8 Public Health Wales CDSC Weekly Influenza Surveillance Report Wednesday 21 August 2013 (covering week )

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1 8 Public Health Wales CDSC Weekly Influenza Surveillance Report Wednesday 21 August 213 (covering week ) Current level of activity: Low Trend: Stable compared to last week News: Update Middle East respiratory syndrome coronavirus (MERS-CoV) (pg 2). Update - human infection with a new avian influenza A(H7N9) virus detected in China (pg 2). Key points Wales The consultation rate for influenza in Wales during week 33 (week ending 18/8/213) reported through the GP Sentinel Surveillance of Infections Scheme is consultations per 1, practice population. The consultation rate has decreased slightly compared to the rate for the previous week (.6 per 1,) and remains below the threshold for normal seasonal activity (25 consultations per 1, per week). The total number of consultations with Out of Hours (OOH) doctors in Wales, reported to Public Health Wales during week 33 decreased to 9,882 (compared to 1,127 in week 32). The proportion of respiratory-related consultations with OOH doctors remained steady at 1.1% (compared to 1.% in week 32) (Figure 5). No samples were collected from patients with influenza symptoms by sentinel GPs during week 32 (Figure 3). During week 32 (latest available data), 49 specimens were received and tested by Public Health Wales Microbiology Cardiff and Swansea Laboratories, from nonsentinel GP and hospitalised patients with influenza like symptoms. One sample tested positive for influenza A(H3), one sample tested positive for RSV, five for rhinovirus, three for parainfluenza and one for adenovirus (Figure 4). Surveillance data from patients in the community and in hospital suggest that influenza is not currently circulating. Influenza B (Yamagata lineage) predominated in Wales during the 212/13 season. However, later in the season an increase in influenza A(H3) activity led to a number of influenza outbreaks, there were also sporadic detections of A(H1N1)pdm29 in the community. Key points Influenza vaccination rates in Wales 212/13 The 212/13 end of season influenza immunisation uptake in Wales report is available from Based on data from 99.8% of Welsh practices for the 212/13 influenza season: o 67.7% of patients aged 65 years and older were vaccinated against influenza (Health Board range 65.4% to 7.%, Figure 7). o 49.7% of patients aged six months to 64 years in at-risk groups* were vaccinated against influenza (Health Board range 45.2% to 52.1%, Figure 8). o 43.6% of pregnant women (without other clinical risks)* were vaccinated against influenza (Health Board range 32.% to 52.8%, Table 4). o Based on data provided by Health Board Occupational Health Departments, up to the end of March 213: 35.5% of NHS staff were vaccinated against influenza (HB range 29.8% to 37.6%). *collected through Audit+ using definitions contained in the Primis+ Seasonal Influenza Vaccine Uptake Reporting Specification for 212/13. The figure for pregnant women includes women that are pregnant or have been pregnant at any point during September 212 to January 213; it does not represent coverage in women who are currently pregnant

2 Key points UK and Europe Based on the latest data available: The RCGP influenza-like illness rate for England in week 32 decreased to 1.1 per 1, (compared to 1.4 per 1, in week 31). In Northern Ireland the combined influenza and influenza-like illness consultation rate for week 32 decreased to.5 per 1, (compared to 5. per 1, in week 31), and remains well below the baseline threshold for normal seasonal activity of 7 per 1, for NI. In Scotland the GP consultation rate for combined influenza like illness and acute respiratory illness for week 32 decreased to 1.6 per 1, (compared to 2.2 per 1, in week 31), and remains below the threshold for normal seasonal activity for Scotland. UK summary data are available each week from the Public Health England National Influenza Report. Euroflu, currently providing fortnightly updates, reports that during week 32, consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) remained at low levels in all countries in the WHO European Region. During week 32 none of the ten specimens collected from sentinel sources tested positive for influenza. For more information on European level influenza surveillance see: News update Middle East respiratory syndrome coronavirus (MERS-CoV) On 1/8/13, WHO reported an additional three laboratory confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV). Globally, from September 212 to date, WHO has been informed of a total of 94 laboratory confirmed cases of human infection with MERS-CoV, including 46 deaths. Based on the current situation and available information, WHO encourages all member states to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. Health care providers are advised to be vigilant among recent travellers returning from the Middle East who develop severe SARI. Updates are available from the WHO Global Alert and Response website: WHO have also issued advice on MERS-CoV for pilgrimages: News update - detection of human infection with avian influenza A(H7N9), China Human infection with a novel avian influenza A(H7N9) virus has been detected in China. As at 11/8/13, a total of 135 cases have been laboratory confirmed with influenza A(H7N9) virus, including 44 deaths. The authorities in the affected locations continue maintain surveillance, epidemiological investigations, close contact tracing, clinical management, laboratory testing and sharing of samples as well as prevention and control measures. So far, there is no evidence of ongoing human-to-human transmission. The risk of international spread of avian influenza A(H7N9) is considered to be low at present, however, it is important that clinicians are aware of the possibility of human infection with animal influenza in persons presenting with severe acute respiratory disease who have been to China recently. The World Health Organisation is following this event closely with the Chinese authorities and updates are available from the WHO Global Alert and Response website:

3 World update The WHO report that as of 16/8/13 influenza activity in the northern hemisphere temperate zones is at inter-seasonal levels. The USA have reported 16 cases of human infection with influenza A(H3N2)v since June this year. In most regions of tropical Asia, influenza activity decreased. In Central America and the Caribbean regions, influenza activity decreased. In tropical South America, influenza A(H1N1)pdm29 remained the most detected respiratory virus. Influenza activity has peaked in southern South America and South Africa; and was mainly due to influenza A(H1N1)pdm29 In Australia and New Zealand influenza activity has been lower than in previous years, but has not yet peaked. In both of these countries influenza A(H3N2) and influenza B have been more commonly detected than influenza A(H1N1)pdm29. Source: WHO influenza update: In New Zealand, the consultation rate for ILI in week 32 was 2.2 consultations per 1, (compared to 27.5 per 1, in week 31), which is below the baseline rate of 5 consultations per 1,. A total of 287 swabs were received from sentinel and non-sentinel surveillance, of these 15 tested positive for influenza (53 influenza B, 33 influenza A(H3N2), eight influenza A(H1N1)pdm9 and 11 influenza A (not sub-typed)). Source: Institute of Environmental Science & Research, New Zealand According to the latest available update (covering 2/7/213 2/8/213),in Australia influenza activity has remained relatively low. Dominant virus type ranges across the country: in Victoria influenza B predominates, whereas in New South Wales influenza A(H1N1)pdm9 predominates and in Western Australia influenza A(H3N2) accounts for most viral detections. Source: Australian Influenza Surveillance Report

4 Summary of influenza activity in Wales Figure 1. Clinical consultation rate per 1, practice population in Welsh sentinel practices (as of 21/8/213) * Consultation rate per 1, Higher than average seasonal activity Normal seasonal activity * Reporting changed to Audit+ surveillance system Week Baseline activity Figure 2. Historical clinical consultation rate per 1, practice population in Welsh sentinel practices (week week ). Consultation rate per 1, Epidemic activity Higher than average seasonal (winter) activity Normal seasonal activity (winter) * October 1996 April 1997 October 1997 April 1998 October 1998 April 1999 October 1999 April 2 October 2 April 21 October 21 April 22 October 22 April 23 October 23 April 24 October 24 April 25 October 25 April 26 October 26 April 27 October 27 April 28 October 28 April 29 October 29 April 21 October 21 April 211 October 211 April 212 October 212 April 213 *Reporting changed to Audit+ surveillance system - 4 -

5 Week Table 1. Age-specific consultations (per 1,) for influenza in Welsh sentinel practices, week week (as of 21/8/213) Specimens submitted Specimens tested Age group < Total Table 2. Specimens submitted for virological surveillance collected from sentinel GPs as of 21/8/213, by week of sample collection. influenza A (H1) influenza A (H3) influenza Positive identifications human parainfluenza rhinovirus adenovirus mycoplasma metapneumovirus B Total RSV - 5 -

6 Figure 3. Specimens submitted for virological testing by sentinel GPs as of 21/8/213, by week of sample collection, week week Influenza A positive Influenza B positive RSV positive Rhinovirus positive Adenovirus positive Parainfluenza positive Mycoplasma positive Human metapneumovirus Negative* Sentinel GP consultation rate per 1, 2 Rate per 1, Sample test results Week ( ) * Tested negative for influenza, adenovirus, rhinovirus, RSV, adenovirus, parainfluenza, mycoplasma and human metapneumovirus Figure 4. Specimens submitted for virological testing for hospital patients and non-sentinel GPs as of 14/8/213, by week of sample collection, week week Influenza A positive Influenza B positive RSV positive Rhinovirus positive Adenovirus positive Parainfluenza positive Mycoplasma positive Human metapneumovirus Negative* dummy Sample test results Week ( ) Combined data for tests carried out in Public Health Wales Microbiology: Cardiff and Swansea laboratories, provided by Public Health Wales Microbiology Cardiff Specialist Virology Centre. * Tested negative for influenza, adenovirus, rhinovirus, RSV, adenovirus, parainfluenza, mycoplasma and human metapneumovirus - 6 -

7 Out of Hours consultations and calls to NHS Direct Wales Figure 5. Weekly total consultations to Out of Hours services in Wales and numbers of respiratory-related diagnoses (as of 21/8/213). 3 Total OOH consultations % of consultations respiratory related Respiratory-related OOH consultations Consultations % of consultations /11/21 12/12/21 9/1/211 6/2/211 6/3/211 3/4/211 1/5/211 29/5/211 26/6/211 24/7/211 21/8/211 18/9/211 16/1/211 13/11/211 11/12/211 8/1/212 5/2/212 4/3/212 1/4/212 29/4/212 27/5/212 24/6/212 22/7/212 19/8/212 16/9/212 14/1/212 11/11/212 9/12/212 6/1/213 3/2/213 3/3/213 31/3/213 28/4/213 26/5/213 23/6/213 21/7/213 18/8/213 Figure 6. Influenza related calls to NHS Direct Wales 1 (as a percentage of total calls) to week (as of as of 21/8/213). 4% 35% Percentage of total calls 3% 25% 2% 15% 1% 5% % 3-Aug-9 31-Aug-9 28-Sep-9 26-Oct-9 23-Nov-9 21-Dec-9 18-Jan-1 15-Feb-1 15-Mar-1 12-Apr-1 1-May-1 7-Jun-1 5-Jul-1 2-Aug-1 3-Aug-1 27-Sep-1 25-Oct-1 22-Nov-1 2-Dec-1 17-Jan Feb Mar Apr-11 9-May-11 6-Jun-11 4-Jul-11 1-Aug Aug Sep Oct Nov Dec Jan Feb Mar-12 9-Apr-12 7-May-12 4-Jun-12 2-Jul-12 3-Jul Aug Sep Oct Nov Dec Jan Feb Mar-13 8-Apr-13 6-May-13 3-Jun-13 1-Jul Jul-13 Week commencing During week 32 the percentage of total calls to NHS Direct Wales which were influenza-related increased to 6.8% (figure 6). 1 Data supplied by Health Statistics and Analysis Unit, Welsh Government. Flu related calls are the sum of calls recorded as 'cold/flu', 'cough', 'headache', 'fever' and 'sore throat'

8 Influenza immunisation in Wales 212/13 Table 3. Uptake of influenza immunisation in patients aged 65y and older and in those aged 6m to 64y at clinical risk 212/13 Health Board Patients aged 65y and older Patients younger than 65y at risk Practice report rate Immunised Immunised (%) Total Immunised Immunised (%) Total Reported Total Report rate (%) Abertawe Bro Morgannwg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys Teaching HB Wales total Data source: General Practice data, extracted using the Audit+ Data Quality System (managed by NWIS Primary Care Informatics Team) Table 4. Uptake of influenza immunisation in pregnant women during 212/13 Total pregnant women Health Board Denominator Immunisation Uptake (%) Abertawe Bro Morgannwg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys Teaching HB Wales total Data source: General Practice data, extracted using the Audit+ Data Quality System (managed by NWIS Primary Care Informatics Team), this figure includes women that are pregnant or have been pregnant at any point during September 212 to January 213. This figure does not represent coverage in women who are currently pregnant. Table 5. Uptake of influenza immunisation in Occupational Health departments in Welsh Health Boards 212/13. Staff immunised HB staff under care Health Board Uptake (%) Abertawe Bro Morgannwg UHB Aneurin Bevan HB Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Hywel Dda HB Powys Teaching HB Wales Data provided by Health Board Occupational Health departments - 8 -

9 Figure 7. Uptake of influenza immunisation in Welsh Health Boards in patients aged 65 years and over 21/11 212/ / / /213 Target Uptake (%) Betsi Cadwaladr UHB Cardiff and Vale UHB Aneurin Bevan HB Wales total Powys Cwm Taf HB Teaching HB Hywel Dda HB Abertawe Bro Morgannwg UHB Data source: General Practice data, extracted using the Audit+ Data Quality System (managed by NWIS Primary Care Informatics Team) Figure 8. Uptake of influenza immunisation in Welsh Health Boards in patients aged 6 months to 64 years with one or more clinical risks 21/11 212/ / / /213 Target 75 Uptake (%) Betsi Cadwaladr UHB Cardiff and Vale UHB Cwm Taf HB Aneurin Bevan HB Wales total Powys Teaching HB Hywel Dda HB Abertawe Bro Morgannwg UHB Data source: General Practice data, extracted using the Audit+ Data Quality System (managed by NWIS Primary Care Informatics Team) - 9 -

10 Links: Public Health Wales influenza surveillance webpage: NICE influenza antiviral usage guidance: Wales influenza information: England influenza surveillance: Scotland influenza surveillance: Northern Ireland influenza surveillance: European Centre for Communicable Disease: European influenza information: Advice on influenza immunisation (for NHS Wales users)

Public Health Wales CDSC Weekly Influenza Surveillance Report Wednesday 21 st January 2015 (covering week )

The The Influenza B in certain countries8 Public Health Wales CDSC Weekly Influenza Surveillance Report Wednesday 21 st January 215 (covering week 3 215) Current level of activity: Low Trend: Decreased