Western Pacific Regional Office of the World Health Organization

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Western Pacific Regional Office of the World Health Organization WPRO Influenza Situation Update, 30 July 2013 http://www.wpro.who.int/emerging_diseases/influenza/en/index.

In northern China, during the week 8 to 14 July 2013, the percentage of visit for ILI (ILI%) at national sentinel hospitals established in 2009 in north China was 1.

1 Western Pacific Regional Office of the World Health Organization WPRO Influenza Situation Update, 30 July SUMMARY Northern Hemisphere In the Northern Hemisphere countries, there has been declining or low-level influenza-like illness (ILI) activity. In northern China, during the week 8 to 14 July 2013, the percentage of visit for ILI (ILI%) at national sentinel hospitals established in 2009 in north China was 1.9%, which was slightly lower to that of the previous week (2.1%) and to the level seen during the same week of 2012 (2.3%). There were no samples positive for influenza viruses out of 828 ILI specimens. In Mongolia, during the week 15 to 21 July 2013, ILI activity based on the proportion of outpatients that were ILI showed an increasing trend. There were no influenza viruses detected from 22 ILI samples submitted for the week ending 7 July During the week 15 to 21 July 2013, ILI activity remained low and continued to decrease in Japan; the number of ILI cases per sentinel reporting site was 0.05 relative to 0.07 the previous week. There were no influenza viruses detected for the week ending 7 July. In the Republic of Korea, for the week ending 20 July 2013, ILI activity continued to remain low, and the number of ILI cases was 1.9 per 1000 patients, similar as the previous week (2.0 per 1000 patients). There were no influenza viruses detected from 198 ILI samples submitted. Subtropics/Tropics In the subtropics/tropics, overall ILI activity was stable and low, with circulation of A (H1N1)pdm09, influenza A(H3), and influenza B. In Southern China, during the week 8 to 14 July 2013, the ILI% at national sentinel hospitals established in 2009 in south China was 2.9%, which was lower to that of the previous week (3.0%) and that of the same week of 2012 (3.1%). 90 of 3193 (2.8%) ILI specimens were positive for influenza: 82 were influenza A (51 H1N1pdm09, 31 H3N2) and 8 were influenza B (lineage not determined). In Hong Kong (China), during 14 to 20 July 2013, local influenza activity slightly increased compared with the past few weeks. Of the 118 samples positive for influenza during this week: 82 influenza A (H3), 31 influenza A(H1N1)2009 and 5 influenza B. In the Mekong, low level influenza activity was reported, although levels in Cambodia and Lao PDR are showing some signs of increase. In Cambodia, during week 7 to 13 July 2013, there were 10 samples positive for influenza out of 40 samples received: 8 were influenza A(H1N1)pdm09 and2 influenza A(H3). In Lao PDR, during 7 to 13 July 2013, from 50 ILI samples submitted, 3

2 samples were positive for influenza: 2 were influenza A (H1N1)pdm09 and 1 influenza B (lineage not determined). In Viet Nam, during 7 to 13 July 2013, 31 samples were received and 4 were positive for influenza: 1 influenza A(H3) and 3 influenza B (lineage not determined). In Singapore, acute respiratory infection (ARI*) activity increased during 14 to 20 July 2013, with 2543 patients seeking treatment compared to 2371 in the previous week, although remaining below the warning level. The proportion of cases with ILI among the polyclinic ARI cases remained low at 1%. Of 84 ILI samples collected in the past 4 weeks, 21.4% were positive for influenza virus. Of all the influenza virus isolates in June 2013, 79.0% were influenza A(H3N2), 3.2% influenza A(H1N1-2009), and 17.7% influenza B. Southern Hemisphere In the Southern Hemisphere ILI activity remained low, with low level circulation of influenza A (H3), influenza B and A(H1N1)pdm09. During the week ending 7 July 2013 in Australia, the sentinel general practitioner ILI consultation rate remained stable at 6.1 cases per 1,000 consultations. Compared with previous years, the ILI consultation rate is slightly lower than the usual rate for this time of year. While influenza A remains the predominant influenza virus type (60%), the proportion of influenza B notifications has continued to increase. In the last 2 weeks ending 7 July 2013, among ILI patient specimens, 9.9% were positive for influenza, up from 3.6% the previous 2 weeks. The majority of these specimens were positive for influenza type A (8.1%) with the remaining specimens positive for influenza B (1.8%). Over a third of the specimens collected were positive for other respiratory viruses. In New Zealand, during 15 to 21 July 2013, influenza activity continued to remain below the baseline threshold. 73 out of 260 samples received were positive for influenza: 35 were influenza B (lineage not determined), 14 influenza A(not subtyped), 15 were influenza A(H3N2) and 9 were influenza A(H1N1)pdm09. Pacific Islands In the Pacific Islands, ILI activity was mostly low and stable. During the week ending 14 July 2013, Federated States of Micronesia, Kirabati and Niue reported weekly ILI case numbers above the threshold of 90% of their historical values. *ARI defined as clinical diagnosis of acute upper respiratory tract infection (ICD : Acute Nasopharyngitis (common cold); 461 Acute Sinusitis; 462 Acute Pharyngitis; 463 Acute Tonsillitis; 464 Acute Laryngitis and Tracheitis; 465 Acute Upper Respiratory Infections of Multiple or Unspecified Sites; 466 Acute Bronchitis and Bronchiolitis). ILI defined as temperature >38C with cough or sore throat.

3 Human infection with avian influenza A(H7N9) virus As of 30 July 2013, a total of 134 cases have been reported (133 from China's National Health and Family Planning Commission and 1 from Taipei Centers for Disease Control). Of these patients, 43 have died. The latest laboratory confirmed case of human infection with H7N9 avian influenza was reported from Hebei province, China. There were no new reported cases since the last reported case on 20 July However, it is expected that there may be further sporadic cases of human infection with the virus. Affected provinces and municipalities continue to maintain surveillance and response activities. WHO does not advise special screening at points of entry with regard to this event, nor does it recommend any travel restrictions be applied. WHO continues to work closely with national authorities and technical partners to gain a better understanding of this disease in humans and will continue to provide updated information as the situation evolves. For more information, visit: ml For latest situation updates on avian influenza A(H5N1), visit ILI% week Percentage of Visits that were ILI in sentinel hospitals (established in 2009), Northern China up to 14 July in 2013 (Source: Chinese National Influenza Center)

4 ILI% week Percentage of Visits that were ILI in sentinel hospitals (established in 2009), ( ) Southern China up to 14 July in 2013 (Source: Chinese National Influenza Center) Outpatient visits Mongolia up to 21 July in 2013 (Source: National Influenza Center of Mongolia)

5 Influenza cases reported per sentinel weekly Japan up to 21 July in 2013 (Source: National Institute of Infectious Diseases) The weekly proportion of ILI visits per 1,000 patients Republic of Korea up to 20 July in 2013 (Source: Korean Center for Disease Control and Prevention)

6 ILI consultation rate at sentinel general outpatient clinics ILI consultation rate at sentinel private doctors Hong Kong (China) up to 20 July in 2013 (Source: Centre for Health Protection)

7 Singapore up to 20 July in 2013 (Source: Ministry of Health) Weekly rate of ILI reported from GP ILI surveillance systems, 1 January 2009 to 7 July 2013, by week* Australia, up to 7 July in 2013 (Source: Australian Department of Health and Ageing) * Delays in the reporting of data may cause data to change retrospectively. As data from the previous Northern Territory surveillance scheme were combined with ASPREN and VIDRL surveillance data in 2009, rates may not be directly comparable with trends (Source: ASPREN and VIDRL i GP surveillance system).

8 Weekly consultation rates for ILI New Zealand up to 21 July in 2013 (Source: New Zealand Ministry of Health and Institute of Environmental Science & Research Ltd.)

9 Note: Numbers of reported cases are not comparable between countries. The purpose of the charts is to show trends over time within each country/area. Pacific Islands up to 14 July 2013 (Source: Pacific Public Health Surveillance Network)

Western Pacific Regional Office of the World Health Organization.

Western Pacific Regional Office of the World Health Organization WPRO Influenza Situation Update, 19 November 2013 http://www.wpro.who.int/emerging_diseases/influenza/en/index.html SUMMARY Northern Hemisphere