Flu focus: No. 1, December 2010 – No. 10, July 2014

1 Issue No.1, December 2010 From the WHO Regional Office for Europe, WHO/Europe - http://www.euro.who.int/ Flu Focus is an e-magazine published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials and resources on influenza. We particularly focus on vaccine and immunization, laboratories and surveillance, and communications, but also present materials and references on clinical management and hospital preparedness. The aim of Flu Focus is to equip the WHO European Region’s Member States and influenza focal points with information and resources that strengthen evidence-informed decision- making and country-specific activities and responses. This e-magazine will be sent to you on a regular basis throughout the influenza season (week 40 - week 20 in the following year). We hope that you will consider this e-magazine as a channel through which to share information across the Region. Flu Focus welcomes new knowledge and experiences in influenza responses – such as your case studies, strategic thinking, supporting material and any other relevant documentation. Please contact influenza@euro.who.int if you wish to submit something for a future issue. This issue can also be found on the WHO Regional Office for Europe website http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/influenza in English and Russian. Flu Focus will provide updates on influenza and spotlight key features that the WHO Regional Office for Europe would like to bring to your attention. In this issue: TOPICAL FEATURES 1. Start of influenza season: web article and WHO Regional Office for Europe recommendations 2. Letter from the WHO Regional Director for Europe to Member States – plus full supporting documentation SURVEILLANCE AND LABORATORY 3. Euro Flu update (week 49, 2010) 4. National influenza centres VACCINE AND IMMUNIZATION 5. WHO vaccine recommendations for 2010-2011 northern hemisphere influenza season PANDEMIC (H1N1) 2009 EVALUATIONS 6. WHO Regional Office for Europe releases report on multi-country evaluation of pandemic planning and response 7. Updated on the review of the global response to the pandemic 8. Useful links and resources 2 Issue No.1 Summary Signs of increasing influenza activity in a number of countries indicated the start of the influenza season in the WHO European Region. This issue of Flu Focus (Issue No.1) presents you with an update from the United Kingdom which, as they do every influenza season, is carefully monitoring people who develop severe disease due to influenza, ensuring that they receive appropriate clinical treatment, and making sure that those at risk of complications due to influenza are vaccinated. We also attach the recent letter and recommendations to Member States issued by the WHO Regional Office for Europe on 15 December 2010. A EuroFlu update on influenza activity across the Region in week 49 is presented, as are the vaccine recommendations for the 2010/2011 influenza season. The process by which national influenza centres (NICs) can attain and retain recognition by WHO is described, and we welcome the first NIC to attain WHO recognition in this way (the Virology Laboratory of Mater Dei Hospital, Msida, Malta) to the Global Influenza Surveillance Network. The evaluation of European regional pandemic preparedness and an update on the global pandemic response are also presented in this issue. TOPICAL FEATURES 1. Start of the influenza season: web article and WHO Regional Office for Europe recommendations Signs of increasing influenza activity in week 49 in a number of countries indicate the start of the influenza season in the WHO European Region. Both influenza A and B viruses are circulating, and both pandemic A(H1N1) 2009 and A(H3N2) have been detected. As in every influenza season, reports of severe and fatal cases have been received. The United Kingdom has reported more people under the age of 65 experiencing severe illness than usual, which may be explained by the fact that the pandemic (H1N1) virus is one of the predominant strains currently circulating. Additionally, of 17 fatal cases reported so far, 14 had not received either trivalent influenza vaccine this season or pandemic influenza vaccine last year. WHO/Europe recommends that health ministries in countries ensure high rates of uptake of seasonal influenza vaccine by individuals who might be at risk of developing complications. Other recommendations on the clinical management of patients can be found in section 2. For the complete web article please visit: http://www.euro.who.int/en/what-we- do/health-topics/diseases-and-conditions/influenza/news2/news/2010/12/start-of- influenza-season Or see the United Kingdom Health Protection Agency’s press release on this story: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1287146915944 2. Letter from the WHO Regional Director for Europe to Member States – plus full supporting documentation On 15 December 2010, the WHO Regional Director for Europe sent a letter to all European Member States alerting health authorities to the start of the influenza season in Europe, so that health care facilities (especially hospitals and critical care units) can prepare for an increase in cases of respiratory illness due to influenza and to highlight the need to vaccinate people at risk of complications due to influenza. Both the letter and an enclosure entitled Key principles, recommendations and considerations for the 2010/2011 northern hemisphere influenza season are attached to this email. 3 SURVEILLANCE AND LABORATORY 3. EuroFlu update (week 49, 2010) Overall low levels but slowly increasing influenza activity in some countries in the European Region Influenza activity remains low in most countries but influenza virus detections are increasing. A total of 20.4% of sentinel specimens tested positive for influenza. Pandemic influenza A(H1N1) 2009, influenza B, and influenza A(H3N2) viruses are circulating in the Region. Current situation – week 49/2010 Of the 34 countries submitting data on influenza-like illness (ILI) or acute respiratory infection (ARI), increasing consultation rates were reported by 11 countries, mostly in children aged 0-14. The increases were generally small, except in the United Kingdom (England) which observed more pronounced increases in both ILI and ARI consultation rates for most age groups. Of the 36 countries reporting on the geographical spread of influenza, most reported either no (13) or sporadic (16) distribution, while 3 reported local activity, 3 regional activity and 1 widespread activity. The impact of influenza on health care systems was low in all but one (Ireland) of the 22 countries reporting on this indicator. Respiratory syncytial virus (RSV) is also circulating and 19 countries reported detections during week 49. For more detailed information, please see www.euroflu.org and http://www.ecdc.europa.eu/en/activities/surveillance/EISN/Pages/home.aspx 4. National influenza centres The process by which a national influenza centre (NIC) can attain and retain recognition by WHO is described in a new publication on the WHO/Europe website. New laboratories requesting WHO recognition must comply with the WHO Terms of Reference for NIC and be able to demonstrate that they meet basic standards of laboratory quality. This is assessed on-site by WHO staff, together with staff from the WHO collaborating centre for reference and research on influenza,1 using a standardized laboratory assessment tool for NIC (NIC-LAT). A copy of NIC-LAT can be obtained by contacting influenza@euro.who.int. The first NIC to attain WHO recognition in this way is the Virology Laboratory of Mater Dei Hospital, Msida, Malta, and we welcome the laboratory to the Global Influenza Surveillance Network.2 This brings the number of countries in the WHO European Region with a WHO-recognized NIC to 40. http://www.euro.who.int/en/what-we-do/health-topics/diseases- andconditions/influenza/publications/2010/how-to-become-a-who-recognized- nationalinfluenza-centre-guidance-on-the-process-for-influenza-laboratories-in-the- whoeuropean-region VACCINE AND IMMUNIZATION 5. WHO vaccine recommendations for the 2010-2011 northern hemisphere influenza season Based on available epidemiological and virological data* provided to WHO between September 2009 and February 2010, WHO has announced the recommended viruses for use in the influenza vaccine for the 2010-2011 northern hemisphere influenza season. The three recommended viruses are: 1 National Institute for Medical Research, Medical Research Council, Mill Hill, London, United Kingdom 2 http://www.who.int/csr/disease/influenza/surveillance/en/ 4 an A/California/7/2009 (H1N1)-like virus (pandemic H1N1 strain); an A/Perth/16/2009 (H3N2)-like virus; and a B/Brisbane/60/2008-like virus. Human influenza viruses evolve continuously, and influenza vaccines are therefore updated every year to contain representative circulating viruses. WHO recommendations are offered as a guide to national public health authorities and vaccine manufacturers, to help them use appropriate viruses for the upcoming season. WHO/Europe has published recommendations on target groups and strategies for influenza vaccination. For the complete recommendations, please follow these links: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/publications/2010/vaccine-recommendations-for-20102011- winter-influenza-season http://www.who.int/csr/disease/influenza/recommendations2010_11north/en/index.html * For data from the European Region, please consult www.euroflu.org. PANDEMIC (H1N1) 2009 EVALUATIONS 6. WHO Regional Office for Europe releases report on multi-country evaluation of pandemic planning and response WHO/Europe has completed a report on its multi-country evaluation of the response to pandemic (H1N1) 2009. This evaluation involved a broad range of stakeholders at national, regional and local levels in seven countries across the Region. Using data collected from more than 90 hours of interviews, it assessed how pandemic preparedness activities (PPA) aided the response to the pandemic. The outcome of this evaluation is a set of recommendations for good practices in pandemic preparedness. It also identifies gaps that should be addressed in future work at the country level and by WHO. Recommendations for good practice in pandemic preparedness: identified through evaluation of the response to pandemic (H1N1) 2009. Read the full text of the report on WHO/Europe's multi-country evaluation. http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/publications/2010/recommendations-for-good-practice- in-pandemic-preparedness-identified-through-evaluation-of-the-response-to- pandemic-h1n1-2009 Evaluation of the response to pandemic (H1N1) 2009 in the European Region. Read more about evaluations conducted by WHO/Europe, other European institutions and countries. http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/pandemic-h1n1-2009/evaluation-of-the-response-to- pandemic-h1n1-2009-in-the-european-region 5 7. Update on the review of the global response to the pandemic The assessment of the global response to the H1N1 pandemic is being conducted by the International Health Regulations Review Committee and will include a review of the functioning of the IHR. The review looks at the role of WHO and aims to identify lessons learned that will be important for strengthening preparedness for and response to future pandemics and public health emergencies. The Review Committee has met several times and interviewed representatives of Member States WHO staff and other stakeholders. The Chair of the Committee will present a progress report during the Executive Board session in January 2011. A fourth meeting of the Review Committee, to which (among others) representatives of States Parties to the IHR will be invited, will take place in March or April 2011.The final report will be presented to the World Health Assembly in May 2011. http://www.who.int/ihr/chairman_note_20101112/en/index.html http://www.who.int/csr/disease/swineflu/frequently_asked_questions/review_committee/ en/index.html 8. Useful links and resources: WHO/Europe influenza facts and figures http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/facts-and-figures WHO/Europe influenza country work http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/country-work WHO/Europe influenza publications http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/publications WHO/Europe Vaccine-preventable diseases and immunization http://www.euro.who.int/vaccine WHO headquarters Immunization, vaccines and biologicals http://www.who.int/immunization/en/ WHO headquarters influenza site http://www.who.int/csr/disease/influenza/en/ European Centre for Disease Prevention and Control (ECDC) influenza site http://www.ecdc.europa.eu/en/healthtopics/influenza/Pages/index.aspx _________________ Sent to you from the WHO Regional Office for Europe You can find the current and archived issues of Flu Focus on the WHO Regional Office for Europe website http://www.euro.who.int/en/what-we-do/health-topics/diseases-andconditions/influenza If you have received this e-magazine and wish to add colleagues, partners, associates or friends (or if you wish to unsubscribe), please contact influenza@euro.who.int. WHO/EURO:2014-6903-46669-67868 © World Health Organization 2011. All rights reserved. 6 Issue No.2, March 2011 From the WHO Regional Office for Europe, WHO/Europe - http://www.euro.who.int/ Flu Focus is an e-magazine published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials and resources on influenza. We particularly focus on vaccine and immunization, laboratories and surveillance, and communications, but also present materials and references on clinical management and hospital preparedness. The aim of Flu Focus is to equip the WHO European Region’s Member States and influenza focal points with information and resources that strengthen evidence-informed decision- making and country-specific activities and responses. This e-magazine will be sent to you on a regular basis throughout the influenza season (week 40 - week 20 in the following year). We hope that you will consider this e-magazine as a channel through which to share information across the Region. Flu Focus welcomes new knowledge and experiences in influenza responses – such as your case studies, strategic thinking, supporting material and any other relevant documentation. Please contact influenza@euro.who.int if you wish to submit something for a future issue. This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe website at http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/publications/flu-focus2/flu-focus in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: http://www.euro.who.int/en/what-we-do/health-topics/diseases- and-conditions/influenza/publications/flu-focus2/flu-focus на английском и русском языках. Flu Focus will provide updates on influenza and spotlight key features that the WHO Regional Office for Europe would like to bring to your attention. In this issue: TOPICAL FEATURES 1. Overview of the epidemiological and virological situation of the 2010/2011 influenza season in the WHO European Region (week 40/2010 to week 03/2011) 2. Preview report of the Fourth IHR Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009 SURVEILLANCE AND LABORATORY 3. Euro Flu bulletin update (week 9, 2011) CLINICAL MANAGEMENT 4. Clinical teleconferences – Organized jointly with ECDC and with support from the Health Protection Agency, United Kingdom 5. Influenza (H1N1) 2009: Key issues for case management OTHER 6. Useful links and resources 7 Issue No.2 Summary As we move towards the end of the 2010/2011 influenza season, this issue of Flu Focus provides you with an overview of the epidemiological and virological situation during the course of the first half of the season. It also provides a link to preview the report from the Fourth IHR Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009. WHO headquarters is currently accepting comments and feedback about this report, in advance of the Fourth IHR Review Committee meeting later this month. The primary focus of this issue is the summary of four multi-country clinical teleconferences that took place from the end of January through the beginning of February. The calls, organized jointly with ECDC and with the support of the Health Protection Agency, United Kingdom, had the objective of facilitating the exchange of information on the clinical management of patients with severe disease due to influenza A(H1N1) 2009 and supporting countries in the Region that are experiencing strains on their critical care services due to severe cases. Additionally, this issue shares a document created to outline the key issues for case management of influenza A(H1N1) 2009, as well as a number of useful links from WHO/Europe and WHO headquarters. TOPICAL FEATURES 1. Overview of the epidemiological and virological situation of the 2010/2011 influenza season in the WHO European Region (week 40/2010 to week 03/2011) This overview of influenza data from the WHO European Region from week 40/2010 through week 3/2011 was submitted for consideration during the WHO Northern Hemisphere Vaccine Strain Selection Meeting, held in Geneva on 14-17 February 2011. As mentioned above, the 2010/2011 influenza season appears to be progressing in a west to east fashion across much of Europe. Increases in influenza activity have been accompanied by increases in hospitalized Severe Acute Respiratory Infections (SARI) and in severe influenza cases admitted to intensive care units. Pandemic influenza A(H1N1) 2009 viruses are the predominant circulating viruses but, in contrast to the 2009/2010 season, there is a higher rate of co- circulation with influenza B viruses and a substantial decrease in the proportion of influenza A(H3N2) viruses. Currently, 98% of antigenically characterized viruses from the 2010/2011 influenza season correspond with the viruses recommended by WHO for inclusion in the 2010/2011 northern hemisphere influenza vaccine. For the complete text of the overview please visit: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/publications/2010/epidemiological-and-virological-situation- update-of-the-20102011-influenza-season-in-the-who-european-region-week- 402010-to-week-032011 2. Preview report of the Fourth IHR Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009 WHO headquarters has now released a preview of the report of the Fourth IHR Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009. Member States are encouraged to provide comments and feedback by email to ihr-pandemicreview@who.int (see note from Chairman via the link below) or during the plenary meeting of the Review Committee in Geneva on 28 March 2011 (invitations sent through permanent missions in Geneva; agenda available via link below). The committee will then finalize the report and present it to the 64th World Health Assembly. 8 WHO/Europe has also performed an evaluation of the pandemic, focusing on how pandemic preparedness aided the response to pandemic (H1N1) 2009. This report provides recommendations on good practices in pandemic preparedness at the national, regional and local level within countries. It also outlines requests for actions WHO should take to assist with pandemic preparedness planning. We would be happy to receive your comments on these recommendations at influenza@euro.who.int. To view the report preview, note from the Chairman and Review Committee meeting agenda, please visit: http://www.who.int/ihr/4th_meeting/en/index.html To view the Recommendations for good practice in pandemic preparedness (identified through evaluation of the response to the global pandemic), please visit: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/publications/2010/recommendations-for-good-practice-in- pandemic-preparedness-identified-through-evaluation-of-the-response-to-pandemic- h1n1-2009 SURVEILLANCE AND LABORATORY 3. EuroFlu bulletin update (week 9, 2011) Continuing influenza activity despite declining trends in many countries ILI and ARI consultation rates continue to decline throughout most parts of the WHO European Region with the majority of countries reporting medium or low activity During week 9/2011, of the 39 countries reporting on consultation rates for ILI and/or ARI, 22 reported decreases while 3 (Armenia, Iceland and Ukraine) reported increases. Among 41 countries reporting on the geographical spread of influenza, a majority reported either widespread (13) or regional (10) activity, while 17 reported either sporadic or local activity. One reported no activity. High-intensity influenza activity was reported only by Georgia (compared with 5 countries last week), while 25 countries reported medium intensity and 14 countries reported low intensity. The impact of influenza on health care systems was severe in one country (Georgia), low in 14 and moderate in 7 of the 22 countries reporting on this indicator. The percentage of sentinel specimens testing positive for influenza is declining overall, but remains high in several countries. Whereas pandemic influenza A(H1N1) 2009 and influenza B currently co-dominate in northern and western Europe, pandemic influenza A(H1N1) 2009 is the dominant virus in the central and eastern parts of the Region. Sentinel surveillance for SARI indicates that SARI hospitalizations are declining in the south-eastern part of the Region, while some countries in central Europe are observing increasing trends. Prior to seasonal increases in influenza activity, a relatively large portion of sentinel SARI hospitalizations occurred in the group aged 0–4. With increases in influenza activity, there have been associated increases in the relative proportion of SARI hospitalizations in older children, young adults and adults. For more detailed information, please see www.euroflu.org and http://www.ecdc.europa.eu/en/activities/surveillance/eisn/pages/index.aspx CLINICAL MANAGEMENT 4. Clinical teleconferences – Organized jointly with ECDC and with support from the Health Protection Agency In January and February 2011, WHO/Europe held a series of four multi-country clinical teleconferences, organized jointly with ECDC and with support from the 9 Health Protection Agency, United Kingdom. Conferences in English took place on 26 January and 9 February, while calls with Russian speaking countries took place on 2 and 16 February. The aim of these teleconferences was two-fold: 1) to facilitate the exchange of information on the clinical management of patients with severe disease due to influenza A(H1N1) 2009 and 2) to support countries in the Region that are experiencing strains on their critical care services due to patients with severe disease caused primarily by A(H1N1) 2009 and related co-morbidities. During the conference calls, clinicians from the United Kingdom and Ireland, as well as public health specialists from various organizations and research institutes in Spain, Germany, Ireland and the United Kingdom, presented their respective experiences with management and information gathering of cases, with a particular emphasis on severe cases. Following these presentations, the Health Protection Agency (HPA) of the United Kingdom led a question and answer (Q&A) session, which allowed clinicians to discuss and review a series of topics related to case management. A report on the Q&A session will be available online and will be shared in the next issue of Flu Focus. 5. Influenza (H1N1) 2009: Key issues for case management WHO/Europe has created a document outlining the key issues for case management of influenza (H1N1) 2009. This document provides clinicians (both general practitioners and hospital physicians) with a summary of the key considerations for the management of patients with influenza A(H1N1) 2009 virus infection, covering the full spectrum of clinical disease. It also provides a list of key WHO guidance related to clinical management. For the complete text of the document in English and Russian, please visit: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/publications/2012/influenza-h1n1-2009-key-issues-for-case- management OTHER 6. Useful links and resources WHO/Europe influenza website http://www.euro.who.int/influenza WHO recommendations on vaccination for 2010/2011 winter influenza season http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/publications/2010/vaccine-recommendations-for-20102011- winter-influenza-season Evaluation of the response to pandemic (H1N1) 2009 in the European Region http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- conditions/influenza/pandemic-h1n1-2009/evaluation-of-the-response-to- pandemic-h1n1-2009-in-the-european-region WHO/Europe Vaccine-preventable diseases and immunization http://www.euro.who.int/vaccine WHO headquarters Immunization, vaccines and biologicals http://www.who.int/immunization/en/ 10 WHO headquarters influenza site http://www.who.int/csr/disease/influenza/en/ European Centre for Disease Prevention and Control (ECDC) influenza site http://www.ecdc.europa.eu/en/healthtopics/influenza/Pages/index.aspx _________________ Sent to you from the WHO Regional Office for Europe You can find the current and archived issues of Flu Focus on the WHO Regional Office for Europe website http://www.euro.who.int/influenza If you have received this e-magazine and wish to add colleagues, partners, associates or friends (or if you wish to unsubscribe), please contact influenza@euro.who.int. WHO/EURO:2014-6903-46669-67868 © World Health Organization 2011. All rights reserved. Issue No.3, July 2011 From the WHO Regional Office for Europe, WHO/Europe - http://www.euro.who.int/ Flu Focus is an e-magazine published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials and resources on influenza. Flu Focus provides updates on influenza and spotlights key features that the WHO Regional Office for Europe would like to bring to your attention. It is sent on a regular basis throughout the influenza season (week 40 - week 20 in the following year). We hope that you will consider this e-magazine as a channel through which to share information across the Region. Flu Focus welcomes new knowledge and experiences in influenza responses – such as your case studies, strategic thinking, supporting material and any other relevant documentation. Please contact influenza@euro.who.int if you wish to submit something for a future issue. This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe website at http://www.euro.who.int/flufocus in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: http://www.euro.who.int/flufocus на английском и русском языках. In this issue: TOPICAL FEATURES 1. Key features of the 2010/2011 influenza season 2. Letter from WHO Regional Director for Europe to Member States about the work of the National Influenza Centres (NIC) 3. Joint WHO Regional Office for Europe/ECDC influenza surveillance meeting and training in shipment of infectious substances 4. Final report of the Fourth IHR Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009 5. Upcoming events a. Joint WHO Regional Office for Europe/ECDC European workshops on pandemic preparedness SURVEILLANCE AND LABORATORY 6. Euro Flu Bulletin update (week 23, 2011) 7. Updated guidance for influenza surveillance PREPAREDNESS AND RESPONSE 8. Clinical Management of Influenza A (H1N1) 2009: the European experience during the 2010/2011 influenza season 9. Recommendations for good practice in pandemic preparedness for National Influenza Centres OTHER 10. Useful links and resources 11 Issue No.3 Summary At the conclusion of the 2010/2011 influenza season, this final issue of Flu Focus opens with an overview of the season. It goes on to provide information about a number of topical features. These include: letters sent out from the WHO Regional Director for Europe to all Member States to highlight the work of the National Influenza Centres (NIC); a short summary of the annual influenza surveillance meeting, held jointly by WHO/Europe and ECDC, as well as a training provided for NIC staff in the shipment of infectious substances; an update to the WHO Regional Office for Europe guidance for influenza surveillance; the publication of recommendations for good practice in pandemic preparedness for NIC; and the final report of the IHR Review Committee. A look at upcoming events and a summary of clinical teleconferences held earlier this year are also provided. This will be the final issue of Flu Focus for the 2010/2011 influenza season. The e-magazine will resume circulation at the start of the 2011/2012 season. We would like to thank the Member States, our partner organization ECDC and the many experts who contribute to the work of WHO/Europe who made this publication possible. TOPICAL FEATURES 1. Key features of the 2010/2011 influenza season in the WHO European Region (week 40/2010-week 18/2011) The first influenza season after the pandemic saw mainly co-circulation of the pandemic (H1N1) 2009 virus, together with influenza B, while relatively little seasonal influenza A (H3N2) was detected. The first increases in consultation rates for influenza-like illness (ILI) were reported in western countries in the Region (Spain and United Kingdom) at the end of November 2010. In some western European countries, increased influenza activity coincided with severe winter weather, respiratory syncytial virus circulation and bacterial co-infections among influenza patients, which consequently strained intensive and critical care services. For details on the clinical management of severe influenza during the 2010/2011 season, please see feature 9 in this issue. Influenza progressed in a west to east fashion across much of Europe this season, as has been seen in previous seasons. Although some countries reported strains on critical care services, the clinical consultation rates in the community as a whole did not exceed those observed in the previous five years in 30 out of 33 countries. The highest consultation rates were observed for children age 0 to 15 years. Pandemic influenza A (H1N1) 2009 and influenza B co-dominated in the Region. Forty-nine countries in the European Region reported sentinel virus detections from ILI and/or Acute Respiratory Infections (ARI) surveillance. Influenza A peaked in weeks 2-4 and influenza B peaked around weeks 6-7. In week 7 the dominance from influenza A shifted to influenza B. For the whole period, influenza A accounted for 60% of all positive samples. Of these viruses, 92% were subtyped; of these, 92% were pandemic A (H1) 2009 and only 8% were influenza A(H3). The relatively few influenza A (H3N2) viruses detected contrasts with North America where A(H3N2) was the dominant influenza A virus. During the 2010/2011 season, data from 10 countries performing sentinel surveillance for Severe Acute Respiratory Infections (SARI) in hospitals that met certain criteria 1 were included in the EuroFlu bulletin for the first time, allowing comparisons between data collected from patients with severe disease (SARI) and those with mild disease (ILI/ARI). Increases in influenza activity in the ILI/ARI sentinel 1 1) Hospitalized patients meeting a syndromic SARI case definition are routinely monitored, tested for influenza and reported to the national level on a weekly basis from a standard and generally stable number of sentinel hospitals; and 2) There has been consistent weekly reporting of epidemiological and virological data from the sentinel SARI system to the EuroFlu surveillance platform during the 2010/2011 influenza season. 12 systems were accompanied by increases in SARI. The percentage of sentinel ILI/ARI specimens testing positive for influenza was very similar to sentinel SARI specimens, as was the prevalence of the different co-circulating viruses. From week 40/2010 to week 18/2011, 27% of sentinel SARI specimens tested positive for influenza. At the peak of influenza activity the percentage of positive specimens was higher and ranged between 40 and 59% in seven countries. Of the detected influenza viruses from SARI cases, 57% were influenza A and 43% were influenza B. Of the influenza A viruses, 92% were pandemic A (H1N1) and 8% were influenza A (H3N2). SARI epidemiological data were generally consistent with virological trends. During the peak of the influenza season, the percent of sentinel SARI specimens that were positive was comparable to what was observed for ILI/ARI and a similar prevalence of influenza A versus B was seen in both SARI and ILI/ARI surveillance. In order to further define the characteristics of severe versus mild disease caused by influenza, it may be necessary to collect virological data by age group and, for SARI cases, analyse virological data for different outcomes (such as requiring only hospitalization or treatment in an intensive care unit or death). Sentinel SARI surveillance is a promising system for monitoring severe disease caused by influenza, as well as risk factors, which would provide timely data on priority groups for vaccination and other interventions to policy makers. Country-level collaborations with WHO/Europe are a priority to further improve data quality. In addition to influenza type and subtype, countries in the European Region perform detailed analyses of influenza viruses allowing the antigenic and genetic characteristics of influenza virus strains to be monitored so that antigenic drift 2 can be detected in a timely manner. The antigenic and genetic characterizations performed during the 2010/2011 season showed that the circulating viruses matched well to the viruses used to produce the seasonal influenza vaccine. For the 2011/2012 northern hemisphere influenza season WHO has recommended that the same virus strains that were used during the 2010/2011 season be included in seasonal influenza vaccines 3 , namely: an A/California/7/2009 (H1N1)-like virus (the pandemic (H1N1) 2009 virus); an A/Perth/16/2009 (H3N2)-like virus; a B/Brisbane/60/2008-like virus (Victoria lineage). 2. Letter from WHO Regional Director for Europe to Member States about the work of the National Influenza Centres (NIC) As the 2010/2011 influenza season drew to a close, the WHO Regional Director for Europe Zsuzsanna Jakab sent a letter to all Member States with a National Influenza Centre (NIC). This letter emphasized the important contribution that NICs make to influenza prevention and control within Member States. It also provided updated information about how NICs obtain and retain WHO recognition and encouraged NICs in all Member States to send more frequent shipments of viruses to WHO Collaborating Centres. The letters requested that Member States support the NICs in these shipments, through the provision of export permits and by ensuring smooth transitions through customs. Relevant reference documents: How to become a WHO-recognized National Influenza Centre: Guidance on the process for influenza laboratories in the WHO European Region: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and- 2 Antigenic drift is a continuous process among influenza viruses by which small genetic changes can lead to changes in the virus antigens that were used to develop seasonal influenza vaccines. This, in turn, may decrease the effectiveness of the vaccine. 3 http://www.who.int/csr/disease/influenza/recommendations_2011_12north/en/index.html 13 conditions/influenza/publications/2010/how-to-become-a-who-recognized-national- influenza-centre-guidance-on-the-process-for-influenza-laboratories-in-the-who- european-region Terms of Reference for National Influenza Centres: http://www.who.int/csr/disease/influenza/TORNICs.pdf 3. Joint WHO Regional Office for Europe/ECDC influenza surveillance meeting and training in shipment of infectious substances On 7-9 June 2011, the WHO Regional Office for Europe (WHO/Europe) and ECDC held their first joint annual influenza surveillance meeting in Ljubljana, Slovenia. The meeting was opened by Dr Mojca Gruntar Cinc, Director-General of the Public Health Directorate of the Ministry of Health of the Republic of Slovenia. The meeting attracted more than 150 representatives from 50 European Member States, as well as invited speakers from the European Region and from the United States. The meeting marked the first time that national focal points for influenza had gathered on a regional level since the launch of the WHO/Europe influenza surveillance platform, EuroFlu, and the 2009 pandemic. The three-day programme focused on the 2010-2011 influenza season, which was dominated by the pandemic (H1N1) 2009 virus and influenza B. Recommendations on a wide range of virological and epidemiological subjects were given, particularly with respect to models for the routine surveillance of severe disease caused by influenza. The meeting emphasized the need for WHO/Europe and ECDC to continue to closely coordinate their work in order to make optimal use of resources during a difficult economic climate and to keep seasonal and pandemic influenza high on the agenda. In closing the meeting, Dr Caroline Brown, head of WHO/Europe’s Influenza & Other Respiratory Pathogens programme, together with Professor Angus Nicoll, ECDC’s Influenza Programme Head, welcomed proposals to co-organize future joint meetings and working groups to address technical issues. In the meantime, presentations and working group materials have been made available to participants and the full technical report is being prepared. From 9 to 10 June 2011, WHO staff with IATA-certification also provided training in the shipment of infectious substances for staff from National Influenza Centres. 32 participants from 26 countries passed the test at the end of the training, which means they are certified to ship infectious substances for a 24 month period. The materials used during the training can be accessed at: http://www.who.int/ihr/i_s_shipping_training/en/index.html 4. Final report of the IHR Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009 The Review Committee on the Functioning of the International Health Regulations (IHR) (2005) assessed and identified lessons learned during the global response to the pandemic influenza A (H1N1) 2009 in order to help strengthen the functioning of the IHR, the ongoing global response (including the role of WHO) and preparedness for future pandemics. While operating independently, the Review Committee gathered information from the WHO Secretariat and, through a series of plenary meetings and deliberative sessions at WHO Headquarters (Geneva), developed a report on the review. The report was transmitted by the Director-General to the Sixty- fourth World Health Assembly, where delegates pledged to follow its recommendations and urged WHO to support countries to reach the necessary core capacities required for countries under the Regulations by 2012. To read the complete text of the final report please visit: http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_10-en.pdf 14 To view the resolution adopting the final report please visit: http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R1-en.pdf 5. Upcoming events Joint WHO/ECDC European workshops on pandemic preparedness In September 2011, ECDC and WHO/Europe will hold three joint workshops on pandemic preparedness. The workshops will include participants from most of the Member States in the WHO European Region. The purpose of these workshops is to provide national experts with a broad understanding of the results of the national and international pandemic evaluations and to discuss future needs for revising national pandemic plans, as well as international guidance. The workshops are a continuation of the joint pandemic preparedness activities carried out by ECDC and the WHO Regional Office for Europe in the past few years. SURVEILLANCE AND LABORATORY 6. EuroFlu bulletin update (week 23, 2011) Influenza activity in Europe is at out-of-season levels Influenza activity is at out-of-season levels throughout the European Region. None of the samples collected from sentinel sources was positive for influenza virus. From non-sentinel sources, only two countries (the Russian Federation and the United Kingdom (England)) reported influenza-positive samples, indicating minimal influenza activity in the Region. The viruses characterized to date are similar to those recommended as components of influenza vaccines for use in the 2011-2012 northern hemisphere influenza season. For more detailed information, please see www.euroflu.org and http://www.ecdc.europa.eu/en/activities/surveillance/eisn/pages/index.aspx 7. Updated guidance for influenza surveillance Recent international mandates and the global experiences with pandemic (H1N1) 2009 virus in human populations call for strengthening influenza surveillance to better target seasonal influenza control programs, to monitor severe disease and to support pandemic preparedness. In order to help surveillance systems in Member States achieve these goals, WHO/Europe has updated the WHO Regional Office for Europe guidance for influenza surveillance in humans, originally released in August 2009. All chapters of the guidance document have been updated to draw on Member State experiences in sentinel surveillance during the past two influenza seasons and pandemic (H1N1) 2009. Several other areas of the document have been strengthened based on a survey of Member States’ perspectives on the original document that was undertaken at the WHO/Europe annual surveillance meeting held in Brasov, Romania from 21 to 23 September 2010. WHO/Europe will continue to work with Member States to identify best practices in influenza surveillance. As they are identified, these concepts will be incorporated into future updates of this document. For the complete, updated text please visit: http://www.euro.who.int/en/what-we- do/health-topics/communicable-diseases/influenza/publications/2009/who-regional- office-for-europe-guidance-for-sentinel-influenza-surveillance-in-humans 15 Note: The updated Russian translation will also be available at this page, as soon as it is finalized. PREPAREDNESS AND RESPONSE 8. Clinical Management of Influenza A (H1N1) 2009: the European experience during the 2010/2011 influenza season During the 2010/2011 northern hemisphere influenza season, severe cases of influenza A (H1N1) 2009 virus infection and related co-morbidities posed clinical management challenges to physicians and healthcare facilities in some countries in the European Region. In January and February 2011, WHO/Europe held a series of four multi-country clinical teleconferences, organized jointly with ECDC and with support from the Health Protection Agency, United Kingdom. The aim of these teleconferences was to support Member States experiencing critical care service strains in addressing these issues and to facilitate the exchange of information on the clinical management of patients with severe disease due to influenza A (H1N1) 2009, in order to help countries yet to experience increased influenza activity to prepare. Two of the teleconferences provided translation into Russian and clinicians from the majority of WHO/European Member States participated. During the conference calls, clinicians, clinical experts and public health specialists from a range of health care systems, organizations and research institutes in Germany, Ireland, Spain and the United Kingdom presented their respective experiences with management and information gathering on severe cases. Following these presentations, the Health Protection Agency led question and answer (Q&A) sessions, drawing from questions submitted by participants, which allowed clinicians to discuss and review a series of topics related to case management. Issues faced by clinicians were related to: 1) the use of antiviral, antimicrobial and other supportive drugs; 2) the clinical management of specific risk groups (children, pregnant women); 3) the use of oxygen therapy in (H1N1) infected patients; 4) the use of critical care techniques for the management of influenza A (H1N1) 2009 cases and bacterial infection related co-morbidities; 5) measures for infection control; and 6) vaccination of pregnant women and other high risk groups. Participants considered the experience and knowledge shared during these teleconferences very useful. The information derived from the Q&A sessions will therefore be used to inform WHO clinical guideline development in the future. In preparation for the upcoming 2011/2012 influenza season, or during the season as needed, the organization of additional clinical teleconferences will be considered. We would like to thank all the clinicians and other experts who participated in the conference calls for their valuable contributions. 9. Recommendations for good practice in pandemic preparedness for National Influenza Centres To assist Member States with the revision of their pandemic plans with respect to laboratory activities after the 2009 influenza H1N1 pandemic, WHO/Europe performed an evaluation of the usefulness of pandemic plans and preparedness activities undertaken by laboratory networks and WHO in the response to the pandemic. Using a systematic approach, National Influenza Centres in six Member 16 States were interviewed by telephone. Six major themes considered essential to pandemic preparedness for laboratories were identified: communication; coordination/collaboration; capacity; adaptation; leadership; and support. Key issues and recommendations for good practice in pandemic preparedness for National Influenza Centres and WHO were subsequently identified. WHO/Europe has now published an evaluation report with these recommendations. The full evaluation can be accessed at the following link: http://www.euro.who.int/en/what-we-do/health-topics/communicable- diseases/influenza/publications/2011/recommendations-for-good-practice-in- pandemic-preparedness-for-national-influenza-centres OTHER 10. Useful links and resources: WHO/Europe influenza website http://www.euro.who.int/influenza WHO/Europe Vaccine-preventable diseases and immunization http://www.euro.who.int/vaccine WHO headquarters Immunization, vaccines and biologicals http://www.who.int/immunization/en/ WHO headquarters influenza site http://www.who.int/csr/disease/influenza/en/ European Centre for Disease Prevention and Control (ECDC) influenza site http://www.ecdc.europa.eu/en/healthtopics/influenza/Pages/index.aspx _________________ Sent to you from the WHO Regional Office for Europe You can find the current and archived issues of Flu Focus on the WHO Regional Office for Europe website http://www.euro.who.int/influenza If you have received this e-magazine and wish to add colleagues, partners, associates or friends (or if you wish to unsubscribe), please contact influenza@euro.who.int 17 WHO/EURO:2014-6903-46669-67868 © World Health Organization 2011. All rights reserved. 18 Issue No.4, November 2011 From the WHO Regional Office for Europe (WHO/Europe) - http://www.euro.who.int/ Flu Focus is an e-magazine published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials and resources on influenza. Flu Focus provides updates on influenza and spotlights key features that the WHO Regional Office for Europe would like to bring to your attention. It is sent on a regular basis throughout the influenza season (week 40 – week 20 in the following year). We hope that you will consider this e-magazine as a channel through which to share information across the Region. Flu Focus welcomes new knowledge and experiences in influenza responses – such as your case studies, strategic thinking, supporting material and any other relevant documentation. Please contact influenza@euro.who.int if you wish to submit something for a future issue. In this issue: TOPICAL FEATURES 1. Summary of the first post-pandemic influenza season in the WHO European Region (2010- 2011 season) 2. WHO/Europe recommendations on influenza vaccination during the 2011-2012 winter season 3. Survey on seasonal influenza vaccine recommendations and coverage during 2008-2009 and 2009-2010 seasons SURVEILLANCE AND LABORATORY 4. Euro Flu Bulletin update (week 42, 2011) 5. WHO Informal Consultation for Improving Influenza Vaccine Virus Selection 6. Support to National Influenza Centres 7. WHO/Europe workshop on sentinel influenza surveillance, 16-17 November 2011 in Istanbul 8. Nomenclature of the pandemic A(H1N1)2009 virus revised PREPAREDNESS AND RESPONSE 9. Leaflet on case management of severe disease updated 10. Pandemic preparedness workshops OTHER 11. Useful links and resources 19 Issue No.4 Summary At the outset of the 2011-2012 influenza season in the WHO European Region, the WHO Regional Office for Europe (WHO/Europe) resumes publication of its e-magazine Flu Focus with its fourth issue. This issue opens with an overview looking back on the 2010-2011 influenza season, which was the first post-pandemic season in the Region. It goes on to provide WHO/Europe's recommendations on influenza vaccination for the 2011-2012 season, as well as information about a survey being conducted on vaccine recommendations and coverage, a WHO informal consultation on vaccine virus selection planned for December and the newly updated leaflet on case management of severe disease. This issue also provides a short synopsis of a series of pandemic preparedness workshops, held jointly this autumn by WHO/Europe and ECDC, and includes links to more detailed summaries of the workshops that have already taken place. The influenza team at WHO/Europe reminds everyone to make sure to get their influenza vaccine, just as they did in October (see photo above). We would like to thank the Member States, our WHO collaborating centres, our partner organization ECDC and the many experts who contribute to the work of WHO/Europe who made this publication possible. TOPICAL FEATURES 1. Summary of the first post-pandemic influenza season in the WHO European Region (2010-2011 season) An overview of the 2010-2011 influenza season has just been published on the WHO/Europe web site. The overview gives an outline of surveillance in the WHO European Region and highlights the main trends observed in the first post-pandemic influenza season in the Region. Two of the main observations in the 2010-2011 influenza season were that the main viruses circulating were pandemic A(H1N1) 2009 virus and influenza B and that the vast majority of the circulating influenza viruses matched well with viruses recommended by WHO for inclusion in the influenza vaccine for the northern hemisphere 2010-2011 season. Influenza had a lower impact in the community in most countries compared with the pandemic. Severe disease due to influenza was seen more commonly in patients less than 65 years of age, as was seen during the pandemic. Read the complete summary at: http://www.euro.who.int/en/what-we-do/health-topics/communicable- diseases/influenza/publications/2011/summary-of-the-first-post-pandemic-influenza-season- in-the-who-european-region-2010-2011 2. WHO/Europe recommendations on influenza vaccination during the 2011-2012 winter season WHO has released its yearly recommendation for the northern hemisphere influenza vaccine and recommends the following virus strains to be included in the influenza vaccine for the 2011-2012 winter season: A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like and B/Brisbane/60/2008-like antigens. Furthermore, WHO recommends that the following groups be vaccinated:  individuals >6 months with chronic heart or lung diseases, metabolic or renal disease, chronic liver disease, chronic neurological conditions, immunodeficiencies; 20  elderly persons over a nationally defined age limit, irrespective of other risk factors;  pregnant women;  health care workers including those that work in homes that care for older persons or those with disabilities;  residents of institutions for older persons and the disabled; and  other groups defined on the basis of national data and capacities. View the complete recommendations at: http://www.euro.who.int/en/what-we- do/health-topics/communicable-diseases/influenza/publications/2011/whoeurope- recommendations-on-influenza-vaccination-during-the-20112012-winter-season Other relevant references: From WHO/Europe influenza site: http://www.euro.who.int/en/what-we-do/health-topics/communicable- diseases/influenza/activities/influenza-vaccines-and-immunization From WHO headquarters: http://www.who.int/influenza/vaccines/virus/recommendations/recommendations_2011_12nort h/en/index.html 3. Survey on seasonal influenza vaccine recommendations and coverage during 2008- 2009 and 2009-2010 seasons In 2003, the World Health Assembly adopted Resolution WHA 56.19 urging Member States to increase influenza vaccination coverage of all people at high risk and to attain coverage of 75% among the elderly by 2010. To assess progress towards this goal, in coordination with ECDC and the VENICE Collaboration (http://venice.cineca.org/), WHO/Europe is conducting a survey in 53 Member States of the WHO European Region on seasonal influenza vaccine recommendations and coverage during the seasons 2008-2009 and 2009-2010. This survey is intended to provide a baseline for all 53 Member States from which to measure future improvements in seasonal influenza vaccine uptake in the Region. The survey, which will be distributed on an annual basis, aims to identify country specific influenza vaccination recommendations, vaccine promotion activities and to assess potential gaps in vaccine provision. In 2010, a similar survey on the use of pandemic influenza A(H1N1) 2009 vaccine in the region was carried out and the obtained data are currently being analysed. The information collected will be used to compile a summary of pandemic influenza A(H1N1) 2009 and seasonal vaccination efforts in the Region from 2008 to 2010. This summary will be shared with participating Member States with the aim of building a common knowledge base and strengthening the performance of influenza vaccination programmes. SURVEILLANCE AND LABORATORY 4. EuroFlu bulletin update (week 42, 2011) Only a few sporadic cases of influenza detected in the WHO European Region Consultation rates for ILI and ARI in outpatient clinics and hospitalizations due to SARI are at low levels throughout the WHO European Region (green on the map). There have been sporadic 21 detections of influenza A(H3N2), influenza A(H1N1)pdm09 and influenza B during recent weeks. For more detailed information, please see: EuroFlu: http://www.euroflu.org European Influenza Surveillance Network (EISN): http://www.ecdc.europa.eu/en/activities/surveillance/eisn/pages/index.aspx 5. WHO Informal Consultation for Improving Influenza Vaccine Virus Selection The second WHO Informal Consultation for Improving Influenza Vaccine Virus Selection will take place from 7-9 December 2011 in the Centre International de Conférences Genève (http://www.cicg.ch/en/).This consultation, a follow-up meeting to the WHO Informal Consultation on the same topic held from 14-16 June 2010, aims to improve the influenza vaccine virus selection process through: exploring ways to improve the extent, timeliness and quality of virological and epidemiological surveillance data; the development and application of new assays and new modeling approaches; the understanding of the relationship between virus characteristics and vaccine efficacy; and the general understanding of regulatory considerations. The Global Influenza Programme has secured limited funds to support the participation of two National Influenza Centres (NICs) per WHO region and is working closely with Regional Offices for nominations of these NICs. If you wish to participate in this meeting at your own cost, please send an email to gisrs-whohq@who.int by Friday, 11 November 2011, to express your interest and to provide your full contact details. WHO will review the requests received and issue official invitation letters. No registration fee is required. For more information about this consultation, please visit: http://www.who.int/influenza/vaccines/virus/mtg_improve_vaccine_virus_selection/en/ 6. Support to National Influenza Centres WHO/Europe continues to support National Influenza Centres (NICs) through training and the provision of proficiency panels, i.e. WHO External Quality Assessment Project for the detection of influenza viruses by PCR (EQAP). A total of 57 influenza laboratories from 45 Member States of the WHO European Region participated in the July 2011 WHO EQAP. Laboratories that do not achieve optimal results are provided with support. WHO/Europe works closely with the WHO collaborating centre for reference and research on influenza, the National Institute for Medical Research in Mill Hill, London, United Kingdom. In the coming months, WHO/Europe will provide financial support to three NIC from Lithuania, Bulgaria and the Russian Federation to receive training at the WHO collaborating centre. WHO/Europe will also support staff from the NIC of Estonia to receive training at the NIC of Finland. We would like to thank these laboratories for the important support they provide to the work of WHO. Other relevant references: External Quality Assessment Project (EQAP): http://www.who.int/influenza/gisrs_laboratory/external_quality_assessment_project/en/ WHO collaborating centre (NIMR): http://www.nimr.mrc.ac.uk/who-influenza-centre The National Institute for Health and Welfare of Finland: http://www.thl.fi/en_US/web/en/ 7. WHO/Europe workshop on sentinel influenza surveillance, 16-17 November 2011 in Istanbul WHO/Europe is organizing this workshop in order to bring together epidemiologists involved in sentinel influenza surveillance and staff from the ministries of health responsible for the 22 surveillance of communicable diseases. During the meeting, participants will discuss technical and operational issues related to influenza surveillance, as well as progress made since the implementation of sentinel surveillance in the countries. Participants of the meeting are from the Newly Independent States. A meeting report will be made available on the WHO/Europe web site following the workshop. 8. Nomenclature of the pandemic A(H1N1)2009 virus revised In view of the pandemic A(H1N1)2009 virus now being considered a seasonal virus, and in order to distinguish it from other influenza A(H1N1) viruses, it was agreed during the WHO Consultation on the Composition of Influenza Vaccines for the Southern Hemisphere 2012 to use the name A(H1N1)pdm09. PREPAREDNESS AND RESPONSE 9. Leaflet on case management of severe disease updated WHO/Europe has released an updated version of its leaflet on case management of severe influenza disease. As before, it contains a short overview of the risk groups for complications, the signs of severe disease related to seasonal influenza, recommendations on infection control, as well as the key elements of treatment of severe cases. View the updated leaflet at: http://www.euro.who.int/en/what-we-do/health-topics/communicable- diseases/influenza/publications/2011/seasonal-influenza-key-issues-for-case-management- of-severe-disease 10. Pandemic preparedness workshops In the autumn 2011, WHO/Europe and the European Centre for Disease Prevention and Control (ECDC) jointly held four workshops on pandemic preparedness. The workshops addressed the changes countries are making in their pandemic preparedness plans as a result of their experience with the pandemic (H1N1) 2009. As part of these changes, countries will put more emphasis on: flexibility, i.e. planning for multiple scenarios but responding based on local risk assessment; on risk communication, especially with health care providers; on more involvement of health care providers in pandemic planning and more emphasis on operational planning at the local level. Furthermore, possible future collaboration between countries on pandemic preparedness, as well as expectations for WHO and ECDC, were addressed during the workshops Summaries of the three first workshops can be found on the WHO/Europe web site at: http://www.euro.who.int/en/what-we-do/health-topics/communicable- diseases/influenza/activities/pandemic-preparedness/joint-who-regional-office-for- europeecdc-workshops-on-pandemic-preparedness. The fourth workshop will take place on 14-15 November and a full report of the four workshops will be published subsequently. OTHER 11. Useful links and resources: WHO/Europe influenza site http://www.euro.who.int/influenza WHO/Europe Vaccine-preventable diseases and immunization site http://www.euro.who.int/vaccine WHO headquarters Immunization, vaccines and biologicals site http://www.who.int/immunization/en/ 23 WHO headquarters influenza site http://www.who.int/csr/disease/influenza/en/ European Centre for Disease Prevention and Control (ECDC) influenza site http://www.ecdc.europa.eu/en/healthtopics/influenza/Pages/index.aspx _________________ Sent to you from the WHO Regional Office for Europe You can find the current and archived issues of Flu Focus on the WHO Regional Office for Europe web site http://www.euro.who.int/flufocus If you have received this e-magazine and wish to add colleagues, partners, associates or friends (or if you wish to unsubscribe), please contact influenza@euro.who.int WHO/EURO:2014-6903-46669-67868 © World Health Organization 2011. All rights reserved. 24 Issue No.5, June 2012 From the WHO Regional Office for Europe (WHO/Europe) - http://www.euro.who.int/ Flu Focus is an e-magazine published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials and resources on influenza. Flu Focus provides updates on influenza and spotlights key features that the WHO Regional Office for Europe would like to bring to your attention. It is sent on a regular basis throughout the influenza season (week 40 – week 20 in the following year). We hope that you will consider this e-magazine as a channel through which to share information across the Region. Flu Focus welcomes new knowledge and experiences in influenza responses – such as your case studies, strategic thinking, supporting material and any other relevant documentation. Please contact influenza@euro.who.int if you wish to submit something for a future issue. This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe website at http://www.euro.who.int/flufocus in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: http://www.euro.who.int/flufocus на английском и русском языках. In this issue: TOPICAL FEATURES 1. Overview of 2011-2012 influenza season in the WHO European Region SURVEILLANCE AND LABORATORY 2. EuroFlu Bulletin update (week 24, 2012) 3. EuroFlu Bulletin look and format updated 4. Report: Taking stock of influenza surveillance in newly independent states 5. Annual joint WHO/Europe and ECDC influenza surveillance meeting 6. Strengthening capacities of influenza laboratory experts: WHO practical course on molecular identification of influenza 7. Mission to review influenza surveillance in Kazakhstan INFLUENZA VACCINE 8. WHO recommendation on 2012-2013 influenza vaccine composition 9. New SAGE recommendations on seasonal influenza vaccine 10. Initial results of VENICE survey PREPAREDNESS AND RESPONSE 11. Report: Key changes to pandemic plans by Member States of the WHO European Region based on lessons learnt from the 2009 pandemic 12. Experts from Tajikistan visit Finland, Denmark as part of pandemic plan revision process 13. Austrian Ministry of Health begins revision of pandemic plan UPCOMING MEETINGS 14. WHO/Europe annual surveillance meeting 15. Pandemic preparedness meetings 16. 1st ISARIC Council Meeting OTHER 17. Peer-reviewed publications 18. Report on management of influenza in resource-limited settings 19. Useful links and resources 25 Issue No.5 Summary At the conclusion of the 2011-2012 influenza season, this issue of Flu Focus offers an overview of the season and highlights the main events and activities that took place during the season. These included several meetings, workshops and missions held around the European Region on topics ranging from the revision of pandemic preparedness plans to influenza surveillance. This issue also provides information about WHO recommendations for the composition of influenza vaccine for the 2012-2013 influenza season in the northern hemisphere, as well as new SAGE recommendations on seasonal influenza vaccine. It shares information about upcoming meetings and provides a list of peer-reviewed publications produced by the influenza programme at WHO/Europe in recent months. We would like to thank the Member States, our WHO collaborating centres, our partner organization ECDC and the many experts who contribute to the work of WHO/Europe who made this publication possible. TOPICAL FEATURES 1. Overview of 2011-2012 influenza season in the WHO European Region The 2011-2012 influenza season began late and was mild compared with recent years. Most countries in the Region reported lower ILI and ARI consultation rates and fewer virological influenza detections in comparison with previous seasons. The season was largely dominated by influenza A(H3N2) virus in contrast to the 2010-2011 season, where A(H1N1)pdm09 was the dominant virus circulating. Resistance to the antivirals oseltamivir and zanamivir was not detected in this season. The complete overview will be posted on the WHO/Europe web site in the coming weeks. SURVEILLANCE AND LABORATORY 2. EuroFlu Bulletin update (week 24, 2012) Influenza activity is at out-of-season levels Based on data reported in week 24/2012 by 32 Member States in the WHO European Region, consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) are now at low levels in all countries in the Region. Only 1 of the 98 specimens (1.0%) collected from sentinel sources tested positive for influenza (type B). 3. EuroFlu Bulletin look updated During the 2011-2012 influenza season, WHO/Europe updated the look and format of the EuroFlu Bulletin. The changes included adding new graphs and tables for a more visual presentation of influenza surveillance data. WHO/Europe plans to continue making updates and improvements to the EuroFlu Bulletin’s look and layout in the coming months, and your feedback about the new format and/or suggested changes is welcome via email: influenza@euro.who.int. 4. Report: Taking stock of influenza surveillance in the newly independent states (NIS) Sentinel surveillance is considered the most efficient system for routine monitoring of influenza, as it provides timely and high-quality data from a limited number of sites. Since 2008, the World Health Organization Regional Office for Europe (WHO/Europe) and the Centers for Disease Control and Prevention (CDC), Atlanta, United States, have collaborated with Member States of the WHO European Region to strengthen sentinel surveillance for influenza. The newly independent states (NIS) have been a particular focus in this regard. In order to review progress in the implementation of sentinel influenza surveillance, a meeting was organized with key experts from the Ministries of Health and national influenza focal points from all NIS. Opportunities and challenges for moving from a universal surveillance of influenza and other respiratory diseases to a sentinel system were also discussed. To see the complete report in English or Russian, please visit: http://www.euro.who.int/en/what- we-do/health-topics/communicable-diseases/influenza/publications/2012/who-meeting-taking- stock-of-influenza-surveillance-in-the-newly-independent-states 26 5. Annual joint WHO/Europe and ECDC influenza surveillance meeting On 30 May–1 June 2012, WHO/Europe and the European Centre for Disease Prevention and Control (ECDC) jointly held their second Annual Influenza Working Meeting in Warsaw, Poland. The meeting attracted over 130 participants from 38 countries, including all EU Member States, countries participating in the South East Europe Health Network, Israel, Switzerland and Turkey. The main work undertaken by delegates in over 20 sessions and 70 talks and discussions was reviewing progress in the last 12 months and agreeing on the work for the coming year. The main meeting covered a wide range of topics in influenza virology and epidemiology, reviewed developments in the TESSy and EuroFlu (the respective ECDC and WHO/Europe influenza surveillance platforms), reported on the activities of the ECDC Community Network Reference Laboratory and the National Influenza Centres, and included a special session on influenza vaccination. A summary report of the meeting will be published later this year and made available on the Internet. The web news story about the meeting can be found here: http://www.euro.who.int/en/what-we-do/health-topics/communicable- diseases/influenza/news/news/2012/6/joint-whoeurope-and-ecdc-annual-influenza-meeting- reflects-on-work-in-progress 6. Strengthening capacities of influenza laboratory experts: WHO practical course on molecular identification of influenza In order to strengthen laboratory capacities for the diagnosis and surveillance of influenza virus infection, the WHO Regional Office for Europe organizes regular training for laboratory staff in influenza virology, molecular techniques and laboratory quality. It also provides quality assurance programs. In May 2012, WHO/Europe held laboratory training on molecular identification of influenza in cooperation with the Research Institute of Influenza of the Ministry of Health, St. Petersburg, Russian Federation. The Institute is a WHO-recognized National Influenza Centre. The specific aim of this training was to provide selected experts from National Influenza Centres and national influenza laboratories with comprehensive laboratory skills in molecular identification of circulating human influenza virus strains. Participants attended from national influenza laboratories in Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan and the Republic of Moldova. Topics addressed during the week-long training included laboratory specimen processing and testing algorithm, viral RNA extraction, principles of real-time reverse-transcription polymerase chain reaction and interpretation of results. The agenda included both formal lectures and practical sessions, which involved hands-on training. The training resulted in improved skills and knowledge for all participants, and the curriculum was subsequently provided to all those who took part. 7. Mission to review influenza surveillance in Kazakhstan Kazakhstan is one of approximately 15 countries in the WHO European Region that performs hospital surveillance of severe disease caused by influenza. Such routine hospital surveillance allows identification of persons at risk for developing severe disease as a result of influenza infection, as well as information on the relative severity of seasonal and pandemic influenza. This type of surveillance was identified as a gap during the 2009 pandemic. Kazakhstan has established a system of 19 sentinel hospitals that report and test cases of severe acute respiratory infections (SARI) according to guidance provided by WHO/Europe. During a mission to the country from 30 May to 7 June 2012, WHO staff discussed the data being collected with national and regional focal points from the Ministry of Health and Sanitary Epidemiological Stations from the cities of Astana and Almaty and from Taldikorgan in the Almaty region and reviewed the activities of the laboratory network. Discussions with the Ministry of Health focused on effective collection and use of surveillance data to inform influenza prevention and control measures. In particular, WHO staff emphasized the benefits of performing influenza testing among only those patients presenting at sentinel sites in order to use resources most efficiently. A similar recommendation was 27 made during an inter-country meeting in 2011 involving 12 NIS countries (see the above report of the WHO Meeting: Taking stock of influenza surveillance in the newly independent states). To view the WHO/Europe guidance for sentinel influenza surveillance in humans, follow this link: http://www.euro.who.int/en/what-we-do/health-topics/communicable- diseases/influenza/publications/2009/who-regional-office-for-europe-guidance-for-sentinel- influenza-surveillance-in-humans For a description of the system in Kazakhstan, follow this link: http://www.euroflu.org/documents/Overview_of_SARI_Surveillance_Systems_13.02.2012.pdf INFLUENZA VACCINE 8. WHO recommendation on 2012-2013 influenza vaccine composition The periodic update of virus strains contained in influenza vaccine is necessary due to the constant evolution of circulating influenza viruses. This leads to changes of the antigenic and genetic characteristics and, hence, a reduced match of the vaccine with circulating virus strains. How closely the vaccine matches circulating virus strains is an important factor for the effectiveness of the vaccine. WHO monitors the evolution of influenza viruses through analysis of viruses shared by National Influenza Centres (NIC) with the WHO collaborating centres for reference and research on influenza, as well as through analysis performed by the NIC, themselves. During the 2011-2012 influenza season, NIC in the WHO European Region analysed the antigenic characteristics of 2 068 influenza viruses. Based on global surveillance data related to the epidemiology and antigenic characteristics of influenza viruses, serological responses to 2011-2012 trivalent seasonal vaccines, and the availability of candidate strains and reagents, WHO recommends that influenza vaccines for use in the upcoming 2012–2013 northern hemisphere influenza season contain the following viruses: • an A/California/7/2009 (H1N1)pdm09-like virus; • an A/Victoria/361/2011 (H3N2)-like virus; and • a B/Wisconsin/1/2010-like virus. The viruses shared by the National Influenza Centres of the WHO European Region contributed significantly to the new recommendations. The complete report can be viewed here: http://www.who.int/influenza/vaccines/virus/recommendations/2012_13_north/en/ A “Questions and Answers” document concerning the recommended composition of influenza virus vaccines for use in the 2012–2013 northern hemisphere influenza season can be viewed here: http://www.who.int/influenza/vaccines/virus/recommendations/201202_qanda_recommendat ion.pdf 9. New SAGE recommendations on seasonal influenza vaccine At its April 2012 meeting, based on new evidence gathered since the previous recommendations were published in 2005, the Strategic Advisory Group of Experts on Immunization (SAGE) provided new recommendations on seasonal influenza vaccine. In countries considering initiating or expanding vaccination programs for influenza, SAGE recommends pregnant women as the most important risk group for inactivated seasonal influenza vaccination. Other risk groups to be considered, in no specific priority order are: health-care workers, children aged 6–59 months, the elderly and those with high risk conditions. WHO/Europe will support the Member States of the European Region to implement these recommendations according to their country priorities and capacities. The complete report from the SAGE meeting, including more detailed information about the new recommendations, can be found by following via this link: http://www.who.int/wer/2012/wer8721.pdf 28 10. Initial results of VENICE survey In October 2011, WHO/Europe in partnership with the VENICE collaboration1 and ECDC performed a survey on seasonal influenza vaccine recommendations and coverage among all Member States in the European Region. The survey was completed by 48 of 53 Member States. It showed that while the vast majority of countries is implementing seasonal influenza vaccination programmes, vaccination uptake in key target groups remains low in many countries with only one country reaching the WHO 2010 target of achieving >75% coverage among elderly. WHO/Europe will continue to work with Member States to increase vaccination uptake in priority target groups, as defined by each country, through an improved understanding of the barriers to achieving high vaccination coverage. PREPAREDNESS AND RESPONSE 11. Report: Key changes to pandemic plans by Member States of the WHO European Region based on lessons learnt from the 2009 pandemic Between September and November 2011, WHO/Europe and ECDC organized four joint workshops on pandemic plan revisions. A total of 45 countries participated in these workshops, with the purpose of summarizing key changes being made to pandemic preparedness plans and enabling countries to learn from each other's experiences. A joint report on the workshops was published earlier this year, which provides the key conclusions and recommendations from the four workshops. To read the report in English or Russian, follow this link: http://www.euro.who.int/en/what- wedo/health-topics/communicable-diseases/influenza/publications/2012/key-changes-to- pandemic-plans-by-member-states-of-the-who-european-region-based-on-lessons-learnt- from-the-2009-pandemic Additionally, three countries in the Region (the Czech Republic, France and the United Kingdom) have published revised plans based on the experience from the 2009 pandemic. View these and other national plans at: http://www.euro.who.int/en/what-we-do/health- topics/communicable-diseases/influenza/country-work/national-plans Finland most recently published a new version of the Finnish preparedness plan for an influenza pandemic. It is available (in Finnish) on the website of the Ministry of Social Affairs and Health: http://www.stm.fi/c/document_library/get_file?folderId=240565&name=DLFE- 20728.pdf 12. Experts from Tajikistan visit Finland and Denmark as part of pandemic plan revision process On 14–16 May 2012, two experts in pandemic preparedness from Tajikistan spent time with the members of the Influenza & other Respiratory Pathogens (IRP) programme at WHO/Europe in Denmark. The purpose of their visit was to revise their pandemic preparedness plan and create a plan that was less focused on pandemic preparedness and more applicable to general emergency preparedness. During the visit, the experts had many useful discussions with members of the IRP, Alert and Response (ARO), Country Emergency Preparedness (CEP) and Public Health Services (PHS) programmes at WHO/Europe. Just prior to the meetings in Copenhagen, the specialists from Tajikistan met with colleagues from Tampere University, Finland, and representatives from the Finnish National Board for Pandemic Preparedness on 12–13 May 2012. They shared experiences related to pandemic preparedness plan development and revision. Participants of both meetings gave positive feedback about the visits. WHO/Europe wishes to thank those who took an active part in the meetings and looks forward to future collaboration with Tajikistan in the area of pandemic preparedness. 1 Vaccine European New Integrated Collaboration Effort http://venice.cineca.org/ 29 13. Austrian Ministry of Health begins revision of pandemic plan An evaluation of the 2009 influenza pandemic has been conducted in Austria, and the Federal Ministry of Health has subsequently initiated the planning process to update the Austrian National Pandemic Plan. On 25 June 2012, the Ministry held a kick-off event for the process, followed by a national-level workshop with all stakeholders. Representatives from WHO/Europe, ECDC and DG SANCO also attended the workshop. UPCOMING MEETINGS 14. WHO/Europe Annual Influenza Surveillance Meeting This meeting, scheduled for September 2012, will focus on sentinel hospital surveillance for severe disease caused by influenza, national influenza bulletins and will include a briefing on the Pandemic Preparedness Framework that was endorsed at the 2011 World Health Assembly 64. National influenza focal points from approximately 15 countries, primarily the newly independent states (NIS), will be invited, as well as staff from the WHO Collaborating Centre for Reference and Research on Influenza, London, United Kingdom. The meeting will build on discussions held during the 2011 meeting in Istanbul, which reviewed the strengths and weaknesses of different surveillance systems for influenza, as well as on information obtained from missions to individual countries (see item above about Kazakhstan mission). 15. Pandemic preparedness meetings WHO/Europe and ECDC will jointly arrange and conduct a series of workshops in the last quarter of 2012. All 53 Member States of the Region will be invited to attend. These workshops will aim to share good practices and make use of the experience gained in pandemic planning for other public health threats as part of national and regional level preparedness and IHR implementation. The meetings will follow the principles of rolling workshops used in the 2011 series of pandemic preparedness workshops, ensuring that experiences from the first will be included in the second, and so forth. 16. 1st ISARIC Council Meeting It is clear from a series of recent outbreaks that initiating clinical research in response to a rapidly emerging infectious disease is extremely challenging, but increasingly important. The International Severe Acute Respiratory Infection Consortium (ISARIC) was formally launched in December 2011 with the goal of establishing a new paradigm for collaborative clinical research in rapidly emerging public health threats. The initial focus of ISARIC is severe respiratory infections with the aim to change the current approach to clinical research during outbreaks. On 2–4 July 2012 ISARIC will hold its first official meeting since it was launched. At this initial meeting, Dr Caroline Brown, programme manager of the Influenza & other Respiratory Pathogens programme at WHO/Europe, will present on the European experience during the 2009 pandemic and the Region’s needs regarding clinical research for future pandemics. OTHER 17. Peer-reviewed publications The members of the Influenza & other Respiratory Pathogens (IRP) Programme at WHO/Europe occasionally author peer-reviewed articles for medical journals, with the intention of disseminating information about the work done in collaboration with Member States to a wider audience. Recent published work and accompanying links are listed below. • Liana Martirosyan, W John Paget, Pernille Jorgensen, Caroline S Brown, Tamara J Meerhoff, Dmitriy Pereyaslov, Joshua A Mott, and the EuroFlu group. The community impact of the 2009 influenza pandemic in the WHO European Region: a comparison with historical seasonal data from 28 countries. BMC Infectious Diseases 2012 12:36. doi:10.1186/1471-2334-12-36. http://www.biomedcentral.com/1471-2334/12/36 30 • Angus Nicoll, Caroline Brown, Franz Karcher, Pasi Penttinen, Michala Hegermann- Lindencrone, Silvia Villanueva, Massimo Ciotti, Lucie Jean-Gilles, Sybille Rehmet & Jonathan S Nguyen-Van-Tam. Developing pandemic preparedness in Europe in the 21st century: experience, evolution and next steps. Bulletin of the World Health Organization Volume 90, Number 4, April 2012, 245-320. http://www.who.int/bulletin/volumes/90/4/11-097972/en/index.html • Ahmed Hashim, Lucie Jean-Gilles, Michala Hegermann-Lindencrone, Ian Shaw, Caroline Brown and Jonathan Nguyen-Van-Tam. Did pandemic preparedness aid the response to pandemic (H1N1) 2009? A qualitative analysis in seven countries within the WHO European Region. In press for Journal of Infection and Public Health. http://www.sciencedirect.com/science/article/pii/S1876034112000603 18. Report on management of influenza in resource-limited settings The report “Clinical management of influenza and other acute respiratory illness in resource- limited settings: learning from the influenza pandemic (H1N1) 2009” has been published on the WHO headquarters website at: http://www.who.int/influenza/patient_care/clinical/858- WHOGIPReport_A4_WEB_FA.pdf 19. Useful links and resources WHO/Europe influenza site http://www.euro.who.int/influenza WHO/Europe Vaccine-preventable diseases and immunization site http://www.euro.who.int/vaccine WHO headquarters Immunization, vaccines and biologicals site http://www.who.int/immunization/en/ WHO headquarters influenza site http://www.who.int/csr/disease/influenza/en/ European Centre for Disease Prevention and Control (ECDC) influenza site http://www.ecdc.europa.eu/en/healthtopics/influenza/Pages/index.aspx _________________ Sent to you from the WHO Regional Office for Europe You can find the current and archived issues of Flu Focus on the WHO Regional Office for Europe website http://www.euro.who.int/flufocus If you have received this e-magazine and wish to add colleagues, partners, associates or friends (or if you wish to unsubscribe), please contact influenza@euro.who.int WHO/EURO:2014-6903-46669-67868 © World Health Organization 2012. All rights reserved. 31 Issue No. 6, December 2012 From the WHO Regional Office for Europe, WHO/Europe – http://www.euro.who.int/ Flu Focus is an e-magazine published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials and resources on influenza. Flu Focus provides updates on influenza and spotlights key features that the WHO Regional Office for Europe would like to bring to your attention. It is sent on a regular basis throughout the influenza season (week 40 − week 20 in the following year). We hope that you will consider this e-magazine as a channel through which to share information across the Region. Flu Focus welcomes new knowledge and experiences in influenza responses – such as your case studies, strategic thinking, supporting material and any other relevant documentation. Please contact influenza@euro.who.int if you wish to submit something for a future issue. This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe web site at http://www.euro.who.int/flufocus in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: http://www.euro.who.int/flufocus на английском и русском языках. In this issue TOPICAL FEATURES 1. Update on novel coronavirus SURVEILLANCE AND LABORATORY 2. Situation analysis of current influenza season 3. Report: Second annual joint WHO/Europe and ECDC Influenza Surveillance Meeting 4. Subregional influenza surveillance meeting 5. Better Labs for Better Health initiative 6. Training courses to minimize risk in shipping of infectious substances 7. Country missions INFLUENZA VACCINE 8. Flu Awareness Day 2012 9. Updated WHO position paper on seasonal influenza vaccination 32 10. WHO/CDC International meeting on influenza vaccine effectiveness PREPAREDNESS AND RESPONSE 11. Pandemic preparedness guidelines and workshop 12. Upcoming release of new textbook: Pandemic Influenza UPCOMING MEETINGS 13. Third annual joint WHO/Europe and ECDC Influenza Surveillance Meeting 14. WHO Consultation on the Composition of Influenza Vaccines for the northern hemisphere 2013–2014 OTHER 15. Recent meetings on influenza disease burden and mortality 16. Peer-reviewed publications 17. Useful links and resources Issue No. 6 summary This issue of Flu Focus offers a flu surveillance update on the 2012–2013 influenza season and an update on the status of a novel coronavirus identified in September 2012. It shares the latest news on influenza-related activities in the European Region, including summaries of expert meetings and WHO country missions. It also provides details of upcoming events and recent publications as well as a list of useful links for further information. We would like to thank the Member States, our WHO collaborating centres, our partner organizations the European Centre for Disease Prevention and Control (ECDC), the United States Centers for Disease Control and Prevention (CDC) and the many experts who contribute to the work of WHO/Europe who made this publication possible. TOPICAL FEATURE 1. Update on novel coronavirus In September 2012, WHO was alerted to the identification of a novel coronavirus in two patients from Saudi Arabia and Qatar who presented with symptoms of severe respiratory disease. Further investigation confirmed a total of 9 cases, 5 of which were fatal, that had occurred in the period April–October 2012 in Saudi Arabia, Qatar and Jordan. Characterization of the full genome sequence of the virus indicates that it belongs to a novel species of coronavirus in the genus Betacoronavirus that is distinct from other known coronaviruses and severe acute respiratory syndrome (SARS). On 29 September WHO issued an interim case definition to help countries strengthen health protection measures against the new virus. From 26 November to 3 December, WHO/Europe and ECDC conducted a rapid survey among Member States on the capabilities of national laboratories to detect and confirm novel coronavirus. Survey 33 findings are being used to develop laboratory testing guidance and to identify other support needs. The reservoir and mode of transmission of the novel coronavirus are under investigation and WHO continues to monitor the situation. No additional cases have been reported to WHO under the International Health Regulations since November; and there is no evidence so far of person-to-person transmission of the novel coronavirus. Findings of the WHO/Europe-ECDC survey were reported in a Eurosurveillance rapid communication on 6 December 2012 Further information and regular updates can be found on the new Coronavirus page set up on the WHO/Europe web site SURVEILLANCE AND LABORATORY 2. Situation analysis of current influenza season (weeks 40–49/2012) The influenza season is slowly beginning in the WHO European Region. Consultation rates for influenza-like illness and acute respiratory infection in outpatient surveillance are at low levels (see map 2: Intensity) and influenza viruses are being sporadically detected in a number of countries (see map 3: Geographic spread). Since the start of the season, influenza A and influenza B viruses have been detected in equal proportions. Of the influenza A subtyped viruses, both A (H3N2) and A(H1N1)pdm09 are circulating. Influenza positive cases were generally reported by countries in western Europe, with more than half of the positive samples reported by 5 countries. Of the influenza viruses characterized antigenically since week 40/2012 (n=43), all correspond with the viruses recommended by WHO for inclusion in the current northern hemisphere seasonal influenza vaccine. The number of hospitalizations due to severe acute respiratory infection (SARI) is at pre-season levels, with only 8 influenza cases detected out of 1200 tested since week 40/2012. 34 WHO/Europe coordinates influenza surveillance with ECDC. For more detailed information, please see the EuroFlu bulletin and the ECDC Weekly Influenza Surveillance Overview (WISO). An update of the situation will be published later in the season. 3. Report: Outcome of second annual WHO/Europe and ECDC Influenza Surveillance Meeting The report on the second annual joint WHO/Europe and ECDC meeting on influenza surveillance held on 30 May−1 June 2012, in Warsaw, Poland has just been released. The report summarizes the discussions, conclusions and recommendations of the meeting’s various working groups, which focused on disease surveillance and mortality monitoring over the previous year and preparations for the 2012–2013 influenza season. The next annual joint WHO/Europe and ECDC Influenza Surveillance Meeting will take place on 29–31 May 2013. Meeting report 4. Subregional influenza surveillance meeting Over 70 epidemiologists, virologists and clinicians involved in influenza surveillance from ten newly independent states (NIS), and the hosting country Latvia, met with experts from Denmark, Romania, Spain, the United Kingdom, WHO headquarters and the United States Centers for Disease Control and Prevention (CDC) on 11–14 September 2012 in Riga, Latvia. Topics included a review of preparations for the 2012–2013 influenza season and studies on the burden of influenza, country presentations on national influenza surveillance systems, presentations of severe influenza cases by clinicians from five countries participating in sentinel SARI surveillance and training on designing a national weekly influenza surveillance bulletin. More information 5. Better Labs for Better Health initiative Improving the quality of laboratory services in health care systems is an essential step towards protecting the health of a country’s population and strengthening the health care system as a whole. WHO/Europe is leading an initiative to improve laboratory capacity and strengthen biosafety in Kyrgyzstan, Republic of Moldova and Tajikistan, with the dual aims of improving the health systems in these countries and developing a model of laboratory strengthening that can be applied in developing countries throughout the Region and beyond. The Better Labs for Better Health initiative was announced at the 4th Annual Conference of the Biosafety Association for central Asia and the Caucasus (BACAC) held 18–20 September 2012 in Almaty, Kazakhstan. 35 More information 6. Training course to minimize risk in shipping of infectious substances WHO headquarters and WHO/Europe conducted a two-day Infectious Substances Shipping Training (ISST) course in Almaty, Kazakhstan, in September 2012. The training in safe packing and transport was aimed at virologists, bacteriologists and laboratory managers and was based on the requirements and standards of the International Air Transport Association (IATA), the International Civil Aviation Organization (ICAO) and the Universal Postal Union (UPU). Successful completion of the course earned participants a 24-month certificate to perform international shipping of infectious substances. Training course in Kazakhstan 7. Country missions Ukraine, 27–31 August 2012 WHO/Europe undertook a mission to Ukraine with CDC to review the implementation of sentinel and universal surveillance for influenza at polyclinics and hospitals (including case definitions, respiratory sample collections, data collection and laboratory analysis) and to discuss options for improving data exchange and integration of the current systems for influenza with stakeholders at the Ministry of Health, Gromachevskyi Institute, State Sanitary Epidemiological Service and State Sanitary Epidemiological Station. Azerbaijan, 22–26 October 2012 This mission was conducted to assess progress in the implementation of sentinel surveillance in polyclinics and hospitals as well as in the performance and capacity of the National Influenza Laboratory. Key findings and recommendations for improvement of the influenza surveillance system were presented at the Ministry of Health on the last day of the mission. More information on the mission and Azerbaijan’s influenza surveillance system Uzbekistan, 29–31 October 2012 The mission was conducted to facilitate the initial stage of influenza sentinel surveillance implementation. Participants from three involved sentinel sites were invited for discussion and training at the National Influenza Center. The Deputy Minister of Health was briefed at the end of the mission. Republic of Moldova, 27–30 November 2012 WHO/Europe undertook a mission to Republic of Moldova with the WHO Collaborating Centre for Reference and Research on Influenza, London, the United Kingdom to evaluate progress of the National Influenza Laboratory in achieving the level of work necessary to meet the National Influenza Centre terms of reference and to become a member of the WHO Global Influenza Surveillance and Response System (GISRS). 36 INFLUENZA VACCINE 8. Flu Awareness Day Influenza vaccine uptake levels in the WHO European Region remain well below the WHO target. To promote vaccination in the Region and answer any questions about influenza prevention and treatment, a group of WHO experts hosted a live twitter chat on 1 November 2012. This date at the start of the northern hemisphere’s influenza season has been designated Flu Awareness Day in the WHO European Region. A feature article on the WHO/Europe home page including a video detailing “The 5 things everyone needs to know about flu” provided additional sources of information to raise public awareness. Feature article 9. Updated WHO position paper on seasonal influenza vaccine publishedOn 23 November 2012, WHO published a new position paper on influenza vaccination. The position paper was updated to reflect new evidence accumulated since 2005 related to influenza burden and vaccine effectiveness and safety in the elderly, pregnant women, children (6 months–5 years), individuals with underlying medical conditions and health care workers, including new data on the epidemiology of influenza in developing and tropical countries. Based on an extensive literature review, the WHO Strategic Advisory Group of Experts (SAGE) recommended that pregnant women be given high priority in countries considering initiating influenza vaccine programmes or expanding the target groups to receive vaccination. The new recommendations also emphasize the inclusion of children aged 6–59 months in national vaccination programmes for influenza depending on national capacity and resources in addition to the traditional target groups: the elderly, persons with chronic illness, health care workers and residents of institutions for older persons and the disabled. Vaccines against influenza. WHO position paper – November 2012 (Available in English, French and soon also in Russian) Meeting of the Strategic Advisory Group of Experts on immunization, April 2012 – conclusions and recommendations 10. WHO/CDC International meeting on influenza vaccine effectiveness, 3–4 December 2012, Geneva, Switzerland The objectives of the meeting were to: • review recent data from influenza vaccine effectiveness studies; • discuss and agree on optimal methodologies for vaccine effectiveness measurements; • explore best practices for conducting vaccine effectiveness studies; 37 • determine critical knowledge gaps in the availability of efficacy or effectiveness data with a particular focus on low and middle-income countries; • discuss challenges in communicating influenza vaccine effectiveness and its importance in vaccine policy development and implementation to derive principles that will help partners communicate effectively with key stakeholders. The meeting concluded with a discussion of next steps, which included proposals to review influenza vaccine effectiveness on a global level, identify gaps in existing data, and develop a WHO guidance document on best practices in conducting vaccine effectiveness studies. PREPAREDNESS AND RESPONSE 11. Pandemic preparedness guidelines and workshop A key activity of WHO/Europe in collaboration with ECDC is to provide Member States with guidance in the development of pandemic influenza preparedness strategies. In response to gaps identified following the 2009 pandemic, Member States are reviewing and revising their preparedness plans. WHO/Europe and ECDC are revising existing European guidance for this effort in line with revisions of the WHO global pandemic preparedness and response guidance. As part of this process, WHO/Europe conducted a workshop in Copenhagen, Denmark, on 5–7 December 2012 for countries of the South-eastern Europe Health Network, the newly independent states, Israel, Switzerland and Turkey. Representatives of 23 Member States presented posters on their countries’ health systems and pandemic preparedness plans, worked in groups to test these plans in the context of two real case studies and exchanged valuable feedback with WHO and ECDC influenza experts. More information on the workshop 12. Upcoming release of new textbook: Pandemic Influenza The second edition of this textbook, which includes a chapter co-authored by WHO/Europe influenza experts Dr Caroline Brown and Michala Hegermann- Lindencrone, is in press and scheduled for release by the end of December 2012. The book is written for students in virology, epidemiology, infectious diseases, public health and medical sciences and will be of interest to all those involved in pandemic preparedness. Incorporating major lessons from the 2009–2010 pandemic, it covers areas such as influenza epidemiology, virology and immunology, vaccinology, pharmaceutical and public health countermeasures, policy issues, biomathematical 38 modelling and ethics. The information is illustrated with case studies in nine countries. Brown, C and Hegermann-Lindencrone, M, “Pandemic preparedness” in Van-Tam, J and Sellwood, C (eds) (2012) “Pandemic Influenza, 2nd Edition”. CABI, Wallingford, United Kingdom. More information and publication notification UPCOMING MEETINGS 13. Third annual joint WHO/Europe and ECDC Influenza Surveillance Meeting This meeting is scheduled to take place in May 2013 and will bring together national influenza focal points from all 53 Member States of the WHO European Region/European Union and EEA Member States, as well as staff from the WHO Collaborating Centre for Reference and Research on Influenza, London, United Kingdom, and international influenza experts. For more information on the meeting please contact influenza@euro.who.int 14. WHO Consultation on the Composition of Influenza Vaccines for the northern hemisphere 2013-2014 Twice annually, WHO organizes consultations with an advisory group of experts to analyse influenza virus surveillance data generated by the WHO Global Influenza Surveillance and Response System (GISRS), and issues a recommendation on the composition of the influenza vaccines for the following influenza season. The consultation meeting for the 2013–2014 influenza season in the northern hemisphere will take place in Geneva, Switzerland, on 18–20 February 2013, followed by an Information Meeting on 21 February 2012 with vaccine manufacturers and national vaccine regulatory agencies. As usual, a representative of one National Influenza Centre in the WHO European Region has been invited as an observer to the meeting. OTHER 15. Recent meetings on influenza disease burden and mortality WHO Informal consultation on influenza disease burden 5–6 December 2012, Geneva, Switzerland The purpose of this meeting was to develop a clear strategy for addressing the critical gaps in our understanding of the influenza disease burden. The objectives were to: • review the status of the influenza disease burden work globally; • evaluate our current knowledge; 39 • discuss critical needs; • discuss next steps for addressing these needs, including coordination mechanisms between WHO and collaborators. WHO will utilize the information gained from these discussions to develop a clear strategy for addressing the critical gaps in our understanding of disease due to influenza. ECDC Influenza mortality workshop 2012 5–7 December 2012, Statens Serum Institut, Copenhagen, Denmark Twenty European countries collaborate in the European Mortality Monitoring Project, which is coordinated by Denmark’s Statens Serum Institut. The 2012 workshop was organized to develop, test and agree on common recommended multivariable models for use in estimating weekly mortality associated with influenza in Europe, while controlling for additional factors such as Respiratory Syncytial Virus (RSV) and meteorological data. As a result of these discussions, a European mortality model for the 2012/13 season will be developed and piloted. More information on the European Mortality Monitoring Project 16. Peer-reviewed publications of WHO/Europe Influenza and other Respiratory Pathogens Programme (IRP) members The IRP team regularly contributes to peer-reviewed articles for medical journals, with the intention of disseminating information about the work done in collaboration with Member States to a wider audience. The following articles published in the past six months were co-authored by IRP members: • Palm D, et al. Laboratory capability for molecular detection and confirmation of novel coronavirus in Europe, Nov. 2012. Euro Surveill. 2012;17(49):pii=20335. • Vega, T, et al. Influenza surveillance in Europe: establishing epidemic thresholds by the Moving Epidemic Method. Influenza and Other Respiratory Viruses Aug. 2012; doi: 10.1111/j.1750-2659.2012.00422.x 17. Useful links and resources WHO/Europe has contributed to translation of the following publications into Russian. • The WHO Laboratory Assessment Tool (and its annexes) Available to download in Russian and in English • The WHO/CDC/CLSI Laboratory Quality Management Training toolkit Available to download in Russian and in English 40 • WHO/CDC/CLSI Laboratory Quality Management Handbook (translation in progress) Available to download in English and through the WHO book shop as a hard copy in English WHO/Europe Influenza site WHO/Europe Vaccines and immunization site WHO headquarters Immunization, vaccines and biologicals site WHO headquarters Influenza site European Centre for Disease Prevention and Control (ECDC) influenza site ~ Sent to you from the WHO Regional Office for Europe Current and archived issues of Flu Focus are available on the WHO Regional Office for Europe web site at http://www.euro.who.int/flufocus If you have received this e-magazine and wish to add colleagues, partners, associates or friends (or if you wish to unsubscribe), please contact influenza@euro.who.int WHO/EURO:2014-6903-46669-67868 © World Health Organization 2012. All rights reserved. Issue No.7, March 2013 Flu Focus is an e-newsletter published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials, upcoming events and resources on influenza. It is sent on a regular basis throughout the influenza season (October – May). This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe web site at http://www.euro.who.int/flufocus in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: http://www.euro.who.int/flufocus на английском и русском языках. In this issue 1. Features: European Immunization Week Novel coronavirus update 2. Surveillance 3. Laboratory 4. Influenza vaccine 5. Pandemic preparedness and response 6. Upcoming events 7. Resources FEATURES European Immunization Week: 22–27 April 2013 Influenza and other vaccine uptake levels in the WHO European Region remain below the WHO targets. To promote immunization in the Region, WHO/Europe 41 leads and coordinates European Immunization Week, which takes place in April each year. Awareness-raising activities organized by participating Member States target parents and caregivers, health care professionals, policy-makers and the media. All are encouraged to actively participate through the EIW 2013 campaign site. Novel coronavirus update Since September 2012, 14 laboratory-confirmed cases of human infection with NCoV, including 8 deaths, have been reported to WHO by Jordan, Qatar, Saudi Arabia and the United Kingdom. The current understanding of this novel virus is that it can cause a severe, acute respiratory infection presenting as pneumonia. Three cases occurred in the same family cluster in Saudi Arabia, and three in the same family cluster in the United Kingdom (UK), however no sustained person-to- person transmission has been identified. It is not yet known how humans have become infected with this virus. Investigations are underway to determine the virus source, types of exposure that lead to infection, mode of transmission and the clinical pattern and course of disease. WHO continues to closely monitor the situation and encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied. Further recommendations and regular updates: WHO/Europe web page on coronavirus infections WHO headquarters Global Alert and Response ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium) clinical research protocols related to NCoV SURVEILLANCE Situation analysis of current influenza season (weeks 40–8/2013) In 2012/2013, the influenza season started in the west/north of the Region at the usual time (about week 49) with progression from west to east, with most western European countries peaking around week 5/2013. While in the eastern part of the Region (e.g. Kazakhstan, the Russian Federation, Ukraine) activity is still 42 increasing as of week 8. This is reflected in the fact that 47% of specimens collected from patients presenting with influenza-like illness (ILI) or acute respiratory infection (ARI) in the Region tested positive for influenza in week 8/2013. There is co-circulation of all three seasonal influenza viruses this season. Since the beginning of the season, based on data from outpatient and hospital surveillance 68% of viruses detected were influenza A and 32% influenza B. Of the subtyped influenza A viruses, 72% were A(H1N1)pdm09 and 28% A(H3N2). 91% of influenza B viruses for which the lineage was determined were of the B/Yamagata lineage (the influenza B virus recommended by WHO for inclusion in this season’s influenza vaccine) and (9%) were of the B/Victoria lineage. This situation is very different from the last influenza season, when A(H1N1)pdm09 and influenza B were detected in less than 10% of circulating viruses. Regarding the impact of influenza this season, the age groups most affected in outpatient surveillance were 0–4, followed by 5–14 and 15–64. In hospitalized cases, in countries performing sentinel surveillance for severe acute respiratory infections (SARI), the main age groups affected are 15–29 and 30–64. This coincides with a shift to dominance of A(H1N1)pdm09 (which is known to cause severe disease in these groups) in most of these countries, starting in week 3/2013 and reaching 64% of detections in week 8/2013. Influenza activity is still increasing in these countries, which are mainly located in the eastern part of the European Region: in week 8/2013, the per cent of SARI specimens positive for influenza continued to rise and was 36%. WHO/Europe coordinates influenza surveillance with ECDC. Detailed information is available in the weekly bulletins: WHO EuroFlu bulletin ECDC Weekly Influenza Surveillance Overview (WISO) Meeting report: Subregional meeting on influenza surveillance 11–14 September 2012, Riga, Latvia This meeting covered a wide range of topics in influenza virology and epidemiology, including a review of past activities and preparations for the 2012/2013 influenza season, studies on the burden of influenza, and country presentations on national influenza surveillance systems. Clinicians from five countries participating in sentinel SARI surveillance presented case studies of severe influenza cases. Among the key conclusions of the meeting was a recognition of the great strides in surveillance made in countries in the eastern part of the Region in the past decade and a call for further strengthening of virological and epidemiological surveillance 43 for mild and severe disease caused by influenza. Sharing this data with WHO will help to better inform global risk assessment and influenza vaccine strain selection. Meeting report International Influenza Networks Meeting 14–16 January 2013, Scottsdale, Arizona, USA Influenza networks across the globe came together to gain an overview of key influenza-focused networks and discuss ways to better integrate and share information, leverage resources and create synergies across networks to enhance global capacity building, preparedness and response. The primary focus was to promote better use and visibility of the existing capacities and outputs of the networks. The first of its kind, this meeting was organized by the United States Association of Public Health Laboratories (APHL) in collaboration with the Influenza Division of the U.S. Centers for Disease Control and Prevention (CDC), Atlanta. More information LABORATORY Better Labs for Better Health initiative in Tajikistan WHO/Europe is leading an initiative to improve laboratory services in Kyrgyzstan, Republic of Moldova and Tajikistan, with the dual aims of improving the health systems in these countries and developing a model of laboratory strengthening that can be applied in countries throughout the Region and beyond. Under the umbrella of this initiative, a training of trainers workshop to enhance biosafety and biosecurity took place in Tajikistan on 28 January–7 February 2013. Laboratory professionals from key national laboratories in Dushanbe participated in the course conducted by WHO experts working in collaboration with the International Science and Technology Center (ISTC) and EuropeAid – the Development and Co-operation Directorate–General of the European Union. As a next step in establishing the Regional Biosafety Training Centre in Dushanbe under this ISTC project, WHO is supporting development of a training curriculum in biosafety for national and regional laboratories in Tajikistan. Also under the Better Labs for Better Health initiative, experts from WHO, the Royal Tropical Institute Amsterdam and Lab Quality for All will start on 25–27 March 2013 working with the newly established National Committee on Coordination and Laboratory Management in Tajikistan to develop a national 44 laboratory policy and strategic plan. More information: Training of trainers workshop International Health Regulations (IHR)–Health Laboratory Strengthening INFLUENZA VACCINE WHO Consultation on the Composition of Influenza Virus Vaccines for the Northern Hemisphere 2013/2014 18–20 February 2013, Geneva, Switzerland This season, 29 National Influenza Centres from 26 Member States of the WHO European Region shared viruses with WHO collaborating centres for reference and research on influenza, contributing to the recommendations of WHO on the composition of influenza virus vaccines for the northern hemisphere 2013/2014. These viruses were selected to be representative of viruses circulating in the European Region up until January 2013. Globally, influenza A(H1N1)pdm09 viruses co-circulated in varying proportions with A(H3N2) and B viruses during the period of September 2012 to January 2013. The majority of A(H1N1)pdm09 viruses were antigenically similar to A/California/7/2009 and the recommendation for inclusion of an A/California/7/2009 (H1N1)pdm09-like virus remains unchanged. For the A(H3N2) vaccine component, A/Victoria/361/2011-like virus that had been propagated in cells was recommended, the same strain recommended for use in influenza vaccines in the 2012/2013 northern hemisphere influenza season and 2013 southern hemisphere season. However, the egg-propagated A/Victoria/361/2011-like viruses used in vaccine production were shown to undergo antigenic changes resulting from adaptation to propagation in eggs. By contrast, both the cell- and egg-propagated A/Texas/50/2012 viruses are antigenically like A/Victoria/361/2011 cell-propagated virus. Therefore it was recommended that A/Texas/50/2012 be used. Regarding the recommendation for the influenza B component of influenza vaccines for the 2013/2014 season, viruses of the B/Yamagata/16/88 lineage remain the recommended lineage due to their predominance above the B/Victoria/2/87 lineage. The majority of recently reported B/Yamagata/16/88 lineage viruses were antigenically distinguishable from the previous vaccine virus B/Wisconsin/1/2010 and were more closely related to B/Massachusetts/2/2012-like viruses. WHO has therefore recommended that these viruses be included as the influenza B component of the vaccine. 45 In summary, the WHO consultation recommended that vaccines for use in the 2013/2014 influenza season (northern hemisphere winter) contain the following: an A/California/7/2009 (H1N1)pdm09-like virus; an A(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011; a B/Massachusetts/2/2012-like virus (Yamagata lineage). B/Victoria/2/87 lineage viruses predominated in some countries, including Australia and China. The majority of recent B/Victoria/2/87 lineage viruses were antigenically and genetically closely related to B/Brisbane/60/2008. It is therefore recommended that vaccines containing two influenza B viruses contain the above three viruses and a B/Brisbane/60/2008-like virus (Victoria lineage). Full report Questions and Answers concerning the recommended composition of influenza virus vaccines for use in the 2013/2014 northern hemisphere influenza season PREPAREDNESS AND RESPONSE Pandemic preparedness mission to Tajikistan 27 February–2 March 2013 In collaboration with the Ministry of Health and GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit–the German Agency for International Cooperation), WHO/Europe consultant Andre Jacobi of the Netherlands National Institute for Public Health and Environment conducted a workshop in Tajikistan to address pandemic preparedness at the operational level and priorities for continued work in the short and long term. In line with the ongoing revision of global pandemic guidance, emphasis was placed on preparedness based on national risk assessment, and parts of the workshop were therefore dedicated to familiarizing participants with the WHO rapid risk assessment manual. As part of the workshop, a one-day exercise was carried out to explore gaps in preparedness and to further specify in which areas work is needed. WHO rapid risk assessment of acute public health events GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit–the German Agency for International Cooperation) RIVM (Rijskinstituut voor Volksgezondheid en Milieu - Netherlands National Institute for Public Health and Environment) 46 UPCOMING EVENTS Pandemic Influenza Preparedness Framework Advisory Group Meeting and Consultations 20–22 March 2013, Geneva, Switzerland The Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits ("PIP Framework") brings together Member States, industry, other key stakeholders and WHO/Europe experts to implement a global, Member-State-developed approach to pandemic influenza preparedness and response. The topic of the Consultations on 21 March is: “Use of the Partnership Contribution”. More information Peer-review meeting on WHO pandemic guidance 11–12 April 2013, Geneva, Switzerland A small group of technical experts on pandemic influenza planning from the five WHO regions will join WHO staff at a peer-review meeting 11–12 April 2013 to contribute to the revision of WHO global pandemic influenza preparedness and response guidelines. Participants will give feedback on a draft revision of the guidance document. Pandemic influenza preparedness and response: WHO guidance document Third ESWI European Influenza Summit 2 May 2013, Brussels, Belgium This summit is an informal platform to exchange good practices and to initiate concrete actions to improve public health protection against influenza. The meeting will be followed on 3 May with a workshop for European public health on the outcome of the ESWI FluQuest survey conducted in 11 countries. More information Third annual joint WHO/Europe and ECDC Influenza Surveillance Meeting 29–31 May 2013 National influenza focal points from all 53 Member States of the WHO European Region will attend this meeting, as well as staff of the WHO Collaborating Centre (WHO CC) for Reference and Research on Influenza, London, United Kingdom, the Centers for Disease Control and Prevention, Atlanta, USA, the WHO CC for Pandemic Influenza and Research, University of Nottingham, United Kingdom, and other international influenza experts. 47 The meeting will review latest developments in influenza surveillance and vaccination in the Region as well as globally, and discuss strategic directions, particularly with respect to strengthening surveillance of severe disease due to influenza, mortality monitoring and maintaining and strengthening laboratory capacities. For more information on the meeting please contact influenza@euro.who.int The Eighth Options for the Control of Influenza Conference 5–10 September 2013, Cape Town, South Africa This Conference is held once every three years to showcase recent advances in the basic science and control and prevention of influenza. Conference web site RESOURCES Publications of WHO/Europe Influenza and other Respiratory Pathogens Programme (IRP) members Dr Caroline Brown, "The role of the WHO Regional Office for Europe in response to seasonal, avian and pandemic influenza", Bundesgesundheitblatt, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, January 2013, Volume 56, Issue 1, pp 47-55. Abstract A limited number of hard copies of this article, as well as the second edition of “Pandemic influenza” textbook, co-authored by WHO influenza experts Dr Caroline Brown and Michala Hegermann-Lindencrone, will be available free of charge at the annual WHO/ECDC influenza surveillance meeting in May 2013. For more information contact influenza@euro.who.int ECDC publication Risk assessment: Seasonal influenza 2012/13 in Europe (EU/EEA countries), February 2013 Abstract and full text Links WHO/Europe: Influenza, Vaccines and immunization WHO headquarters: Influenza, Immunization, vaccines and biologicals ECDC: Influenza 48 ~ Sent to you from the WHO Regional Office for Europe We value your input. To comment, contribute content or add associates to the mailing list, please contact influenza@euro.who.int Flu Focus is also available on the WHO Regional Office for Europe web site in English and Russian. 49 WHO/EURO:2014-6903-46669-67868 © World Health Organization 2013. All rights reserved. Issue No. 8, July 2013 Flu Focus is an e-newsletter published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials, upcoming events and resources on influenza. It is sent on a regular basis throughout the influenza season (October – May). This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe web site at http://www.euro.who.int/flufocus in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: http://www.euro.who.int/flufocus на английском и русском языках. In this issue 1. Features a. MERS-CoV update b. Avian influenza A(H7N9) update 2. Surveillance 3. Laboratory 4. Pandemic preparedness and response 5. Upcoming events 6. Resources Features Middle East Respiratory Syndrome Coronavirus (MERS-CoV) update As of 21 July 2013, WHO has been informed of a total of 90 laboratory-confirmed cases of infection with MERS-CoV worldwide, including 45 deaths: 11 of these cases have been reported from countries in the WHO European Region and include 5 deaths. So far, three patterns of epidemiology have been exhibited by MERS-CoV cases: sporadic cases in communities for which neither the source of the virus infection nor how these people became infected is known, clusters of infections in families in which there is close contact with a sick family member, and clusters of infections in health care facilities whereby the most likely pattern of transmission is from an infected person admitted to hospital with subsequent transmission of the virus to other people in the health care facility. Although no current evidence of sustained human-to-human transmission, MERS-CoV may evolve to spread quickly among humans and affect wider geographical areas. To address knowledge gaps in understanding the emergence of this virus, clinical manifestations and the transmission risk, over 100 public health experts met at WHO’s Eastern Mediterranean Regional Office in Cairo, Egypt, on 20–22 June 2013 to identify priority public health actions to respond to the ongoing outbreak of disease caused by the virus. The experts came from all the countries in the Middle East, North Africa and Europe which have already registered MERS-CoV cases, and from throughout WHO’s Eastern Mediterranean Region (EMR). 50 On 5 July 2013, reflecting the need for a global response to the continuing outbreak, WHO Director-General Margaret Chan called for the establishment of an Emergency Committee on MERS-CoV under the International Health Regulations (IHR). Based on the information now available and using a risk-assessment approach, the Committee members unanimously decided on 17 July 2013 that the situation does not at present meet the conditions for a Public Health Emergency of International Concern (PHEIC). Also on 5 July 2013, WHO Regional Director for Europe Zsuzsanna Jakab arranged a comprehensive briefing on MERS-CoV for health ministers attending the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020 in Vienna, Austria, to ensure the full engagement of European Member States in this global effort. WHO/Europe will continue to help Member States prepare for the occurrence of cases of MERS-CoV by supporting the development of laboratory capacities and by providing protocols for case management, infection control and patient sampling. Member States are encouraged to continue surveillance for MERS-CoV, educate health care workers about the disease and prepare national case investigation protocols. Detailed epidemiological, clinical and virological data should be collected from each case and shared with WHO. Furthermore, countries should be prepared to collect serum samples for serological studies to support this work. WHO/Europe publishes a regular summary of the MERS-CoV situation and key WHO guidance on its web site in English and Russian. The Office coordinates the regional response to MERS-CoV with the European Union and the European Centre for Disease Prevention and Control, and facilitates information exchange among countries in the WHO European and Eastern Mediterranean regions. MERS-CoV updates – European Region MERS-CoV updates – worldwide Avian influenza A(H7N9) update As of 20 July 2013, a total of 134 laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus have been reported to WHO; 133 cases by China National Health and Family Planning Commission and one case by the Taipei Centers for Disease Control (Taipei CDC). Although cases have been reported in both men and women, and across a wide age range, most cases have occurred in middle-aged or older men. Forty- three people have died, and most of the other cases were considered severe. Human infection appears to be related to exposure to live poultry or contaminated environments. Closure of live bird markets is believed to have had a significant impact on the spread of the disease: since the end of May 2013, only 1 additional case has been reported to WHO (on 20 July). However, much remains unknown about this virus, including the animal reservoir(s) in which it is circulating, the main exposures and routes of transmission, and the scope of the spread of this virus among people and animals. Although four small human clusters have been reported, evidence does not support sustained human-to-human transmission. The WHO Regional Office for Europe is organizing training in central Asia and the Caucasus with the aim of strengthening capacities to detect, assess and respond to emerging pathogens such as A(H7N9) and MERS-CoV. The training will also prepare countries for the upcoming influenza season with a focus on treating severe acute respiratory infections. Avian influenza A(H7N9) updates – European Region Avian influenza A(H7N9) updates – worldwide Recommendations Based on the current situation and available information regarding both MERS-CoV and influenza A(H7N9), WHO encourages all Member States to continue their surveillance for severe acute respiratory infections and to review carefully any unusual patterns. WHO does not advise special screening at points of entry with regard to either of these events nor does it currently recommend the application of any travel or trade restrictions. Surveillance 51 Overview of 2012/2013 influenza season The WHO European Influenza Surveillance Network (EuroFlu) presents epidemiological and virological data that are collected on seasonal influenza by clinician and laboratory networks on a weekly basis. European Union and European Economic Area Member States report to the European Centre for Disease Prevention and Control with which the WHO Regional Office for Europe coordinates influenza surveillance. During the 2012/2013 influenza season, EuroFlu received data from 49 out of 53 Member States. Key features of the 2012/2013 influenza season Similar to previous seasons, the 2012/2013 influenza season started around week 48/2012, peaked around week 5/2013 and lasted until week 16/2013. In general, influenza morbidity rates, influenza-like illness (ILI), acute respiratory infections (ARI) or severe acute respiratory infections (SARI) were higher than in the previous season. Influenza activity was reported as low or medium, with 11 countries reporting higher than usual levels of influenza activity at some point in time over the entire season, compared to 4 countries reporting higher than usual levels in the previous season. All three seasonal influenza viruses co-circulated this season, with, in general, influenza A viruses predominating early in the season followed by influenza B. Overall, 63% of viruses were influenza A and 37% influenza B; and of the sub-typed influenza A viruses, about two-thirds were A(H1N1)pdm09 and one third A(H3N2). Severe cases occurred mainly in those above 15 years of age and were due mainly to A(H1N1)pdm09 and influenza B. Excess all-cause mortality as determined in up to 18 countries that participate in the EuroMoMo project (www.euromomo.eu/index.html) was only observed in those above age 64 and was comparable with the previous season. The majority of influenza viruses that were characterized antigenically corresponded to those recommended by WHO for inclusion in the current northern hemisphere seasonal influenza vaccine, suggesting a good match of circulating viruses with the seasonal influenza vaccine. Monitoring for susceptibility to influenza antivirals showed no indication of increased resistance to neuraminidase inhibitors among influenza viruses circulating in the Region this season. However, as in previous years, all A(H1N1)pdm09 and A(H3N2) viruses screened for susceptibility to adamantanes were found to be resistant. WHO/Europe coordinates influenza surveillance with ECDC. Detailed information is available in the regular bulletins: WHO EuroFlu bulletin ECDC Weekly Influenza Surveillance Overview (WISO) Third annual joint WHO/Europe and ECDC Influenza Surveillance Meeting 29–31 May 2013, Istanbul, Turkey The WHO/ECDC annual meeting helps strengthen the influenza and other respiratory viruses surveillance community in Europe by bringing together key stakeholders, addressing pertinent issues and flagging key updates. Building and strengthening this network is paramount for ECDC and WHO/Europe’s collaboration with Member States, on routine as well as critical and urgent issues, such as the recent emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza A(H7N9) virus. Among the participants at the 2013 meeting were national influenza focal points from the 50 Member States of the WHO European Region that report surveillance data to the EuroFlu platform. They reviewed recent developments in the field and discussed ways to increase collaboration and improve the quality of surveillance data collection. Important outcomes of the meeting include recommendations for the EuroFlu platform, sharing of national/severe influenza surveillance information and review of virus sharing practices in the Region for the vaccine strain selection process. The meeting report will be posted on the WHO/Europe web site (www.euro.who.int/influenza). Workshop on data management and analysis 52 1–3 May 2013, Nijmegen, the Netherlands This workshop was designed for epidemiologists involved in routine data entry, data management and data analysis in Member States participating in a study of severe acute respiratory-tract infections (SARI) aimed at identifying risk factors for severe disease. These data may subsequently be used to target risk groups for vaccination and treatment. The main objectives of the workshop were to introduce participants to: • the basics of management of surveillance data; • development of databases; • quality of surveillance data; • epidemiological data analysis of surveillance data. The workshop was organized jointly by WHO/Europe, the United States Centers for Disease Control and Prevention and Radboud University Nijmegen Medical Centre, the Netherlands, and was attended by 12 participants from Albania, Armenia, Belarus, Georgia, Kyrgyzstan, Russian Federation and Ukraine. Overview of sentinel systems for hospitalized severe acute respiratory infections (SARI) represented in the weekly EuroFlu surveillance bulletin 10 February 2013 Laboratory New National Influenza Centre (NIC) in the WHO Global Influenza Surveillance and Response System (GISRS) Photo: Radu Cojocaru In November 2012, a team of WHO experts and a representative of the WHO Collaborating Centre for Reference and Research on Influenza at NIMR, London, United Kingdom, conducted an on-site assessment of the National Influenza Laboratory of the Republic of Moldova, upon request of the country’s Ministry of Health. Based on the results of this assessment, the Laboratory was recognized in March 2013 as a WHO National Influenza Centre. WHO warmly welcomes this new NIC in the European Region to the WHO Global Surveillance and Response System (GISRS), which now comprises 141 NICs in 111 WHO Member States. The Laboratory is located in Chisinau and headed by Constantin Spinu. The WHO/Europe influenza team looks forward to fruitful collaboration with our colleagues in the Republic of Moldova. Contact information: Constantin Spinu National Influenza Centre Str. Cosmescu 3 Chisinau, MD 2028 Republic of Moldova e-mail: cspinu@cnsp.md , influenza@cnsp.md 53 More on the Global Influenza Surveillance and Response System (GISRS) Laboratory procedures for A(H7N9) The WHO Collaborating Centre for Reference and Research on Influenza at the Chinese National Influenza Centre in Beijing, China has shared laboratory procedures for serological detection of avian influenza A(H7N9) infections by turkey haemagglutination-inhibition assay and by microneutralization assay. Laboratory Procedures: Serological detection of avian influenza A(H7N9) virus infections by turkey haemagglutination-inhibition assay 23 May 2013 More on laboratory procedures Preparedness and response 2nd ISIRV International Symposium on Neglected Influenza Viruses 7–8 March 2013, Dublin, Ireland ISIRV is an independent and international scientific professional society that promotes the prevention, detection, treatment and control of influenza and other respiratory virus diseases. This second meeting on zoonotic and animal influenza viruses explored the latest influenza surveillance data, vaccination and control strategies, diagnostic techniques, experimental research data and epidemiological and economic impact studies relating to swine, equine, canine and other nonhuman/nonavian influenza viruses. Along with representatives from the Food and Agriculture Organization and OFFLU (global network of expertise on animal influenza), a representative of WHO/Europe participated in an expert panel discussion at the Symposium, during which officials, researchers and clinicians were encouraged to continue to pursue a coordinated approach to the control of influenza in humans and animals. Presentation abstracts Pandemic Influenza Preparedness Framework Advisory Group Meeting and Consultations 20–22 March 2013, Geneva, Switzerland The Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits ("PIP Framework") brings together Member States, industry, other key stakeholders and WHO/Europe experts to implement a global, Member-State-developed approach to pandemic influenza preparedness and response. The topic of the Consultations on 21 March was: “Use of the Partnership Contribution”. Meeting report Third ESWI European Influenza Summit 2 May 2013, Brussels, Belgium This summit is an informal platform to exchange good practices and to initiate concrete actions to improve public health protection against influenza. The meeting was followed on 3 May with a workshop for European public health authorities on the outcome of the ESWI FluQuest survey conducted in 11 countries. A summit report and presentations will be posted on the ESWI Flu Summit web site. Upcoming events The Eighth Options for the Control of Influenza Conference 5–10 September 2013, Cape Town, South Africa 54 This Conference is held once every three years to showcase recent advances in the basic science and control and prevention of influenza. Conference web site Resources MERS-CoV WHO guidelines for investigation of cases of human infection with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) 5 July 2013 Interim surveillance recommendations for human infection with Middle East respiratory syndrome coronavirus (in English and Russian) 27 June 2013 Public health officials agree priority actions to detect and control MERS-CoV 22 June 2013 Treatment of MERS-CoV: Decision Support Tool 18 June 2013 WHO International travel and health update 5 June 2013 Infection prevention and control during health care for probable or confirmed cases of novel coronavirus (nCoV) infection 6 May 2013 Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do 11 February 2013 Influenza A(H7N9) WHO risk assessment: Human infections with avian influenza A(H7N9) virus 7 June 2013 Interim WHO surveillance recommendations for human infection with avian influenza A(H7N9) virus 10 May 2013 Laboratory biorisk management for laboratories handling human specimens suspected or confirmed to contain avian influenza A(H7N9) virus causing human disease- interim recommendations 10 May 2013 Diagnostic preparedness in Europe for detection of avian influenza A(H7N9) viruses ECDC, Technical briefing note, 23 April 2013 Summary of status of development and availability of avian influenza A(H7N9) candidate vaccine viruses 10 May 2013 Origin and diversity of novel avian influenza A H7N9 viruses causing human infection: phylogenetic, structural, and coalescent analyses Liu D, Shi W, Shi Y, Wang D, Xiao H, Li W, et al. In: Lancet. 2013/05/07 ed. Human infections with avian influenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution Arima Y, Zu R, Murhekar M, Vong S, Shimada T and the WHO Regional Office for the Western Pacific Event Management Team, In: Western Pacific Surveillance and Response Journal, 2013, 4(2). doi:10.5365/wpsar.2013.4.2.005 Seasonal influenza 55 ECDC influenza communication toolkit This toolkit aims to assist European Union Member States in devising communication activities to increase influenza vaccination uptake and promote preventive measures to limit its spread. The toolkit materials are designed to ensure that target audiences have access to the degree of information they may require. EuroFlu – WHO/Europe influenza surveillance Weekly Influenza Surveillance Overview (WISO) – ECDC Global epidemiological update Global virological update Links WHO/Europe: Influenza, Vaccines and immunization WHO headquarters: Influenza, Immunization, vaccines and biologicals ECDC: Influenza ~ Sent to you from the WHO Regional Office for Europe We value your input. To comment, contribute content or add associates to the mailing list, please contact influenza@euro.who.int Flu Focus is also available on the WHO Regional Office for Europe web site in English and Russian. 56 WHO/EURO:2014-6903-46669-67868 © World Health Organization 2013. All rights reserved. Issue No. 9, December 2013 Flu Focus is an e-newsletter published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials, upcoming events and resources on influenza. It is sent on a regular basis throughout the influenza season (October – May). This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe web site at http://www.euro.who.int/flufocus in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: http://www.euro.who.int/flufocus на английском и русском языках. In this issue 1. Features: Flu Awareness Day Tailoring Immunization Programmes - TIP Flu Guide 2. Surveillance 3. Laboratory 4. Influenza vaccine 5. Pandemic preparedness and response FEATURES Flu Awareness Day The second WHO/Europe Flu Awareness Day took place on 6 November 2013 with a particular focus on encouraging health care workers to be vaccinated against seasonal influenza. There was a feature on the WHO/Europe home page and a power point presentation aimed at health care workers was prepared and launched on that day. Other products included twitter activity and a Russian translation of vaccine safety advice. Information for health care workers TIP Flu Guide WHO’s successful Guide to Tailoring Immunization Programmes (TIP) has been adapted to 57 help Member States boost health care worker vaccination rates. Health care workers constitute a priority group for seasonal influenza vaccination and yet uptake of the vaccine is low. The TIP approach is a practical way for Member States to develop strategies and the adapted version for flu vaccination is currently being piloted in one country. A TIP Flu Guide will be published in 2014. More on the TIP Flu project SURVEILLANCE EuroFlu Bulletin In coordination with the European Centre for Disease Prevention and Control (ECDC), WHO/Europe produces the EuroFlu Bulletin throughout the influenza season. In week 49, 2–8 December, influenza activity in the WHO European Region was at a pre-season, low level. Co- circulation of influenza A(H1N1)pdm09, A(H3N2) and type-B viruses was reported by countries for week 48/2013. Sporadic detections have been reported by several mainly western European countries and the percentage of sentinel samples from patients presenting to primary care that tested positive for influenza was low at 4%, which is common for this time of the year. For more detailed information, please see the EuroFlu bulletin and the ECDC Weekly Influenza Surveillance Overview. An update of the situation will be published later in the season. LABORATORY WHO/Europe practical course on influenza virology  In order to strengthen laboratory capacities for influenza diagnosis and surveillance, the WHO Regional Office for Europe held an annual laboratory training on influenza virology at the National Influenza Centre in St Petersburg, the Russian Federation, 25–29 November 2013. The training focused on improving the capacity of laboratories to determine the antigenic profiles of circulating strains of human influenza virus, and thus better contribute to the process of selecting viruses to share with WHO collaborating centres for reference and research on influenza and subsequent selection of virus strains for seasonal influenza vaccine production. Training improves European laboratories' capacity to detect influenza “Better Labs for Better Health” initiative The WHO/Europe laboratory strengthening initiative, Better Labs for Better Health, aims to assist Member States in developing national laboratory policies and plans including the implementation of laboratory quality management systems and improving training curricula for laboratory staff. The work benefits all laboratories dealing with health. Work has already started in Tajikistan and the Republic of Moldova. Cross-sectoral national laboratory working groups are getting support from their respective governments as well as WHO/Europe and its partner, the Royal Tropical Institute, Amsterdam (KIT). The project has strong laboratory quality and biosafety components. It is supported by WHO tools and training available in English and Russian including a laboratory quality management 58 system training toolkit and biosafety content. Similar work started in Uzbekistan in September 2013 in collaboration with the German Partnership Program for Excellence in Biological and Health Security. Laboratory quality management system training toolkit Biosafety and laboratory biosecurity INFLUENZA VACCINE The 2013-2014 influenza vaccination recommendations Information Sheet – Observed rate of vaccine reactions: Influenza vaccine This document produced by WHO headquarters in 2012 is now also available in Russian. PREPAREDNESS AND RESPONSE European meeting on generic and pandemic preparedness, Bratislava A meeting co-organized with ECDC was held 20–21 November with national experts from 39 countries. The meeting focused on the updated Pandemic influenza risk management: WHO interim guidance. In particular the meeting addressed how to assess the severity of a pandemic, and implementation of the core capacities of the International Health Regulations (2005) in relation to the new European Union decision on serious cross-border threats to health (1082/2013/EU), which came into force on 25 October 2013. Decision document from Bratislava meeting The roadmap to implement this decision and in particular the provisions related to the Health Security Committee were discussed in detail in the plenary meeting on 28–29 November 2013 in Luxembourg. WHO continues to cooperate closely with the European Commission (EC) in the context of the roadmap for WHO/EC collaboration on health security issues. Update on roadmap for EC/WHO collaboration on health security A full report of the meeting in Bratislava will follow. Middle East respiratory syndrome coronavirus (MERS-CoV) Cases of MERS-CoV continue to occur, but no cases were detected in travellers to the Hajj in the Kingdom of Saudi Arabia, which took place 13–18 October this year. Of 33 WHO European Member States from which information was received, between 12 September and 21 November 2013, 12 tested a total of 444 suspected MERS-CoV cases and none of these were confirmed. As of 4 November 2013, WHO has been informed of a total of 150 laboratory-confirmed cases of MERS-CoV of which 64 have died. Although a few cases have been confirmed in the WHO European Region among travellers returning from the Middle East (all occurring before June 2013), the majority of cases have been detected in the Arabian peninsula. WHO encourages its Member States to strengthen their capacities to detect this virus and, following the current WHO surveillance recommendations, recent travellers returning from the Middle East who develop 59 severe acute respiratory infection should be tested for MERS-CoV. WHO information on MERS-CoV Avian influenza A(H7N9) As of 24 October 2013, a total of 137 cases, including 45 deaths, of avian influenza A (H7N9) have been reported to WHO. Although small family clusters have been reported among previous cases, evidence does not support sustained human-to-human transmission of the virus. In its risk assessment of 7 October, WHO wrote that sporadic human cases and small clusters would not be unexpected in previously affected and possibly areas/countries that neighbour China, especially as winter approaches in the northern hemisphere. However, the current likelihood of community-level spread of this virus is considered low. Avian influenza overview WHO/Europe response to A(H7N9) and MERS-CoV WHO/Europe is supporting countries in strengthening their response to A(H7N9) and MERS- CoV. From September to December 2013 trainings and workshops in the clinical management of cases of severe acute respiratory infections (SARI), the development of laboratory assays and outbreak response were conducted in Azerbaijan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. The trainings have highlighted the need to improve country capacities to conduct investigations around cases of emerging severe respiratory infections and to enhance both the knowledge of critical care clinicians as well as the resources available to them to provide supportive care to patients with respiratory failure. WHO/Europe response UPCOMING EVENTS The WHO Regional Office for Europe and ECDC 4th Joint Annual Influenza Surveillance Meeting will take place on 3-5 June 2014. RESOURCES Translated into Russian: WHO information sheet on influenza vaccine safety Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update as of 22 November WHO/Europe update in English and Russian: Avian influenza A(H7N9) virus Links EuroFlu – WHO/Europe influenza surveillance 60 Weekly Influenza Surveillance Overview (WISO) – ECDC Global Epidemiological update Global virological update WHO/Europe: Influenza, Vaccines and immunization WHO headquarters: Influenza, Immunization, vaccines and biologicals ECDC: Influenza ~ Sent to you from the WHO Regional Office for Europe We value your input. To comment, contribute content or add associates to the mailing list, please contact influenza@euro.who.int Flu Focus is also available on the WHO Regional Office for Europe web site in English and Russian. 61 WHO/EURO:2014-6903-46669-67868 © World Health Organization 2013. All rights reserved. Issue No. 10, July 2014 Flu Focus is an e-newsletter published by the WHO Regional Office for Europe that covers recent developments, research, reports, materials, upcoming events and resources on influenza. This issue of Flu Focus will be available shortly on the WHO Regional Office for Europe web site at http://www.euro.who.int/flufocus in both English and Russian. Этот выпуск Flu Focus будет также вскоре помещен на сайте Европейского регионального бюро ВОЗ: http://www.euro.who.int/flufocus на английском и русском языках. In this issue 1. Features a) Study in Montenegro reveals low levels of flu vaccination among health care workers b) Capacity building for dealing with vaccine safety in Kazakhstan c) Orientation meeting, creating capacity to implement TIP 2. Surveillance 3. Laboratory 4. Influenza vaccine 5. Pandemic preparedness and response FEATURES Study in Montenegro reveals low level of seasonal flu vaccination among health care workers Survey results showing unsatisfactory levels of seasonal flu vaccination among health care workers were presented at a workshop during European Immunization Week 2014 in Podgorica, Montenegro. Building capacity to respond to vaccine safety concerns This event, held in February 2014 in Astana, Kazakhstan, addressed the need to build Member States’ ability to communicate effectively when real or perceived vaccine-related events occur. It was the first in a series of multi-country training workshops and participants came from Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. Orientation meeting, creating capacity to implement TIP Consultants from 8 countries attended a training workshop on 23–24 June 2014 on implementation of the WHO/Europe "Tailoring immunization programmes" (TIP) guide and related guides developed to 62 promote uptake of influenza vaccination (TIP Flu) and support the response to antimicrobial resistance (TAP). SURVEILLANCE New version of the EuroFlu Bulletin The final issue of the EuroFlu Bulletin was published on 15 May 2014. Plans are in place for a replacement bulletin produced in conjunction with the European Centre for Disease Prevention and Control (ECDC), this is to be launched from October 2014. Enquiries can be directed to influenza@euro.who.int. 50 Member States meet to discuss influenza surveillance National focal points for epidemiological and virological surveillance in the WHO European Region, reference laboratory representatives and involved international institutions met in Vienna, Austria, 11–13 June 2014 for the 4th Joint WHO/Europe and ECDC Annual European Influenza Surveillance Meeting. LABORATORY New resources support lab quality management To help laboratories implement systems to manage quality control, WHO recently launched a suite of resources in several languages. New collaborating centre for laboratory strengthening – KIT Biomedical Research The Netherlands’ KIT Biomedical Research is to become a WHO collaborating centre for laboratory strengthening for a period of four years starting in 2014. KIT stands for Koninklijk Instituut voor de Tropen, which means Royal Tropical Institute. Workshop on lab policy development in Uzbekistan WHO/Europe and the WHO Country Office in Uzbekistan have been providing support to the Ministry of Health of Uzbekistan on development of a national laboratory policy. Launch of training in laboratory management for influenza specialists An influenza laboratory management training course for 24 specialists from national influenza laboratories in selected eastern European countries was held in Istanbul, Turkey, 19–23 May 2014. Specialist training for virologists The WHO Collaborating Centre for Reference and Research on Influenza, at the National Institute for Medical Research, London, United Kingdom provided training to build capacity in monitoring influenza viruses, determining the impact of the influenza season and informing influenza vaccine strain selection. External quality assessment for National Influenza Centres ECDC has published the reports from the external quality assessment exercises for the rapid detection of influenza virus, its isolation, culture and influenza virus antiviral susceptibility testing. These were conducted by the European Reference Laboratory Network for Human Influenza (ERLI-Net) for National Influenza Centres (NICs) in the European Union. WHO/Europe supported the distribution of panels to national influenza centres in the wider WHO European Region. Inactivated avian influenza A(H7N9) virus was also included and this provided the first opportunity to assess A(H7N9) detection capabilities across the WHO European Region. A regional report will be available in due course. Influenza antiviral susceptibility Influenza virus detection, isolation and culture 63 Partners meet to discuss how better labs mean better outcomes for patients Some 60 participants met in Copenhagen at a two-day regional meeting to discuss strengthening laboratory capacities to support national programmes in eastern Europe and central Asia on 17 and 18 June. INFLUENZA VACCINE 2014–2015 influenza vaccine composition in the northern hemisphere The WHO Consultation and Information Meeting on the Composition of Influenza Virus Vaccines for the Northern Hemisphere 2014–2015 took place in the week beginning 17 February 2004 in Geneva, Switzerland. PREPAREDNESS AND RESPONSE Middle East respiratory syndrome coronavirus (MERS-CoV): situation update and cases reported in the Netherlands Since April 2012, and as of 16 May 2014, 614 laboratory‐confirmed cases of human infection with Middle East respiratory syndrome coronavirus (MERS‐CoV) have been reported to WHO, including 181 deaths. Middle East respiratory syndrome coronavirus (MERS-CoV) update: Greece reports first case On 18 April 2014, the Ministry of Health in Greece reported one laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV). Brochure: Global solidarity. Addressing our health responsibilities for Pandemic Influenza Preparedness Pandemic viruses respect no borders. All countries, rich and poor, large and small, must work together to prepare for its onset and to respond effectively. Pandemic Influenza Preparedness Framework Meeting 8–10 July WHO/Europe This meeting marked the official launch of the Pandemic Influenza Preparedness (PIP) Framework Implementation Plan in Armenia, Tajikistan, Turkmenistan and Uzbekistan – the 4 Member States selected for support in 2014. RESOURCES EuroFlu – WHO/Europe influenza surveillance Weekly Influenza Surveillance Overview (WISO) – ECDC Global Epidemiological update Global virological update WHO/Europe: Influenza, Vaccines and immunization WHO headquarters: Influenza, Immunization, vaccines and biologicals ECDC: Influenza Sent to you from the WHO Regional Office for Europe. We value your input. To comment, contribute content or add associates to the mailing list, please contact influenza@euro.who.int © World Health Organization 2014. All rights reserved. 64 WHO/EURO:2014-6903-46669-67868