Influenza surveillance: country, territory and area profiles: 2016

Influenza Surveillance Country, Territory and Area Profiles 2016 October 2016 © World Health Organization 2016 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. 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Contents Data .......................................................................................................................................................... 1 Abbreviations ........................................................................................................................................ 1 Source .................................................................................................................................................... 1 Albania ..................................................................................................................................................... 3 Armenia ................................................................................................................................................... 4 Austria ...................................................................................................................................................... 5 Azerbaijan ................................................................................................................................................ 6 Belarus ..................................................................................................................................................... 7 Belgium .................................................................................................................................................... 8 Bosnia and Herzegovina .......................................................................................................................... 9 Bulgaria .................................................................................................................................................. 10 Croatia.................................................................................................................................................... 11 Cyprus .................................................................................................................................................... 12 Czech Republic ....................................................................................................................................... 13 Denmark ................................................................................................................................................ 14 Estonia ................................................................................................................................................... 15 Finland ................................................................................................................................................... 16 France .................................................................................................................................................... 17 Georgia................................................................................................................................................... 18 Germany ................................................................................................................................................ 19 Greece .................................................................................................................................................... 20 Hungary .................................................................................................................................................. 21 Iceland.................................................................................................................................................... 22 Ireland .................................................................................................................................................... 23 Israel ...................................................................................................................................................... 24 Italy ........................................................................................................................................................ 25 Kazakhstan ............................................................................................................................................. 26 Kyrgyzstan .............................................................................................................................................. 27 Latvia ...................................................................................................................................................... 28 Lithuania ................................................................................................................................................ 29 Luxembourg ........................................................................................................................................... 30 Malta ...................................................................................................................................................... 31 Montenegro ........................................................................................................................................... 32 Netherlands ........................................................................................................................................... 33 Norway ................................................................................................................................................... 34 Poland .................................................................................................................................................... 35 Portugal.................................................................................................................................................. 36 Republic of Moldova .............................................................................................................................. 37 Romania ................................................................................................................................................. 38 Russian Federation ................................................................................................................................ 39 Serbia ..................................................................................................................................................... 40 Slovakia .................................................................................................................................................. 41 Slovenia .................................................................................................................................................. 42 Spain ...................................................................................................................................................... 43 Sweden .................................................................................................................................................. 44 Switzerland ............................................................................................................................................ 45 Tajikistan ................................................................................................................................................ 46 The former Yugoslav Republic of Macedonia ........................................................................................ 47 Turkey .................................................................................................................................................... 48 Turkmenistan ......................................................................................................................................... 49 Ukraine ................................................................................................................................................... 50 United Kingdom of Great Britain and Northern Ireland ........................................................................ 51 Uzbekistan ............................................................................................................................................. 54 Kosovo (in accordance with Security Council resolution 1244 (1999)) ................................................. 55 Notes ...................................................................................................................................................... 56 © World Health Organization, 2016. All rights reserved. October 2016 1 Data Abbreviations ARI Acute respiratory infection ATC Anatomical Therapeutic Chemical classification system CD Case definition ECDC European Centre for Disease Prevention and Control GP General practitioner/general practice HDU High dependency unit HMO Health maintenance organization (Israel) hMPV Human metapneumovirus HPSC Health Protection Surveillance Centre (Ireland) ICPC International Classification of Primary Care ICU Intensive care unit ILI Influenza-like illness I-MOVE Influenza - Monitoring Vaccine Effectiveness) network NHS National Health Service (United Kingdom) NIC National Influenza Centre PAHO Pan American Health Organization PCR Polymerase chain reaction PHE Public Health England RSV Respiratory syncytial virus SARI Severe acute respiratory infection WHO World Health Organization Source The data in the profiles are submitted by the country, territory or area and are presented here unedited.

Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 3 Albania Total population: 2,889,676 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Universal Sentinel - Virological surveillance from other hospitals in the country Population covered (%) 6% 100% 62% 38% Number of health facilities/ hospitals - - 11 27 Case definition used WHO 2014 ECDC WHO 2014 WHO 2014 Year introduced 2009 1999 2009 2009 Type of health facilities/ hospitals Paediatric practice General practice Polyclinic General practice Paediatric practice Polyclinic Emergency department 8 Regional Hospitals, 2 University Hospital Centre (Paediatric Hospital, Infectious Diseases Hospital) 1 Lung Diseases Hospital District hospitals Epidemic threshold No Yes No No Sampling strategy Two polyclinics in Tirana. Samples are collected 2x/week (Tue, Thu), samples are collected from first 5 patients at each site (paediatric and adult patients) When increase of cases is noted in different districts or age groups and outbreaks All SARI cases are sampled at all times (24 hrs/7 days a week) SARI cases See Notes. Map Locations of sentinel facilities (map of 2014-15 situation). Change in some sites were reported for the 2015-16 season: Sentinel SARI sites are located in different regions of the country – Shkoder, Kukes, Tirana (Pediatric Hospital, Infectious Disease Hospital, Lung Diseases Hospital), Elbasan, Durres, Fier, Vlore, Korçe, Gjirokaster. This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend SARI sentinel hospital Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 4 Armenia Total population: 3,006,154 Income group: lower-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Universal Sentinel - - Population covered (%) - 100% - - Number of health facilities/ hospitals 6 facilities All medical facilities 9 hospitals - Case definition used WHO ECDC WHO - Year introduced 2010 1990 2010 2009 Type of health facilities/ hospitals Polyclinic General practice Polyclinic Intensive care unit General/internal medicine Paediatric medicine Mother care institute Epidemic threshold No Yes No No Sampling strategy - - - - See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 5 Austria Total population: 8,543,932 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Influenza- Like illness (ILI) Type Sentinel - - - Virological samples from hospitals and unaffiliated physicians Population covered (%) 0.5-1.0% - Number of health facilities/ hospitals 50 - Case definition used ECDC ECDC Year introduced 2000/2001 1952 Type of health facilities/ hospitals - General practice - Paediatric practice Paediatricians, paediatric clinic, infectious disease hospital outpatient department and infectious disease hospital department Epidemic threshold Yes Sampling strategy It is advised to collect 3-5 specimens per week No sampling strategy, physicians take nasopharyngeal swabs for diagnostic purposes See Notes. Map Locations of sentinel facilities (one dot represents several facilities in a city) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ILI sentinel facility Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 6 Azerbaijan Total population: 9,629,779 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - Sentinel - - Population covered (%) 20% 2.9% Number of health facilities/ hospitals 16 facilities 2 hospitals Case definition used WHO WHO Year introduced 2009 2009 Type of health facilities/ hospitals Paediatric practice Polyclinic Infectious disease ward Pulmonary ward Epidemic threshold Yes No Sampling strategy 3 every ill patient Each patient See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 7 Belarus Total population: 9,500,422 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel Sentinel - Virological surveillance from cases of severe respiratory Infection for the purpose of differential diagnostics and treatment from all hospitals Population covered (%) 5.2% 50% 30% 100% Number of health facilities/ hospitals 13 facilities 189 facilities 11 hospitals - Case definition used WHO ECDC WHO - Year introduced 2010 2010 2010 2010 Type of health facilities/ hospitals Paediatric practice Polyclinic General practice Paediatric practice Polyclinic Emergency department Infectious disease department ICU General therapeutic Pediatric Obstetrics and gynecology Infectious disease Pulmonary ICU General therapeutic Pediatric Obstetrics and gynecology Infectious disease Pulmonary Epidemic threshold Yes Yes No No Sampling strategy In epidemic period: 10 specimens collected per week by each age group in each site; In non- epidemic period: 10 specimens collected per 2 weeks by each age group in each site according to the decision of the doctor See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 8 Belgium Total population: 11,226,322 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel Not reported to FluNewsEurope - - Population covered (%) 1.3% 1.3% - Number of health facilities/ hospitals 170 170 - Case definition used Sudden onset of fever with respiratory symptoms AND general symptoms. Acute respiratory infection of the upper, medium or lower respiratory tract (including common cold, rhinitis, (rhino)pharyngitis, angina, sinusitis, otitis, laryngitis, (laryngo)- tracheitis, bronchitis, bronchiolitis and (bronco)pneumonia) without flu syndrome. Samples from patients presenting with severe influenza in particular specific conditions: ARDS (acute respiratory distress syndrome), ECMO (extracorporeal membrane oxygenation), death, suspicion of antiviral resistance, returning from abroad or in case of outbeaks Year introduced 1985 1985 2011-2012 Type of health facilities/ hospitals General practice General practice Hospitals Epidemic threshold Yes No No Sampling strategy Specimens collected from first 2 ILI cases per week by GP - Only cases from patient with severe suspected influenza (see case definition ) See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 9 Bosnia and Herzegovina Total population: 3,817,554 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type* Universal Universal Universal - - Population covered (%) 100% 100% 100% Number of health facilities/ hospitals 135 facilities: - 52 facilities Republic of Srpska); - 79 facilities (Federation of Bosnia and Herzegovina); - 4 facilities (Brcko distict of Bosnia and Herzegovina) 135 facilities: - 52 facilities (Republic of Srpska); - 79 facilities (Federation of Bosnia and Herzegovina); - 4 facilities (Brcko Distict of Bosnia and Herzegovina) 30 hospitals: - 10 hospitals (Republic of Srpska); -19 hospitals (Federation of Bosnia and Herzegovina); - 1 hospital (Brcko District of Bosnia and Herzegovina ) Case definition used WHO 2011 ECDC WHO 2011 Year introduced - 2009 (Federation of Bosnia and Herzegovina, Republic of Srpska, Brcko District of Bosnia and Herzegovina) - 2009 (Federation of Bosnia and Herzegovina, Republic of Srpska, Brcko District of Bosnia and Herzegovina) - 2009 (Federation of Bosnia and Herzegovina, Brcko District of Bosnia and Herzegovina); - 2013 (Republic of Srpska) with current WHO case definition Type of health facilities/ hospitals General practice Paediatric practice Polyclinic Emergency department General practice Paediatric practice Polyclinic University Clinical Centers, General hospitals (Intensive care units, Paediatric wards, Infectious disease wards, Respiratory disease wards) Epidemic threshold No No No Sampling strategy No (Universal surveillance-depend on the availability and capacity of the reference laboratory) - All SARI cases are sampled at all times (24 hrs/7 days a week) - depending on the availability and capacity of the reference laboratory Universal in the Republika Srpska and in the Federation of Bosnia and Herzegovina (since 2009). Aggregated data from the level of Bosnia and Herzegovina are reported to Flu News Europe. See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 10 Bulgaria Total population: 7,223,937 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type - Sentinel - - Virological surveillance from 40 hospitals in the country Population covered (%) 5.3% - Number of health facilities/ hospitals 208 40 Case definition used ECDC ECDC - ILI and ARI case definition Year introduced 2001 1958 Type of health facilities/ hospitals General practices General practice (GP); Polyclinic; ICU/critical care; Infectious disease hospital and ward; Paediatric hospital and ward; Pulmonary ward; General hospital Epidemic threshold Yes No Sampling strategy - All ILI/SARI cases are sampled at all times. ARI cases are sampled during respiratory disease outbreaks. See Notes. Map Locations of sentinel facilities (not reported). The sentinel health facilities are situated in all 28 major cities - regional centers of Bulgaria. This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 11 Croatia Total population: 4,255,853 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection(ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Universal - - - - Population covered (%) 100% Number of health facilities/ hospitals - Case definition used ECDC Year introduced 1975 Type of health facilities/ hospitals General practice Paediatric practice Polyclinic Emergency department Hospital Epidemic threshold No Sampling strategy - See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 12 Cyprus Total population: 861,900 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel - - - Population covered (%) 80% 80% Number of health facilities/ hospitals 54 54 Case definition used Sudden appearance of fever >39°C for at least 2 days AND respiratory symptoms, malaise, myalgia, headache. No case definition used Year introduced 2003 2003 Type of health facilities/ hospitals Paediatric outpatient department of public hospital; Adult outpatient department of public hospital; Office of Primary Health Care Paediatrician and Adult Physician in Private Sector Paediatric outpatient department of public hospital; Adult outpatient department of public hospital; Office of Primary Health Care Paediatrician and Adult Physician in Private Sector Epidemic threshold No No Sampling strategy 5 random specimens per week per reporting centre 5 random specimens per week per reporting centre See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 13 Czech Republic Total population: 10,542,666 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel - - Upon request from non- sentinel site Population covered (%) ~50% ~50% - Number of health facilities/ hospitals 2,230 general practitioners and 1,240 paediatricians 2,230 general practitioners and 1,240 paediatricans - Case definition used ECDC ECDC ECDC Year introduced 2004 1956 1956 Type of health facilities/ hospitals General practice Paediatric practice General practice Paediatric practice - Epidemic threshold No Yes No Sampling strategy One sample from general practice (e.g. adults) and one sample from paediatric practice (e.g. age up to 18 years) per week from all regions are collected during influenza season (e.g. week 40-week 20 of next season) One sample from general practice (e.g. adults) and one sample from paediatric practice (e.g. age up to 18 years) per week from all regions are collected during influenza season (e.g. week 40-week 20 of next season) Upon request from non- sentinel site See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 14 Denmark Total population: 5,646,899 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - Data on national influenza tests are obtained weekly from a national microbiology database. Clinical microbiological departments at hospitals send positive influenza samples to the NIC for further characterization for virological surveillance. Population covered (%) 4% National data for influenzatest Number of health facilities/ hospitals 140 Case definition used Sudden onset of fever, muscle pain and respiratory tract symptoms Year introduced 1994 Type of health facilities/ hospitals General practice Epidemic threshold Yes No Sampling strategy GPs are asked to swab the first 5 ILI patients they see. 5 Sample kits are sent to 1/3 of all GPs at three different time points in the season. See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 15 Estonia Total population: 1,316,203 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Universal - - Virological surveillance from 3 health facilities in the country Population covered (%) 13,6% 100% - Number of health facilities/ hospitals 16 facilities (80 medical doctors) 470 facilities (925 medical doctors) 3 Case definition used ECDC ECDC - Year introduced 2006 1954 2000 Type of health facilities/ hospitals General practice Polyclinic Family doctor General practice Paediatric practice Polyclinic Family doctor General hospitals including children hospital Epidemic threshold Yes No No Sampling strategy Each sentinel site collected up to 10 specimens per week according ECDC case definition - See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ILI sentinel facility Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 16 Finland Total population: 5,479,660 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Universal - Universal (voluntary) Universal Population covered (%) Nearly 100% (ILI-visits) Nearly 100% (ILI-visits) - 100% Number of health facilities/ hospitals About 160 health care centres report ILI- visits, 13 of them also collect virological specimens 18 health care centres of garrisons collect virological specimens About 250 health care centres report ILI-visits, 13 of them also collect virological specimens 18 health care centres of garrisons collect virological specimens 13 All hospitals and outpatient clinics Case definition used ECDC ECDC ARI admitted to intensive care unit No case definition Year introduced 2013 2013 2014 1995 Type of health facilities/ hospitals General practice General practice Intensive care unit All hospitals and outpatient clinics Epidemic threshold Yes No No No Sampling strategy Up to 5 specimens are collected per week. Up to 5 specimens are collected per week. clinical basis clinical basis See Notes. Map Locations of sentinel facilities (not available as system is universal) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 17 France Total population: 64,121,248 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - Universal Virological surveillance from 44 hospitals in the country Population covered (%) - ~100% - Number of health facilities/ hospitals - - 44 hospitals Case definition used Sudden onset of fever >39°C with respiratory symptoms and myalgia Laboratory- confirmed influenza no Year introduced 1984 2009 1994 Type of health facilities/ hospitals General practice Intensive care unit General hospitals Epidemic threshold Yes No No Sampling strategy First 2 ILI cases of the week >90% of cases sampled No sampling strategy. All the virological and serological data obtained from in-patients sampled See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ILI sentinel facility Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 18 Georgia Total population: 3,727,000 Income group: lower-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - Sentinel - Virological testing is performed for unusual cases of SARI Population covered (%) 1.6% - - Number of health facilities/ hospitals 1 facility 5 hospitals (Children's hospital in Tbilisi and Kutaisi sentinel sites) - Case definition used WHO 2014 WHO 2014 PAHO/WHO 2014, unusual SARI Year introduced 2007 2007 2015 Type of health facilities/ hospitals General practice Paediatric practice Polyclinic ICU Internal medicine Paediatric medicine Maternity ward Infectious disease ward Respiratory disease ward Therapeutic/chronic disease ward Most non-sentinel data come from SARI cases collected at the sentinel hospitals in Batumi, Akhaltsikhe and Zugdid (virological surveillance only) Epidemic threshold No No No Sampling strategy Every 3rd ILI patient on Tuesday and Thursday Every SARI patient on Tuesday and Thursday Every unusual case of SARI See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 19 Germany Total population: 80,646,264 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type - Sentinel - - Virological samples sent to the NIC from different sources other than sentinel Population covered (%) >1% - Number of health facilities/ hospitals 650 facilities - Case definition used Patients with pharyngitis, bronchitis or pneumonia (with or without fever) - Year introduced 1992 1998 Type of health facilities/ hospitals General practice Paediatric practice - Epidemic threshold Yes No Sampling strategy Specimens collected from the first ILI (ECDC cd) patients per week in different age groups - See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 20 Greece Total population: 11,000,777 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - - Population covered (%) ~3% Number of health facilities/ hospitals 197 facilities Case definition used ECDC Year introduced 2004 (revised in 2014) Type of health facilities/ hospitals7 Primary Health Care Center National Organization for the Provision of Health Care Services (NOPHCS) Unit Private practice Epidemic threshold No Sampling strategy No sampling is performed (during the 2015-2016 season). See Notes. Map Locations of sentinel facilities (Not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 21 Hungary Total population: 9,889,540 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - - Population covered (%) >20% - Number of health facilities/ hospitals ~1,400 - Case definition used ECDC Year introduced 2005 Type of health facilities/ hospitals General practice Paediatric practice Hospitals Epidemic threshold Yes No Sampling strategy Advise to collected 2 specimens of ILI patients per week by site Diagnostic purposes See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 22 Iceland Total population: 327,318 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Universal - - - - Population covered (%) 100% Number of health facilities/ hospitals - Case definition used ECDC Year introduced - Type of health facilities/ hospitals General practice Emergency department Epidemic threshold No Sampling strategy - See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 23 Ireland Total population: 4,675,164 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - Universal All respiratory specimens referred to National Virus Reference Laboratory which are tested for influenza. Population covered (%) 5.8% 100% - Number of health facilities/ hospitals 61 facilities 58 acute care public and private hospitals - Case definition used ECDC Laboratory- confirmed influenza ECDC Year introduced 2000 2009 2000 (HPSC began surveillance in 2000) Type of health facilities/ hospitals General Practice All acute hospitals Mainly hospitals and some GPs (excluding sentinel GPs) Epidemic threshold Yes No No Sampling strategy For sentinel GPs participating in IMOVE study: up to 5 ILI patients per week aged <65 years and all patients aged ≥65 years should be tested. All other sentinel GPs swab one ILI patient per week. No sampling strategy No sampling strategy See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ILI sentinel facility Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 24 Israel Total population: 8,215,667 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - Virological surveillance from one hospitals in the country (influenza, RSV, hMPV, Adenovirus, Parainfluenza-3) Population covered (%) 25% - Number of health facilities/ hospitals Community clinics of the 2nd largest HMO in the country. 1 Case definition used Patients diagnosed with ILI. For the virological surveillance, we make use of sentinel network of 26 clinics. Nasopharyngeal swabs are collected from patients presenting with acute fever of at least 37.8 degrees Celsius accompanied with at least one of the following symptoms: runny nose, sore throat, cough, myalgia. none Year introduced 2000 2012/2013 winter Type of health facilities/ hospitals General practice Paediatric practice Tertiary medical centre Epidemic threshold Yes Not relevant Sampling strategy All patients diagnosed with ILI. Swabs are taken from patients at their first or second day of illness. Hospitalized cases with ARI See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 25 Italy Total population: 59,788,668 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - - Population covered (%) 2% Number of health facilities/ hospitals 900 Case definition used Sudden onset AND fever >38°C AND at least one of the following systemic symptoms: headache, malaise, chills, sweats, fatigue; AND at least one of the following respiratory symptoms: cough, sore throat, nasal obstruction. Year introduced 1999 Type of health facilities/ hospitals General practice Paediatric practice Epidemic threshold Yes Sampling strategy - See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 26 Kazakhstan Total population: 17,371,620 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Universal Sentinel - - Population covered (%) 9.4% 100% - Number of health facilities/ hospitals 32 facilities - 25 hospitals Case definition used Cases of acute respiratory viral diseases accompanied by fever > 38oC and cough , which are observed at least once within 7 days from the onset of the disease - WHO 2011 Year introduced 2008 - 2010 Type of health facilities/ hospitals Paediatric polyclinic Adult polyclinic Paediatric practice Polyclinic Infectious disease hospital Public hospitals Pulmonary dep. General/internal Paediatric Infectious disease ward Epidemic threshold No Yes No Sampling strategy Sampling is carried out on a weekly basis from patients with ILI (age > 1 year) and onset illness <72 hours) Monthly Sampling is carried out on SARI patients (age > 1 year) and onset illness <72 hours, for persons >18 years not more than 7 days from the onset of the disease; Samples taken for max 1 patient per day from each age group. See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 27 Kyrgyzstan Total population: 5,843,617 Income group: lower-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Universal Sentinel - - Population covered (%) 2.8% 100% - Number of health facilities/ hospitals 3 facilities – 4 hospitals Case definition used WHO WHO WHO Year introduced 2009 1950 2008 Type of health facilities/ hospitals General practice Polyclinic General practice Polyclinic Intensive care unit Infectious disease ward Pulmonary ward Epidemic threshold No Yes Yes Sampling strategy - - - See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 28 Latvia Total population: 1,989,354 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel - - Virological surveillance mainly from hospitals and also outpatient facilities in the country Population covered (%) 5.2% 5.2% - Number of health facilities/ hospitals 72 facilities 72 facilities - Case definition used ECDC ECDC ECDC Year introduced 1995 1995 1995 Type of health facilities/ hospitals General practice Paediatric practice General practice Paediatric practice Any type of hospitals and outpatients facilities Epidemic threshold Yes No No Sampling strategy Preferable ILI cases are sampled, including all age groups; 50-100 specimens per season mainly in Riga (Capital) Preferable ILI cases are sampled, including all age groups 50-100 specimens per season mainly in Riga (Capital) Hospitalised severe ILI cases are sampled at any time (24 hrs/7 days per week) See Notes. Map Locations of sentinel facilities T This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 29 Lithuania Total population: 2,916,798 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel - - - Population covered (%) 2.5% 2.5% Number of health facilities/ hospitals 86 medical doctors 86 medical doctors Case definition used ECDC - Year introduced 2004 2004 Type of health facilities/ hospitals General practice General practice Epidemic threshold Yes Yes Sampling strategy - Doctor decides when to take a sample and from which age group See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 30 Luxembourg Total population: 556,573 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel - - - Population covered (%) - - Number of health facilities/ hospitals 15 15 Case definition used ECDC ECDC Year introduced 2003 2003 Type of health facilities/ hospitals General practice Paediatric practice General practice Paediatric practice Epidemic threshold Yes No Sampling strategy All patients are sampled in principle - See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 31 Malta Total population: 427,421 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - Virological data from admissions with SARI at our only state hospital from some respiratory physicians Population covered (%) - All hospital admissions Number of health facilities/ hospitals 6 GPs Only one state hospital in Malta Case definition used WHO 2014 WHO 2014 Year introduced 2003 2009 Type of health facilities/ hospitals General practice Main state hospital Epidemic threshold No No Sampling strategy Patients that accept to have specimen taken by GP At discretion of hospital respiratory physician or paediatrician See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 32 Montenegro Total population: 625,292 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Universal - Universal - - Population covered (%) 100% 100% Number of health facilities/ hospitals 29 health facilities 8 hospitals Case definition used ECDC WHO 2011 Year introduced 2009 2016 Type of health facilities/ hospitals General practice Paediatric practice Polyclinic General hospitals Clinical Centre of Montenegro Epidemic threshold No No Sampling strategy ILI/ARI patient All SARI cases are sampled at all times See Notes. Map Locations of sentinel facilities (not reported because system is universal) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 33 Netherlands Total population: 16,868,020 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel Sentinel Sentinel Virologic surveillance from 21 virology laboratories in the country Population covered (%) 0.7% 7% 6% 3% - Number of health facilities/ hospitals 40 280 2 1 21 virology laboratories Case definition used Acute onset AND rectal temperature >38°C AND at least one of the following symptoms: cough, coryza, sore throat, frontal headache, retrosternal pain, myalgia ICPC codes R74, R75, R77, R78, R80 WHO 2014 WHO 2014 All influenza-virus positive laboratory results Year introduced 1970; Testing of specimens introduced in 1994. 2015 2015 2015 - Type of health facilities/ hospitals General practice General practice 1 general hospital, 1 university medical centre 1 general hospital Virology laboratories Epidemic threshold Yes No No No No Sampling strategy All ILI patients ≥65 years and first two ILI patients <65 years presenting Monday-Wednesday. If no ILI patients Mo-We then first two ILI or ARI patients presenting Thursday – Sunday. In absence of ILI cases, samples are collected from ARI cases. No sampling, syndromic surveillance only No sampling, syndromic surveillance only All SARI patients ≥65 years of age during influenza season Based on diagnostic requests from physicians, no national sampling strategy See Notes. Map Locations sentinel sites. This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 34 Norway Total population: 5,147,970 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Universal - - - - Population covered (%) 100% Number of health facilities/ hospitals All general practices All emergency clinics in primary health care Case definition used - Year introduced - Type of health facilities/ hospitals General practice Emergency clinic in primary health care Epidemic threshold Yes Sampling strategy - See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 35 Poland Total population: 38,619,976 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - Virological surveillance from hospitals in the country Population covered (%) 19% 100 % Number of health facilities/ hospitals 625 - Case definition used ECDC ECDC Year introduced 2004 1951 Type of health facilities/ hospitals General practice General practice Epidemic threshold No No Sampling strategy Advised specimens collected 7 days a week (by age, site) Advised specimens collected 7 days a week (by age, site) See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 36 Portugal Total population: 10,402,343 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - Virological surveillance from 91 hospitals in the country Population covered (%) 2.1% - Number of health facilities/ hospitals 124 general practitioners 91 Case definition used ECDC ECDC Year introduced 1989 1989 Type of health facilities/ hospitals General practice Hospital/General practice Epidemic threshold Yes No Sampling strategy GP are advised to select all ILI cases All cases are sampled See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ILI sentinel facility Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 37 Republic of Moldova Total population: 3,558,566 Income group: lower-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel Sentinel - Any health facility that is not covered by sentinel surveillance Population covered (%) 11% 11% 43% 57% Number of health facilities/ hospitals 10 facilities 17 hospitals 492 facilities Case definition used ECDC ECDC WHO <2011 ILI – ECDC case def. ARI – WHO case def. SARI – WHO <2011 case def. Year introduced 2004 1995 2009/changed 2015 2009 Type of health facilities/ hospitals Polyclinic Polyclinic Intensive care unit General/internal medicine Paediatric medicine Infectious disease and Respiratory disease ward Therapeutic/chronic disease ward Intensive care unit General/internal medicine Paediatric medicine Infectious disease and Respiratory disease ward Therapeutic/chronic disease ward Polyclinic Epidemic threshold No Yes No No Sampling strategy Weekly 12 samples are collected from the first patient with case definitions symptoms in 10 facilities regardless of age group beginning with week 40 till week 20, inclusive year round in case of their existence. See ILI. 20 samples are collected weekly from the patients with SARI symptoms in 17 hospitals from start till the end of the season (week 40 – week 20), inclusive year round in case of their existence. Any sample collected from patients with severe evolution of ILI, ARI and SARI, in outbreaks, patients from high risk group regardless of age group and period of the year. See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 38 Romania Total population: 19,651,554 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel Sentinel - For IL/ARI: Virological surveillance from all health care providers in the country Population covered (%) 2% 2% 22% - Number of health facilities/ hospitals 192 192 20 - Case definition used ECDC and WHO 2014 ECDC An acute respiratory illness with a history of fever or measured fever of ≥38°C and cough and shortness of breath or difficulty breathing, with onset within the past 10 days, requiring hospitalization overnight. For ILI : ECDC and WHO 2014 Year introduced 2014 2001 2009 - Type of health facilities/ hospitals General practice General practice Intensive care unit General/internal medicine Paediatric medicine Infectious disease ward Respiratory disease ward - Epidemic threshold Yes Yes No No Sampling strategy On Tuesdays (from week 40-onset influenza season) swabs from all cases presented and who meet the ILI case definition are collected; after the onset of the season the algorithm is established by the National Center, according to specific season parameters Depending on the epidemiological context ARI cases can be sampled and tested for influenza From week 46 until the onset of the influenza season, the first 3 detected SARI cases in each sentinel hospital are sampled; after that, only the first detected SARI case in each sentinel hospital is sampled. - See Notes. Map Locations of sentinel facilities: For SARI there are 6 sentinel counties and Bucuresti Municipality This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ILI sentinel facility ARI sentinel facility SARI sentinel hospital Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 39 Russian Federation Total population: 143,429,440 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel Sentinel - Traditional virological surveillance from great number of hospitals and polyclinics in the country Population covered (%) - - - About 35% of population Number of health facilities/ hospitals 14 facilities 14 facilities 19 hospitals (10 laboratories confirmed influenza by PCR) 58 laboratories confirmed influenza by PCR testing of clinical samples obtained from different local hospitals and other health facilities Case definition used WHO WHO WHO National Year introduced 2010 2010 2010 1971 Type of health facilities/ hospitals Polyclinic (GP) Polyclinic (GP) Intensive care unit Paediatric medicine Infectious disease and respiratory disease wards Intensive care unit; general/internal medicine Paediatric medicine Infectious disease and Respiratory disease ward Epidemic threshold No No No Yes Sampling strategy The average number of samples taken from ILI/ARI patients taken is 29 per week; all age groups are included. The average number of samples taken from ILI/ARI patients taken is 29 per week; all age groups are included. All SARI cases are sampled. The average number of SARI cases sampled is 26 per week; all age groups are included. Not less than 20-50 samples per week tested (depending on epidemiological situation) See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 40 Serbia Total population: 7,164,132 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Universal - Sentinel - - Population covered (%) 100% - Number of health facilities/ hospitals 158 11 Case definition used WHO 2011 WHO 2011 Year introduced 2006 2009 Type of health facilities/ hospitals General practice Paediatric practice Intensive care unit General/internal medicine Paediatric medicine Infectious disease ward Respiratory disease ward Epidemic threshold Yes No Sampling strategy ILI cases are sampled mostly in the first 4 days in the week, during the working hours. Sentinel SARI cases are sampled mostly in the first 4 days in the week, during the working hours. See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend SARI sentinel hospital Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 41 Slovakia Total population: 5,422,861 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel Universal - - Population covered (%) - - 100% Number of health facilities/ hospitals 88 88 74 Case definition used ECDC ECDC WHO <2011 Year introduced 2002 2002 2009 Type of health facilities/ hospitals General practice Paediatric practice General practice Paediatric practice Intensive care unit Epidemic threshold No No No Sampling strategy - - - See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 42 Slovenia Total population: 2,066,068 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel - - Non-sentinel Population covered (%) 4.0% 4.0% 100 % Number of health facilities/ hospitals 40 facilities 40 facilities All included Case definition used ECDC ECDC Not applicable – respiratory samples tested according to physician judgement in patients with ARI Year introduced 2008 (before that year case national definition in place) 2008 (before that year case national definition in place) 2010 Type of health facilities/ hospitals General/Family practices Paediatric practices School doctors General/Family practices Paediatric practices School doctors See above – most samples derive from hospitalized patients with ARI but not exclusively Epidemic threshold No No No Sampling strategy Samples taken from ILI patients – more intensive sampling advised in the beginning of the season, number of samples not limited In principle, samples are collected from patients with ILI, not ARI 2 hospitals (200.000 inhabitants) send specimens with more comprehensive dataset directly to National Influenza Center (NIC), laboratories testing samples from other hospitals report weekly cumulative data to NIC. See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 43 Spain Total population: 46,259,716 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - Sentinel Information on influenza positive specimens coming from virological diagnostic assays in regional influenza laboratories Population covered (%) 2.2% 46,4% - Number of health facilities/ hospitals 789 91 hospitals - Case definition used ECDC Laboratory-confirmed influenza in all wards Any Year introduced 1996 2009 1996 Type of health facilities/ hospitals General practice Paediatric practice All wards Mainly public general hospitals Laboratories belonging to the Spanish Influenza Surveillance System, mainly in public hospitals Epidemic threshold Yes No No Sampling strategy Samples are collected from the first 2 patients who attend the sentinel facility during the week. All patients who meet clinical criteria of severe influenza like illness who required hospitalization (pneumonia/septic shock/ ARDS/multiple organ dysfunction syndrome or admitted to intensive care) are sampled. Any See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 44 Sweden Total population: 9,696,110 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel sampling only - - Universal Virological surveillance from all laboratories in the country Population covered (%) 8% 100% (Note: 50% under- reporting expected) 100% Number of health facilities/ hospitals 99 sites 78 intensive care units 28 laboratories Case definition used ECDC Lab-confirmed influenza ILI based on clinical presentation (close to ECDC definition) Year introduced 2006 2013 1993, changed 2015 Type of health facilities/ hospitals Mainly general practice but also some infectious disease and paediatric clinics are included Intensive care unit Primarily emergency/ urgent care and hospitals, and infectious disease and paediatric clinics, and some primary care facilities Epidemic threshold No No Yes Sampling strategy Up to 5 specimens collected per week per site Clinician decision Clinician decision See Notes. Map Locations of sentinel facilities (not available) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 45 Switzerland Total population: 8,211,383 Income group: high System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - Laboratory surveillance Population covered (%) 1.9% 100% (universal) Number of health facilities/ hospitals 150-200 <250 Case definition used WHO <2011 Laboratory-confirmation of influenza Year introduced 1987 1988 Type of health facilities/ hospitals General practice Paediatrician Laboratories Epidemic threshold Yes No Sampling strategy About 45% of all Sentinel facilities collect specimens. These sample - all ILI patients if the incidence is below the epidemic threshold - every 4th-10th ILI patient if the incidence is above the epidemic threshold Mandatory notification of influenza detection See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ILI sentinel facility Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 46 Tajikistan Total population: 8,295,840 Income group: low System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Universal Universal - - - Population covered (%) - - Number of health facilities/ hospitals - - Case definition used WHO <2011 Year introduced - - Type of health facilities/ hospitals - - Epidemic threshold No No Sampling strategy - - See Notes. Map Locations of sentinel facilities (not reported as system is universal) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 47 The former Yugoslav Republic of Macedonia Total population: 2,075,625 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Universal - - - - Population covered (%) 100% Number of health facilities/ hospitals All Case definition used ECDC Year introduced 1966 Type of health facilities/ hospitals General practice Paediatric practice Polyclinic Infectious disease clinic All other health facilities from primary, secondary and tertiary level of health care Epidemic threshold Yes Sampling strategy First detected ILI cases who meets the case definition for ILI in each sentinel site See Notes. Map Locations of sentinel facilities (not reported as system is universal) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 48 Turkey Total population: 77,523,792 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - - Samples sent from the centers other than sentinel centers Population covered (%) 1% - Number of health facilities/ hospitals 17 province/ 180 family health care doctors - Case definition used WHO <2011 WHO 2014 Year introduced 2004 2004 Type of health facilities/ hospitals General practice Hospitals Epidemic threshold No No Sampling strategy Every Thursday one sample is collected from the first patient showing case definition symptoms There is no determined strategy See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ILI sentinel facility Capital Legend Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 49 Turkmenistan Total population: 5,307,188 Income group: upper-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type - - - - - Population covered (%) - Number of health facilities/ hospitals 1 Case definition used - Year introduced - Type of health facilities/ hospitals - Epidemic threshold - Sampling strategy - See Notes. Map Locations of sentinel facilities (not reported) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 50 Ukraine Total population: 45,002,496 Income group: lower-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Universal Sentinel - - Population covered (%) 20,7467 100% 2 927 852 - Number of health facilities/ hospitals 8 facilities - 10 hospital - Case definition used WHO 2011 WHO WHO 2011 WHO Year introduced 2007 1976 2007 1976 Type of health facilities/ hospitals General practice Paediatric practice Polyclinic General practice Paediatric practice Polyclinic Intensive care unit Infectious disease and Respiratory disease ward Maternity units Intensive care unit Paediatric Infectious disease and Respiratory disease ward General practice Paediatric practice Polyclinic Intensive care unit Infectious disease and Respiratory disease ward Maternity units Epidemic threshold No Yes No Yes Sampling strategy 4 by site during the 40-20 weeks; 2 by site during week 21- 39 10 samples per week from each facility 6 by site during the week 40-20; 3 by site during week 21-39; All severe cases should be sampled 10 samples per week from each facilities See Notes. Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 51 United Kingdom of Great Britain and Northern Ireland Total population: 64,331,348 Income group: high England System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - Universal. All patients admitted to HDU/ICU with a laboratory- confirmed influenza infection should be reported. Influenza data are collected from pathology systems transmitted from PHE, NHS and private microbiology laboratories across England Population covered (%) 1.7% 100% 100% Number of health facilities/ hospitals ~100 General Practices ~150 hospitals >200 Case definition used ILI is clinically defined as an individual presenting in primary care with an acute respiratory illness with physician- diagnosed fever or complaint of feverishness Fever (>=38° C) or history of fever in previous 7 days AND two or more of: cough, sore throat, headache, rhinorrhoea, myalgia; D&V, increased resp rate, poor feeding - Year introduced 1964 2010 - Type of health facilities/ hospitals General practice Intensive care units PHE, NHS and private microbiology laboratories Epidemic threshold Yes – MEM threshold No No Sampling strategy At the start of the season 2-3 ILI cases are swabbed per week. At the peak of the season max. 20 patients are swabbed per week All cases should be sampled - See Notes. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 52 Northern Ireland System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel Universal ICU only - Population covered (%) 11% 11% 100% Number of health facilities/ hospitals 37 facilities 37 facilities 5 Trusts Case definition used A disabling acute respiratory illness accompanied by severe fever and myalgia – Read Code H27 ECDC Laboratory- confirmed influenza in ICU patients Year introduced 2001 2009 2011 Type of health facilities/ hospitals General practice General practice Intensive care unit Epidemic threshold Yes No No Sampling strategy Specimens collected weekly - - See Notes. Scotland System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel - - - Population covered (%) - - Number of health facilities/ hospitals - - Case definition used - - Year introduced - - Type of health facilities/ hospitals General practice General practice Epidemic threshold Yes Yes Sampling strategy - - Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 53 Wales System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - - Universal - Population covered (%) 11.7% 100% Number of health facilities/ hospitals 44 facilities 19 hospitals Case definition used - - Year introduced - - Type of health facilities/ hospitals General practice All wards Epidemic threshold Yes No Sampling strategy - - See Notes. Map Locations of sentinel facilities (not available) This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Capital Legend Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 54 Uzbekistan Total population: 31,025,500 Income group: lower-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel Sentinel - - - Population covered (%) 0.16% 0.16% Number of health facilities/ hospitals 1 facility 1 facility Case definition used WHO WHO Year introduced 2012 2012 Type of health facilities/ hospitals7 General practice Polyclinic General practice Polyclinic Epidemic threshold No Yes Sampling strategy - - See Notes Map Locations of sentinel facilities This map is an approximation of actual borders. The designations employed and the presentation of this material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Influenza surveillance profiles © World Health Organization, 2016. All rights reserved. October 2016 55 Kosovo (in accordance with Security Council resolution 1244 (1999))1 Total population: 1,827,231 Income group: lower-middle System characteristic Primary care Hospital Non-sentinel Influenza- Like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Type Sentinel - Sentinel - - Population covered (%) 48.4% 48.4% Number of health facilities/ hospitals 5 5 Case definition used WHO, ECDC WHO, ECDC Year introduced 2012 Type of health facilities/ hospitals -Paediatric practice -General practice -Infective diseases -Lung diseases (all health care levels) -Paediatric practice -ICU -Infective diseases -Lung diseases (secondary and tertiary health care levels) Epidemic threshold No Sampling strategy All sentinel centers in Prishtina and Prizren. Samples are collected twice per week on Monday and Thursday. All SARI cases are sampled at all times (24 hrs/7 days a week). See Notes. Locations of sentinel facilities: Prishtina region: 5 sentinel centres in Prishtina. Prizren region: 1 sentinel centre with adequate clinics and hospital units. Map Map not available. 1 For the purposes of this publication, all references to "Kosovo” should be understood/read as “Kosovo (in accordance with Security Council resolution 1244 (1999))”. Influenza surveillance profiles October 2016 © World Health Organization, 2016. All rights reserved. 56 Notes – : Not available/ not known. The profiles include only systems which provide data to the joint European Centre for Disease Prevention and Control (ECDC)–WHO Regional Office for Europe influenza bulletin, Flu News Europe (https://flunewseurope.org/). Mid-year population presented is based on 2014 data, according to the WHO Regional Office for Europe’s European Health for All database (http://data.euro.who.int/hfadb). Income is based on the World Bank list of economies (July 2014) (http://data.worldbank.org/about/country- and-lending-groups). The type of surveillance can be defined as: 1. sentinel; 2. universal; or 3. non-sentinel. (http://www.euro.who.int/__data/assets/pdf_file/0020/90443/E92738.pdf?ua=1) 1. A sentinel surveillance system is formed by one or more designated health care facilities or providers that routinely and consistently collect epidemiological information from patients presenting with an illness consistent with a specified case definition. Representative clinical specimens are collected from all or a subset of patients according to a randomized/standardized sampling protocol. Sentinel surveillance systems provide an efficient way to obtain high-quality data on relatively common conditions from a manageable number of locations. Each sentinel site should include facilities that together represent the population under surveillance. 2. A universal surveillance system is formed by all designated health care facilities or providers in a country, territory or area. This generally includes reporting of all clinician-defined “ARI” and is part of the national disease surveillance systems of several Member States in the WHO European Region. These universal systems provide subnational resolution of clinician-reported respiratory disease activity. 3. A non-sentinel surveillance system includes other types of surveillance system (e.g. laboratory surveillance), which do not meet the definition of the other two types of system. Non-sentinel surveillance generally refers to viruses reported from/detected in patients from non-sentinel surveillance systems. In the WHO European Region, this includes viruses from clinical diagnostic laboratories, outbreaks, or universal ARI surveillance systems that do not have randomized/ standardized sampling strategies. The most common case definitions can be found in the table below: ILI ECDC Sudden onset of symptoms and at least one of the following four systemic symptoms: fever or feverishness, malaise, headache, myalgia and at least one of the following three respiratory symptoms: cough, sore throat or shortness of breath. WHO <2011 Sudden onset of fever >38 C° AND cough OR sore throat in the absence of other diagnosis. WHO 2014 An acute respiratory infection with: measured fever of ≥ 38 C° and cough; with onset within the last 10 days. ARI ECDC Sudden onset of symptoms, and at least one of the following four respiratory symptoms: cough, sore throat, shortness of breath, coryza, and a clinician’s judgement that the illness is due to an infection. SARI WHO 2011 An acute respiratory illness with onset during the previous 7 days requiring overnight hospitalization that includes: history of fever or measured fever of ≥ 38°C, AND cough, AND shortness of breath or difficulty breathing. WHO <2011 An acute respiratory infection with: history of fever or measured fever of ≥ 38 C°; and cough; with onset within the last 10 days; and requires hospitalization. WHO 2014 Onset of the following symptoms ≤7 days prior to hospital admission: Fever >38°C AND cough OR sore throat AND shortness of breath or difficulty in breathing. For children aged <5 years the WHO case definition for pneumonia and severe pneumonia is applied.* *Pneumonia: cough OR difficulty in breathing AND breathing faster than 40 breaths/minute (12 – 59 months); breathing faster than 50 breaths/minute (2 – 11 months); Severe pneumonia: cough OR difficulty in breathing AND any of the following general severe signs: unable to drink or breastfeed OR vomits everything OR convulsions OR lethargy or unconsciousness OR chest in drawing or stridor in a calm child.”