Respiratory virus surveillance country, territory and area profiles for the WHO European Region, 2023

Respiratory virus surveillance country, territory and area profiles for the WHO European Region 2023 Document number: WHO/EURO:2024-9857-49629-74316 © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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In no event shall WHO be liable for damages arising from its use. iii Contents Data ......................................................................................................................................................................................... v Notes ....................................................................................................................................................................................... v Albania ..................................................................................................................................................................................... 1 Armenia ................................................................................................................................................................................... 3 Austria ..................................................................................................................................................................................... 5 Azerbaijan ................................................................................................................................................................................ 7 Belarus ..................................................................................................................................................................................... 8 Belgium .................................................................................................................................................................................. 10 Bosnia and Herzegovina ........................................................................................................................................................ 13 Bulgaria ................................................................................................................................................................................. 16 Croatia ................................................................................................................................................................................... 18 Cyprus .................................................................................................................................................................................... 20 Czechia .................................................................................................................................................................................. 22 Denmark ................................................................................................................................................................................ 24 Estonia ................................................................................................................................................................................... 26 Finland ................................................................................................................................................................................... 28 France .................................................................................................................................................................................... 30 Georgia .................................................................................................................................................................................. 33 Germany ................................................................................................................................................................................ 35 Greece ................................................................................................................................................................................... 37 Hungary ................................................................................................................................................................................. 39 Iceland ................................................................................................................................................................................... 41 Ireland ................................................................................................................................................................................... 43 Israel ...................................................................................................................................................................................... 45 Italy ........................................................................................................................................................................................ 47 Kazakhstan ............................................................................................................................................................................ 49 Kyrgyzstan ............................................................................................................................................................................. 51 Latvia ..................................................................................................................................................................................... 54 Liechtenstein ......................................................................................................................................................................... 56 Lithuania ................................................................................................................................................................................ 58 Luxembourg .......................................................................................................................................................................... 60 iv Malta ..................................................................................................................................................................................... 62 Montenegro .......................................................................................................................................................................... 65 Netherlands (Kingdom of the) ............................................................................................................................................... 67 North Macedonia .................................................................................................................................................................. 70 Norway .................................................................................................................................................................................. 72 Poland ................................................................................................................................................................................... 76 Portugal ................................................................................................................................................................................. 78 Republic of Moldova ............................................................................................................................................................. 80 Romania ................................................................................................................................................................................ 82 Russian Federation ................................................................................................................................................................ 85 Serbia ..................................................................................................................................................................................... 87 Slovakia ................................................................................................................................................................................. 89 Slovenia ................................................................................................................................................................................. 91 Spain ...................................................................................................................................................................................... 93 Sweden .................................................................................................................................................................................. 95 Switzerland ............................................................................................................................................................................ 97 Tajikistan ............................................................................................................................................................................. 100 Türkiye ................................................................................................................................................................................. 102 Turkmenistan ...................................................................................................................................................................... 104 Ukraine ................................................................................................................................................................................ 108 United Kingdom .................................................................................................................................................................. 110 England ............................................................................................................................................................................ 110 Northern Ireland ............................................................................................................................................................. 113 Scotland ........................................................................................................................................................................... 116 Wales ............................................................................................................................................................................... 119 Uzbekistan ........................................................................................................................................................................... 121 Kosovo[1] .............................................................................................................................................................................. 123 __________________________________________________________________________________________________ [1] All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). v Data The data in these profiles were submitted by the country, territory or area during the period July to December 2023, with the exception of data from Poland, which were submitted during 2021. The data presented here are unedited. The European Centre for Disease Prevention and Control (ECDC) coordinated the collection of data from the European Union (EU)/European Economic Area (EEA). Notes • These profiles include only details of surveillance systems that provide data to The European Surveillance System (TESSy) and are used in the drafting of the joint ECDC–WHO Regional Office for Europe respiratory virus bulletin, European Respiratory Virus Summary (ERVISS). a • Mid-year population estimates are based on 2023 data, except for the United Kingdom (UK; for which 2022 population estimates were used). Population data for EU/EEA countries were derived from Eurostat and population data for non- EU/EEA countries were derived from United Nations sources, where available, and were otherwise supplemented by Eurostat sources, except for the UK (population estimates from UK sources were used). • Income groups are based on the June 2022 World Bank list of economies. b • The type of surveillance can be defined in one of three ways: a. sentinel, b. universal or c. non-sentinel. c,d • A sentinel surveillance system is formed by one or more designated health care facility or provider that routinely and consistently collect(s) epidemiological information from patients presenting with an illness consistent with a specified case definition. Representative clinical specimens are collected from all or a subset of patients according to a randomized/standardized sampling protocol. Sentinel surveillance systems provide an efficient way to obtain high-quality data on relatively common conditions from a manageable number of locations. Each sentinel site should include facilities that together represent the population under surveillance. • A universal surveillance system is formed by all designated health care facilities or providers in a country, territory or area. This generally includes reporting of all clinician-defined acute respiratory infections (ARI) and is part of the disease surveillance systems of several countries, territories and areas in the WHO European Region. These universal systems provide subnational or equivalent resolution of clinician-reported respiratory disease activity. • A non-sentinel surveillance system includes other types of surveillance system (for example, laboratory surveillance), which do not meet the definition of the other two types of system. Non-sentinel surveillance generally refers to viruses reported from/detected in patients from non-sentinel surveillance systems. In the WHO European Region, this includes viruses from clinical diagnostic laboratories, outbreaks or universal ARI surveillance systems that do not have randomized/standardized sampling strategies. _________________________________________________________________________________________________ a European Respiratory Virus Surveillance Summary. Copenhagen: World Health Organization Regional Office for Europe; 2024 (https://www.erviss.org/, accessed 12 February 2024). b World Bank Country and Lending Groups. Washington: World Bank; 2024 (http://data.worldbank.org/about/country-and-lending- groups, accessed 26 April 2024). c Guidance for sentinel influenza surveillance in humans. Copenhagen: WHO Regional Office for Europe; 2011. (https://apps.who.int/iris/handle/10665/107265, accessed 12 February 2024). d Operational considerations for respiratory virus surveillance in Europe. Copenhagen: ECDC–WHO Regional Office for Europe; 2022 (https://iris.who.int/handle/10665/360349, accessed 12 February 2024). vi • The most common case definitions can be found in Table 1 below. Table 1. Common case definitions for respiratory virus syndromic surveillance Organization Surveillance case definition Influenza-like illness (ILI) ECDC Sudden onset of symptoms and at least one of the following four systemic symptoms: fever or feverishness, malaise, headache, myalgia and at least one of the following three respiratory symptoms: cough, sore throat or shortness of breath. WHO 2014 An acute respiratory infection with: measured fever of ≥38°C and cough; with onset within the last 10 days. WHO 2011 An acute respiratory illness with onset during the last 7 days with: measured temperature ≥ 38°C, AND cough. WHO before 2011 Sudden onset of fever >38°C AND cough OR sore throat in the absence of other diagnosis. Acute respiratory infection (ARI) ECDC, WHO Sudden/acute onset of at least one of the following four respiratory symptoms: cough, sore throat, shortness of breath, coryza, and a clinician’s judgement that the illness is due to an infection. Severe acute respiratory infection (SARI) WHO 2014 An acute respiratory infection with: history of fever or measured fever of ≥38°C; and cough; with onset within the last 10 days; and requires hospitalization. WHO 2011 An acute respiratory illness with onset during the previous 7 days requiring overnight hospitalization that includes: history of fever or measured fever of ≥38°C, AND cough, AND shortness of breath or difficulty breathing. WHO before 2011 Onset of the following symptoms ≤7 days prior to hospital admission: Fever >38°C AND cough OR sore throat AND shortness of breath or difficulty in breathing. For children aged <5 years the IMCI case definition for pneumonia and severe pneumonia is applied. a ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; IMCI: Integrated Management of Childhood Illness; SARI: severe acute respiratory infection; WHO: World Health Organization. a Pneumonia: cough OR difficulty in breathing AND breathing faster than 40 breaths/minute (12–59 months); breathing faster than 50 breaths/minute (2–11 months); Severe pneumonia: cough OR difficulty in breathing AND any of the following general severe signs: unable to drink or breastfeed OR vomits everything OR convulsions OR lethargy or unconsciousness OR chest in drawing or stridor in a calm child. • For sampling strategy, different methods can be used. The most common are listed below. • Systematic sampling: samples are collected in a systematic way. This includes: i. interval sampling (for example, every Xth patient who meets the case definition is selected for testing and data collection); and ii. alternate day sampling (for example, all patients who meet the case definition are selected who present to a facility on a certain day or days of the week). • Convenience sampling: this is also called ad hoc sampling and does not adhere to a predetermined system (for example, five samples per week or the first two cases that meet the case definition are sampled. • All cases: samples are collected from all cases that meet the case definition. 1 Albania Total population: 2 832 388 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – Clinical Integrated clinical and virological – – Virological – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – Influenza, RSV and SARS-CoV-2 – – Influenza and SARS-CoV-2 – Reporting period Year-round – – Year-round Year-round – – Year-round – Population covered 20.0% – – 100.0% 90.0% – – 100.0% – Type of primary health care facilities/hosp itals General and paediatric practice, polyclinic – – General and paediatric practices, polyclinic, emergency department in hospitals 11 regional hospitals, 3 university hospitals (paediatric service, infectious diseases service, intensive care service, lung disease hospital and maternity services in regional hospitals) – – Regional and district hospitals, non-sentinel hospitals and non-sentinel primary care, such as general and specialty practice, polyclinic, paediatric care, etc. – Number of primary health care facilities/hosp itals 8 facilities – – 421 14 hospitals – – 421 – Case definition used WHO 2014 – WHO 2014 ECDC, WHO WHO 2014 – – WHO 2014 – 2 Year surveillance system introduced 2014 – – 2000 2009 – – 2009 – Are epidemic thresholds used for this surveillance system? Yes – – Yes Yes – – No – Sampling strategy methodology Systematic sampling – – Convenienc e sampling Convenience sampling – – – – Sampling strategy Sampling is performed in 6 primary health care centres in Tirana and 1 in Durres and 1 Fier. The first 5 patients (on Tuesdays and Thursdays) are sampled at each polyclinic. Sampling of both paediatric and adult patients occurs. – – Sampling occurs when there is an increase in cases in different districts or age groups. Sampling occurs when there is an increase in cases in different districts or age groups. – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 3 Armenia Total population: 2 777 923 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – Integrated clinical and virological Integrated clinical and virological – – – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS- CoV-2 – – – Influenza, RSV and SARS-CoV-2 Reporting period Year-round – – Year-round Year-round – – – Year-round Population covered N/A – – 100.0% N/A – – – N/A Type of primary health care facilities/hospit als Polyclinic – – General practice, polyclinic ICUs, general ward, paediatric ward, maternal health institute – – – General practice, polyclinics Number of primary health care facilities/hospit als 5 facilities – – All facilities 8 hospitals – – – All health facilities Case definition used WHO 2014 – – ECDC, WHO WHO 2014 – – – Laboratory- confirmed influenza Description if a national specific case definition WHO 2014, including a history of fever within the last 10 days – – – – – Year surveillance system introduced 2010 – – 1990 2010 – – – 2009 4 Are epidemic thresholds used for this surveillance system? No – – Yes No – – – No Sampling strategy methodology Systematic sampling – – Convenience sampling Systematic sampling – – – Convenience sampling Sampling strategy A different systematic sampling methodology is applied in each facility. The sampling is random, so all age groups are covered. – – A small number of samples are taken and tested for influenza from ARI patients (2 per week). A different systematic sampling methodology is applied in each facility. The sampling is random, so the patients of all age groups are covered. – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; N/A: not applicable; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 5 Austria Total population: 9 104 772 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – – – Clinical – – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – – – – Influenza, RSV and SARS-CoV-2 Reporting period Virological data: year- round; clinical data: weeks 40–20 – – – – Year-round – – Weeks 40–20 Population covered 1.5% – – – – All persons insured in the Austrian social system (99% of Austrian population) – – Not available Type of primary health care facilities/hos pitals General practice, paediatric practice – – – – All hospitals (except rehabilitation facilities) – – Paediatricians, paediatric clinic, infectious disease hospital outpatient department and infectious disease hospital departments Number of primary health care facilities/hos pitals 180 facilities (the same as in the ARI surveillance) – – – – Approximately 150 hospitals – – Not available Case definition used ECDC – – – – National – – ECDC Year surveillance system introduced 2000/2001 – – – – 2023 – – 1952 Are epidemic thresholds used for this surveillance system? Yes – – – – No – – No 6 Sampling strategy methodology used Convenience sampling – – – – – – Sampling strategy Each sentinel site collects 3-5 specimens per week. – – – – No sampling strategy. Samples are taken for diagnostic purposes. – – No sampling strategy. Physicians take nasopharyngeal swabs for diagnostic purposes. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 7 Azerbaijan Total population: 10 412 605 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – Clinical Integrated clinical and virological – Integrated clinical and virological – – Respiratory pathogens tested for from surveillance system samples Influenza only – – – Influenza and SARS-CoV-2 – – – Reporting period Year-round – – – Year-round – – – – Population covered 20.0% – – – 2.9% – 23.0% – – Type of primary health care facilities/hospitals Paediatric practice, polyclinic – – – Infectious disease ward of the hospital, pulmonology ward of the hospital – 1 – – Number of primary health care facilities/hospitals 15 facilities – – – 2 hospitals – 17 facilities – – Case definition used WHO, <2011 – – – WHO, <2011 – – – – Year surveillance system introduced 2009 – – – 2009 – – – – Are epidemic thresholds used for this surveillance system? Yes – – – No – – – – Sampling strategy methodology Systematic sampling – – – Systematic sampling – – – – Sampling strategy A sample is taken from every 3rd patient. All age groups are included. – – – A sample is taken from every 3rd patient. All age groups are included. – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 8 Belarus Total population: 9 498 190 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – Integrated clinical and virological – Integrated clinical and virological – – – Virological Respiratory pathogens tested for from surveillance system samples Influenza and SARS-CoV-2 – Influenza and SARS-CoV-2 – Influenza and SARS-CoV-2 – – – SARS-CoV-2 Reporting period Year-round – Year-round – Year-round – – – Year-round Population covered 19.6% – 58.4% – 22.0% – – – 100.0% Type of primary health care facilities/hos pitals Paediatric practice (polyclinic), polyclinic – General practice, paediatric practice, polyclinics (adult), emergency ward, infectious disease ward, pulmonology ward – ICU, general, paediatrics, obstetrics, emergency, infectious disease, pulmonology hospitals/wards – – – ICU, general, paediatrics, obstetrics, infectious disease, pulmonology hospitals/wards Number of primary health care facilities/hos pitals 29 facilities – 198 facilities – 35 facilities – – – All facilities Case definition used WHO 2011 – ECDC, WHO – WHO 2011 – – – WHO 2011 Year surveillance system introduced 2010 – 2010 – 2010 – – – 2010 Are epidemic thresholds used for this surveillance system? Yes – Yes – No – – – No 9 Sampling strategy methodology used Convenience sampling – Convenience sampling – Convenience sampling – – – Sampling strategy During the epidemic and interepidemic period, 30 samples are collected per week (in total from sites that are included in the sentinel surveillance system in each region, from adults and children). – During the epidemic and interepidemic period, 30 samples are collected per week (in total from sites that are included in the sentinel surveillance system in each region, from adults and children). – During the epidemic and interepidemic period, 30 samples are collected per week (in total from sites that are included in the sentinel surveillance system in each region, from adults and children). – – – At the physician’s discretion. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 10 Belgium Total population: 11 742 796 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Unive rsal Surveillance system Integrated clinical and virological – Clinical – Integrated clinical and virological – – – Integrated clinical and virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS- CoV-2 – Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS-CoV- 2 – – – Influenza, RSV and SARS-CoV-2 Reporting period Until 2022: - clinical data : year-round - virological data: weeks 40–20 (no sampling from 04/2020 until 10/2021) From 2023 on: Clinical and virological: year-round – Until 2021: - clinical data : year-round 2021-2022 - clinical data : year-round - virological data: weeks 40– 20 (no sampling from 04/2020 until October 2021) From 2023 on: clinical and virological: year-round – Until 2020: - clinical and virological data: only surveillance during increased influenza activity in the country (usually weeks 52-week 17) From 2021 on: clinical and virological: year-round – – – Year-round Population covered 1.0% – 1.0% – Until September 202 3: the population covered is estimated at 9% of the Belgian population; from October 2023: the population covered is estimated at 19.5% of the Belgian population – – – Not available 11 Type of primary health care facilities/hosp itals General practice – General practice – General hospitals (all wards) – – – General hospitals (all wards) Number of primary health care facilities/hosp itals 100 facilities – 100 facilities – Until September 202 3: 6 hospitals; from October 2023 on: 10 hospitals – – – 103 hospitals Case definition used National – National – National – – – Description if a national specific case definition Sudden onset of fever with respiratory symptoms and general symptoms – ARI of the upper, medium or lower respiratory tract (including common cold, rhinitis, (rhino)pharyngit is, angina, sinusitis, otitis, laryngitis, (laryngo)- tracheitis, bronchitis, bronchiolitis and (bronco)pneum onia) without influenza syndrome – Until September 202 3: adapted from the SARI WHO 2014 case definition: an ARI with onset within the last 10 days of history of fever, or measured fever of ≥ 38 °C, and cough or dyspnoea (shortness of breath or difficulty to breath) and requiring hospitalization (24h or more). From October 2023 on: a broader case definition applied for recruitment of cases, but in a first phase the same case definition as before will be used for reporting to TESSy – – – Samples from patients presenting with severe influenza in particular specific conditions: ARDS, ECMO, death, suspicion of antiviral resistance, returning from abroad or in case of outbreaks Year surveillance system introduced 1985 – 1985 – 2011–2012 – – – 2011–2012 12 Are epidemic thresholds used for this surveillance system? Yes – No – Yes – – – No Sampling strategy methodology used Convenience sampling – Convenience sampling – All cases – – – Convenienc e sampling Sampling strategy Until 2021: the first 2 ILI cases in a week seen by a GP. From 2022 on: the first 3 ILI cases in a week seen by a GP. – Until 2021: no samples collected. From 2022 on: the first 2 ARI cases in a week seen by a GP. – All hospitalized patients meeting the case definition are sampled. – – – Only cases from patients with severe suspected influenza. ARDS: acute respiratory distress syndrome; ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ECMO: extracorporeal membrane oxygenation; GP: general practitioner; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; TESSy: The European Surveillance System; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 13 Bosnia and Herzegovina Total population: 3 210 790 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological (Federation of Bosnia and Herzegovina ; Republic of Srpska) Clinical – Clinical Integrated clinical and virological (Federation of Bosnia and Herzegovina; Republic of Srpska ) Clinical – – – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 (Republic of Srpska) – – – Influenza, RSV and SARS-CoV-2 (Republic of Srpska) Influenza, and SARS- CoV-2 (Brcko district of Bosnia and Herzegovina) – – – Reporting period Weeks 40– 20 Weeks 40– 20 – Weeks 40–20 Weeks 40–20 Weeks 40– 20 – – – Population covered 2% in the Republic of Srpska, < 1% in the Federation of Bosnia and Herzegovina 100.0% – 100.0% – 100.0% – – – Type of primary health care facilities/hospitals Primary health care centre General practice, paediatric practice, polyclinic, emergency department – General practice, paediatric practice, polyclinic, emergency department Federation of Bosnia and Herzegovina: University clinical centre; general hospital; Republic of Srpska: University clinical centre Republic of Srpska (ICU, pulmonology, paediatric and infectious diseases clinic) University clinical centre, general hospitals (ICU, paediatric wards, infectious disease wards, and respiratory disease wards) – – – 14 Number of primary health care facilities/hospitals 2 facilities in Federation of Bosnia and Herzegovina; 1 facility in Republic of Srpska (Primary Health Care Centre Banja Luka) 135 facilities (52 primary health care facilities in the Republic of Srpska, 79 facilities in the Federation of Bosnia and Herzegovina, and 4 facilities in Brcko district of Bosnia and Herzegovina) – 135 facilities (52 primary health care facilities in the Republic of Srpska, 79 facilities in the Federation of Bosnia and Herzegovina, 4 facilities in Brcko district of Bosnia and Herzegovina) Federation of Bosnia and Herzegovina: 3 facilities (2 university clinical centres and 1 general hospital); Republic of Srpska: 1 facility (University Clinical Center of the Republic of Srpska) 29 hospitals and 4 clinical centres: 9 hospitals and 1 clinical centre in the Republic of Srpska, 19 hospitals and 3 clinical centre in the Federation of Bosnia and Herzegovina and 1 hospital in Brcko district of Bosnia and Herzegovina – – – Case definition used WHO 2011 WHO 2011 – ECDC, WHO WHO 2014 WHO 2014 – – – Year surveillance system introduced 2014 2012 (Republic of Srpska) 2009 (Federation of Bosnia and Herzegovina and Brcko district of Bosnia and Herzegovina) – 2012 (Republic of Srpska) 2009 (Federation of Bosnia and Herzegovina and Brcko district of Bosnia and Herzegovina) 2014 2013 (Republic of Srpska) 2009 (Federation of Bosnia and Herzegovina and Brcko district of Bosnia and Herzegovina) – – – Influenza epidemic threshold used? – Yes – No No No – – – Sampling strategy methodology used Systematic sampling – – – All cases – – – – 15 Sampling strategy Federation of Bosnia and Herzegovina: samples are collected from the first 3 ILI patients meeting the case definition on the Monday. All age groups are included in the sampling. Republic of Srpska: 2 samples are collected per week: the first paediatric and first adult sample. No samples collected. – No samples collected. Federation of Bosnia and Herzegovina: SARI cases are sampled at all times (24 hours/7 days a week) but may depend on the availability and capacity of the reference laboratory. Systematic sampling in Republic of Srpska: first 10 SARI cases in that facility (from the selected departments) are sampled. – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 16 Bulgaria Total population: 6 447 710 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – – Integrated clinical and virological – – – – – Virological Respiratory pathogens tested for from surveillance system samples – – Influenza and SARS-CoV-2 – – – – – Influenza, RSV and SARS-CoV- 2 Reporting period – – Year-round – – – – – Year-round Population covered – – 5.4% – – – – – 100% Type of primary health care facilities/hospitals – – General practices – – – – – General practices, polyclinics, ICUs/critical care units, infectious disease hospital and wards, paediatric hospitals and wards, pulmonary wards and general hospitals Number of primary health care facilities/hospitals – – 218 facilities – – – – – 40 hospitals Case definition used – – ECDC, WHO – – – – – ECDC: ILI and ARI case definitions Description if a national specific case definition – – – – – – – Year surveillance system introduced – – 2001 – – – – – 1958 17 Are epidemic thresholds used for this surveillance system? – – Yes – – – – – No Sampling strategy methodology used – – Convenience sampling – – – – – Sampling strategy – – 10–20 cases from each of the 28 regions of the country that meet the case definition are sampled. All age groups are included in the sampling. Information available: age, sex, geographical information, diagnosis, date of sampling. The sampling procedure does not differ between the start and the peak of the season. All cases are included in the sampling strategy. – – – – – Convenience sampling strategy. All age groups are included in the sampling. Information available: age, sex, geographical information, diagnosis, date of sampling. The sampling procedure does not differ between the start and the peak of the season. All cases are included in the sampling strategy. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 18 Croatia Total population: 3 850 894 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – Clinical – – – – – – – Respiratory pathogens tested for from surveillance system samples – – – – – – – – Influenza, RSV and SARS- CoV-2 Reporting period – Weeks 40/current year to week 20/next year – – – – – – – Population covered – 100.0% – – – – – – – Type of primary health care facilities/hospitals – General practice and paediatric practice within the primary care – – – – – – – Number of primary health care facilities/hospitals – Until 2023 data from around 2 570 primary health care facilities have been collected by 21 county epidemiological units and sent by email to the Croatian Institute of Public Health, with the different level of reporting. In 2023 the process of connecting the Central Health Information System of the Republic of Croatia (CEZIH) and National Public Health Information System (NAJS) has been initiated to collect ILI data directly from the primary sources (primary care) aiming to increase level of reporting and timeliness – – – – – – – 19 Case definition used – ECDC – – – – – – – Year surveillance system introduced – 1975 – – – – – – – Are epidemic thresholds used for this surveillance system? – Yes – – – – – – – Sampling strategy methodology used – Convenience sampling – – – – – – – Sampling strategy – Sentinel ILI surveillance has not been established in Croatia so far because there is no legal framework providing mandate and resources for such surveillance. During the meeting at the MoH in July 2022, urgent need to strengthen respiratory infections surveillance was presented by CIPH experts. MoH concluded that a working group for drafting regulation to ensure mandate and resources for such surveillance will be established in near future. – – – – Sentinel SARI surveillance has not been established in Croatia so far because there is no legal framework for such surveillance. During the meeting at the MoH in July 2022, urgent need to strengthen respiratory infections surveillance was presented by CIPH experts. MoH concluded that a working group for drafting regulation to ensure mandate and resources for such surveillance will be established in near future. – – ARI: acute respiratory infection; CIPH: Croatian Institute of Public Health; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; MoH: Ministry of Health; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS- CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 20 Cyprus Total population: 920 701 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – – Integrated clinical and virological – – – Integrated clinical and virological – – Respiratory pathogens tested for from surveillance system samples – – Influenza, RSV and SARS-CoV-2 – – – Influenza, RSV and SARS-CoV-2 – – Reporting period – – Year-round – – – Year-round – – Population covered – – 7.7% – – – – – – Type of primary health care facilities/hospitals – – General practice, paediatric practice – – – 5 general hospitals (all wards) and 1 paediatric Hospital (all wards). The hospitals cover all districts of the country – – Number of primary health care facilities/hospitals – – – – – – 6 hospitals – – Number of primary care practitioners if number of primary health care facilities is not known – – 50 physicians – – – – – – Case definition used – – ECDC, WHO – – – SARI (WHO 2014) – – Description if a national specific case definition – – – – – – – – – Year surveillance system introduced – – 2003 – – – 2013 – – Are epidemic thresholds used for this surveillance system? – – No – – – No – – 21 Sampling strategy methodology used – – Convenience sampling – – – All cases – – Sampling strategy – – GPs are asked to swab up to 2 patients with ARI each week. All age groups are included in the sampling. The sampling procedure remains the same throughout the year. All cases are included in the sampling strategy. – – – All positive samples are reported. If COVID-19 is negative the patients are predominantly tested for influenza/RSV. – – ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; GP: general practitioner; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV- 2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 22 Czechia Total population: 10 827 529 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – Integrated clinical and virological – – Integrated clinical and virological – – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS- CoV-2 – Influenza, RSV and SARS-CoV-2 – – Influenza, RSV and SARS-CoV- 2 – – Influenza, RSV and SARS-CoV-2 Reporting period Clinical year- round; virological weeks 40–20 – Clinical year- round; virological weeks 40–20 – – Year-round – – – Population covered ~50% – ~50% – – ~100% – – – Type of primary health care facilities/hospita ls General practice, paediatric practice – General practice, paediatric practice – – All ICUs – – – Number of primary health care facilities/hospita ls 3 470 facilities – 3 470 facilities – – – – – – Case definition used ECDC – ECDC, WHO – – WHO 2014 – – ECDC Description if a national specific case definition – – – – WHO 2014 (with modification for necessity of hospitalization at ICU) – – – Year surveillance system introduced 2004 – 1956 – – 2010 – – 1956 23 Are epidemic thresholds used for this surveillance system? Yes – Yes – – No – – No Sampling strategy methodology used Convenience sampling – Convenience sampling – – All cases – – – Sampling strategy 2–3 samples from general practice and 2–3 samples from paediatric practice per week from all regions are collected during the influenza season (weeks 40– 20). – 2–3 samples from general practice and 1–2 samples from paediatric practice per week from all regions are collected during the influenza season (weeks 40–20). – – – – – Upon request from the non- sentinel site. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 24 Denmark Total population: 5 932 654 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – – – Integrated clinical and virological – – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – – Influenza, RSV and SARS-CoV-2 – – Influenza, RSV and SARS-CoV-2 Reporting period Weeks 40–39, implemented year-round from season 2021– 2022 – – – – – – – Year-round Population covered ~4–5% – – – – National – – 100.0% Type of primary health care facilities/hospitals General practice – – – – All hospitals are included – – All Number of primary health care facilities/hospitals 130–150 primary care facilities since season 2021– 2022 – – – – – – – All national hospitals, outpatient clinics and general practices Case definition used ECDC – – – – – – – National clinical guidelines for testing Description if a national specific case definition – – – – – SARI case definition is under development – – – Year surveillance system introduced 1994 – – – – Expected season 2023– 2024 – – 2010 Are epidemic thresholds used for this surveillance system? Yes – – – – – – – No Sampling strategy methodology used Systematic sampling – – – – All cases – – All cases 25 Sampling strategy GPs are asked to swab 2 patients with ILI each week. All age groups and patient groups. – – – – – – – There are national guidelines for when to swab patients in and outside hospitals during and outside the influenza season. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; GP: general practitioner; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 26 Estonia Total population: 1 365 884 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – Clinical – – – Integrated clinical and virological – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – Influenza, RSV and SARS-CoV-2 – – – Influenza, RSV and SARS-CoV-2 – Reporting period Year-round – – Year-round – – – Year-round – Population covered 8.8% – – 100.0% – – Not available Not available Not available Type of primary health care facilities/hospit als General practice, medical centres, family doctor – – General practice, paediatric practice, polyclinic, family doctor – – – 1. Laboratory- confirmed influenza hospitalization from all hospitals reported through e-register 2. case-based data from region and central hospitals about laboratory- confirmed influenza cases – Number of primary health care facilities/hospit als – – – 431 facilities – – – 17 hospitals – Number of primary care practitioners if number of primary health care facilities is not known 65 family doctors – – – – – – – – Case definition used ECDC – – ECDC, WHO – – Not available – Not available Year surveillance system introduced 2006 – – 1954 – – 2011 – 27 Are epidemic thresholds used for this surveillance system? Yes – – Yes – – No No – Sampling strategy methodology used All cases – – Convenience sampling – – – All cases – Sampling strategy Each sentinel site collects up to 10 specimens per week from patients who meet the ECDC case definition. All age groups are included. – – Depends on physician`s decision; non- systematic – – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 28 Finland Total population: 5 563 970 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Clinical Integrated clinical and virological Clinical – – Virological Clinical Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV- 2 – Influenza, RSV and SARS-CoV-2 – – – – – Influenza only Reporting period Clinical and virological, year-round – Clinical and virological, year-round – – – – Year-round Year-round, especially at the beginning and the end of influenza season and interseason Population covered NA 100.0% NA 100.0% NA NA Not known. All ICUs in Finland are included; specimens are collected on sentinel basis 100.0% – Type of primary health care facilities/hos pitals General practice General practice General practice General practice – – ICU Secondary health care – Number of primary health care facilities/hos pitals Selected general practices, health care centres of garrisons and private clinics All public general practice – All public health practices – – – All ICUs – 29 Case definition used ECDC – ECDC, WHO – – – ARI treated in ICU Laboratory- confirmed case with hospitalization with relevant (respiratory infection) ICD- 10 codes 7 days before or 14 days after laboratory confirmation No case definition used Year surveillance system introduced 2013 2013 2013 2013 – – 2014 2021 1995 Are epidemic thresholds used for this surveillance system? No Yes No No – – No No No Sampling strategy methodology used Convenience sampling – Convenience sampling – – – – Convenience sampling Convenience sampling Sampling strategy Up to 5 specimens are collected per week. – Up to 5 specimens are collected per week. – – – – Defined on clinical basis. All ICUs are asked to send 5–10 clinical samples from patients with clinically suspected influenza infections that require intensive care. – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICD-10: International Statistical Classification of Diseases and Related Health Problems, tenth revision; ICU: intensive care unit; ILI: influenza-like illness; N/A: not applicable; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 30 France Total population: 68 172 977 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – Integrated clinical and virological – Integrated clinical and virological – Integrated clinical and virological – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS-CoV- 2 – Influenza and COVID-19 – Influenza, RSV and SARS-CoV- 2 Reporting period Will start week 35–23 – Will start week 35–23 – Year- round – Will start week 35 2023 Week 40 2023 to week 20 2024 Population covered – – – – – – – – – Type of primary health care facilities/hospitals General practice and paediatricia ns – General practice and paediatricia ns – Secondary /tertiary care hospitals – ICU – Mostly large, university hospitals, but also smaller, local hospitals Number of primary health care facilities/hospitals – – – – 3 hospitals – 190 wards /hospitals – Around 40 hospitals participate every week, participati on can vary substantial ly; currently mainland France only Number of primary care practitioners if number of primary health care facilities is not known Clinical, 305 GPs; virological, 183 GPs – Clinical, 305 GPs; virological, 183 GPs – – – – – – 31 Case definition used National – National – WHO 2014 – Laborator y- confirmed influenza and cases diagnosed as influenza by a clinician No clinical case definition used: only lab- confirmed influenza, RSV and SARS-CoV- 2 are reported Description if a national specific case definition Sudden onset of fever ≥ 39 °C with muscle pain and respiratory signs – Sudden onset of fever with ARI symptoms – – – – N/A Year surveillance system introduced 1984 – 2020 – 2021 – 2009 – 1994 Are epidemic thresholds used for this surveillance system? No – No – No – No – No Sampling strategy methodology used Systematic sampling – Systematic sampling – all cases – All cases – – Sampling strategy First ARI case of the week, irrespective of age. No difference in sampling procedure between start and peak of the season. If the patient has an ILI, it is mentioned on the clinical questionnai re. – First ARI case of the week, irrespective of age. No difference in sampling procedure between start and peak of the season. – – – – – No sampling strategy. All samples taken from patients (probably mostly inpatients, but possibly also patients visiting the ER), for diagnosis of influenza, RSV or SARS-CoV- 2 ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; ER: emergency room; GP: general practitioner; ICU: intensive care unit; ILI: influenza-like illness; N/A: not applicable; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. 32 See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 33 Georgia Total population: 3 728 229 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – – Integrated clinical and virological – – – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV- 2 – – – Influenza, RSV and SARS-CoV- 2 – – – Influenza, RSV and SARS-CoV-2 Reporting period Year-round – – – Year-round – – – Year-round Population covered 2.7% – – – No data available – – – No data available Type of primary health care facilities/hospitals Polyclinics – – – General practice hospitals, paediatric hospitals – – – General practice hospitals Number of primary health care facilities/hospitals 5 – – – 6 – – – 2 Case definition used WHO 2014 – – – WHO 2014 – – – WHO 2014 Description if a national specific case definition An ARI with: measured fever of ≥ 38 C° and cough; with onset within the last 10 days – – – An ARI with: history of fever or measured fever of ≥ 38 C°; and cough; with onset within the last 10 days; and requires hospitalization – – – Unusual SARI case definition: • Patients with SARI that do not respond to treatment, or with deterioration in their clinical course and with inconclusive laboratory tests • SARI without a determined cause that occurs in a healthcare worker that cared for patients with respiratory infections • SARI that is associated with infections in animals (infected and dead poultry or pigs) • Clusters of SARI or 34 pneumonia: two or more cases in members of the same family, work places, or social networks. • An unexpected pattern of respiratory disease or pneumonia such as an increase in apparent mortality, a shift in the age group associated with severe influenza, or a change in the pattern of clinical presentation of influenza-associated disease • An abundance of SARI cases: abrupt, unexpected changes in the trend of respiratory disease observed in routine surveillance Year surveillance system introduced 2006 – – – 2006 – – – 2006 Are epidemic thresholds used for this surveillance system? No – – – No – – – No Sampling strategy methodology used Systematic sampling – – – Systematic sampling – – – Sampling strategy First 3–5 patients per day from Monday to Friday – – – First 3–5 patients per day from Monday to Friday – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 35 Germany Total population: 84 358 845 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentine l Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – – Integrated clinical and virological – Integrated clinical and virological – – – Virological Respiratory pathogens tested for from surveillance system samples – – Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS- CoV-2 – – – – Reporting period – – Year-round – Year-round – – – Year-round Population covered – – > 1% – > 5% – – – – Type of primary health care facilities/hospitals – – General practice, paediatric practice – Hospitals with general wards – – – General practice, paediatric practice, hospitals, other laboratories Number of primary health care facilities/hospitals – – ~750 practices, clinical/syndromi c, subset of 100 practices virological – 70 hospitals clinical/syndr omic / subset of 5 hospitals also virological – – – – Case definition used – – National – National – – – – Description if a national specific case definition – – Syndromic surveillance: patients with pharyngitis, bronchitis or pneumonia (with or without fever); usage of ICD-10 codes for ARI: J00–J22, B34.9 and J44.0 – Syndromic surveillance: admitted patients with ICD-10 codes J09–J22 – – – – Year surveillance system introduced – – 1992 – 2015 clinical / 2020 virological – – – 1998 36 Are epidemic thresholds used for this surveillance system? – – No – No – – – No Sampling strategy methodology used – – Systematic sampling – All cases – – – Systematic sampling Sampling strategy – – From season 2020/2021: specimens collected from the first ARI patients per week in different age groups; until season 2020/21: sampling of ILI patients (using the ECDC case definition). – All SARI cases tested in hospital. – – – No sampling strategy. Virological samples are sent to the NIC for further analysis/charact erization from different sources. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICD-10: International Statistical Classification of Diseases and Related Health Problems, tenth revision; ILI: influenza-like illness; NIC: National Influenza Centre; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 37 Greece Total population: 10 413 982 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – – Clinical – – Virological – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS- CoV-2 – – – – – – Reporting period Year-round – – – Year- round – – Year-round – Population covered ~1.5% of primary care physicians – – – ~45% – – 100.0% – Type of primary health care facilities/hospitals Primary health care centres, private practitioners – – – Hospitals – – All health facilities of the country including private practice offices – Number of primary health care facilities/hospitals 199 facilities – – – 14 – – – Case definition used ECDC – – – WHO 2014 – – – Description if a national specific case definition – – – – Laboratory- confirmed influenza – Laboratory- confirmed influenza – Year surveillance system introduced 2004 (revised in 2014) – – – 2023 – – 1) 2004 for the national mandatory notification system (reporting of laboratory- confirmed influenza cases). 2) 2010 for the active data collection of laboratory- confirmed influenza cases treated in ICUs. 3) 2020 for the reporting of SARS- – 38 CoV-2 tests in the COVID-19 national registry Are epidemic thresholds used for this surveillance system? No – – – No – – No – Sampling strategy methodology used Convenience sampling – – – – – – All cases – Sampling strategy Sampling plan: all age groups, at sentinel physician’s discretion, up to 10 per week. – – – To be defined. – – – – ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV- 2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 39 Hungary Total population: 9 599 744 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – Integrated clinical and virological – Integrated clinical and virological – – – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS- CoV-2 – Influenza, RSV and SARS- CoV-2 – Influenza, RSV and SARS-CoV-2 – – – – Reporting period Weeks 40–20 – Weeks 40–20 – Yearly – – – Weeks 40–20 Population covered (%) > 20% – > 20% – > 80% – – – Not available Type of primary health care facilities/hospitals General practice, paediatric practice – General practice, paediatric practice – 14 tertiary hospital, 8 secondary hospital, 2 specialized hospital – – – – Number of primary health care facilities/hospitals Approximately 1 300 primary health care facilities – Approximately 1 300 primary health care facilities – 24 hospitals – – – Not available Case definition used ECDC – ECDC, WHO – WHO 2014 – – – No specified case definition Year surveillance system introduced 2005 – 2022 – 2022 – – – – Are epidemic thresholds used for this surveillance system? Yes – No – No – – – No Sampling strategy methodology used Convenience sampling – Convenience sampling – Convenience sampling – – – – 40 Sampling strategy Doctors are advised to collect max 5 specimens of ILI patients per week per site. – Doctors are advised to collect maximum 5 specimens of ARI patients per week per site. – – – – – Sampling is performed for diagnostic purposes. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 41 Iceland Total population: 387 758 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – Integrated clinical and virological – Clinical – – – Integrated clinical and virological Integrated clinical and virological Respiratory pathogens tested for from surveillance system samples – – – – – – – – – Reporting period – Year-round – Year-round – – – Year-round Year-round Population covered – 100.0% – 100.0% – – – 100.0% 100.0% Type of primary health care facilities/hospitals – General practice, emergency department, long-term care, selected private practitioners – General practice, emergency department – – – All health care facilities – Number of primary health care facilities/hospitals – 94 facilities – 94 facilities – – – – – Case definition used – National – National – – – ECDC – Description if a national specific case definition – ICD-10 codes J09, J10 and J11 with subcodes – Selected ICD- 10 codes for respiratory symptoms and infections – – – – – Year surveillance system introduced – 2009 – 2011 – – – 2009 – Are epidemic thresholds used for this surveillance system? – Yes – No – – – No – 42 Sampling strategy – No sampling strategy. Sampling is based on clinical suspicion for diagnostic purposes. – – – – – No sampling strategy. – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICD-10: International Statistical Classification of Diseases and Related Health Problems, tenth revision; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 43 Ireland Total population: 5 271 395 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universa l Sentinel Universal Surveillance system Integrated clinical and virological – Integrated clinical and virological – Integrated clinical and virological – – Integrated clinical and virological Virological Respiratory pathogens tested for from surveillance system samples – – Influenza, RSV and SARS- CoV-2 – Influenza, RSV and SARS-CoV- 2 – – Influenza, RSV and SARS-CoV-2 Influenza and RSV Reporting period Year-round – Year-round – Year-round – – Year-round Year-round Population covered 10.0% – 10.0% – 7.6% – – 100.0% Not available Type of primary health care facilities/hospitals General practice – General practice – Hospital – – Hospital Hospitals, general practices and nursing homes (excluding sentinel general practices) Number of primary health care facilities/hospitals 100 practices – 100 practices – 1 – – All hospitals Not available Case definition used ECDC – ECDC, WHO – National – – National No case definition used Description if a national specific case definition – – – – https://www.h psc.ie/a- z/respiratory/a cuterespiratoryi nfection/surveil lance/severeac uterespiratoryi nfectionssari/2 024reports/ – – https://ww w.hpsc.ie/n otifiabledise ases/casede finitions/ – Year surveillance system introduced 2000 – 2022 – 2021 – – Influenza was made notifiable in 2004, RSV made notifiable in 2012; 2000 44 COVID-19 in 2000 Are epidemic thresholds used for this surveillance system? Yes – No – No – – No – Sampling strategy methodology used Systematic sampling – Systematic sampling – All cases – – All cases All cases Sampling strategy . – First five ARI (which includes ILI) patients consulting each week are swabbed. – – – – – Based on clinical need, no sampling strategy. ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 45 Israel Total population: 9 174 470 Income group: High income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Virological Clinical – – – – – Virological – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – – – – Influenza, RSV and SARS-CoV-2 – Reporting period Week 40 to April of the following year, sentinel primary care clinics Year-round for ILI primary care visits from an HMO in Israel – – – – – Year-round – Population covered 36 clinics nationwide 25.0% – – – – – Patients hospitalized in general hospitals – Type of primary health care facilities/hospitals Selected community general, paediatric and internal medicine clinics Community clinics of the 2nd largest HMO in the country – – – – – All general hospitals in Israel – Number of primary health care facilities/hospitals 36 clinics (this is related to laboratory surveillance only) – – – – – – 25 hospitals – Case definition used National – – – – – – – – Description if a national specific case definition Acute fever of ≥ 37.8 °C accompanied by at least one of the following symptoms: runny nose, sore throat, cough, myalgia – – – – – – – – Year surveillance system introduced 2000 – – – – – – 2020 – 46 Are epidemic thresholds used for this surveillance system? No Yes – – – – – No – Sampling strategy methodology used Convenience sampling All cases – – – – – – – Sampling strategy Convenience sampling. Swabs are taken from some ILI cases. Swabs are taken on the first or second day of illness. – – – – – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; HMO: health maintenance organization; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 47 Italy Total population: 58 997 201 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – – – Integrated clinical and virological – Integrated clinical and virological – Respiratory pathogens tested for from surveillance system samples Influenza and SARS- CoV-2 – – – – Influenza only – Influenza, SARS- CoV-2 and RSV – Reporting period Clinical, weeks 42– 17; virological, weeks 46– 17 – – – – Weeks 42–17 – Weeks 42–17 – Population covered 4.0% – – – – 100.0% – Unable to calculate it because we don’t have a denominator – Type of primary health care facilities/hospit als General practice, paediatric practice – – – – ICU – Hospitals – Number of primary health care facilities/hospit als 1500 facilities – – – – – – Unable to calculate because the surveillance system does not collect a hospital identifier – Case definition used ECDC – – – – National – ILI-ECDC + hospitalized – Description if a national specific case definition – – – – – Every hospitalized patient in ICU and/or in ECMO with SARI (according to the WHO 2011 case definition) and/or ARDS symptoms is eligible. Only the positive cases for any of the influenza viruses are reported. – – – Year surveillance 1999 – – – – 2009 – 2000 – 48 system introduced Are epidemic thresholds used for this surveillance system? Yes – – – – No – No – Sampling strategy methodology used Convenience sampling – – – – All cases – Convenience sampling – Sampling strategy The protocol requests collection of 2 swabs per week for each age group (0–4; 5–14; 15– 64; 65+) with no differences between the start and the peak of the season. – – – – All SARI cases admitted to ICU as per the definition above. – Each region decides their own strategy of sampling of hospitals and cases within hospitals (e.g., some hospitals may test all patients and others only a sample of them). – ARDS: acute respiratory distress syndrome; ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ECMO, extracorporeal membrane oxygenation; ICU: intensive care unit; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 49 Kazakhstan Total population: 19 606 586 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – Integrated clinical and virological Integrated clinical and virological – – – – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – Influenza, RSV and SARS- CoV-2 Influenza, RSV and SARS-CoV-2 – – – – Reporting period Year-round – – From W40 to W20, but ARVI cases are recorded all year round Year-round – – – – Population covered 8.8% – – 100.0% – – – – – Type of primary health care facilities/hospitals Children’s polyclinic, adult polyclinic – – Polyclinics (for children and adults), infectious disease hospital, state hospital, pulmonary ward Hospital wards: general, paediatric, pulmonary, infectious disease – – – – Number of primary health care facilities/hospitals 30 facilities – – – 27 hospitals – – – – Case definition used WHO 2011 – – – WHO 2014 – – – – Year surveillance system introduced 2008 – – – 2008 – – – – Are epidemic thresholds used for this surveillance system? No – – Yes No – – – – Sampling strategy methodology used Systematic sampling – – Convenience sampling Systematic sampling – – – – 50 Sampling strategy Samples are taken from patients over 1 year of age who meet the standard ILI case definition and have been ill no more than 72 hours, with a minimum of 3 and no more than 5 patients from each age group: 1–4, 5–14, 15–29, 30–64, 65 and older. Samples from ILI patients are collected by a team by visiting the patient's home. Each polyclinic sends a mobile team with a clinician to the patients subject to laboratory examination: in a four-week month, once; in a five- week month, twice. If there was no visit for some reason, the schedule for that day may include taking samples at the polyclinic’s triage point. – – Monthly, in at least 10 patients with ARVI, influenza, with pronounced clinical symptoms in the pre- epidemic and epidemic periods of ARVI and influenza Samples are taken from patients with SARI (in children over 1 year of age, no later than 72 hours from the onset of the disease; for people over 18, no later than 7 days from the onset of the disease). Swabs are taken from not more than 1 patient daily from each age group: 1–4 and 5–14 in children’s inpatient facilities, 15–29, 30–64, 65 and older in adult inpatient facilities. The number of people surveyed per week is at least 3 from each age group (a total of at least 15 for all age groups per week). – – – – ARI: acute respiratory infection; ARVI: acute respiratory viral infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; W: week; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 51 Kyrgyzstan Total population: 6 735 295 Income group: lower middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – Clinical Integrated clinical and virological Virological Clinical Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – Influenza, RSV and SARS-CoV-2 Reporting period Weekly, year-round – – Weekly, year-round Weekly, year- round Weekly, year- round Weekly, year- round Population covered Data not available – 100.0% Data not available – – – – – Type of primary health care facilities/hospitals Polyclinics – – Polyclinics and hospitals Hospitals – It is carried out using PCR in the National Virological Laboratory and in 3 virological laboratories of the Centres for Disease Prevention and State Epidemiological Surveillance (in the cities of Osh and Bishkek, and in the Ysyk-Ata District) – – Number of primary health care facilities/hospitals 4 facilities – – All health care organizations in the republic except private ones 4 hospitals – At the moment, confirmation is carried out in 4 virological laboratories – – Case definition used WHO 2014 – – National WHO 2014 – – – – 52 Description if a national specific case definition Standard case definition for ILI: an acute respiratory illness with onset during the last 10 days and characterized by the following symptoms: • an increase in body temperature to 38°C or higher (as measured), • cough. – – Acute upper respiratory infections of multiple and unspecified sites (code J06 according to ICD-10) Standard case definition for SARI: an acute respiratory disease with onset during the last 10 days, requiring hospitalization and characterized by the following symptoms: • an increase in body temperature of 38°C or higher (based on measurement or history), • cough. – An influenza case confirmed by one of the laboratory diagnostic methods recommended for the diagnosis of influenza in the country. – – Year surveillance system introduced 2009 – – 2009 2008 – 2008–2009 – – Are epidemic thresholds used for this surveillance system? No – – Yes No – No Yes Yes Sampling strategy methodology used All cases – – – All cases – – – – Sampling strategy Samples are collected from all patients meeting the standard definition of an ILI case, all ages, all age groups within a week, with a duration of illness not exceeding 10 days from onset. – – No samples collected. Samples are collected from all patients meeting the standard definition of a SARI case, all age groups within a week, with a duration of illness not exceeding 10 days from onset. – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICD-10: International Statistical Classification of Diseases and Related Health Problems, tenth revision; ILI: influenza-like illness; PCR: polymerase chain reaction; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. 53 a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 54 Latvia Total population: 1 883 008 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Clinical – Integrated clinical and virological – Clinical – – – Virological Respiratory pathogens tested for from surveillance system samples – – – – – – – – – Reporting period Week 40/2022 to week 20/2023 – Week 40/2022 to week 20/2023 – Week 40/2022 to week 20/2023 – – – Year-round Population covered 4.0% – 4.0% – – – – – – Type of primary health care facilities/hospitals General practice, paediatric practice – General practice, paediatric practice – 7 regional hospitals and 3 hospitals in capital city – – – All types of hospitals and outpatient facilities Number of primary health care facilities/hospitals – – – – 10 hospitals – – – – Number of primary care practitioners if number of primary health care facilities is not known 42 GPs – 42 GPs – – – – – Case definition used ECDC – ECDC, WHO – National – – – – Description if a national specific case definition – – – – By ICD-10 influenza and influenza- associated pneumonia – – – – Year surveillance system introduced 1995 – 1995 – 2006 – – – – 55 Are epidemic thresholds used for this surveillance system? Yes – Yes – No – – – No Sampling strategy methodology used Convenience sampling – Convenience sampling – Convenience sampling – – – Convenience sampling Sampling strategy ILI cases are preferably sampled at the GPs’ sentinel sites and include patients in all age groups. No specimens for sentinel were taken in the 2022– 2023 season by GPs. – – – – – – – Hospitalized severe ILI cases are sampled at any time (24 hours, 7 days per week) ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; GP: general practitioner; ICD-10: International Statistical Classification of Diseases and Related Health Problems, tenth revision; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 56 Liechtenstein Total population: 39 677 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – – – – – – – Virological Wastewater surveillance implemented in Liechtenstein Respiratory pathogens tested for from surveillance system samples – – – – – – – Influenza A and B, COVID-19 COVID-19, Influenza A and B, RSV are monitored with wastewater surveillance Reporting period – – – – – – – Ongoing – Population covered – – – – – – – 100.0% – Type of primary health care facilities/hospital s – – – – – – – – – Number of primary health care facilities/hospital s – – – – – – – – – Number of primary care practitioners if number of primary health care facilities is not known – – – – – – – – – Case definition used – – – – – – – Laboratory- confirmed influenza – Description if a national specific case definition – – – – – – – Laboratory- confirmed by PCR Samples examined by PCR Year surveillance system introduced – – – – – – – 2012 2020 COVID-19, 2022 Influenza A and B and RSV 57 Are epidemic thresholds used for this surveillance system? – – – – – – – – – Sampling strategy methodology used – – – – – – – All cases. There is 1 sewage treatment plant in Liechtenstein. ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 58 Lithuania Total population: 2 857 279 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Clinical Integrated clinical and virological Clinical – – – – – Respiratory pathogens tested for from surveillance system samples Influenza and SARS-CoV-2 – Influenza, RSV and SARS-CoV- 2 – – – – – – Reporting period Year-round Year- round Year-round Year-round – – – – – Population covered 1–5% 100.0% 1–5% 100.0% – – – – – Type of primary health care facilities/hospitals General practice General practice General practice General practice – – – – – Number of primary health care facilities/hospitals 73 facilities Primary health facilities 363 73 facilities Primary health facilities 363 – – – – – Case definition used ECDC – ECDC, WHO – – – – – – Year surveillance system introduced 2004 > 20 years 2004 > 20 years – – – – – Are epidemic thresholds used for this surveillance system? Yes Yes Yes Yes – – – – – Sampling strategy methodology used Convenience sampling – Convenience sampling – – – – – – Sampling strategy All cases are included according to medical doctor’s decision. – On Tuesdays according to medical doctor’s decision. – – – – – – 59 ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 60 Luxembourg Total population: 660 809 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Virological Clinical – – – – – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – – – – – Influenza, RSV and SARS-CoV- 2 Reporting period Weeks 40–20 (interseason voluntary) – Weeks 40– 20 (interseason voluntary) – – – – – Started week 2020-40 for influenza. Started week 2020-9 for COVID-19. Hopefully will be starting week 2023-40 for RSV. Population covered 3.0% – 3.0% – – – – – 100.0% Type of primary health care facilities/hospitals General practice, paediatric practice – General practice, paediatric practice – – – – – All private and hospital clinical laboratories are required to report positive samples Number of primary health care facilities/hospitals 17 facilities – 17 facilities – – – – – 3 private and 4 hospital laboratories doing electronic reporting Case definition used ECDC – ECDC, WHO – – – – – ECDC Description if a national specific case definition Respiratory symptoms and sudden fever > 38.0 °C and myalgia – – – – – – – – 61 Year surveillance system introduced 2003 – 2003 – – – – – 2020 Are epidemic thresholds used for this surveillance system? Yes – No – – – – – No Sampling strategy methodology used All cases – – – – – – – All cases Sampling strategy In principle, all patients are sampled. – No samples collected. – – – – – All laboratory- confirmed cases are reported. ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 62 Malta Total population: 542 051 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Clinical – – – – Integrated clinical and virological – Integrated clinical and virological Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – – Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS-CoV-2 SARS-CoV- 2 Reporting period Weeks 40– 20; last year 2022 and this year 2023 has been extended throughout the year – – – – Started on 2021- W05, year-round – 2022-W40, year-round 2022- W44, year- round Population covered 15.0% – – – – 100.0% – 100.0% 100.0% Type of primary health care facilities/hospitals General practice and health centres – – – – State hospital – State hospital waste water collection sites Number of primary health care facilities/hospitals 7 facilities – – – – 1 – 1 3 Case definition used WHO 2014 – – – – National – – WHO 2014 63 Description if a national specific case definition – – – – – Patient admitted with the following symptoms: cough OR shortness of breath and fever or feverishness with an onset within past 10 days – Hospitalized patients with laboratory confirmation within 14 days prior or during hospital admission; laboratory- confirmed patients who have influenza subtyping results; patients who have SARS-CoV-2 sequencing results available – Year surveillance system introduced 2003 – – – – 2021 – 2022 2022 Are epidemic thresholds used for this surveillance system? No – – – – No – No No Sampling strategy methodology used Convenience sampling – – – – All cases – All cases – Sampling strategy Patients that accept having a specimen taken. – – – – Sample collection is based on clinician’s decision. All age groups, all target groups are included. Sample collection strategy and protocol did not change throughout the period of surveillance. – Sample collection is based on clinician’s decision. All age groups all target groups are included. Sample collection strategy and protocol changed throughout the period of surveillance as impacts of pandemics changed. . 64 ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; W: week; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 65 Montenegro Total population: 626 441 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Integrated clinical and virological – – Integrated clinical and virological Integrated clinical and virological – Integrated clinical and virological – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – Influenza and SARS-CoV-2 Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS- CoV-2 – Reporting period Weeks 40– 20 Weeks 40–20 – – Weeks 40–20 Weeks 40– 20 – Year-round – Population covered Not available 100.0% – – Not available Not available – Not available – Type of primary health care facilities/hospitals General practice, paediatric practice General practice, paediatric practice, polyclinic – – General hospitals, Clinical Centre of Montenegro. Special Hospital for Respiratory diseases Brezovik, General Hospital Berane General hospital, Special Hospital for pulmonary diseases and TB, Clinical Centre of Montenegro – General hospital, Special Hospital for pulmonary diseases and TB, Clinical Centre of Montenegro – Number of primary health care facilities/hospitals 6 facilities 29 facilities – – 3 hospitals 3 hospitals – 3 hospitals (General Hospital 7, Special Hospital 3, Clinical Centre of Montenegro) – Case definition used ECDC ECDC – – WHO 2014 WHO 2014 – ECDC – Year surveillance system introduced 2015–2016 2009 – – 2016 2016 – 2009 – Are epidemic thresholds used for this surveillance system? Yes Yes – – No No – – – Sampling strategy methodology used Convenienc e sampling – – – All cases All cases – – – 66 Sampling strategy The first suspected case of ILI in each week is sampled. – – – All SARI cases are sampled at all times. All SARI cases are sampled at all times. – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 67 Netherlands (Kingdom of the) Total population: 17 811 291 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Clinical – Virological – – – – – Virological Respiratory pathogens tested for from surveillance system samples – – Influenza, RSV and SARS- CoV-2 – – – – – Influenza, RSV and SARS-CoV-2 Reporting period Year-round – Year-round – – – – – Year-round Population covered 1.0% – Unknown – – – – – – Type of primary health care facilities/hospit als General practice – General practice – – – – – 1) and 2) virology diagnostic laboratories, mostly hospital-based; 3) none, as the sampled patients did not need to visit a health care facility to be able to participate in this surveillance system Number of primary health care facilities/hospit als ~40 – ~140 – – – – – 1) Around 35 laboratories; 2) around 20 laboratories, (some overlap with (1)); 3) none, as the sampled patients did not need to visit a health care facility to be able to participate in this surveillance system Case definition used National – National – – – – – – 68 Description if a national specific case definition Acute onset and rectal temperatur e > 38 °C, and at least one of the following symptoms: cough, coryza, sore throat, frontal headache, retrosternal pain, myalgia – ILI or another ARI – – – – – 1 and 2) Based on diagnostic requests from physicians, no specific case definition; 3) any person who participates in the Infectieradar study and report in the weekly questionnaire cough, sore throat, shortness of breath, runny nose or stuffy nose, with an onset not longer ago than five days. Year surveillance system introduced 1970 – 1992 – – – – – 1) 1948; 2) 1964; 3) 2022 Are epidemic thresholds used for this surveillance system? Yes – No – – – – – – Sampling strategy methodology used – – Convenience sampling – – – – – Convenience sampling Sampling strategy – – Participating GPs are instructed to sample at least the first two people in the week with an ARI, including at least one patient with ILI (PEL criteria) and one patient younger than 10 years, with a maximum of five samples per GP per week. – – – – – 1) 5–6 influenza virus-positive specimens maximum per week per laboratory; randomly selected and special cases. 2) All influenza virus-, RSV- and SARS-CoV-2- positive laboratory diagnoses of the reporting laboratory. This is based on diagnostic requests from physicians; there is no national sampling strategy. 3) A maximum of 200 participants (randomly selected) with ARI complaints are asked to send in a sample. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; GP: general practitioner; ILI: influenza- like illness; PEL: permissible exposure limit; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. 69 See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 70 North Macedonia Total population: 2 085 635 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – Clinical – – Integrated clinical and virological – – – – Respiratory pathogens tested for from surveillance system samples – Influenza and SARS-CoV-2 – – Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS- CoV-2 – – – Reporting period – Weeks 40–20 – – Weeks 40–20 – – – – Population covered – 100.0% – – 46.7% – – – – Type of primary health care facilities/hospitals – General practice, paediatric practice, polyclinic, infectious disease clinic, all other health facilities from primary care, secondary care and tertiary level of health care – – Selected hospitals as SARI sites Infectious disease clinic, all other health facilities from secondary and tertiary level of health care – – – Number of primary health care facilities/hospitals – All – – 7 hospitals – – – – Case definition used – WHO 2014 – – WHO 2014 – – – – Year surveillance system introduced – 1966 – – 2014 – – – – Are epidemic thresholds used for this surveillance system? – Yes – – – – – – – Sampling strategy methodology used – – – – Convenience sampling – – – – 71 Sampling strategy – For universal surveillance there is no sampling strategy. Based on clinician’s decision. – – The first 5 cases detected at the Sentinel Hospital each week that meet the case definition. – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 72 Norway Total population: 5 488 984 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – Clinical Virological Clinical – Integrated clinical and virological – – Virological Respiratory pathogens tested for from surveillance system samples – – Influenza, RSV and SARS-CoV-2 – – Influenza, RSV and SARS- CoV-2 – – – Reporting period – Year-round Year-round Year-round – Year-round – – Year-round Population covered – 99.0% 3.0% 99.0% – 100.0% – – 100.0% Type of primary health care facilities/hospitals – General practices, emergency clinics in primary health care General practices, emergency clinics in primary health care General practices, emergency clinics in primary health care – All publicly funded hospitals in Norway and all medical microbiology laboratories performing SARS-CoV-2, influenza virus and RSV diagnostics – – Medical microbiology laboratories performing influenza virus diagnostics Number of primary health care facilities/hospitals – – Approx. 80 facilities – – All publicly funded hospitals in Norway – – 19 laboratories Number of primary care practitioners if number of primary health care facilities is not known – The mean number of physicians registering reimbursem ent claims was 6 228 for the period week 30- 2022 to week 19- 2023 (minimum 5 412, – The mean number of physicians registering reimbursement claims was 6 228 for the period week 30-2022 to week 19- 2023 (minimum 5 412, maximum 6 469) – – – – – 73 maximum 6 469) Case definition used – National ECDC, WHO National – National – – National Description if a national specific case definition – ICPC-2 diagnosis code “R80 influenza” where an ILI case is defined as: myalgia and cough without abnormal findings upon airway examination except inflammatio n of nasal mucosa and throat, plus three or more of the following: sudden onset of symptoms (within 12 hours); fever, chills or feverishness ; malaise and fatigue; influenza in the community; ongoing influenza epidemic; laboratory- confirmed influenza – ICPC-2 diagnosis code "R01 pain respiratory system", "R02 shortness of breath/dyspnoe a", "R03 wheezing", "R04 breathing problem, other", "R05 cough", "R07 sneezing/nasal congestion", "R08 nose symptom/comp laint other", "R09 sinus symptom/comp laint", "R21 throat symptom/comp laint", "R24 hemoptysis", "R25 sputum/phlegm abnormal", "R27 fear of respiratory disease, other", "R29 respiratory symptom, complaint other", "R33 microbiological/ immunological sample", "R71 whooping cough", "R72 strep throat", "R74 upper respiratory infection, – SARI case: inpatient hospital admission with ≥ 1 of the following ICD-10 codes registered at discharge: J00–J06, J09– J22, J80, U07.1 and U07.2 ), A37, H65–H67 (acute otitis media only). Together with the microbiologic al data, more specific case definitions for hospital admissions with laboratory- confirmed 1) influenza, 2) COVID-19 and 3) RSV can be used and they are defined as follows: 1) ICD-10 discharge code J09–J11 + RT-PCR test positive for influenza A/B virus, 2) ICD- 10 discharge code U07.1 or U07.2 + RT- PCR test – – Laboratory- confirmed influenza 74 acute", "R75 sinusitis acute/chronic", "R76 tonsillitis, acute", "R77 laryngitis/trach eitis, acute", "R78 bronchitis/ bronchiolitis, acute", "R79 chronic bronchitis", "R80 influenza", "R81 pneumonia", "R82 pleurisy/pleural effusion", "R83 respiratory infection, other", "R99 respiratory disease, other", "R991 suspected COVID-19" and "R992 confirmed COVID-19" positive for SARS-CoV-2, and 3) ICD-10 discharge code J12.1, J20.5 or J21.0 + RT-PCR test positive for RSV Year surveillance system introduced – 2014 (with historical data from 2006). Prior to this there was a sentinel system for ILI that started in 1998; before that clinical influenza was notifiable (aggregated ) Laboratory sentinel system was introduced in 1979, with revised structure 2022, after COVID-19 (primary testing in external laboratory, integrated respiratory virus analysis, more GPs included). Expanded from ILI to ARI inclusion to better capture RSV and SARS- CoV-2. 2017 – 2021 – – 1982 75 Are epidemic thresholds used for this surveillance system? – Yes No Yes – No – – No Sampling strategy methodology used – – Convenience sampling – Convenience sampling – – All cases Sampling strategy – No samples collected. Approx. general practices and primary care emergency wards are participating in the voluntary network of respiratory virus sentinel practices coordinated by the NIC. These send in ARI patient specimens all year round. All ages included but bias toward working-age patients. No samples collected. – There are no national guidelines regarding testing and hence no systematic testing of SARI cases. – – Medical microbiology laboratories that perform influenza virus diagnostics daily report all detections, by type and subtype, as case-based data to MSIS Laboratory Database from 2020–2021 season. These laboratories also submit influenza- (and SARS-CoV-2)- positive specimens to the NIC, each up to five samples per type per week plus special cases (severe, unusual circumstances, suspicion of resistance). ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; ICD-10: International Statistical Classification of Diseases and Related Health Problems, tenth revision; ICPC-2: International Classification of Primary Care, second edition; ILI: influenza-like illness; MSIS: Norwegian Surveillance System for Communicable Diseases; NIC: National Influenza Centre; RSV: respiratory syncytial virus; RT-PCR: reverse transcription polymerase chain reaction; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 76 Poland Total population: 36 753 736 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – – – – – – Integrated clinical and virological Respiratory pathogens tested for from surveillance system samples – – – – – – – – – Reporting period Year-round – – – – – – – Year-round Population covered 3.0% – – – – – – – 100.0% Type of primary health care facilities/hospitals General practice – – – – – – – General practice, hospitals Number of primary health care facilities/hospitals 517 facilities – – – – – – – – Case definition used ECDC – – – – – – – ECDC Year surveillance system introduced 2004 – – – – – – – 1951 Are epidemic thresholds used for this surveillance system? No – – – – – – – No Sampling strategy methodology used Convenience sampling – – – – – – – Convenience sampling Sampling strategy Collection of specimens 7 days per week (by age and sentinel site) is recommended. The sampling procedure is the same during the whole season, all cases and all age groups are included. – – – – – – – There is no national sampling strategy. Sampling is based on the doctor's decision. 77 ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 78 Portugal Total population: 10 467 366 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – – Integrated clinical and virological – Clinical – Integrated clinical and virological – Virological Respiratory pathogens tested for from surveillance system samples – – Influenza, RSV and SARS-CoV-2 – – – – – Influenza, RSV and SARS- CoV-2 Reporting period – – Clinical: year- round; virological: year-round – All year round – All year round – All year round Population covered – – Unknown – 9.04155% – Unknown – – Type of primary health care facilities/hospitals – – GPs and since 2022/2023 includes also primary care units – Central hospitals – ICUs – Non-sentinel surveillance: hospitals and emergency departments Number of primary health care facilities/hospitals – – 64 GPs and 73 primary care centres – 2 hospital centres (1 in Lisbon and 1 in Oporto). We are recruiting 2 more hospitals – 33 ICUs – 29 hospitals Case definition used – – ECDC, WHO – National – National – There is no specific case definition for testing as patients are tested according to the guidelines and the clinical judgement 79 Description if a national specific case definition – – – – ICD-10 codes covering respiratory infections and complicatio ns of respiratory infections – Hospitalized influenza- confirmed cases by RT- PCR – – Year surveillance system introduced – – ILI since 1989, ARI since 2020 – 2020 – 2011–2012 – 2009 Are epidemic thresholds used for this surveillance system? – – Yes – No – No – No Sampling strategy methodology used – – Systematic sampling – All cases – – – – Sampling strategy – – Each GP and centre should select until 5 patients/wee k for swabbing. – Accordingly with the national guidelines, all patients hospitalized due to a respiratory infection should be tested for influenza and SARS- CoV-2. – All respiratory patients admitted in ICU are tested for influenza (and now also for SARS-CoV- 2). – Hospitals reported all cases weekly tested for influenza, RSV and other respiratory viruses. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICD-10: International Statistical Classification of Diseases and Related Health Problems, tenth revision; GP: general practitioner; ICU: intensive care unit; ILI: influenza-like illness; RSV: respiratory syncytial virus; RT-PCR: reverse transcription polymerase chain reaction; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 80 Republic of Moldova Total population: 3 435 883 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Clinical Integrated clinical and virological Clinical Integrated clinical and virological Clinical Integrated clinical and virological – Integrated clinical and virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS-CoV-2 – Influenza and SARS- CoV-2 Reporting period Year-round Weekly from week 40 to week 20; monthly from week 21 to week 39 Year-round Weekly from week 40 to week 20; monthly from week 21 to week 39 Year-round Weekly from week 40 to week 20; monthly from week 21 to week 39 Weekly from week 40 to week 20 – – Population covered 11.0% 100.0% 11.0% 100.0% 43.0% 100.0% – – – Type of primary health care facilities/hospi tals General practices General practices General practices General practices ICU, general/inte rnal medicine, paediatric medicine, infectious disease and respiratory disease ward, therapeutic/ chronic disease ward – ICU, general/internal medicine, paediatric medicine, infectious disease and respiratory disease ward, therapeutic/chr onic disease ward – – Number of primary health care facilities/hospi tals 10 facilities ~369 facilities 10 facilities ~369 facilities 12 hospitals ~68 hospitals 12 hospitals – – 81 Case definition used WHO 2014 WHO 2014 ECDC, WHO ECDC, WHO WHO 2014 WHO 2014 WHO 2014, EDCD – – Year surveillance system introduced 2009 – 2009 – 2009 – 2009 – – Are epidemic thresholds used for this surveillance system? Yes Yes Yes Yes No No No – – Sampling strategy methodology used Convenience sampling – Convenience sampling – Convenience sampling – Convenience sampling – – Sampling strategy 18 swabs are collected weekly (between week 40 and week 20) from the first patients who meet the ILI/ARI case definition. Out of season, samples are collected when there are patients who meet the case definition. All age groups are included in the sampling. During the flu season, when necessary, samples from non- sentinel facilities to the flu are investigat ed. It is not a programm ed number of samples. Varies from season to season. 18 swabs are collected weekly (between week 40 and week 20) from the first patients who meet the ILI/ARI case definition. Out of season, samples are collected when there are patients who meet the case definition. All age groups are included in the sampling. During the flu season, when necessary, samples from non- sentinel facilities to the flu are investigat ed. It is not a programm ed number of samples. Varies from season to season. 28 swabs are collected weekly (between week 40 and week 20) from first patients who meet the SARI/ILI case definition. Out of season, samples are collected when there are patients who meet the case definition. All age groups are included in the sampling. During the flu season, when necessary, samples from non- sentinel facilities to the flu are investigate d. It is not a programme d number of samples. Varies from season to season. 28 swabs are collected weekly (between week 40 and week 20) from the first patients who meet the SARI/ILI case definition. Out of season, samples are collected when there are patients who meet the case definition. All age groups are included in the sampling. – Non- sentinel facilities collect samples for more severe cases of ILI and SARI. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 82 Romania Total population: 19 054 548 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – Integrated clinical and virological – Integrated clinical and virological – – – Virological Respiratory pathogens tested for from surveillance system samples – – – – Influenza, RSV and SARS-CoV-2 – – – – Reporting period Year-round – Year- round – Weeks 46–20 – – – – Population covered 2.0% – 2.0% – 13.0% – – – 100.0% Type of primary health care facilities/hospitals General practice – General practice – ICU, internal medicine, paediatric medicine, infectious diseases ward/hospital, respiratory disease ward/ hospital – – – Hospitals, primary health care practices, specialized medical practices, health centres, outpatient clinics, emergency services providers, home care providers, long-term care institutions Number of primary health care facilities/hospitals 192 facilities – 192 faciliti es – 19 hospitals – – – Around 12 000 GPs and 10 000 other health facilities/ hospitals Case definition used WHO 2014 – National – National – – – For ILI: WHO 2014 83 Description if a national specific case definition An acute respiratory illness with fever ≥ 38 °C, cough, onset within the last 10 days, in the absence of other clinical diagnosis – An acute respirator y illness with sudden onset and at least one of the following: cough, sore throat, breathing difficulties , coryza – An acute respiratory illness with a history of fever or measured fever of ≥ 38 °C, and cough and shortness of breath or difficulty breathing, with onset within the past 10 days, requiring hospitalization overnight – – – For ILI: WHO 2014 Year surveillance system introduced 2001 – 2001 – 2009 – – – 2014 Are epidemic thresholds used for this surveillance system? Yes – Yes – Yes – – – No Sampling strategy methodology used Systematic sampling – Convenien ce sampling – All cases – – – – Sampling strategy On Tuesdays and Thursday, from week 40 (onset of influenza season) swabs are collected from all cases presented and who meet the ILI case definition. All ILI-negative cases should have been tested for SARS- CoV-2. After the onset of the season the algorithm is established by the National Center, according to specific season parameters. – Dependin g on the epidemiol ogical context, ARI cases can be sampled and tested for influenza. – Between week 46 and week 20, ALL detected SARI cases in each sentinel hospital should have been sampled and tested for influenza viruses, SARS- CoV-2, RSV and other etiologies. – – – For ILI: there is only a sentinel sampling strategy. Non-sentinel: sampling is done for the more serious cases, depending on the funds available for payment of the tests. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; GP: general practitioner; ICU: intensive care unit; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. 84 a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 85 Russian Federation Total population: 144 444 305 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Integrated clinical and virological Integrated clinical and virological Integrated clinical and virological Integrated clinical and virological Clinical – – – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS-CoV- 2 Influenza, RSV and SARS-CoV-2 – – – Reporting period Year-round Year-round Year-round Year-round Year-round Year-round – – – Population covered About 15% of the population lives in cities with sentinel sites 35.0% About 15% of the population lives in cities with sentinel sites 35.0% About 15% of the population lives in cities with sentinel sites 35.0% – – About 35% of the population Type of primary health care facilities/hospitals Polyclinics, infectious disease hospitals, general hospitals (infectious disease wards) Polyclinics, infectious disease hospitals, general hospitals (infectious disease wards) Polyclinics, infectious disease hospitals, general hospitals (infectious disease wards) Polyclinics, infectious disease hospitals, general hospitals (infectious disease wards) Infectious disease hospitals for adults and children, infectious disease wards at general hospitals, ICUs Infectious disease hospitals for adults and children, infectious disease wards at general hospitals, ICUs – – Polyclinics, infectious disease hospitals, general hospitals (infectious disease wards) Number of primary health care facilities/hospitals 13 polyclinics in 7 cities 61 cities 13 polyclinics in 7 cities 61 cities 18 hospitals in 8 cities 61 cities – – 58 laboratories Case definition used WHO 2011 No case definition used WHO 2011 No case definition used WHO 2011 No case definition used – – – Year surveillance system introduced 2010 2005 2010 1971 2010 – – 1971 Are epidemic thresholds used for this surveillance system? No Yes No Yes No No – – No 86 Sampling strategy methodology used Convenience sampling Convenience sampling Convenience sampling Convenience sampling Systematic sampling Convenience sampling – – Convenience sampling Sampling strategy The average number of samples from patients with ILI/ARI is 29 per week on average for each city; all age groups are included. Convenience sampling. The average number of samples from patients with ILI/ARI is 29 per week on average for each city; all age groups are included. Convenience sampling. Samples are taken from SARI patients, selected as per the WHO 2011 definition. During the COVID-19 pandemic, the percentage tested is 50–60%. Convenience sampling. – – A citywide average of 10– 50 samples are tested weekly for influenza. The exact number is determined by the epidemiological situation. ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV- 2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 87 Serbia Total population: 7 149 026 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Integrated clinical and virological Clinical – Integrated clinical and virological – Integrated clinical and virological Integrated clinical and virological Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS- CoV-2 Influenza, RSV and SARS- CoV-2 – – Influenza, RSV and SARS-CoV- 2 – Influenza Influenza Influenza, RSV and SARS-CoV-2 Reporting period Year-round Year-round Year- round – Year-round – Year- round Year- round Year-round Population covered – 100.0% – – – – – – – Type of primary health care facilities/hospitals General practice, paediatric practice General practice, paediatric practice – – ICU, general/interna l medicine, paediatric medicine, infectious disease ward, respiratory disease ward – – – – Number of primary health care facilities/hospitals 21 health care facilities 158 facilities 21 health care facilities – 9 hospitals – – – – Case definition used WHO 2011 WHO 2011 ECDC, WHO – WHO 2014 – – – – Year surveillance system introduced 2009 2006 2009 – 2009 – – – – Are epidemic thresholds used for this surveillance system? No Yes No – No – – – – 88 Sampling strategy methodology used Convenience sampling Convenience sampling – – Convenience sampling – – – – Sampling strategy ILI cases are sampled during all 5 days in the week. All age groups are included in sampling. There is no difference in the sampling procedure between the start and peak of the season. ILI cases are sampled during all 5 days in the week. All age groups are included in sampling. There is no difference in the sampling procedure between the start and peak of the season. – – SARI cases are sampled during all 5 days in the week. All age groups are included in sampling. There is no difference in the sampling procedure between the start and peak of the season. – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 89 Slovakia Total population: 5 428 792 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Univers al Surveillance system Integrated clinical and virological Clinical Integrated clinical and virological Clinical Integrated clinical and virological – – – – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS- CoV-2 Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS-CoV-2 Influenza, RSV and SARS-CoV-2 – – – Reporting period Weekly/ year-round Year-round Year-round/ weekly Year-round/ weekly Year-round/ weekly Year-round/ weekly – – Year-round/ weekly Population covered 5.0% 100.0% 3.5% 100.0% 3.5% 100.0% – – 53.2% Type of primary health care facilities/hospitals General practice, paediatric practice General practice, paediatric practice General practice, paediatric practice General practice, paediatric practice General practice, paediatric practice ICUs Department of infectology, pneumology – – General practice, paediatric practice, hospitals Number of primary health care facilities/hospitals – – – – – 74 hospitals – – 3 635 facilities Number of primary care practitioners if number of primary health care facilities is not known – – 130 – 130 – – – – Case definition used – ECDC – ECDC, WHO – – – – ECDC, WHO, WHO 2014 Year surveillance system introduced – 2002 – 2002 – 2009 – – 2002 90 Are epidemic thresholds used for this surveillance system? – Yes – Yes – No – – – Sampling strategy methodology used Convenience sampling Convenience sampling Convenience sampling Convenienc e sampling – All cases – – – Sampling strategy Every 5th case (on each work day of the week) at the sentinel site that meet the case definition is sampled, all age groups. Based on the doctor’s decision. All cases are included in the sampling strategy. Every 5th case (on each work day of the week) at the sentinel site that meet the case definition is sampled, all age group. Based on the doctor’s decision. All cases are included in the sampling strategy. – All reported SARI cases are laboratory tested. – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 91 Slovenia Total population: 2 116 972 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – Clinical – – – – – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – – – – – – Reporting period Year-round – Year-round – – – – – Year-round Population covered 6.0% – 6.0% – – – – – 100.0% Type of primary health care facilities/hospitals Family practices, paediatric practices, school doctors – Family practices, paediatric practices, school doctors – – – – – Hospitals Number of primary health care facilities/hospitals 62 facilities – 62 facilities – – – – – All facilities/hospitals Case definition used ECDC – ECDC, WHO – – – – – No case definition used. Most samples are derived from hospitalized patients with ARI, but not exclusively Year surveillance system introduced 1999 – 1999 – – – – – 2010 Are epidemic thresholds used for this surveillance system? Yes – Yes – – – – – No Sampling strategy methodology used Convenience sampling – Convenience sampling – – – – – – 92 Sampling strategy Samples are collected from patients with acute respiratory symptoms. Sentinel physicians select on form if clinical presentation resembles ILI or ARI. The number of samples is not limited. – Samples are collected from patients with acute respiratory symptoms. Sentinel physicians select on form if clinical presentation resembles ILI or ARI. The number of samples is not limited. – – – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 93 Spain Total population: 48 085 361 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – – Integrated clinical and virological – Integrated clinical and virological – – – Virological Respiratory pathogens tested for from surveillance system samples – – Influenza, RSV and SARS-CoV- 2 – Influenza, RSV and SARS- CoV-2 – – – Influenza and RSV Reporting period – – Clinical: week 40–39. Virological: week 40–39 – Year-round (week 40–39) – – – – Population covered – – 14.1% regarding the participants Spanish regions – 16.4% regarding the participants Spanish regions – – – – Type of primary health care facilities/hospitals – – General practice, paediatric practice – All wards, mainly in public general hospitals – – – Laboratories mainly in public hospitals Number of primary health care facilities/hospitals – – – – 24 hospitals – – – – Number of primary care practitioners if number of primary health care facilities is not known – – 1 263 primary care practitioners – – – – – – Case definition used – – ECDC, WHO – National – – – – Description if a national specific case definition – – – – An acute respiratory illness with onset within the last 10 days; and requires hospitalization – – – – Year surveillance system introduced – – 2020 – 2020 – – – 1996 94 Are epidemic thresholds used for this surveillance system? – – No – No – – – – Sampling strategy methodology used – – Systematic sampling – Systematic sampling – – – – Sampling strategy – – Samples are collected from the first 2–5 ARI patients (depending on the region) who attend the sentinel facility during the week. All age groups are included in sampling. – Samples are collected from all SARI patients hospitalized on Tuesday and/or Wednesday. – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 95 Sweden Total population: 10 521 556 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Virological – Virological – – – – Clinical Virological Respiratory pathogens tested for from surveillance system samples Influenza and SARS- CoV-2 – Influenza and SARS- CoV-2 – – – – Influenza – Reporting period Weeks 40– 20. During the pandemic the surveillance did run summer 2020, 2021 and 2022. – Week 40– 20. During the pandemic the surveillance did run summer 2020, 2021 and 2022. – – – – Year-round Year-round Population covered At least one participating practice from nearly all of our 21 regions. Difficult to calculate a percentage covered and not as relevant, since we do not collect rates of ILI/ARI – At least one participating practice from nearly all of our 21 regions. Difficult to calculate a percentage covered and not as relevant, since we do not collect rates of ILI/ARI – – – – Nearly 100%, has improved during the COVID-19 pandemic. Population- based denominator for reporting ICUs for the hospital- based system exists. 100.0% Type of primary health care facilities/hospitals General practice (previously also infectious disease and paediatric clinics) – General practice (previously also infectious disease and paediatric clinics) – – – – ICU Emergency care, hospitals, infectious disease and paediatric clinics, primary care facilities 96 Number of primary health care facilities/hospitals 51 practices included spring 2023 – 51 practices included spring 2023 – – – – Circa 80 ICUs Circa 28 microbiological laboratories (these also report analyses performed at other hospitals without microbiological laboratories) Case definition used ECDC – ECDC, WHO – – – – Laboratory- confirmed influenza or COVID-19 Laboratory- confirmed influenza cases (and since 2020, laboratory- confirmed COVID-19 cases) Year surveillance system introduced 2006 – 2006 – – – – 2013 1993 Are epidemic thresholds used for this surveillance system? No – No – – – – No Yes Sampling strategy methodology used Convenience sampling – Convenience sampling – – – – – – Sampling strategy Up to 5 specimens collected per week per site. – Up to 5 specimens collected per week per site. – – – – No sampling strategy. Samples are collected based on decision of the clinician. No sampling strategy. Samples are collected based on decision of the clinician. ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV- 2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 97 Switzerland Total population: 8 796 622 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – Integrated clinical and virological – – – Integrated clinical and virological – Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS- CoV-2 – – – Influenza and SARS- CoV-2 – Influenza and SARS-CoV-2 Reporting period Clinical, year-round; virological, until 2019 week 40 to week 16 (of the following year); since 2020 year- round – Clinical, year- round; virological, year-round – – – SARS-CoV-2, year-round; influenza, weeks 44– 16 – Year-round Population covered 1.8% – 1.8% – – – – – 100.0% Type of primary health care facilities/hospitals General practice, paediatricia n – General practice, paediatrician – – – Hospitals/ paediatric hospitals – Laboratories Number of primary health care facilities/hospitals 160-180 facilities. – 160-180 facilities – – – 18 hospitals – <200 laboratories Case definition used WHO <2011. – ECDC, WHO – – – – – Laboratory- confirmed influenza and SARS-CoV-2 98 Description if a national specific case definition – – Before week 40/2022: acute respiratory illness and/or fever ≥ 38 °C without other etiology, and/or sudden anosmia, and/or ageusia and/or acute confusion or deterioration of general condition in the elderly without other etiology) – – – – – – Year surveillance system introduced 1987 – 2020 – – – For influenza, 2018; for SARS- CoV-2, 2020 – For influenza, 1988; for SARS-CoV-2, 2020 Are epidemic thresholds used for this surveillance system? Yes – No – – – No – No Sampling strategy methodology used Convenienc e sampling – Convenience sampling – – – All cases – – 99 Sampling strategy 30–40% of the sentinel facilities collect specimens. Sampling of ILI patients should take place randomly and as evenly as possible throughout the week. If it is easier to organize for practitioners , sampling can instead be carried out randomly on defined days of the week. Weekly number of samples per practitioner is dependent on the region and on laboratory capacity. – 30–40% of the sentinel facilities collect specimens. Sampling of ILI patients should take place randomly and as evenly as possible throughout the week. If it is easier to organize for practitioners, sampling can instead be carried out randomly on defined days of the week. Weekly number of samples per practitioner is dependent on the region and on laboratory capacity. – – – – – Mandatory notification of influenza detection. Consequently, no standard sampling strategy. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 100 Tajikistan Total population: 10 143 489 Income group: lower middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Clinical Integrated clinical and virological Clinical Integrated clinical and virological Clinical Integrated clinical and virological Virological – Respiratory pathogens tested for from surveillance system samples Influenza and SARS-CoV-2 – Influenza and SARS- CoV-2 – Influenza and SARS- CoV-2 – – Influenza and SARS- CoV-2 – Reporting period W40–W20 W40–W20 W40–W20 W40–W20 W40–W20 – W40–W20 – – Population covered 0.4% 100.0% 0.4% 100.0% 20.0% – 20.0% – – Type of primary health care facilities/hospitals Health centre (polyclinic) Health centre (polyclinic) Health centre (polyclinic) Health centre (polyclinic) Hospital Hospital NIC NIC – Number of primary health care facilities/hospitals 1 facility 2 845 facilities – 2 845 facilities 8 hospitals 375 1 – Case definition used WHO 2014 National ECDC, WHO National WHO 2014 – – – – Description if a national specific case definition – Cases are diagnosed primarily on the basis of clinical signs, therefore the system provides for the surveillance of both viral and bacterial acute respiratory diseases – Cases are diagnosed primarily on the basis of clinical signs, therefore the system provides for the surveillance of both viral and bacterial acute respiratory diseases – – – – – Year surveillance system introduced 2016 – 2016 – 2016 – 2016 – – 101 Are epidemic thresholds used for this surveillance system? No No No No No – No – – Sampling strategy methodology used Systematic sampling – Systematic sampling – Systematic sampling – Systematic sampling – – Sampling strategy Operational Guidelines for Sentinel Influenza Surveillance in the Republic of Tajikistan. There is no sampling strategy. Operational Guidelines for Sentinel Influenza Surveillance in the Republic of Tajikistan. There is no sampling strategy. All patients meeting the SARI case definition (WHO, 2014) who are admitted through the emergency department on Monday, Tuesday and Wednesday. Samples are taken from patients in all age groups. The sampling procedure does not differ between the start and the peak of the season. All cases are included in the sampling strategy. – Operational Guidelines for Sentinel Influenza Surveillance in the Republic of Tajikistan. – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; NIC: National Influenza Centre; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; W: week; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 102 Türkiye Total population: 85 816 150 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – – Integrated clinical and virological – – – – Respiratory pathogens tested for from surveillance system samples Influenza, Adenovirus, Parainfluenzavirus (1,2,3,4), Coronavirus (HKU1, 229E, NL63, OC43), Parechovirus, Enterovirus, Rhinovirus, Human bocavirus, RSV A/B, Human metapneumovirus, SARS-CoV-2 – – – Influenza virus, Adenovirus, Parainfluenzavirus (1,2,3,4), Coronavirus (HKU1, 229E, NL63, OC43), Parechovirus, Enterovirus, Rhinovirus, Human bocavirus, RSV A/B, Human metapneumovirus, SARS-CoV-2 – – – – Reporting period Week 40–39 – – – Week 40–39 – – – – Population covered 1.0% – – – Not available – – – – Type of primary health care facilities/hospitals Family physician centres – – – ICU, emergency department, internal disease department, paediatric disease department, infectious disease department, pulmonary disease department – – – – Number of primary health care facilities/hospitals 220 facilities – – – 9 hospitals – – – – Case definition used ILI ECDC – – – WHO 2014 – – – – Description if a national specific case definition – – – – WHO 2014; age- specific case definitions – – – – 103 Year surveillance system introduced 2004 – – – 2016 – – – – Are epidemic thresholds used for this surveillance system? No – – – No – – – – Sampling strategy methodology used Convenience sampling – – – All cases – – – – Sampling strategy At least one sample for each week randomly chosen until Friday showing ILI case definition, including all age groups, by 220 family doctors. – – – Samples are collected from all patients who meet the SARI case definition, all age- groups included, in 9 hospitals. – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 104 Turkmenistan Total population: 6 516 053 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – Integrated clinical and virological Integrated clinical and virological – Integrated clinical and virological Integrated clinical and virological – Respiratory pathogens tested for from surveillance system samples Influenza and SARS- CoV-2 Influenza and SARS- CoV-2 Influenza and SARS- CoV-2 Influenza and SARS-CoV-2 Influenza and SARS-CoV-2 Influenza and SARS- CoV-2 – – – Reporting period From W40 to W20 of the following year Year- round – Year-round Year-round – – Year-round – Population covered – – – 100.0% Data not available – – 100.0% – Type of primary health care facilities/hospitals Polyclinic – – Polyclinics and hospitals Hospital – – Polyclinics and hospitals – Number of primary health care facilities/hospitals 1 facility – – All 1 hospital – – All – Case definition used WHO 2014 – – ECDC, WHO WHO 2014 – – National – 105 Description if a national specific case definition Standard case definition for ILI: ARI with onset within the previous 10 days AND a measured temperatur e of ≥ 38.0 °C AND cough. Patients with ILI are a subgroup of patients clinically diagnosed with ARI, i.e., ILI is equated to ARI with fever and cough. – – Acute onset of symptoms AND at least one of the following respiratory symptoms: cough; sore throat (pharyngitis); shortness of breath; runny nose AND a clinician’s judgement that the illness is due to an infection. ARI may or may not be accompanied by a fever. ARI may include the following conditions: 1. Acute nasopharyngitis, runny nose, including rhinitis (acute), nasal catarrh 2. Acute nasopharyngitis and acute rhinopharyngitis 3. Acute sinusitis 4. Acute pharyngitis 5. Acute tonsillitis 6. Acute laryngitis and tracheitis 7. Acute obstructive laryngitis, epiglottitis and bronchitis 8. Acute upper respiratory infections of multiple and unspecified localization 9. Pneumonia of viral and bacterial origin, as well as secondary pneumonia due to underlying diseases such as chronic heart failure Standard case definition for SARI: ARI requiring hospitalization with onset within the previous 10 days, history of fever or measured temperature ≥ 38.0 °C AND cough. SARI cases are inpatients hospitalized with an overnight stay (full hospitalization). Patients discharged on the same day do not meet the case definition. If a patient with SARI seeks care from a hospital but refuses hospitalization, they cannot be considered a SARI case. – – Influenza is an acute viral infectious disease with airborne transmission of the pathogen, characterized by painful bouts of fever, high temperature, headache, muscle pain, severe loss of strength, and usually a productive or nonproductiv e cough, as well as other respiratory symptoms during 10 days. ARI is an acute respiratory infection characterized by acute onset and at least one of the following four respiratory symptoms: • cough; • sore throat (pharyngitis); • shortness of breath; • runny nose; and a • clinician’s judgement that the illness is due to an infection; • the presence or absence of fever – 106 Year surveillance system introduced 2021 – – 2019 2021 – – 2019 – Are epidemic thresholds used for this surveillance system? No – – No No – – No – Sampling strategy methodology used Systematic sampling – – Convenience sampling Systematic sampling – – Convenience sampling – Sampling strategy • Every day, the first two to three patients meeting the ILI case definition should be sent to the procedure room for a smear; there should be no more than 20 samples per week from one sentinel site. All age groups are included; procedures are not standard throughout the season; only individuals who meet the standard sentinel ILI case definition are included. – – Recommended risk groups for laboratory sampling for suspected influenza/ARI: • pregnant women; • persons living in long-term care facilities (homes for the elderly and disabled, boarding schools, etc.); • persons undergoing inpatient treatment: ➢ Children aged 6 months to 5 years with a severe form of ARI/influenza. ➢ Persons with chronic heart or lung disease, metabolic or renal disease, chronic liver damage, chronic neurological disorders, or immunodeficiency states with severe ARI/influenza. ➢ Elderly people (over 65 years old) with severe ARI/influenza. ➢ Healthcare workers. ➢ Veterinary workers, farmers, etc., who were in contact (2–14 days prior to the SARI patients are encouraged to submit a sample for influenza testing Monday through Sunday, with a maximum of 20 samples per week. – – Recommende d risk groups for laboratory sampling for suspected influenza/ARI: • pregnant women; • persons living in long-term care facilities (homes for the elderly and disabled, boarding schools, etc.); • persons undergoing inpatient treatment: ➢ Children aged 6 months to 5 years with a severe form of ARI/influenza. ➢ Persons with chronic heart or lung disease, metabolic or renal disease, chronic liver damage, chronic neurological disorders, or immunodefici ency states with severe ARI/influenza. ➢ Elderly people (over 65 years old) with severe – 107 disease) with sick or deceased wild birds, poultry, pigs, as well as workers of zoos and circuses. ➢ Persons who developed an acute respiratory infection of unknown etiology after staying (2–14 days prior to the disease) in a region that is not epidemically safe for new types of influenza. Note: Taking samples for laboratory research is at the discretion of the attending physician. ARI/influenza. ➢ Healthcare workers. ➢ Veterinary workers, farmers, etc., who were in contact (2–14 days prior to the disease) with sick or deceased wild birds, poultry, pigs, as well as workers of zoos and circuses. ➢ Persons who developed an ARI of unknown etiology after staying (2–14 days prior to the disease) in a region that is not epidemically safe for new types of influenza. Note: Taking samples for laboratory research is at the discretion of the attending physician. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 108 Ukraine Total population: 36 744 586 Income group: lower middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – Clinical Integrated clinical and virological – – – – Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – Influenza, RSV and SARS-CoV-2 – – – – Reporting period Year-round – – W40–W20 Year-round – – – – Population covered 0.1% – – 100.0% 6.5% – – – – Type of primary health care facilities/hospitals Primary health care – – Primary health care and hospitals Infectious disease and multidisciplinary hospitals (ICUs, paediatric, infectious diseases and pulmonology wards) – – – – Number of primary health care facilities/hospitals 15 primary health care facilities – – All primary health care facilities and hospitals in the country 20 hospitals – – – – Case definition used WHO 2014 – – No case definition used WHO 2014 – – – – Year surveillance system introduced 2016 – – 2016 – – – – – Are epidemic thresholds used for this surveillance system? No – – Yes No – – – – Sampling strategy methodology used Convenience sampling – – – Convenience sampling – – – – 109 Sampling strategy Each physician participating in the sentinel surveillance system collects samples from no more than the first 3 patients meeting the ILI case definition per week. Sampling covers all age groups. All patients are included in the sampling strategy. The sampling procedure does not differ between the start and the peak of the season. – – Sampling is done without a specific strategy. Samples are taken at the discretion of the physician for diagnostic purposes but not for surveillance purposes. No laboratory testing of samples is carried out in the ARVI routine surveillance system. Each sentinel hospital collects samples from no more than 5 patients meeting the SARI case definition per week. Sampling covers all age groups. All patients are included in the sampling strategy. The sampling procedure does not differ between the start and the peak of the season. – – – – ARI: acute respiratory infection; ARVI: acute respiratory viral infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV- 2: severe acute respiratory syndrome coronavirus 2; W: week; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 110 United Kingdom Total population: 67 596 281 Income group: high income England Total population: 57 106 398 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological – – – Integrated clinical and virological – – Integrated clinical and virological Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – – – Influenza, RSV and SARS-CoV- 2 – – Influenza and SARS-CoV-2 – Reporting period Reported via TESSy week 40–20 each season – – – Usually week 40–20. Currently year- round – – Reported via TESSy weeks 40–20 each season Reported via TESSy weeks 40–20 each season Population covered Approximatel y 35% for ILI, less for respiratory swabbing – – – 20–25% – – 100.0% 100.0% Type of primary health care facilities/hospitals General practice – – – Acute hospitals – – ICUs and HDUs PHE, NHS and private microbiology laboratories Number of primary health care facilities/hospitals Over 1 000 contribute ILI data. Fewer practices contribute to the virological surveillance scheme – – – Aggregate level Flu/RSV in 2022–2023 to week 20: 46 spotter trusts overall, of which 23 were regular contributors (16% coverage for regular participants). Aggregate ARI, 2022–2023 to week 20: 60 spotter trusts (regular), 40% coverage – – 141 hospitals eligible. Around 100 routinely contribute > 200 laboratories 111 Case definition used National – – – National – – National – Description if a national specific case definition ILI = ARI with likely/measur ed temperature ≥ 38 °C plus cough plus systemic symptom, sudden onset last 10 days, no more plausible Dx. ARI = ILI or UTRI or LRTI or suspected infectious exacerbation of a chronic respiratory condition – – – Confirmed influenza, RSV and/or SARS- CoV-2, suspected or excluded COVID-19, patients not tested for COVID-19 and other causes of ARI. We accept a clinical working diagnosis of ARI. – – A case is defined as: any individual admitted to hospital ICU/HDU AND has a laboratory- confirmed influenza A (including H1, H3 or novel) or influenza B infection. Symptoms: history of or observed fever (≥ 38 °C) with onset of previous 10 days AND at least two of: cough, sore throat, headache, rhinorrhoea, limb or joint pain, vomiting, diarrhoea, increased respiratory rate or poor feeing) – Year surveillance system introduced 1964 – – – – – 2010 – Are epidemic thresholds used for this surveillance system? Yes – – – Yes – – Yes No Sampling strategy methodology used Convenience sampling – – – All cases – – All cases Convenience sampling 112 Sampling strategy At the start of the season < 100 ILI/ARI cases are swabbed per week. At the peak of the season > 500 patients are swabbed per week. Patients are selected by sentinel practices if they meet the case definition, all ages are eligible; there are no exclusions based on demographic s or medical conditions/th eir absence. – – – – – – All cases should be sampled. – ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; Dx: diagnosis; ECDC: European Centre for Disease Prevention and Control; HDU: high dependency unit; ICU: intensive care unit; ILI: influenza-like illness; LRTI: lower respiratory tract infection; NHS: National Health Service; PHE: Public Health England; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; TESSy: The European Surveillance System; URTI: upper respiratory tract infection; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 113 Northern Ireland Total population: 1 910 543 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Clinical – Clinical – – – Virological Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS- CoV-2 – – – – – – Influenza, RSV and SARS-CoV- 2 – Reporting period Year-round Year- round – Year- round – – – Year-round Year-round Population covered Currently unknown as new surveillance system is being developed for 23/24 100.0% – 100.0% – – – 100.0% All care homes Type of primary health care facilities/hospitals General practice General practice – General practice – – – All hospitals – Number of primary health care facilities/hospitals Currently unknown as new surveillance system is being developed for 23/24 319 – 319 – – – All hospitals – Case definition used National National – – – – – National National 114 Description if a national specific case definition GP-diagnosed ILI, based on clinician’s indication on form GP- diagnosed ILI, based on clinician’s indication on form – GP- diagnosed ARI, based on clinician’s indication on form – – – – FLI outbreak definition: two or more cases within the same 48-hour period OR three or more cases arising within the same 72-hour period, which meet the same clinical case definition and where an epidemiological link can be established AND evidence of transmission within the facility. Oral temperature of 37.8 °C or more PLUS new onset or acute worsening respiratory symptoms OR in older people an acute deterioration in physical or mental ability without other known cause Year surveillance system introduced 2001 2009 – – – – – 2011 – Are epidemic thresholds used for this surveillance system? No Yes – – – – – No No Sampling strategy methodology used Convenience sampling All cases – – – – – All cases – 115 Sampling strategy Currently: up to a maximum of 5 patients per week that meet the case definition. Swabbing should be undertaken regardless of vaccination status and within 7 days of onset of symptoms. In 2023/24: currently unknown as new surveillance system is being developed for 23/24. All clinically diagnosed cases of ILI. – All clinically diagnosed cases of ARI. – – – All confirmed cases of influenza in hospital patients for whom respiratory screen tests are requested. Swabs taken of first cases in care home with symptoms. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; GP: general practitioner; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 116 Scotland Total population: 5 447 700 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system – Clinical Integrated clinical and virological Clinical Integrated clinical and virological Integrated clinical and virological – Integrated clinical and virological Virological Respiratory pathogens tested for from surveillance system samples – – Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS- CoV-2 Influenza, RSV and SARS-CoV- 2 – Influenza, RSV and SARS-CoV- 2 Influenza, RSV and SARS-CoV-2 Reporting period – Year-round Year-round Year-round Year-round Year- round – Year- round Year-round Population covered – 100.0% Participating practices only 100.0% Approximately 5% 100.0% – 100.00% 100.0% Type of primary health care facilities/hospitals – General practice General practices General practice All hospitals All hospitals – All hospitals All hospital wards Number of primary health care facilities/hospitals – 930 facilities 147 general practices 930 facilities Up to 10 – – – 274 hospitals Case definition used – National ECDC National National National – National National Description if a national specific case definition – Aggregated automated GP extracts on ILI and ARI consultations based on READ codes. Definition of ILI and ARI are based on clinical discretion. Sudden/acute onset of at least one of the following four respiratory symptoms: cough, sore throat, shortness of breath, coryza, and a clinician’s judgement that the illness is due to an infection. Aggregated automated GP extracts on ILI and ARI consultations based on READ codes. Definitions of ILI and ARI are based on clinical discretion. Slightly adapted WHO 2014 definition: Hospital admission for ARI with symptoms beginning in the past 14 days, history of fever or measured fever ≥ 38 °C OR cough OR shortness of breath AND a clinician's A patient discharged from a Scottish hospital who has one or more of the following ICD-10 codes: J09–22, J80, U07.1 - U07.2, J04 or B97.4 – Patients admitted as an emergency to a hospital (excluding surgical and mental health specialties, and emergency admissions with patient injury codes) who have Based on clinical discretion of healthcare professional. 117 judgement that the illness is due to a respiratory infection a positive influenza, RSV or SARS-CoV- 2 test result, taken within a period of between 14 days before the admission date and 48 hours after the admission date. Patients identified from RAPID dataset Year surveillance system introduced – 2009 2000 Modified 2020 for COVID requirements, extended to 10 pathogens 2021 2009 Under development 2020 – 2020 2009 Are epidemic thresholds used for this surveillance system? – Yes No Yes No No – No Yes Sampling strategy methodology used – – All cases – Convenience sampling All cases – All cases All cases 118 Sampling strategy – No samples collected All cases No samples collected. All eligible patients who meet case definition – – – – ARI: acute respiratory infection; COVID-19: coronavirus disease 2019; ECDC: European Centre for Disease Prevention and Control; GP: general practitioner; ICD-10: International Statistical Classification of Diseases and Related Health Problems, tenth revision; ILI: influenza-like illness; RAPID: Rapid Preliminary Inpatient Data; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 119 Wales Total population: 3 131 640 Income group: high income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Clinical Virological Clinical Integrated clinical and virological – – Virological Virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV-2 – Influenza, RSV and SARS-CoV- 2 – Influenza, RSV and SARS- CoV-2 – – Influenza – Reporting period Year-round During periods of heightene d activity Year- round During periods of heightene d activity Year-round – – – Year-round Population covered 11.8% 100.0% 11.8% 100.0% Currently approximately 9%, but will increase when new sites come online – – 100.0% 100.0% Type of primary health care facilities/hospitals General practice General practice General practice General practice Hospital emergency department – – All wards Hospitals; non-sentinel general practices Number of primary healthcare facilities/hospitals 42 facilities 350 facilities 42 facilities 350 facilities 4 sites, with further expansion underway – – 19 hospitals 19 hospitals and ad hoc non-sentinel general practices Case definition used National National National National National – – Laboratory- confirmed influenza in patients tested with respiratory symptoms Laboratory- confirmed influenza in patients tested with respiratory symptoms 120 Description if a national specific case definition GP- diagnosed ILI, based on clinician’s indication on form GP- diagnosed ILI, based on Read/ SNOMED codes GP- diagnosed ARI, based on clinician’s indication on form GP- diagnosed ARI, based on Read/ SNOMED codes Symptomatic presentations in emergency department where there is an intention to admit. Plan to move to agreed ECDC SARI-Net definitions – – – – Year surveillance system introduced 1987 2009 1987 2020 2020 – – 2005 2005 Are epidemic thresholds used for this surveillance system? Yes No No No No – – No No Sampling strategy methodology used All cases All cases All cases All cases All cases – – All cases All cases Sampling strategy. Sentinel GPs are asked to swab all diagnosed ILI/ARI cases (around the peak of an epidemic this may be limited to the first 5 patients diagnosed in each practice per week). All clinically diagnosed cases of ILI. Sentinel GPs are asked to swab all diagnosed ARI cases (around the peak of an epidemic this may be limited to the first 5 patients diagnosed in each practice per week). All clinically diagnosed cases of ARI. All symptomatic presentations in emergency department where there is an intention to admit. At times of high pressure in emergency department, completeness of reporting may decrease. We are setting in place a means to estimate completeness of reporting. – – All confirmed cases of influenza in hospital patients for whom respiratory screen tests are requested. All confirmed cases of influenza in hospital patients (with a very small proportion of non-sentinel GP patients) for whom respiratory screen tests are requested. ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; GP: general practitioner; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; SNOMED: Systematized Nomenclature of Medicine; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 121 Uzbekistan Total population: 35 163 897 Income group: lower middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Clinical Integrated clinical and virological Clinical Integrated clinical and virological Clinical – – – Respiratory pathogens tested for from surveillance system samples – – – – – – – – – Reporting period Year-round Year- round Year-round Year-round Year-round Year- round Year- round Randomly, year-round Population covered 0.16% of the country’s population – 0.16% of the country’s population – 0.03% of the country’s population – – – – Type of primary health care facilities/hospitals General practice, polyclinic – General practice, polyclinic – Inpatient facilities (children’s hospital, infectious disease hospital, emergency medical care centre) Hospitals for the hospitaliz ation of patients with SARI – – – Number of primary health care facilities/hospitals 1 facility – 1 facility – 3 hospitals – – – – Case definition used WHO 2014 – WHO 2014 – WHO 2014 – – – – Description if a national specific case definition ARI with the following symptoms: history of fever or, at the time of examination, a temperature of 38 °C or higher, cough, onset within the – Acute onset of clinical signs with at least one of the following respiratory disorders: cough, sore throat, runny nose, – ARI with the following signs: history of fever or temperature at the time of examination 38 °C or more, cough, onset within the previous 10 days, ARI with the following signs: history of fever or temperat ure at the time of examinati on 38 °C – – – 122 previous 10 days. and clinical judgement that the illness is due to infection. hospitalization required or more, cough, onset within the previous 10 days, hospitaliz ation required Year surveillance system introduced 2016 – 2016 – 2016 2016 – – – Are epidemic thresholds used for this surveillance system? Yes – Yes – Yes – – – – Sampling strategy methodology used Convenience sampling – Convenienc e sampling – Systematic sampling All cases – – – Sampling strategy Five doctors are assigned, an average of 25 samples/smears are collected weekly from the outpatient clinic from patients who have been diagnosed with ILI meeting the ILI case definition. – – Swabs taken from all patients hospitalized on the first day of the week who meet the case definition of SARI. – – – – ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ILI: influenza-like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. [1] All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 123 Kosovo[1] Total population: 1 663 546 Income group: upper middle income System characteristic Primary care Hospitala Otherb Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed respiratory virus Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological Clinical Integrated clinical and virological Clinical Integrated clinical and virological Clinical Integrated clinical and virological Integrated clinical and virological Integrated clinical and virological Respiratory pathogens tested for from surveillance system samples Influenza, RSV and SARS-CoV- 2 – – Influenza, RSV and SARS-CoV- 2 Influenza, RSV and SARS-CoV- 2 – – – Influenza, RSV and SARS-CoV-2 Reporting period Weeks 40–20 – – Weeks 40–20 Whole year – Whole year – Whole year Population covered 48.4% Whole population 48.4% Whole population 48.4% Whole population 48.4% Whole population – Type of primary health care facilities/hospitals General practice, paediatric practice, infectious disease, lung disease (all health care levels) – – All health care levels Paediatric practice, ICU, infectious diseases, lung disease (secondary and tertiary health care levels) – – – Paediatric practice, ICU, infectious diseases, lung disease (secondary and tertiary health care levels) Number of primary health care facilities/hospitals 5 facilities 34 facilities 5 facilities 34 facilities 5 facilities – 5 facilities – 5 facilities Case definition used WHO 2014 WHO 2014 – ECDC, WHO WHO 2014 – – – ECDC, WHO 124 Year surveillance system introduced 2014 2014 – 2014 2014 – – – 2021 Are epidemic thresholds used for this surveillance system? Yes Yes – No No – – – No Sampling strategy methodology used Systematic sampling Systematic sampling – Systematic sampling All cases – – – Systematic sampling Sampling strategy In Pristina and Prizren. Samples are collected twice per week on Monday and Thursday. In Pristina and Prizren. Samples are collected twice per week on Monday and Thursday. – In Pristina and Prizren. Samples are collected twice per week on Monday and Thursday. All SARI cases are sampled at all times (24 hours/7 days per week). – – – All SARI cases are sampled at all times (24 hours/7 days per week). ARI: acute respiratory infection; ECDC: European Centre for Disease Prevention and Control; ICU: intensive care unit; ILI: influenza- like illness; RSV: respiratory syncytial virus; SARI: severe acute respiratory infection; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WHO: World Health Organization. See Notes for more information on respiratory virus surveillance systems and a description of WHO and ECDC case definitions. a Hospital-based surveillance can be carried out by SARI surveillance or by “laboratory-confirmed” surveillance. Both system types include patients that have been admitted to hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza, RSV and/or SARS-CoV-2. In laboratory-confirmed surveillance, patients testing positive for influenza, RSV and/or SARS-CoV-2 are reported, regardless of meeting the SARI case definition. b Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands (Kingdom of the) North Macedonia Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Türkiye Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eurocontact@who.int Website: www.who.int/europe Document number WHO/EURO:2024-9857-49629-74316 (PDF)