Influenza Surveillance Country, Territory and Area Profiles 2019 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Marmorvej 51 DK - 2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2019 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. 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The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. © European Centre for Disease Prevention and Control 2019 This publication follows WHO terminological practice. The names and designations of countries used in this publication should not be understood as an endorsement by ECDC of the terminology used. The designations used, and the presentation of the maps therein, do not represent ECDC’s official position on the legal status of any country, territory, city or area or of its authorities, or the delimitation of its frontiers and boundaries. Suggested citation for full report. European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Influenza Surveillance Country, Territory and Area Profiles 2019; 2019. Suggested citation for tables and figures. European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Influenza Surveillance Country, Territory and Area Profiles 2019; 2019. i Contents Data ........................................................................................................................................................ iii Abbreviations ......................................................................................................................................... iii Notes ...................................................................................................................................................... iv Albania .................................................................................................................................................... 1 Armenia ................................................................................................................................................... 3 Austria ..................................................................................................................................................... 5 Azerbaijan ............................................................................................................................................... 7 Belarus .................................................................................................................................................... 9 Belgium ................................................................................................................................................. 11 Bosnia and Herzegovina ........................................................................................................................ 14 Bulgaria ................................................................................................................................................. 18 Croatia ................................................................................................................................................... 21 Cyprus ................................................................................................................................................... 23 Czech Republic ...................................................................................................................................... 26 Denmark ................................................................................................................................................ 28 Estonia ................................................................................................................................................... 30 Finland ................................................................................................................................................... 32 France.................................................................................................................................................... 34 Georgia .................................................................................................................................................. 36 Germany ................................................................................................................................................ 38 Greece ................................................................................................................................................... 40 Hungary ................................................................................................................................................. 42 Iceland ................................................................................................................................................... 44 Ireland ................................................................................................................................................... 46 Israel ...................................................................................................................................................... 48 Italy ....................................................................................................................................................... 50 Kazakhstan ............................................................................................................................................ 53 Kyrgyzstan ............................................................................................................................................. 56 Latvia ..................................................................................................................................................... 59 Lithuania ............................................................................................................................................... 61 Luxembourg .......................................................................................................................................... 63 ii Malta ..................................................................................................................................................... 65 Montenegro .......................................................................................................................................... 67 Netherlands........................................................................................................................................... 69 Norway .................................................................................................................................................. 73 Poland ................................................................................................................................................... 77 Portugal ................................................................................................................................................. 79 Republic of Moldova ............................................................................................................................. 81 Republic of North Macedonia ............................................................................................................... 83 Romania ................................................................................................................................................ 85 Russian Federation ................................................................................................................................ 88 Serbia .................................................................................................................................................... 90 Slovakia ................................................................................................................................................. 92 Slovenia ................................................................................................................................................. 94 Spain ...................................................................................................................................................... 96 Sweden .................................................................................................................................................. 99 Switzerland .......................................................................................................................................... 101 Tajikistan ............................................................................................................................................. 103 Turkey ................................................................................................................................................. 106 Turkmenistan ...................................................................................................................................... 108 Ukraine ................................................................................................................................................ 113 United Kingdom of Great Britain and Northern Ireland ..................................................................... 115 England............................................................................................................................................ 115 Northern Ireland ............................................................................................................................. 118 Scotland .......................................................................................................................................... 121 Wales............................................................................................................................................... 124 Uzbekistan ........................................................................................................................................... 126 Kosovo (in accordance with United Nations Security Council Resolution 1244 [1999]) .................... 128 iii Data The data in these profiles were submitted by the country, territory or area during the period July 2018 to January 2019, with the exception of data from Cyprus and Kosovo* (in accordance with United Nations Security Council Resolution 1244 [1999]), which were submitted during 2017. The data here are presented unedited. Abbreviations ARI Acute respiratory infection ECDC European Centre for Disease Prevention and Control GP General practitioner/general practice HDU High dependency unit HMO Health maintenance organization (Israel) ICD International classification of diseases ICPC International Classification of Primary Care ICU Intensive care unit ILI Influenza-like illness MEM Moving epidemic method NHS National Health Service (United Kingdom) NIC National Influenza Centre PAHO Pan American Health Organization PCR Polymerase chain reaction PHE Public Health England RSV Respiratory syncytial virus SARI Severe acute respiratory infection WHO World Health Organization * For the purposes of this publication, all references to “Kosovo” should be understood/read as “Kosovo (in accordance with Security Council resolution 1244 (1999))”. iv Notes I. These profiles include only details of national surveillance systems which provide data to The European Surveillance System (TESSy) and used in the drafting of the joint European Centre for Disease Prevention and Control (ECDC)–WHO Regional Office for Europe influenza bulletin, Flu News Europe (https://flunewseurope.org/). II. Mid-year population estimates are based on 2016 data, according to the WHO Regional Office for Europe’s European Health for All database (http://data.euro.who.int/hfadb). III. Income group is based on the June 2018 World Bank list of economies (http://data.worldbank.org/about/country-and-lending-groups). IV. The type of surveillance can be defined as: 1. sentinel; 2. universal; or 3. non-sentinel. (http://www.euro.who.int/__data/assets/pdf_file/0020/90443/E92738.pdf?ua=1) 1. A sentinel surveillance system is formed by one or more designated health care facilities or providers that routinely and consistently collect epidemiological information from patients presenting with an illness consistent with a specified case definition. Representative clinical specimens are collected from all or a subset of patients according to a randomized/standardized sampling protocol. Sentinel surveillance systems provide an efficient way to obtain high‐quality data on relatively common conditions from a manageable number of locations. Each sentinel site should include facilities that together represent the population under surveillance. 2. A universal surveillance system is formed by all designated health care facilities or providers in a country, territory or area. This generally includes reporting of all clinician‐defined “ARI” and is part of the national disease surveillance systems of several Member States in the WHO European Region. These universal systems provide subnational resolution of clinician‐reported respiratory disease activity. The most common case definitions can be found in the table below: ILI ECDC Sudden onset of symptoms and at least one of the following four systemic symptoms: fever or feverishness, malaise, headache, myalgia and at least one of the following three respiratory symptoms: cough, sore throat or shortness of breath. WHO <2011 Sudden onset of fever >38 C° AND cough OR sore throat in the absence of other diagnosis. WHO 2011 An acute respiratory illness with onset during the last 7 days with, measured temperature ≥38°C, AND cough. WHO 2014 An acute respiratory infection with: measured fever of ≥38 C° and cough; with onset within the last 10 days. 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. SARI WHO <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.* 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 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. *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. v Sampling strategies A. Systematic sampling: samples are collected in a systematic way. This includes: • Interval sampling – e.g. every 5th patient who meets the case definition is selected for testing and data collection. • Alternate day sampling – e.g. select all patients who meet the case definition presenting to a facility on a certain day or days of the week. B. Convenience sampling: this is also called ad hoc sampling and does not adhere to a pre-determined system – e.g. 5 samples per week or the first 2 cases that meet the case definition are sampled. C. All cases: samples are collected from all cases that meet the case definition. 1 Albania Total population: 2,903,700 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Week 40-20. Year-round. Year-round. Year-round. Population covered (%) 6.0% 100.0% 62.0% 38.0% Type of health facilities/ hospitals General practice, paediatric practice, polyclinic. General practice, paediatric practices, polyclinic, emergency department. 8 regional hospitals, 2 university hospital centres (paediatric hospital, infectious diseases hospital), 1 lung hospital. District hospitals. Number of health facilities/ hospitals 2 facilities. All facilities. 11 hospitals. 27 hospitals. Case definition used WHO 2014. ECDC, WHO. WHO 2014. WHO 2014. 2 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Year introduced 2009 1999 2009 2009 Epidemic threshold No. Yes. No. No. Sampling strategy methodology Systematic sampling. Convenience sampling. All cases. Convenience sampling. Sampling strategy Sampling is performed in 2 polyclinics in Tirana. 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 and in outbreaks. All SARI cases are sampled at all times (24hrs/7 days a week). SARI cases. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 3 Armenia Total population: 3,026,048 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Year-round. Year-round. Population covered (%) Not available. 100.0% Not available. Not available. Type of health facilities/ hospitals Polyclinic. General practice, polyclinic. Intensive care unit, general/internal medicine, paediatric medicine, mother care institute. General practice, polyclinic. Number of health facilities/ hospitals 5 facilities. All facilities. 7 hospitals. All health facilities. Case definition used WHO 2014. ECDC, WHO. WHO 2014. Laboratory- confirmed influenza. 4 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition WHO 2014, including "history" of fever within last 10 days. Year introduced 2010 1990 2010 2009 Epidemic threshold No. Yes. No. No. Sampling strategy methodology Systematic sampling. Convenience sampling. Systematic sampling. Convenience sampling. Sampling strategy There is a systematic sampling strategy that differs in each facility. It is random, so all age groups are represented. A small number of ARI cases are sampled and tested for influenza (2 per week). There is a systematic sampling strategy that differs in each facility. It is random, so all age groups are represented. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 5 Austria Total population: 8,569,633 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Virological. Reporting period Week 40-20. Week 40-20. Population covered (%) 1.0% Not available. Type of health facilities/ hospitals General practice, paediatric practice. Paediatricians, paediatric clinic, infectious disease hospital outpatient department and infectious disease hospital department. Number of health facilities/ hospitals 85 facilities. Not available. Case definition used ECDC. ECDC. 6 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Year introduced 2000/2001. 1952 Epidemic threshold Yes. No. Sampling strategy methodology Convenience sampling. Sampling strategy Each sentinel site collects 3-5 specimens per week. No sampling strategy. Physicians take nasopharyngeal swabs for diagnostic purposes. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 7 Azerbaijan Total population: 9,868,447 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Integrated clinical and virological. Reporting period Year-round. Year-round. Population covered (%) 20.0% 2.9%. 23.0% Type of health facilities/ hospitals Paediatric practice, polyclinic. Infectious disease ward, pulmonary ward. Not available. Number of health facilities/ hospitals 16 facilities. 2 hospitals. 18 facilities. Case definition used WHO <2011. WHO <2011. Description of national case definition Year introduced 2009 2009 8 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. No. Sampling strategy methodology Systematic sampling. Systematic sampling. Sampling strategy Every 3rd patient is sampled. All age groups are sampled. Every 3rd patient is sampled. All age groups are sampled. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 9 Belarus Total population: 9,481,521 Income group: upper middle System characteris tic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentinel Univers al Sentinel Universa l Sentinel Univers al Sentin el Univers al Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Year-round. Year-round. Population covered (%) 5.2% 50.0% 30.0% 100.0% Type of health facilities/ hospitals Paediatric practice, polyclinic. General practice, paediatric practice, polyclinic, emergency department, infectious disease department. Intensive care unit, general therapeutic, paediatric, obstetrics and gynecology, infectious disease, pulmonary hospitals/wards. Intensive care unit, general therapeutic, paediatric, obstetrics and gynecology, infectious disease, pulmonary hospitals/wa rds. Number of health facilities/ hospitals 13 facilities. 189 facilities. 11 hospitals. All facilities. 10 Case definition used WHO 2014. ECDC, WHO. WHO 2014. WHO 2014. Description of national case definition Year introduced 2010 2010 2010 2010 Epidemic threshold Yes. Yes. No. No. Sampling strategy methodolog y Convenience sampling. Convenience sampling. Convenience sampling. Sampling strategy In an epidemic period, 10 specimens are collected each week by age group in each site. In a non- epidemic period, 10 specimens are collected every second week by each age group in each site. In an epidemic period, 10 specimens are collected each week by age group in each site. In a non-epidemic period, 10 specimens are collected every second week by each age group in each site. In an epidemic period, 10 specimens are collected each week by age group in each site. In a non-epidemic period, 10 specimens are collected every second week by each age group in each site. According to the decision of the doctor. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 11 Belgium Total population: 11,371,928 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Integrated clinical and virological. Reporting period Clinical: year- round; Virological: week 40-20. Year-round. Most hospitals will start to report as soon as the ILI incidence of GP visits is increasing. Year-round. Population covered (%) 1.3% 1.3% Not available. Not available. Type of health facilities/ hospitals General practice. General practice. General hospitals (all wards). General hospitals (all wards). Number of health facilities/ hospitals 105 facilities. 105 facilities. 6 hospitals. 117 hospitals. Case definition used National. National. National. 12 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Sudden onset of fever with respiratory symptoms and general symptoms. Acute respiratory infection of the upper, medium or lower respiratory tract (including common cold, rhinitis, (rhino)pharyngitis, angina, sinusitis, otitis, laryngitis, (laryngo)- tracheitis, bronchitis, bronchiolitis and (bronco)pneumonia) without influenza syndrome. Adapted from the case definition proposed in WHO guidance: an acute respiratory illness 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). Samples from patients presenting with severe influenza in particular specific conditions: ARDS (acute respiratory distress syndrome), ECMO (extracorporeal membrane oxygenation), death, suspicion of antiviral resistance, returning from abroad or in case of outbreaks. Year introduced 1985 1985 2011-2012. 2011-2012. Epidemic threshold Yes. No. No. No. Sampling strategy methodology Convenience sampling. All cases. Convenience sampling. 13 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy The first 2 ILI cases in a week seen by the GP. No samples collected. All hospitalized patients meeting the case definition are sampled. Only cases from patients with severe suspected influenza. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 14 Bosnia and Herzegovina Total population: 3,802,134 Income group: upper middle System characteris tic Primary care Hospital* Other ** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentine l Universal Sentin el Univers al Sentinel Univers al Sentin el Univers al Surveillance system Integrated clinical and virological. Clinical. Clinical. Integrated clinical and virological. Clinical. Reporting period Week 40- 20. Week 40-20. Week 40- 20. Week 40-20. Week 40- 20. Population covered (%) 2% in the Republic of Srpska, less than 1% in Federation B&H. 100.0% 100.0% 100.0% Type of health 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, respiratory disease wards). 15 Number of health facilities/ hospitals 1 facility in the Federation of Bosnia and Herzegovin a; 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 Herzegovin a and 4 facilities in Brcko district of Bosnia and Herzegovin a). Federation of Bosnia and Herzegovina: 3 facilities (2 University clinical centres and 1 general hospital); RS: 1 facility. 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 Herzegovin a and 1 hospital in Brcko district of Bosnia and Herzegovin a. Case definition used WHO 2011. WHO 2011. ECDC, WHO. WHO 2014. WHO 2014. Description of national case definition 16 Year 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 Herzegovin a and Brcko district of Bosnia and Herzegovin a). 2014 2013 (Republic of Srpska) 2009 (Federatio n of Bosnia and Herzegovin a and Brcko district of Bosnia and Herzegovin a). Epidemic threshold Yes. No. No. No. Sampling strategy methodolog y Systematic sampling. All cases. 17 Sampling strategy Federation of Bosnia and Herzegovin a: samples are collected from the first 3 ILI patients meeting the case definition on the Monday. All age group 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 hrs/7 days a week) but may depend on the availability and capacity of the reference laboratory. Republic of Srpska: All SARI cases in that facility (from the selected departments) are sampled. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 18 Bulgaria Total population: 7,097,796 Income group: upper middle System characteristi c Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentinel Universa l Sentinel Universal Sentine l Universa l Sentine l Universa l Surveillance system Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Population covered (%) 5.4% Type of health facilities/ hospitals General practices. General practices, polyclinics, intensive care/critical care units, infectious disease hospital and wards, paediatric hospital and wards, pulmonary wards, and general hospitals. 19 Number of health facilities/ hospitals 218 facilities. 40 hospitals. Case definition used ECDC, WHO. ECDC - ILI and ARI case definitions. Description of national case definition Year introduced 2001 1958 Epidemic threshold Yes. No. Sampling strategy methodology Convenience sampling. 20 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, data 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. According to the decision of the doctors. All age groups are included in the sampling. Information available: age, sex, geographica l information , diagnosis, data 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. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 21 Croatia Total population: 4,225,001 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Reporting period Week 40-20. Population covered (%) 100.0% Type of health facilities/ hospitals General practice and paediatric practice. Number of health facilities/ hospitals Data from around 2570 health care facilities within primary care are collected by 21 county epidemiological units and sent to the national level (CIPH). Case definition used ECDC. 22 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Year introduced 1975 Epidemic threshold No. Sampling strategy methodology Convenience sampling. Sampling strategy Patients are sampled based on the GP's or epidemiologist's decision. All age groups are included. Most samples are collected at the start and during the peak of the season. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 23 Cyprus Total population: 843,165 Income group: high Data in the table is from 2017 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Virological. Reporting period Week 40-20. Week 40-20. Week 40-20. Week 40-20. Population covered (%) 90.0% >80%. Type of health facilities/ hospitals Paediatric outpatient department in public hospitals; adult outpatient department in public hospitals; offices of primary health care paediatrician and adult-care physicians practicing in the private sector. Paediatric outpatient department in public hospitals; adult outpatient department in public hospitals; offices of primary health care paediatrician and adult-care physicians practicing in the private sector. Nearly all hospitals in the private and public sectors. Public hospitals and Public Health Centres. 24 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Number of health facilities/ hospitals Clinical: 55 facilities; Virological: 10 public health physicians collect specimens for influenza diagnosis. 55 facilities. 9 hospitals. Case definition used National. National. Description of national case definition Sudden appearance of fever >39°C for at least 2 days AND respiratory symptoms, malaise, myalgia, headache. Severe acute respiratory illness requiring hospitalization including ICU admissions with confirmed virological specimen for influenza. Year introduced 2003 2003 2013 Epidemic threshold No. No. No. Sampling strategy methodology Convenience sampling. 25 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy 5-7 specimens are collected from each site per week. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 26 Czech Republic Total population: 10,548,058 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Clinical: year- round; Virological: week 40-20. Clinical: year- round; Virological: week 40-20. Year-round. Population covered (%) ~50% ~50% ~100% Type of health facilities/ hospitals General practice, paediatric practice. General practice, paediatric practice. All ICUs. Number of health facilities/ hospitals 3570 facilities. 3570 facilities. Case definition used ECDC. ECDC, WHO. WHO 2014. ECDC. Description of national case definition WHO 2014 (with modification for necessity of hospitalization at ICU). 27 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Year introduced 2004 1956 2010 1956 Epidemic threshold Yes. Yes. No. No. Sampling strategy methodology Convenience sampling. Convenience sampling. All cases. Sampling strategy One sample from general practice and one sample from paediatric practice per week from all regions are collected during the influenza season (week 40-20). One sample from general practice and one sample from paediatric practice per week from all regions are collected during the influenza season (week 40-20). Upon request from the non- sentinel site. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 28 Denmark Total population: 5,724,456 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Virological. Reporting period Week 40-20. Year-round. Population covered (%) 3.0% 100.0% Type of health facilities/ hospitals General practice. All. Number of health facilities/ hospitals 100 facilities. All national hospitals, out- patients clinics and GPs. Case definition used National. Description of national case definition Sudden onset of fever, muscle pain and respiratory tract symptoms. Year introduced 1994 2010 29 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. No. Sampling strategy methodology Convenience sampling. All cases. Sampling strategy GPs are asked to swab the first 5 ILI patients they see. Sample kits are sent to 1/3 of all GPs at three different points in time during the season: before the start of the season, and just before and just after the peak. There are national guidelines for when to swab patients in and outside hospitals during and outside the influenza season. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 30 Estonia Total population: 1,309,104 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Year-round. Year-round. Population covered (%) 13.6% 100.0% Not available. Not available. Type of health facilities/ hospitals General practice, polyclinic, family doctor. General practice, paediatric practice, polyclinic, family doctor. ICU of central and regional hospitals. 2 regional hospitals and 1 central hospital. Number of health facilities/ hospitals 17 facilities. 449 facilities. 9 hospitals. 3 hospitals. Case definition used ECDC. ECDC, WHO. Not available. Not available. Description of national case definition Year introduced 2006 1954 2011 2000 31 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. Yes. No. No. Sampling strategy methodology Convenience sampling. Convenience sampling. Convenience sampling. Convenience sampling. Sampling strategy Each sentinel site collects up to 10 specimens per week from cases that meet the ECDC case definition. All age groups are included. Depends on doctor's decision; non- systematic. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 32 Finland Total population: 5,523,904 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Virological. Reporting period Clinical: year- round; Virological: weeks 40-20. Clinical: year- round; Virological: weeks 40-20. Clinical: year- round; Virological: weeks 40-20. Clinical: year- round; Virological: weeks 40-20. Population covered (%) 50.0% 50.0% Not known. All ICUs in Finland are included; specimens are collected on sentinel basis. 100.0% Type of health facilities/ hospitals General practice. General practice. Intensive care unit. All hospitals and outpatient clinics. Number of health facilities/ hospitals Clinical: 160 facilities; Virological: 25 facilities. Clinical: 160 facilities; Virological: 25 facilities. 13 intensive care units. All hospitals and outpatient clinics. Case definition used ECDC. ECDC, WHO. ARI treated in intensive care unit. No case definition used. 33 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Year introduced 2013 2013 2014 1995 Epidemic threshold No. No. No. No. Sampling strategy methodology 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 infection that require intensive care. Defined on clinical basis. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 34 France Total population: 64,668,129 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Week 40-17. Week 45-15. Week 40-17. Population covered (%) 0.7% ~100% Type of health facilities/ hospitals General practice. Intensive care unit. General hospitals. Number of health facilities/ hospitals Clinical: 458 facilities; Virological: 299 facilities. 204 hospitals. 44 hospitals. Case definition used National. Laboratory- confirmed influenza and cases diagnosed as influenza by the clinician. No case definition used. Description of national case definition Sudden onset of fever >39°c with respiratory symptoms and myalgia. 35 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Year introduced 1984 2009 1994 Epidemic threshold No. No. No. Sampling strategy methodology Convenience sampling. All cases. Sampling strategy First ILI case of the week, irrespective of age. No difference in sampling procedure between start and peak of the season. Virtually all. No sampling strategy. All samples taken from in-patients for diagnosis of influenza. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 36 Georgia Total population: 3,727,000 Income group: lower middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Year round. Year round. Year round. Population covered (%) 1.7% Not available. Not available. Type of health facilities/ hospitals General practice, paediatric practice, polyclinic. Children's hospital in Tbilisi and Kutaisi sentinel site that includes 4 hospitals. Wards included are: intensive care unit, internal medicine, paediatric, maternity, infectious disease, respiratory disease, therapeutic/chronic disease. Hospitals in Batumi, Akhaltsikhe and Zugdidi (virological surveillance only). Number of health facilities/ hospitals 1 facility. 5 hospitals. Not available. 37 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Case definition used WHO 2014. WHO 2014. PAHO/WHO 2014, unusual SARI. Description of national case definition Measured fever of ≥ 38 c° and cough; with onset within the last 10 days. Measured fever of ≥ 38 c° and cough; with onset within the last 10 days and requires hospitalization. Year introduced 2007 2007 2015 Epidemic threshold No. No. No. Sampling strategy methodology Systematic sampling. Systematic sampling. Sampling strategy Every 3rd ILI patient on Tuesday and Thursday. Every SARI patient on Tuesday and Thursday. ICU patient or every unusual case of SARI. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 38 Germany Total population: 80,682,351 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Population covered (%) >1% Type of health facilities/ hospitals General practice, paediatric practice. General practice, paediatric practice, hospitals, other laboratories. Number of health facilities/ hospitals 650 facilities. Case definition used National. Description of national case definition Patients with pharyngitis, bronchitis or pneumonia (with or without fever). 39 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Year introduced 1992 1998 Epidemic threshold No. No. Sampling strategy methodology Convenience sampling. Convenience sampling. Sampling strategy Specimens collected from the first ILI patients (using the ECDC case definition) per week in different age groups. No sampling strategy. Virological samples are sent to the NIC for further analysis/characterization from different sources. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 40 Greece Total population: 10,919,459 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Reporting period Week 40-20. Week 40-20. Year-round. Population covered (%) ~1.5% 100.0% 100.0% Type of health facilities/ hospitals Primary health care centres, National Organization for Healthcare Services Provision (EOPYY) clinics, private practitioners. All ICUs. All health facilities of the country including private practice offices. Number of health facilities/ hospitals 145 facilities. Case definition used ECDC. National. National. 41 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition . Laboratory confirmed influenza. Laboratory confirmed influenza. Year introduced 2004 (revised in 2014). 2010 2004 Epidemic threshold No. No. No. Sampling strategy methodology Convenience sampling. All cases. All cases. Sampling strategy Sampling plan for 2018-2019: all age groups, at sentinel physician’s discretion, up to 5 per week. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 42 Hungary Total population: 9,821,318 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Virological. Reporting period Week 40-20. Week 40-20. Population covered (%) >20% Not available. Type of health facilities/ hospitals General practice, paediatric practice. Number of health facilities/ hospitals ~1350-1400 facilities. Not available. Case definition used ECDC. No specified case definition. Description of national case definition Year introduced 2005 43 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. No. Sampling strategy methodology Convenience sampling. Sampling strategy Doctors are advised to collect 2 specimens of ILI patients per week per site. Sampling is performed for diagnostic purposes. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 44 Iceland Total population: 331,778 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Integrated clinical and virological. Reporting period Year-round. Year-round. Year-round. Year-round. Population covered (%) 100.0% 100.0% 100.0% 100.0% Type of health facilities/ hospitals General practice, emergency department, long term care, selected private practitioners. General practice, emergency department. All health care facilities. Number of health facilities/ hospitals 94 facilities. 94 facilities. Case definition used National. National. ECDC. Description of national case definition ICD-10 codes J09, J10 and J11 with sub-codes. Selected ICD-10 codes for respiratory symptoms and infections. 45 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Year introduced 2009 2011 2009 Epidemic threshold Yes. No. No. Sampling strategy methodology Sampling strategy No sampling strategy. Sampling is based on clinical suspicion for diagnostic purposes. No sampling strategy. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 46 Ireland Total population: 4,713,993 Income group: high System characteristi c Primary care Hospital* Other* * Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentinel Universa l Sentinel Universal Sentine l Universa l Sentine l Universa l Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Year-round. Week 40-20. Week 40- 20. Population covered (%) 6.3% 100.0% Not available. Type of health facilities/ hospitals General practice. All acute hospitals. Hospitals, GPs and nursing homes (excluding sentinel GPs). Number of health facilities/ hospitals 60 facilities. 60 acute care public and private hospitals. Not available. Case definition used ECDC. Laboratory- confirmed influenza. Laboratory -confirmed influenza. 47 Description of national case definition Year introduced 2000 2009 (all ages); 2003 (0-14). 2000 Epidemic threshold Yes. No. No. Sampling strategy methodology Convenience sampling. All cases. All cases. Sampling strategy One ILI patient swabbed a week by each sentinel GP. Recommended to swab first ILI case consulting each GP each week. For sentinel GPs participating in IMOVE: up to 5 ILI patients per week aged <65 and all patients aged ≥65 should be swabbed. Recommended to swab the first five ILI cases (<65) consulting each GP each week. All cases reported. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 48 Israel Total population: 8,192,463 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Clinical. Integrated clinical and virological. Reporting period Year-round. Year-round. Population covered (%) 25.0% 25.0% Type of health facilities/ hospitals General practice, paediatric practice. Community clinics of country’s 2nd largest health maintenance organization. Tertiary medical centre. Number of health facilities/ hospitals 33 clinics - this is only related to laboratory surveillance. 1 hospital. Case definition used National. Hospitalized ARI cases. 49 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Acute fever of at least 37.8° accompanied by at least one of the following symptoms: runny nose, sore throat, cough, myalgia. Year introduced 2000 2000 Epidemic threshold Yes. No. Sampling strategy methodology 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. Hospitalized ARI cases. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 50 Italy Total population: 60,592,600 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Virological. Reporting period Clinical: week 42-17; Virological: week 46-17. Week 42-17. Week 46-17. Population covered (%) 2.0% 100.0% 100.0% Type of health facilities/ hospitals General practice, paediatric practice. General practice, paediatric practice and hospitals. Hospitals. Hospitals. Number of health facilities/ hospitals 900 facilities. 417 1000 Case definition used ECDC. No case definition used. National. Not available. 51 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Every hospitalized patient in ICO 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 introduced 1999 1999 2009 2009 Epidemic threshold Yes. No. No. No. Sampling strategy methodology Convenience sampling. All cases. 52 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal 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 cases hospitalized in ICU and/or in ECMO with SARI and ARDS symptoms confirmed for influenza must be reported. Not available. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 53 Kazakhstan Total population: 17,855,384 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Reporting period Year-round. Week 40-20. Year-round. Population covered (%) 8.8% 100.0% Type of health facilities/ hospitals Paediatric polyclinic, polyclinic for adults. Paediatric practice, polyclinic, infectious disease hospital, state hospital, pulmonary diseases ward. General, paediatric, pulmonary and infectious diseases wards. Number of health facilities/ hospitals 30 facilities. 27 hospitals. Case definition used WHO 2011. WHO 2014. 54 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Year introduced 2008 2008 Epidemic threshold No. Yes. No. Sampling strategy methodology Convenience sampling. Convenience sampling. Convenience sampling. Sampling strategy Samples are taken weekly from patients over the age of 1 year, presenting at sentinel polyclinics and meeting ILI case definition, with disease duration no longer than 72 hours: 3 to 5 patients from each age group: 1-4, 5-14, 15- 29, 30-64, 65 and older. Samples are taken monthly from at least 10 patients with ARI or influenza, with pronounced clinical symptoms in the pre- epidemic and epidemic periods of ARI and influenza morbidity. Samples are taken from SARI patients (children older than 1 year - 72 hours or less since onset of illness; for persons >18 years - not later than 7 days since onset of illness). Swabs are taken not more than from 1 patient daily from each age group: 1-4, 5-14 in paediatric hospitals; 55 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal 15-29, 30-64, 65 and older in hospitals for adults. The weekly number of samples is at least 3 from each age group (the total weekly number for all age groups – at least 15). See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 56 Kyrgyzstan Total population: 6,033,769 Income group: lower middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Virological. Clinical. Reporting period Year-round. Year-round. Year-round. Year-round. Year-round. Population covered (%) Not available. 100.0% Not available. Type of health facilities/ hospitals Polyclinics. Polyclinics and hospitals. Hospitals. National virological and 3 virological laboratories under the Centres for Disease Prevention and State Public Health Surveillance. Number of health facilities/ hospitals 4 facilities. All facilities. 5 hospitals. Confirmation currently is carried out by 4 virological laboratories. Case definition used WHO 2014. National. WHO 2014. 57 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Case definition of influenza-like illness (ILI): acute respiratory disease with onset in previous 7 days and with the following symptoms: • measured fever ≥ 38°c; • cough. Acute upper respiratory infections of multiple and unspecified sites (ICD-10 code J06). Case definition of severe acute respiratory infection (SARI): acute respiratory disease with onset in previous 7 days, requiring hospitalization, and with the following symptoms: measured fever or history of fever ≥ 38°c, cough. Laboratory confirmed cases. Year introduced 2016 2009 2009 2005 Epidemic threshold No. Yes. No. No. Yes. Sampling strategy methodology Convenience sampling. Convenience sampling. 58 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy The first patients (> 1 year of age) that meet the ILI case definition; at least 3 patients from each age group during the week. No samples collected. The first patients (> 1 year of age) that meet the SARI case definition; at least 3 patients from each age group during the week. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 59 Latvia Total population: 1,955,742 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Clinical. Virological. Reporting period Week 40- 20. Week 40-20. Week 40-20. Year-round. Population covered (%) 5.7% 5.7% Type of health facilities/ hospitals General practice, paediatric practice. General practice, paediatric practice. 9 regional hospitals and 2 hospitals in capital city. All types of hospitals and outpatient facilities. Number of health facilities/ hospitals 70 facilities. 70 facilities. 11 hospitals. Case definition used ECDC. ECDC, WHO. National. Description of national case definition By ICD-10 influenza and influenza- associated pneumonia. Year introduced 1995 1995 2006 60 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. Yes. No. No. Sampling strategy methodology Convenience sampling. Convenience sampling. Convenience sampling. Convenience sampling. Sampling strategy ILI cases are preferably sampled at the GP sentinel sites and include patients in all age groups. Over 100 specimens were taken in the 2017-2018 season, mainly by GPs in Riga city. Very few cases that meet the ARI case definition are sampled. Hospitalized severe ILI cases are sampled at any time (24 hrs/7 days per week). See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 61 Lithuania Total population: 2,850,030 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Year-round. Population covered (%) 2.8% 2.8% Type of health facilities/ hospitals General practice. General practice. Number of health facilities/ hospitals 94 facilities. 94 facilities. Case definition used ECDC. No case definition used. Description of national case definition Year introduced 2004 2012 62 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. Yes. Sampling strategy methodology All cases. Convenience sampling. Sampling strategy All cases are included. On Tuesday according to medical doctor's decision. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 63 Luxembourg Total population: 576,243 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Virological. Reporting period Week 40-20. Week 40-20. Week 40-20. Population covered (%) 3.0% 3.0% Not available. Type of health facilities/ hospitals General practice, paediatrician practice. General practice, paediatrician practice. General practice, paediatricians, pneumologist, neo-natalogist. Number of health facilities/ hospitals 15 facilities. 15 facilities. 4 facilities/hospitals. Case definition used ECDC. ECDC, WHO. Description of national case definition Respiratory symptoms and sudden fever >38.0° and myalgia. Year introduced 2003 2003 64 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. No. No. Sampling strategy methodology All cases. All cases. Sampling strategy In principle, all patients are sampled. No samples collected. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 65 Malta Total population: 419,615 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Virological. Reporting period Week 40-20. Week 36-20. Population covered (%) 25.0% 100.0% Type of health facilities/ hospitals General practice. State hospital. Number of health facilities/ hospitals 9 facilities. 1 hospital. Case definition used WHO 2014. WHO 2014. Description of national case definition Year introduced 2003 2009 66 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold No. No. Sampling strategy methodology Convenience sampling. Sampling strategy Patients that accept having a specimen taken. At the discretion of the hospital respiratory physician or paediatrician. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 67 Montenegro Total population: 626,101 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Reporting period Week 40-20. Week 40-20. Week 40-20. Population covered (%) Not available. 100.0% 100.0% Type of health facilities/ hospitals General practice, paediatric practice. General practice, paediatric practice, polyclinic. General hospitals, Clinical Centre of Montenegro. Number of health facilities/ hospitals 4 facilities. 29 facilities. 8 hospitals. Case definition used ECDC. ECDC. WHO 2011. Description of national case definition Year introduced 2015/2016. 2009 2016 68 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. No. Sampling strategy methodology Convenience sampling. All cases. Sampling strategy The first suspected case of ILI in each week is sampled. All SARI cases are sampled at all times. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 69 Netherlands Total population: 16,979,729 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Clinical. Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Year-round. Year-round. Year-round. Population covered (%) 0.8% 1) ARI syndrome: 8% 2) ARI virology: 0.8%. 6.0% 3.0% Type of health facilities/ hospitals General practice. 1) ARI syndrome: general practice. 2) ARI virology: general practice; same network as sentinel ILI. General hospital, University medical centre. General hospital. Virology diagnostic laboratories; mostly hospital based. Number of health facilities/ hospitals 40 facilities. 1) 340 facilities. 2) 40 facilities. 2 hospitals. 1 hospital. 1) 18 laboratories. 2) 19 laboratories (11 overlap with (1)). 70 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Case definition used National. National. National. National. 1) 5-6 influenza virus positive specimens max per week per laboratory; randomly selected and special cases. 2) All influenza virus and RSV- positive laboratory diagnoses. Description of national case definition Acute onset and rectal temperature >38°c and at least one of the following symptoms: cough, coryza, sore throat, frontal headache, retrosternal pain, myalgia. 1) ICPC codes R74, R75, R77, R78, R80, R81. 2) Any ARI other than ILI (ICPC codes R74, R77, R78, R80, R81). A SARI patient with: * at least one systemic symptom or sign: fever or feverishness, malaise, headache or myalgia or deterioration of general condition (asthenia or loss of weight or anorexia or confusion or dizziness) and An influenza case is defined as a patient hospitalized with SARI with a respiratory sample positive for influenza. SARI case definition: * at least one systemic symptom or sign: fever or feverishness, malaise, headache or myalgia or deterioration Based on diagnostic requests from physicians; no specific case definition. 71 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal * at least one respiratory symptom or sign (cough, sore throat or shortness of breath) at admission and * the symptoms should not have started (or clearly worsened, if chronic) more than 7 days before admission. of general condition (asthenia or loss of weight or anorexia or confusion or dizziness) and * at least one respiratory symptom or sign (cough, sore throat or shortness of breath) at admission and * the symptoms should not have started (or clearly worsened, if chronic) more than 7 days before admission. Year introduced 1970; testing of specimens introduced in 1994. 1) 2015 2) 1994. 2015 2015 1) 1948 2) 1964. Epidemic threshold Yes. No. No. No. No. 72 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy methodology Convenience sampling. Convenience sampling. Convenience sampling. Convenience sampling. Sampling strategy The first two ILI patients. If there are no ILI patients Mon -Wed, then the first two ILI or ARI patients presenting Thursday -Sunday. In the absence of ILI cases, samples are collected from ARI cases. Preferably at least one child < 10 yrs. 1) No sampling, syndromic surveillance only. 2) See ILI surveillance. No sampling strategy. All SARI cases of 65 years or older during the influenza season. Based on diagnostic requests from physicians; no national sampling strategy. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 73 Norway Total population: 5,271,958 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Virological. Clinical. Clinical. Virological. Virological. Reporting period Year-round. Week 40-20. Year-round. Week 40-20. Year-round. Population covered (%) 3.0% 99.0% 99.0% 60.0% 100.0% Type of health 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; Lab-confirmed SARI: Hospital laboratories at regional hospitals and university hospitals. Hospital laboratories at regional hospitals and university hospitals. Medical microbiology laboratories performing influenza virus diagnostics. Medical microbiology laboratories performing influenza virus diagnostics. Number of health facilities/ hospitals 70 facilities. 5750 facilities. 5750 facilities. 9 hospitals. 17 laboratories. Case definition used WHO 2014. National. National. National. National. 74 Description of national 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 inflammation 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 "R05 cough", "R74 Acute upper respiratory infection", "R78 Acute bronchitis/bronchiolitis" and "R83 respiratory infection not classified elsewhere. R05 includes productive or non- productive/dry cough. R74 includes acute rhinitis, pharyngitis, cold, nasopharyngitis, upper respiratory infections. R78 includes acute lower respiratory infection not classified elsewhere, bronchitis not classified elsewhere, larynges tracheobronchitis, respiratory infection not classified elsewhere and tracheobronchitis. R83 respiratory infections not classified elsewhere; includes diphtheria, emphysema, epiglottitis, chronic pharyngitis, chronic nasopharyngitis, chronic rhinitis not classified elsewhere, fungal respiratory infection, lung abscess, protozoal infection (without pneumonia). Hospitalized and laboratory-confirmed influenza. Corresponding data on outpatients tested are also available. Laboratory confirmed influenza. 75 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Year introduced Laboratory sentinel system was introduced in 1979. 2014 Prior to this there was a sentinel system for ILI that started in 1998; before that clinical influenza was notifiable (aggregated). 2017 2014 1982 Epidemic threshold Yes. No. No. Sampling strategy methodology Convenience sampling. All cases. All cases. Sampling strategy 70 general practices and primary care emergency wards are participating in the voluntary network of influenza sentinel practices coordinated by the NIC. These send in ILI patient specimens all No samples collected. Medical microbiology laboratories that perform influenza virus diagnostics report all detections, by virus type (A, B), with testing denominators by age group (0-4, 5-15, 15- 24, 25-59, >60) and hospitalization status (inpatient/outpatient). Medical microbiology laboratories that perform influenza virus diagnostics report weekly all detections, by type and subtype, with testing denominators by age group (0-4, 5-14, 15-24, 25- 59, >60). 76 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal year round, based on the WHO 2014 case definition. All ages included but bias toward working-age patients. These labs also submit influenza positive specimens to the NIC, each up to five samples per type per week plus special cases (severe, unusual circumstances, suspicion of resistance). See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 77 Poland Total population: 38,426,809 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Reporting period Year-round. Year-round. Population covered (%) 3.0% 100.0% Type of health facilities/ hospitals General practice. General practice, hospitals. Number of health facilities/ hospitals 536 facilities. Case definition used ECDC. ECDC. Description of national case definition Year introduced 2004 1951 78 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold No. No. Sampling strategy methodology Convenience sampling. Convenience sampling. Sampling strategy Collection of specimens 7 days a 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. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 79 Portugal Total population: 10,304,434 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Virological. Virological. Reporting period Clinical: year-round; virological: week 40-20. Population covered (%) 2.1% Not available. Type of health facilities/ hospitals General practice. ICU/hospitals. Hospitals, emergency units. Number of health facilities/ hospitals 125 facilities. 33 ICU/24 hospitals. 100 emergency units, 19 hospitals (laboratory network). Case definition used ECDC. National. ECDC. Description of national case definition Hospitalized influenza- confirmed cases. 80 Year introduced 1989 2011-2012. 1989: emergency units. 2009: hospital (laboratory network). Epidemic threshold Yes. No. No. Sampling strategy methodology Convenience sampling. Sampling strategy Samples are collected from ILI cases, from GP patient list, all ages, and during the whole season. Once a week (Wednesdays) the ICU sends information on cases admitted to ICU during the previous week with laboratory confirmation for influenza. All cases and all age groups are included in sampling; the same sampling procedure is used throughout the season. Laboratory based surveillance. All cases are sampled. Cases sampled fit the ECDC case definition and/or the clinician's decision. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 81 Republic of Moldova Total population: 3,553,056 Income group: lower middle System characteris tic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentinel Univers al Sentinel Universa l Sentinel Univers al Sentin el Univers al Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Reporting period Year-round. Year-round. Year-round. Week 40-20. Population covered (%) 11.0% 11.0% 43.0% 57.0% Type of health facilities/ hospitals Health centres. Health centres. Intensive care unit, general/internal 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, health centres. Number of health facilities/ hospitals 10 facilities. 10 facilities. 17 hospitals. 492 facilities. 82 Case definition used WHO 2014. ECDC, WHO. WHO 2014. ILI: WHO 2014; ARI: ECDC/WHO; SARI: WHO 2014. Description of national case definition Year introduced 2017 2017 2017 2017 Epidemic threshold No. Yes. No. No. Sampling strategy methodolog y Convenience sampling. Convenience sampling. Convenience sampling. Sampling strategy 12 swabs are taken weekly (between week 40 and week 20) from the first patients who meet the ILI/ARI case definition. These swabs are taken between week 40 and week 20; outside this period swabs are taken in case of their existence. 12 swabs are taken weekly (between week 40 and week 20) from the first patients who meet the ILI/ARI case definition. These swabs are taken between week 40 and week 20; outside this period swabs are taken in case of their existence. 20 swabs are taken weekly from first patient who meets the SARI/ILI case definition. These swabs are taken between week 40 and week 20; outside this period swabs are taken in case of their existence. Non-sentinel: sampling is done for the more serious cases of ILI or SARI. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 83 Republic of North Macedonia Total population: 2,081,012 Income group: upper middle System characterist ic Primary care Hospital* Other* * Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentinel Universal Sentin el Univers al Sentinel Univers al Sentin el Univers al Surveillance system Integrated clinical and virological. Clinical. Clinical. Integrated clinical and virological. Integrated clinical and virological. Reporting period Year- round. Year-round. Year- round. Week 40-20. Week 40- 20. Population covered (%) 2.0% 100.0% 2.0% 100.0% Type of health facilities/ hospitals General practices. General practice, paediatric practice, polyclinic, infectious disease clinic, all other health facilities from primary care, secondary tertiary level of health care. General practices. Number of health facilities/ hospitals 14 facilities. All. 14 facilities. 5 hospitals. Case definition used WHO 2014. ECDC, WHO. WHO 2014. Laboratory -confirmed influenza. 84 Description of national case definition Year introduced 2014 1966 2014 Epidemic threshold Yes. No. Sampling strategy methodology Convenienc e sampling. Convenien ce sampling. Sampling strategy For sentinel ILI/ARI, from 2017- 2018 season, advise collecting 2 specimens per site per week from first patients presenting with ILI. All age groups and all cases are included in sampling strategy. No samples collected. For universal surveillanc e there is no sampling strategy. Based on clinician's decision. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 85 Romania Total population: 19,372,734 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Week 46-20. Week 40-20. Population covered (%) 2.0% 2.0% 19.0% 100.0% Type of health facilities/ hospitals General practice. General practice. Intensive care unit, general/internal medicine, paediatric medicine, infectious disease ward, respiratory disease ward. Hospitals, primary health care practices, specialized medical practices, health centres, outpatient clinics, emergency services providers, home care providers, long term care institutions. Number of health facilities/ hospitals 192 facilities. 192 facilities. 19 hospitals. Around 12,000 GPs and 10,000 other health facilities/hospitals. 86 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Case definition used WHO 2014. ECDC, WHO. National. For ILI: WHO 2014. Description of national 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 respiratory 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 introduced 2014 2001 2009 2014 Epidemic threshold Yes. Yes. No. No. Sampling strategy methodology Systematic sampling. Convenience sampling. Convenience sampling. 87 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy On Tuesdays from week 40 (onset of influenza season) swabs are collected from all cases presented and who meet the ILI case definition. After the onset of the season the algorithm is established by the National Centre, according to specific season parameters. Depending on the epidemiological context, ARI cases can be sampled and tested for influenza. From week 46 until the onset of the influenza season, the first 3 detected SARI cases in each sentinel hospital are sampled. After that, only the first detected SARI case in each sentinel hospital is sampled. 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. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 88 Russian Federation Total population: 143,439,832 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza 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. Reporting period Year-round. Year-round. Year-round. Year-round. Year-round. Year-round. Population covered (%) About 17% of population live in cities where sentinel facilities are located 35.0% About 17% of population live in cities where sentinel facilities are located 35.0% About 17% of population live in cities where sentinel facilities are located 35.0% Around 35% of population Type of health facilities/ hospitals Polyclinics, infectious diseases hospitals, general hospitals (infectious diseases wards). Polyclinics, infectious diseases hospitals, general hospitals (infectious diseases wards). Polyclinics, infectious diseases hospitals, general hospitals (infectious diseases wards). Polyclinics, infectious diseases hospitals, general hospitals (infectious diseases wards). Infectious diseases hospitals for adults and children, infectious diseases wards in general hospitals, intensive care units. Infectious diseases hospitals for adults and children, infectious diseases wards in general hospitals, intensive care units. Polyclinics, infectious diseases hospitals, general hospitals (infectious disease wards). Number of health facilities/ hospitals 14 facilities. 61 cities. 14 facilities. 61 cities. 19 hospitals in 10 cities. 61 cities. 58 laboratories. 89 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Case definition used WHO 2011. No case definition used. WHO 2011. No case definition used. WHO 2011. No case definition used. Description of national case definition Year introduced 2010 2005 2010 1971 2010 Not known. 1971 Epidemic threshold No. Yes. No. Yes. No. No. No. Sampling strategy methodology Convenience sampling. Convenience sampling. Convenience sampling. Convenience sampling. All cases. Convenience sampling. Convenience sampling. Sampling strategy Average weekly number of samples from ILI/ARI patients in each city – 29; all age groups are included. Convenience sampling. Average weekly number of samples from ILI/ARI patients in each city – 29; all age groups are included. Convenience sampling. Samples are taken from all SARI patients according to WHO 2011 case definition. Convenience sampling. On average, 10– 50 samples are tested weekly for influenza in each city. Exact number is determined based on the epidemiological situation. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 90 Serbia Total population: 7,131,787 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Week 40-20. Week 40-20. Year-round. Population covered (%) 100.0% 80.0% Type of health facilities/ hospitals General practice, paediatric practice. Intensive care unit, general/internal medicine, paediatric medicine, infectious disease ward, respiratory disease ward. Number of health facilities/ hospitals 158 facilities. 10 hospitals. Case definition used WHO 2011. WHO 2011. 91 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Year introduced 2006 2009 Epidemic threshold Yes. No. Sampling strategy methodology Convenience sampling. Convenience sampling. Sampling strategy ILI cases are sampled mostly during the first 4 days in the week. All age groups are included in sampling. Sentinel SARI cases are sampled mostly during the first 4 days in the week. All age groups are included in sampling. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 92 Slovakia Total population: 5,429,418 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Clinical. Clinical. Integrated clinical and virological. Virological. Reporting period Year-round. Year-round. Year-round. Year-round. Population covered (%) 100.0% 100.0% 100.0% 53.2% Type of health facilities/ hospitals General practice, paediatric practice. General practice, paediatric practice. Intensive care unit. General practice, paediatric practice, hospitals. Number of health facilities/ hospitals 88 facilities. 88 facilities. 74 hospitals. 3635 facilities. Case definition used ECDC. ECDC, WHO. WHO 2014. ECDC, WHO, WHO 2014. Description of national case definition Year introduced 2002 2002 2009 2002 93 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. Yes. No. Sampling strategy methodology Convenience sampling. Convenience sampling. All cases. Sampling strategy Based on the doctor's decision. All cases are included in the sampling strategy. Based on the doctor's decision. All cases are included in the sampling strategy. All reported SARI cases are laboratory tested. Based on the doctor's decision. All cases are included in the sampling strategy. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 94 Slovenia Total population: 2,064,241 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Virological. Reporting period Year-round. Year-round. Year-round. Population covered (%) 4.0% 4.0% 100.0% Type of health facilities/ hospitals General practice, paediatric practice, school doctors. General practice, paediatric practice, school doctors. Hospitals. Number of health facilities/ hospitals 45 facilities. 45 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. 95 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Year introduced 1999 1999 Epidemic threshold No. No. No. Sampling strategy methodology Convenience sampling. Sampling strategy Samples are collected from ILI patients. More intensive sampling is advised during the beginning of the season. The number of samples is not limited. No samples are collected. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 96 Spain Total population: 46,468,102 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Clinical: week 40-20. Virological: year-round. Year-round. Week 40-20 weekly reporting. Week 21-39 monthly reporting. Population covered (%) 2.5% 52.0% Type of health facilities/ hospitals General practice, paediatric practice. All wards mainly in public general hospitals. Laboratories mainly in public hospitals. Number of health facilities/ hospitals 582 facilities. 100 hospitals. Case definition used ECDC. Laboratory- confirmed influenza in all wards. Influenza- confirmed cases (no case definition used). 97 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Based on the ECDC case definition. The system is based on the notification of those laboratory- confirmed influenza hospitalized cases in all wards who match the Spanish severe hospitalized confirmed influenza case definition. This case definition includes several severity criteria: “any case with clinical features compatible with influenza, requiring hospitalization for clinical severity: at least one of the following criteria: pneumonia, septic shock, acute respiratory distress syndrome, multiple organ dysfunction syndrome, admission to ICU, or death. 98 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Year introduced 1996 2009 1996 Epidemic threshold Yes. No. No. Sampling strategy methodology Convenience sampling. All cases. Convenience sampling. Sampling strategy Samples are collected from the first 2 patients who attend the sentinel facility during the week. All age groups are included in sampling and the sampling procedure does not differ between the start and the peak of the season. All patients who meet clinical criteria of severe influenza like illness who required hospitalization (pneumonia/septic shock/ ARDS/multiple organ dysfunction syndrome, admission to ICU or death) are sampled. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 99 Sweden Total population: 9,851,852 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Virological. Clinical. Virological. Reporting period Week 40-20. Year-round. Year-round. Population covered (%) 8.0% 100% (with 25% underreporting). 100.0% Type of health facilities/ hospitals General practice, infectious disease and paediatric clinics. Intensive care unit. Emergency care, hospitals, infectious disease and paediatric clinics, primary care facilities. Number of health facilities/ hospitals 80 facilities. 78 intensive care units. 28 microbiological laboratories (these also report analyses performed at other hospitals without microbiological laboratories). 100 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Case definition used ECDC. Laboratory- confirmed influenza. Laboratory- confirmed influenza cases. Patients presenting with ILI - similar to ECDC ILI case definition. Description of national case definition Year introduced 2006 2013 1993, changed in 2013. Epidemic threshold No. No. Yes. Sampling strategy methodology Convenience sampling. Sampling strategy 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. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 101 Switzerland Total population: 8,379,477 Income group: high System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Virological. Reporting period Clinical: all year round. Virological: week 40-16. Year-round. Population covered (%) 1.9-2.0%. 100.0% Type of health facilities/ hospitals General practice, paediatrician. Laboratories. Number of health facilities/ hospitals 150-200 facilities. <200 laboratories. Case definition used WHO <2011. Laboratory- confirmed influenza. Description of national case definition Year introduced 1987 1988 102 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold Yes. No. Sampling strategy methodology Convenience sampling. Sampling strategy About 45% of the sentinel facilities collect specimens. They sample all ILI patients when the incidence is below the epidemic threshold, and every 4th-5th ILI patient when the incidence is above the epidemic threshold. Mandatory notification of influenza detection. Consequently, no standard sampling strategy. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 103 Tajikistan Total population: 8,640,714 Income group: low System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Clinical. Integrated clinical and virological. Reporting period Week 40-20. Week 40-20. Week 40-20. Week 40-20. Week 40-20. Population covered (%) 100.0% 100.0% 10.3% Type of health facilities/ hospitals Health centre. Health centres (PHC) and hospitals. Health centres (PHC) and hospitals. Hospital. Number of health facilities/ hospitals 1 facility. 3085 facilities. 3085 facilities. 1 hospital. Case definition used National. National. WHO 2014. 104 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Cases are identified primarily based on clinical diagnoses, consequently the system includes surveillance of both viral and bacterial acute respiratory diseases. Cases are identified primarily based on clinical diagnoses, consequently the system includes surveillance of both viral and bacterial acute respiratory diseases. Year introduced 2016 2016 2016 Epidemic threshold No. No. No. No. No. Sampling strategy methodology Systematic sampling. 105 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy No sampling strategy. No sampling strategy. All patients that meet the SARI case definition (WHO 2014) who are newly hospitalized through the admission unit on Monday, Tuesday and Wednesday. All age groups are included in sampling. There is no difference in sampling procedures between the start and the peak of the season. All cases are included in the sampling strategy. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 106 Turkey Total population: 79,277,962 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Week 40-20. Week 40-20. Week 40- 20. Population covered (%) 1.0% Not available. Not available. Type of health facilities/ hospitals Family physician centres. Intensive care unit, emergency department, internal disease department, paediatric disease department, infectious disease department, pulmonary disease department. All hospitals. Number of health facilities/ hospitals 220 facilities. 10 hospitals. The number of health facilities is not constant. Samples are collected from any hospital in the country. 107 Case definition used WHO <2011. WHO 2014. WHO 2014. Description of national case definition WHO 2014; age-specific case definitions. Year introduced 2004 2016 2004 Epidemic threshold No. No. No. Sampling strategy methodology 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 that meet the SARI case definition, all age-groups included, in 10 hospitals. No sampling strategy. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 108 Turkmenistan Total population: 5,438,670 Income group: upper middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza 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. Reporting period Year-round. Year-round. Year-round. Year-round. Year-round. Population covered (%) 100.0% Not available. 100.0% Type of health facilities/ hospitals Polyclinic. Polyclinics and hospitals. Hospital. Polyclinics and hospitals. Number of health facilities/ hospitals 1 facility. All facilities. 1 hospital. All. Case definition used WHO <2011. National. WHO 2011. National. 109 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Case definition of influenza-like illness (ILI): acute respiratory disease with onset in previous 7 days and with the following symptoms: • measured fever ≥38°c; • cough. ARI – acute respiratory infection: characterized by sudden onset of symptoms, and at least one of the following four respiratory symptoms: • cough; • sore throat; • shortness of breath; • coryza; and • a clinician’s judgement that the illness is due to an infection. • the presence or absence of fever. ARI includes diseases under the ICD-10 codes J00-J06. Case definition of severe acute respiratory infection (SARI): acute respiratory disease with onset in previous 7 days, requiring hospitalization, and with the following symptoms: • measured fever or history of fever ≥38 °c, • cough, • shortness of breath or difficulty in breathing, not caused by nasal congestion or other types of upper respiratory obstruction. Note: – the term “shortness of breath” means abnormal frequency and depth of breathing, Influenza case – a case confirmed by use of one of the laboratory tests recommended for influenza diagnosis in the country. 110 caused by lack of air, not related to nasal congestion or other types of upper respiratory obstruction or other mechanical causes; – severe acute respiratory disease can mean a new illness, developed in presence of the main condition or as its complication; – SARI is not equivalent to classic pneumonia and does not always manifests as pneumonia. Many cases of severe respiratory problems can be caused by, e.g. exacerbation of a chronic lung or heart disease and have no signs of pneumonia. 111 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Year introduced 2016 2009 2016 2009 Epidemic threshold No. No. No. No. No. Sampling strategy methodology Convenience sampling. Convenience sampling. Systematic sampling. Convenience sampling. Convenience sampling. Sampling strategy Two throat swabs are taken from each of two patients referred by the family physician. The first swab is used for rapid testing on-site, the second is sent (compliant to cold chain requirements) to the virological reference laboratory at the Centre for Public Health and Nutrition for PCR testing. Samples are taken from patients admitted from 8 a.m. Tuesday till 8 a.m. Wednesday, who present three positive indicators, with onset of the symptoms ≤7 days prior to hospital admission. The number of daily samples should not exceed 10. 112 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal One throat swab is taken from subsequent patients, referred by family physicians, for on-site rapid testing. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 113 Ukraine Total population: 44,624,373 Income group: lower middle System characteristi c Primary care Hospital* Other* * Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory- confirmed influenza Sentinel Universa l Sentinel Universa l Sentinel Universa l Sentine l Universa l Surveillance system Integrated clinical and virological. Clinical. Clinical. Integrated clinical and virological. Reporting period Year-round. Year-round. Week 40-20. Year-round. Population covered (%) 0.1% 0.1% 100.0% 6.5% Type of health facilities/ hospitals Primary health care. Primary health care. Primary health care. Intensive care unit, paediatric infectious disease ward, respiratory disease ward. Number of health facilities/ hospitals 7 facilities. 7 facilities. All facilities. 10 hospitals. Case definition used WHO 2014. ECDC, WHO. No case definition used WHO 2011. Description of national case definition Use WHO 2011 case definition. Year introduced 2018 2018 2007 114 Epidemic threshold No. No. Yes. No. Sampling strategy methodology Systematic sampling. Systematic sampling. Sampling strategy Each doctor involved in sentinel surveillance during the reporting week takes samples from the first two patients that meet the case definition. All age groups are included in the contingents for sampling. All patients are included in the sampling strategy. The procedure for taking samples at the beginning and at the peak of the season does not differ. Samples are collected without applying a sampling strategy. Samples are collected from patients at the discretion of the physician. 6 samples per week by site during weeks 40-20; 3 samples per week by site during weeks 21-39. All severe cases should be sampled. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 115 United Kingdom of Great Britain and Northern Ireland Total population: 65,111,143 Income group: high England System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Virological. Reporting period Week 40-20. Week 40-20. Week 40-20. Population covered (%) 1.7% 100.0% 100.0% Type of health facilities/ hospitals General practice. Intensive care units. PHE, NHS and private microbiology laboratories. Number of health facilities/ hospitals 190 general practices. 150 hospitals. >200 laboratories. Case definition used National. 116 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition ILI is clinically defined as an individual presenting in primary care with an acute respiratory illness with physician- diagnosed fever or complaint of feverishness. Laboratory- confirmed influenza in ICU patients (symptoms: fever (>=38° c) or history of fever in previous 7 days and two or more of: cough, sore throat, headache, rhinorrhoea, myalgia; D&V, increased respiratory rate, poor feeding). Year introduced 1964 2010 Epidemic threshold Yes. No. No. Sampling strategy methodology Convenience sampling. All cases. Convenience sampling. 117 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy At the start of the season 2-3 ILI cases are swabbed per week. At the peak of the season max. 20 patients are swabbed per week. All cases should be sampled. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 118 Northern Ireland System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Virological. Clinical. Virological. Virological. Reporting period Week 40-20. Year-round. Year-round for universal surveillance (reported to TESSy); week 40-20 for ICU- based surveillance. Year-round. Population covered (%) 11.6% 98.0% 100.0% 100.0% Type of health facilities/ hospitals General practice. General practice. All hospitals for universal surveillance; all ICU/HDU units for ICU surveillance. All facilities. Number of health facilities/ hospitals 37 facilities. 325 facilities. All hospitals. All facilities. Case definition used National. National. Laboratory- confirmed influenza. Laboratory- confirmed influenza. 119 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition A disabling acute respiratory illness accompanied by severe fever and myalgia. All cases have symptoms consistent with clinical ‘flu', ‘flu- like illness' and acute respiratory illness (read codes) are automatically extracted from GP practices on a daily basis. Year introduced 2001 2009 2011 2011 Epidemic threshold No. Yes. No. No. Sampling strategy methodology Convenience sampling. All cases. All cases. All cases. 120 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy In 2018: up to a maximum of 5 patients per week that meet the case definition. Swabbing should be undertaken regardless of vaccination status and within seven days of onset of symptoms. No virological samples collected. All cases should be sampled. All cases should be sampled. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 121 Scotland System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Clinical. Integrated clinical and virological. Virological. Reporting period Week 40-20. Year-round. Year-round. Week 40-20. Year-round. Population covered (%) 6.6% 100.0% 100.0% 100.0% 100.0% Type of health facilities/ hospitals General practice. General practice. General practice. All hospitals that can provide intensive care management (3rd level care). All hospital wards. Number of health facilities/ hospitals Virological: 27 facilities. 947 facilities. 947 facilities. ~30 ICUs. 274 hospitals. Case definition used National. National. National. National. National. 122 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Based on clinical discretion of GP but recommended definition is: ILI is defined as an individual presenting in primary care with an acute respiratory illness with physician- diagnosed fever or complaint of feverishness in the previous 7 days. Acute is defined as sudden onset of symptoms. Aggregated automated GP extracts on ILI and ARI consultations based on READ codes. Definition of ILI and ARI are based on clinical discretion. Aggregated automated GP extracts on ILI and ARI consultations based on READ codes. Definition of ILI and ARI are based on clinical discretion. Laboratory- confirmed influenza cases admitted to the hospital for intensive care management. Based on clinical discretion of healthcare professional. Year introduced 2000 2009 2009 2009 2009 Epidemic threshold No. Yes. Yes. No. No. Sampling strategy methodology Convenience sampling. All cases. All cases. 123 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy At start of the season: one sample per week from any patient who presents within seven days of the onset of their symptoms. Once influenza is circulating: up to first 3 patients per week who present within seven days of the onset of their symptoms with the following age group distribution: 1 swab in those aged <15 years; 1 in 15-64 and 1 in 65+. No samples collected. No samples collected. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 124 Wales System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Virological. Virological. Virological. Reporting period Year-round. Year-round. Year-round. Population covered (%) 11.8% 100.0% 11.8% 100.0% 100.0% Type of health facilities/ hospitals General practice. General practice. General practice. All wards. Hospitals; non- sentinel general practices. Number of health facilities/ hospitals 42 facilities. 420 facilities. 42 facilities. 19 hospitals. 19 hospitals and ad-hoc non- sentinel general practices. Case definition used National. National. National. Laboratory- confirmed influenza in patients tested with respiratory symptoms. Laboratory- confirmed influenza in patients tested with respiratory symptoms. Description of national case definition GP diagnosed ILI. GP diagnosed ILI. GP diagnosed ILI (ECDC ILI definition given as guidance). Year introduced 1987 2009 1987 2005 2005 Epidemic threshold Yes. No. No. No. No. 125 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Sampling strategy methodology All cases. All cases. All cases. All cases. Sampling strategy Sentinel GPs are asked to swab all diagnosed ILI 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 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. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 126 Uzbekistan Total population: 30,300,446 Income group: lower middle System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Clinical. Integrated clinical and virological. Reporting period Week 40-20. Week 40-20. Week 40-20. Population covered (%) 0.2% 0.2% 0.0% Type of health facilities/ hospitals General practice, polyclinic. General practice, polyclinic. Hospital, maternity hospital. Number of health facilities/ hospitals 1 facility. 1 facility. 3 hospitals. Case definition used WHO 2014. WHO 2014. WHO 2014. Description of national case definition Year introduced 2016 2016 2016 127 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Epidemic threshold No. No. Sampling strategy methodology Convenience sampling. Systematic sampling. Sampling strategy Each of 5 designated physicians takes a swab from a single patient meeting the ILI case definition during the first day of the week. Swabs are taken from all patients meeting the SARI case definition that are hospitalized during the first day of the week. See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. 128 Kosovo (in accordance with United Nations Security Council Resolution 1244 [1999]) Total population: … Income group: lower middle Data in the table is from 2017 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Surveillance system Integrated clinical and virological. Integrated clinical and virological. Integrated clinical and virological. Reporting period Week 40-20. Week 40-20. Week 40-20. Population covered (%) 48.4% 48.4% Type of health facilities/ hospitals General practice, paediatric practice, infectious disease, lung disease (all health care levels). All health care levels. Paediatric practice, intensive care unit, infectious diseases, lung disease (secondary and tertiary health care levels). Number of health facilities/ hospitals 5 facilities. 34 facilities. 5 facilities. Case definition used WHO 2014 ECDC, WHO WHO 2014 129 System characteristic Primary care Hospital* Other** Influenza-like illness (ILI) Acute respiratory infection (ARI) Severe acute respiratory infection (SARI) Laboratory-confirmed influenza Sentinel Universal Sentinel Universal Sentinel Universal Sentinel Universal Description of national case definition Year introduced 2012 2017/2018 2014 Epidemic threshold No No No Sampling strategy methodology Systematic sampling. Systematic sampling. All cases. Sampling strategy In Prishtina and Prizren. Samples are collected twice per week on Monday and Thursday. In Prishtina and Prizren. Samples are collected twice per week on Monday and Thursday. All SARI cases are sampled at all times (24 hrs/7 days a week). See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions. * Hospital-based surveillance can be carried out by "Severe acute respiratory infection" (SARI) surveillance or by "laboratory-confirmed influenza" surveillance. Both system types include patients that have been admitted to the hospital. In SARI surveillance, the number of SARI cases is reported and all or a subset are tested for influenza. In laboratory-confirmed surveillance, the cases that have been tested positive for influenza are reported. ** Other: this column includes other surveillance systems that do not fall under primary care and/or hospital-based surveillance. European Centre for Disease Prevention and Control (ECDC) Gustav III:s Boulevard 40, SE-169 73 Solna Sweden Tel. +46 858 60 10 00 Fax. +46 858 60 10 01 www.ecdc.europa.eu Contact us publications@ecdc.europa.eu Follow us on Twitter @ECDC_EU Like our Facebook page www.facebook.com/ECDC.EU 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 www.euro.who.int Contact us euinfluenza@who.int Follow us on Twitter @WHO_EUROPE Like our Facebook page www.facebook.com/WHOEurope
Всемирная организация здравоохранения (ВОЗ / WHO) · Technical Documents
Influenza surveillance: country, territory and area profiles 2019
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