| Week 45 : 02/11/2009-08/11/2009 | 13 November 2009, Issue N° 331 |
Further increase in detections of pandemic (H1N1) 2009 in the WHO European Region. Seven countries report very high influenza activity Key points: week 45/2009
There have been 174 deaths due to acute respiratory infection (ARI) reported from Ukraine and 344 people are currently in intensive care units, 45 of whom are on mechanical ventilation. Rates of ARI are at a higher level than any reported for six years and in some regions for 13 years. Current situation: week 45/2009 Seventeen countries have reported increases in influenza-like illness (ILI) and/or ARI consultations (defined as countries with increases in the previous three weeks). These increases are particularly notable in the group aged 5–14 years. In eight of these countries (Germany, the Netherlands, Norway, Republic of Moldova, Romania, Slovakia, Spain and Sweden), the positivity rate of sentinel swab specimens exceeded 20% (minimum number of tested sentinel specimens: 20). The intensity of clinical activity was described as very high in Norway, Sweden, Bulgaria and the Republic of Moldova for the first time. Other countries reporting continued very high intensity this week were Iceland, Ireland and the Russian Federation (Urals region and far eastern region). Eight countries/regions described high clinical activity: Belarus, Finland, Kazakhstan, Poland, Russian Federation (central, north-western, Siberian and Volga region), Turkey, Ukraine and Northern Ireland. The clinical incidence of ILI and/or ARI was reported as widespread in 19 countries. The Republic of Moldova reported very high intensity, widespread clinical incidence and severe impact of influenza on health services. Impact was reported as moderate in nine countries, including Ukraine, and low in 17 others. For an overview of the season so far, click here. Increased clinical illness was reported in Bulgaria and the Republic of Moldova. In Bulgaria, incidence rates were above the epidemic threshold in 10 out of 28 regions. The incidence was highest in children. Current rates are similar to those reported in the 2006-2007 influenza season. For the Republic of Moldova, 555 specimens out of 1141 tested were positive for pandemic (H1N1) 2009 (including five fatal cases). While clinical influenza activity has increased over the past weeks in 17 countries, it has passed its peak in Belgium, Iceland, and Ireland, and has levelled off or passed its peak in the United Kingdom. Low or medium levels of influenza activity are reported in southern Russian Federation, Azerbaijan, Georgia, the Baltic states, the Czech Republic and Slovakia and in most of these countries incidence is increasing. In the period 5–12 November, 18 countries reported 145 new deaths associated with laboratory-confirmed pandemic (H1N1) 2009, raising the total since April 2009 from 326 to 471. The deaths were in Bulgaria (9), Croatia (2), Finland (5), France (4), Germany (3), Greece (2), Hungary (1), Ireland (2), Israel (8), Italy (34), the Netherlands (13), Norway (3), the Republic of Moldova (3), Serbia (6), Slovenia (1), Sweden (1), Turkey (31) and the United Kingdom (17). Virological update: week 45/2009 Of the 27 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 3.5% (Georgia) to 68.3% (Bosnia and Herzegovina). Ten of these countries reported rates greater than 50%. Sentinel physicians in the Region collected 4129 respiratory specimens in week 45/2009, of which 1853 (45%) were positive for influenza virus. Of the 1853 influenza-virus detections, 1845 were type A (1781 pandemic A(H1) and 64 not subtyped) and 8 were type B. In addition, 11 311 non-sentinel-source specimens were reported positive for influenza virus in week 45/2009: 11 292 type A (9682 pandemic A(H1), 25 A(H3), 14 seasonal A(H1), 1571 not subtyped) and 19 type B. Of the total 36 087 specimens that have tested positive for influenza virus since week 40/2009, 30 308 (84%) were pandemic influenza A(H1) and these accounted for 99% of all influenza A viruses that were subtyped. In addition, 213 were seasonal influenza A(H1); 113 were influenza A(H3); 5366 were influenza A not subtyped; and 87 were influenza B. The number of influenza detections has risen sharply each week from about 1600 in week 40/2009 to over 13 000 in week 45/2009. Comment A total of 14 countries have reported high or very high intensity of influenza activity. A generally increasing trend in clinical data is confirmed by an increase in virological influenza detections. Notably, countries in Scandinavia, and eastern and south-eastern Europe are affected by the pandemic. Influenza detections far exceed historical peaks and indicate a surge of work in the laboratories in several countries. The pandemic (H1N1) 2009 virus is dominant and continues to account for high levels of influenza activity for the time of year. Reports are widespread of pressure on intensive care facilities. As of week 45/2009, 16 countries have started pandemic influenza vaccination campaigns. Reports of adverse events are fewer than reported for seasonal influenza vaccination and most events are mild local or systemic reactions. Eight countries in the Region are eligible to receive vaccine donated to WHO and this will begin by late November or early December 2009. Further information 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. Erratum: The percentage positive for Denmark in the table below is incorrect. A total of 38 sentinel specimens were collected of which 22 (58%) were positive for pandemic (H1N1) 2009. |
