Thursday, February 10, 2011

Flu Season is not over yet, but February marks the peak

As of mid February 2011, influenza activity in the United States remains elevated, but it appears to have peaked in the majority of European, North African and Middle Eastern countries.

  • There were more outpatient visits for influenza-like illness (ILI): 4.5% vs the national baseline of 2.5%, it was above region-specific baseline levels in all US regions. 
    • Twenty states (Alabama, Arkansas, Colorado, Georgia, Idaho, Indiana, Louisiana, Maryland, Missouri, New Jersey, New Mexico, New York, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia, and West Virginia) experienced high ILI activity.
    • Nine states (California, Florida, Hawaii, Illinois, Kansas, Kentucky, Mississippi, Pennsylvania, and Wyoming) experienced moderate ILI activity.
    • New York City and five states (Arizona, Massachusetts, Nebraska, Nevada, and Wisconsin) experienced low ILI activity.
    • Minimal ILI activity was experienced by the District of Columbia and 16 states (Alaska, Connecticut, Delaware, Iowa, Maine, Michigan, Minnesota, Montana, New Hampshire, North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Vermont, and Washington).
  • The geographic spread of influenza in 37 states was reported as widespread; 10 states reported regional influenza activity; the District of Columbia reported local activity; Puerto Rico, the U.S. Virgin Islands, and three states reported sporadic influenza activity, and Guam reported no influenza activity.  

Global flu activity (see CDC page for current information), was most prominent in the tropical regions of Asia. From February, cases of respiratory disease were high in Singapore and Hong Kong, and 90% of influenza-positive samples were 2009 H1N1. Influenza activity continued to rise in southern China, where 46% of ILI specimens in Week 5 tested positive for influenza, a 3% increase from Week 4. 2009 H1N1 was the predominant subtype.

According to WHO, Madagascar reported an increase in influenza activity, with the co-circulation of influenza B and A (H3N2). There was little influenza activity reported in the tropical regions of the Americas or in sub-Saharan Africa. 

Influenza activity in the majority of North African and Middle Eastern countries appears to have peaked, except for Algeria, where flu activity increased. The percentage of influenza-positive respiratory specimens was also high in Pakistan, Iran and Oman, where 2009 H1N1 and type B viruses co-circulated in relatively equal numbers.
According to the Public Health Agency of Canada, influenza activity increased slightly in Week 5, but remained below the peak reported earlier this season. The percentage of influenza-positive respiratory samples increased from 17% in Week 4 to 19% in Week 5. Since the beginning of the influenza season, 88% of subtyped influenza A specimens have been influenza A (H3N2).
According to the China National Influenza Center, influenza activity rose in recent weeks in northern China. In Week 5, 21% of influenza-like illness (ILI) specimens were influenza-positive, and 2009 H1N1 viruses were predominant. WHO reported that Mongolia saw an increase in 2009 H1N1 virus detections, while Japan saw a sharp increase in ILI activity.
Activity in the Southern Hemisphere remained low.

In Europe, 2 countries (Georgia and Luxembourg) and the Siberian region of the Russian Federation reported very high intensity of influenza activity; 8 countries reported high intensity; 27 reported medium intensity and 4 countries, low intensity. 23 countries reported widespread activity. Of the 25 countries reporting on the impact of influenza on health care systems, 1 (Georgia) reported severe impact; 14 countries reported moderate impact and 10, low impact.

Of the 41 countries reporting on consultation rates for ILI and ARI, 8 (Albania, Belarus, the Czech Republic, Iceland, Kazakhstan, the Republic of Moldova, Serbia and Slovakia) reported increases while 6 (Ireland, Israel, Malta, Norway, Spain and the United Kingdom (England)) reported decreases. Influenza activity has apparently passed its peak in 24 countries in this region. In general, the highest consultation rates were reported for children aged 0–4 and 5–14 years.

WHO/Europe received sentinel surveillance data on hospitalized SARI cases from 9 countries (Armenia, Georgia, Kazakhstan, Kyrgyzstan, Romania, the Republic of Moldova, the Russian Federation, Serbia and Ukraine). Sentinel SARI hospitalizations are at the highest levels observed for the season so far in Georgia and Serbia. In Georgia, however, outpatient clinical consultation rates declined from week 5 to week 6, while the relative percentage of both SARI and ILI specimens testing positive for influenza B increased. Sentinel SARI hospitalizations in Kazakhstan, Kyrgyzstan, Romania and the Russian Federation have declined somewhat from observed peaks in weeks 3–5, but remain notably elevated above pre-season levels, with 30–50% of sentinel SARI specimens testing positive for influenza in each of these countries. Sentinel SARI admissions in the Republic of Moldova and Ukraine are at levels below prior peaks. Nevertheless, a significant percentage of sentinel SARI specimens continue to test positive for influenza, and the proportion of influenza A detections in sentinel SARI specimens in Ukraine increased in week 6. Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in the “Overview of sentinel SARI systems in EuroFlu”.

Table and graphs (Europe)

ILI per
ARI per
Virology graph
and pie chart
AlbaniaHighLocalModerate7816.7%Type A, Subtype pH1 and H3503.6(graphs)Click here

Click here
AustriaMediumNoneLow7068.6%Type A, Subtype pH1N10.0(graphs)33.2(graphs)Click here
AzerbaijanLowSporadicLow170%None292.7(graphs)Click here
BelarusMediumLocalModerate3330.3%Type A, Subtype pH11938.6(graphs)Click here
BelgiumMediumWidespread5362.3%Type B and Type A, Subtype pH1391.1(graphs)1695.1(graphs)Click here
Bosnia and HerzegovinaType A, Subtype pH1(graphs)Click here
BulgariaMediumRegional1428.6%Type A, Subtype pH10.0(graphs)1439.3(graphs)Click here
CroatiaHighWidespreadLowType A, Subtype pH1186.6(graphs)Click here
Czech RepublicMediumWidespread2975.9%Type B and Type A, Subtype pH1N1296.7(graphs)1583.2(graphs)Click here
DenmarkMediumWidespread5125.5%None(graphs)0.0(graphs)Click here
EnglandLowSporadic13711.7%Type A and B18.4(graphs)424.7(graphs)Click here
EstoniaMediumWidespread5534.6%Type A, Subtype pH1N123.1(graphs)502.3(graphs)Click here
FinlandWidespread6271.0%Type B and Type A, Subtype pH10.0(graphs)0.0(graphs)Click here
FranceMediumWidespreadLow23241.4%Type B and Type A, Subtype pH1N10.0(graphs)2824.4(graphs)Click here
GeorgiaVery HighWidespreadSevere5791.2%Type B and Type A, Subtype pH11627.6(graphs)

Click here
GermanyMediumRegional30561.0%Type A, Subtype pH1N10.0(graphs)1342.3(graphs)Click here
GreeceHighWidespread1872.2%Type A, Subtype pH1N1361.0(graphs)0.0(graphs)Click here
HungaryHighWidespreadModerate1629.3%Type A, Subtype pH1587.9(graphs)0.0(graphs)Click here
IcelandMediumRegionalModerate00%57.6(graphs)0.0(graphs)Click here
IrelandMediumWidespreadLow5339.6%Type B50.3(graphs)0.0(graphs)Click here
IsraelMediumWidespreadModerate5853.5%Type A and B52.8(graphs)Click here
ItalyHighWidespreadModerate23036.5%Type A, Subtype pH1N1965.4(graphs)0.0(graphs)Click here

Click here
KyrgyzstanLowNoneLow1435.7%Type A and B9.3(graphs)82.4(graphs)

Click here
LatviaMediumWidespread2147.6%Type B and Type A, Subtype pH1(graphs)Click here
Lithuania1457.1%Type B and Type A, Subtype pH1(graphs)Click here
LuxembourgVery HighWidespread10862.0%Type B and Type A, Subtype pH110.2 *(graphs)27.9 *(graphs)Click here
The former Yugoslav Republic of MacedoniaNone(graphs)Click here
MaltaLowLocalLow00%3.6 *(graphs)0 *(graphs)Click here
NetherlandsMediumWidespread3129.0%Type B70.9(graphs)0.0(graphs)Click here
Northern IrelandLowLocalType B35.6(graphs)372.6(graphs)Click here
NorwayMediumWidespread2560.0%Type B145.8(graphs)0.0(graphs)Click here
PolandMediumRegional11429.8%Type A, Subtype pH1180.8(graphs)0.0(graphs)Click here
PortugalMediumWidespread850.0%Type A, Subtype pH150.0(graphs)0.0(graphs)Click here
Republic of MoldovaMediumLocalModerate6966.7%Type B and Type A, Subtype pH1N137.8(graphs)394.3(graphs)

Click here
RomaniaMediumWidespreadModerate5545.5%Type B and Type A, Subtype pH1N193.8(graphs)2855.0(graphs)

Click here
Russian FederationHighWidespreadModerate6645.5%Type A, Subtype pH157.0(graphs)1295.9(graphs)

Click here
ScotlandMediumLocalLow4841.7%Type B8.9(graphs)262.1(graphs)Click here
SerbiaHighRegionalModerate2365.2%Type A, Subtype pH1N1218.2(graphs)

Click here
SlovakiaMediumRegionalModerate572.5(graphs)2820.6(graphs)Click here
SloveniaMediumWidespread3982.1%Type B and Type A, Subtype pH169.6(graphs)1711.9(graphs)Click here
SpainMediumRegional34036.5%Type B152.4(graphs)0.0(graphs)Click here
SwedenHighWidespreadLow5572.7%Type B12.6(graphs)0.0(graphs)Click here
SwitzerlandMediumWidespread312.0(graphs)Click here
TurkeyMediumLocalModerate30450.0%None(graphs)Click here
UkraineMediumLocalLow1428.6%Type B and Type A, Subtype pH14.6 *(graphs)641.4(graphs)

Click here
WalesLowSporadicLow8.3(graphs)0.0(graphs)Click here
Europe310944.2%Click here
Preliminary data

Intensity: Low = no influenza activity or influenza activity at baseline level; Medium= usual levels of influenza activity; High = higher than usual levels of influenza activity; Very high = particularly severe levels of influenza activity.
Percentage positive: percentage of sentinel swabs that tested positive for influenza A or B
Dominant type: this assessment is based on data from sentinel and non-sentinel sources
ARI: acute respiratory infection
ILI: influenza-like illness
Population: per 100,000 population
*: the value in the table for these countries reflects the percent (e.g. from 0.0 to 100.0) of total outpatient encounters that were due to ILI/ARI rather than a consultation rate per 100,000


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