Influenza Update N 162

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1 Update N June 2012 Summary The season is largely finished in the temperate countries of the northern hemisphere with some persistent low level transmission in eastern Europe and northern China. Most northern hemisphere temperate countries have now stopped weekly data reporting. Some tropical countries are experiencing an increase or stable transmission of viruses including countries in Central America, the Caribbean, South America and, in Sub-Saharan Africa. The season has not yet started in the temperate countries of the southern hemisphere, although several countries including Australia, Chile, Paraguay and South Africa have reported small but sustained increase of virus detections. A(H3N2) viruses are the most commonly detected type/sub-type in recent weeks in the Southern Hemisphere temperate region. A detailed review of the recent season in the temperate countries of the northern hemisphere is available online at: Note: Global epidemiology and surveillance updates are periodically collected from data reported by National authorities or organizations responsible for these reporting these data. For further information on specific virus activity in the world and scientific literature for practitioners and other professionals in the field, please visit the following pages (links are at the end of the document): Virological Update Peer-reviewed Literature: A population-based study of neurologic manifestations of severe A(H1N1)pdm09 in California. update 22 June

2 Countries in the emperate zone of the northern hemisphere transmission in all reporting countries in the emperate regions of the northern hemisphere has continued to decrease and is now nearly at inter-seasonal levels. North America activity continued to decline both in Canada and the United States of America ( USA). In Canada, -like illness ( ILI) consultation rate declined from 11 at the end of May to 7 ILI consultations per 1,000 patient visits during the first week of June. In the USA, only 0.9% of all out- of patient visits were due to ILI activity, well below the seasonal threshold, and the percentage pneumonia and deaths has consistently declined. In both countries, the percentage of specimens testing positive for virus has declined to low levels. Europe activity across Europe has also returned to very low or undetectable levels in most countries in the region with exception of a few countries in eastern Europe which continued to report sporadic activity with decreasing or stable trends. Northern Africa and eastern Mediterranean Most countries of northern Africa and the eastern Mediterranean regions reported no activity. Only Oman and Qatar reported very low numbers of both A and B viruses. Temperate countries of Asia No notable activity is being reported from Japan, Mongolia or the Republic of Korea. However, low level transmission of is still being observed in northern China. Of all outpatient visits 2.7% were due to ILI in northern China, which is slightly higher than the percentages observed during the past four weeks. Since the beginning of April 2012, there has been a transition of dominating virus from B to A(H3N2) virusess in northern China and the small numbers of viruses now being detected theree are primarily the latter subtype. Number of specimens positive for by subtype in the northern hemisphere Data source: FluNet ( Global Surveillance and Data generated on 21/06/ :27:10 UTC update 22 June

3 Countries in the tropical zone Tropical countries of the Americas A few countries in Central America, the Caribbean, and tropical South America have reported recent increases in the transmission of viruses. In Central America, the number of respiratory specimens testing positive for viruses has increased notably during the past few weeks in El Salvador, where more than 40% of all samples tested were positive for A(H1N1)pdm09. A(H1N1)pdm09 has also recently been circulating in Honduras, Panama, and Guatemala, though numbers of viruses detected are now quite low. In the Caribbean, circulation of A(H3N2) has continued in Dominican Republic and detections of B increased in Cuba in comparison with previous weeks. In the tropical zone of South America, co-circulation of A(H1N1)pdm09 and B viruses has been reported in two countries, Bolivia and Peru. Sub-Saharan Africa In Sub-Saharan Africa, limited available data indicate very low level or no activity in most countries. In eastern Africa, the most active area of the continent, notable transmission of A(H3N2) viruses was reported in Madagascar and (H1N1)pdm09 in Rwanda. Transmission in Kenya has subsidedd during the past few weeks to very low levels. In western Africa, Ghanaa has reported recent transmission of A(H3N2). Tropical Asia Most countries of tropical Asia continue to report activity at a low level. In south China the percentage of visits with ILI to national sentinel sites continues to decrease in comparison to the last three weeks, thoughh it remains elevated (3%) in comparison to the same period of the previous two years. A(H3N2) remained the most commonly detected virus, accounting for 74% of all subtyped A viruses. China, Hong Kong Special Administrative Region reported activity at a continued high level, somewhat unusual for this period of the year. From 13 January to 13 June 2012, there were 268 cases of associated ICU admissions, in which 65% (n=173) were fatal. During the period 6 June to 13 June 2012, 12 out of the 14 cases of associated ICU admissions were fatal. Fatal cases have predominantly occurred in individuals over the age of 65 years and the majority were due to A(H3N2). Patient visits due to ILI in in-patient services, out-patient services and emergency departments have decreased in comparison to the previous two weeks; yet the level remains increased in comparison to the same period from the previous two years. Rates of hospital admission with principal diagnosis of and weekly number of deaths with any diagnosis of in public hospitalss have also decreased when compared to previous weeks. Number of specimens positive for by subtype in South East Asia Data source: FluNet ( Global Surveillance and Data generated on 21/06/ :27:10 UTC update 22 June

4 Countries in the emperate zone of the southern hemisphere In the emperate regions of the southern hemisphere the overall ILI activity and virus detections remained low, however some slight increases in activity are beginning to be reported in the southern cone of South America. Temperate countries of South America Chile and Paraguay reported persistently ncreasing detections of in the past few weeks, though numbers are still low. In Chile, of specimens collected in Week 23 (n= 1284), was positive in 4.6% of cases. A(H3N2) was the most commonly detected virus of thesee positive cases (75%). In Paraguay, ILI consultationss has increased in the last 3 weeks and among samples analyzed (n=93), about 15% were positive for A(H1N1)pdm09, continuing the increase from previous weeks. activity in Argentina is still essentially undetectable. Number of specimens positive for by subtype in the temperate South America transmissionn zone Temperate countries of Southern Africa In South Africa, an increasing trend of ILI and SARI cases has been reported. The detection rate of viruses rose to 21% in week 21, and remained above 10% in week 22. A(H3N2) and B have been the most common viruses detected in recent weeks. Oceania, Melanesiaa and Polynesia In Australia from the period 3 June to 9 June 2012, of the 360 ILI samples tested, 14% (n=49) were positive for. This represents an increase in comparison to the previous period (6.8%). Of those positive results, 59% weree subtype A(H3N2). In New Zealand, ILI activity remained low. update 22 June

5 Number of specimens positive for by subtype in Oceania, Melanesia and Polynesia Data source: FluNet ( Global Surveillance and Data generated on 21/06/ :56:22 UTC Source of data The Global Programme monitors activity worldwide and publishes an update every two weeks. The updates are based on available epidemiological and virological data sources, including FluNet (reported by the Global Surveillance and Response System) and reports from WHO Regional Offices and Member States. Completeness can vary among updates due to availability and quality of data available at the time when the update is developed. Link to web pages Epidemiological updates: surveillancee Epidemiological updates archives 2012: Virological surveillancee updates : Virological surveillancee updates archives : Contactt fluupdate@who.int update 22 June

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