and severe impact of influenza on health services. Impact was reported moderate in 7 countries and low in 16 others. For an overview, see the Seasons tables section on EuroFlu.
While clinical influenza activity has increased over the past weeks in 17 countries, it may have passed its peak in Ireland, Iceland and the United Kingdom (Northern Ireland). Countries with recent increases in influenza activity include Bulgaria, Norway and the Russian Federation, indicating the further circulating of influenza across the European Region. In week 44/2009, levels of clinical influenza activity above the baseline were observed in Portugal, Serbia and Ukraine, and the level in Ukraine was significantly higher than those in the same week in six previous seasons.
In the period 27 October – 4 November, 11 countries reported 47 new deaths associated with laboratory-confirmed pandemic (H1N1) 2009 influenza: Belgium (2), Bulgaria (1), Croatia (1), Germany (3), Ireland (8), Norway (4), Portugal (2), the Republic of Moldova (1), Turkey (8), Ukraine (1) and the United Kingdom (16). This raises the total number of deaths reported since April 2009 from 281 to 328. Croatia and Ukraine reported their first laboratory-confirmed deaths during this week.
Virological update: week 44/2009
Of the 19 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 0% (Azerbaijan, Georgia) to 85% (United Kingdom (Northern Ireland)). Sentinel physicians in the Region collected 2730 respiratory specimens in week 44/2009, of which 1219 (45%) were positive for influenza virus. This is a much higher proportion than is typical for week 44 (less than 4% during 2004–2008). Of the 1219 influenza virus detections, 1218 were type A (1156 pandemic A(H1), 1 A(H3) and 61 not subtyped) and 1 was type B.
In addition, 7333 non-sentinel-source specimens were reported positive for influenza virus in week 44/2009: 7328 type A (5572 pandemic A(H1), 36 A(H3), 31 seasonal A(H1), 1689 not subtyped) and 5 type B. The seasonal influenza A subtype detections were reported by Kazakhstan and the Russian Federation.
Since week 40/2009, 21 851 specimens have tested positive for influenza virus. Of these, 17 644 (81%) were pandemic influenza A(H1), which accounts for 98% of all influenza A viruses that were subtyped. In addition, 335 were seasonal influenza A/H1; 87 were influenza A(H3); 3726 were influenza A not subtyped; and 59 were influenza B. Since week 40/2009, the number of influenza detections has risen sharply, from about 1600 to more than 8500 in week 44/2009. Three countries (Norway, the Russian Federation and Spain) accounted for more than 4000 of these detections. This number far exceeds the peak of detections during the summer of 2009 (about 3000 in week 30/2009) and is the highest recorded number of positive specimens in the Region in any week since 1996 (see graphs for Europe).
Qualitative reporting, clinical trend data and virological data are all consistent with an increasing intensity and geographic spread of influenza infections in the European Region. For the first time, countries in the Region reported very high intensity of clinical influenza activity. Influenza detections far exceed historical peaks and indicate a surge on the laboratories in several countries. The pandemic (H1N1) 2009 virus is dominant in most countries and continues to account for high levels of influenza activity for the time of year. Since the start of the pandemic, Ukraine is the first country to report a severe impact, mainly reflecting the strain on hospital and intensive care services. This situation highlights the need for countries to be prepared to cope with a surge of patients with severe respiratory disease, to identify best-practice scenarios for treatment and to implement vaccination programmes.
The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe and WHO headquarters web sites.