Você está na página 1de 6

NPHS Weekly Influenza Surveillance Report

Friday 10 July 2009

Summary

 The clinical consultation rate for influenza in Wales reported through the GP
Surveillance of Infections Scheme increased during week 27 from 1.4 per 100,000 to
5.1 per 100,000; this is within baseline levels (less than 25 consultations per 100,000
practice population).

 During week 27, four samples were submitted from sentinel GPs for virological testing as part
of the GP Surveillance of Infections Scheme (see table 3), one of these samples tested
positive for swine influenza A(H1N1)v (patient aged 25 – 34yrs from the Cardiff area, with a
recent history of travel to Spain). Since week 40 2008, 119 samples have been received from
sentinel GPs including three from Gwent GPs Out of Hours Service and 116 have been
tested. Sixteen samples have tested positive for influenza A (one of which was identified as
swine influenza A(H1N1)v) and three have tested positive for influenza B.

 In England the RCGP influenza like illness rate increased during week 27 from 29.6 per
100,000 to 51.9 per 100,000, and is now above the baseline threshold of 30 consultations per
100,000. In Northern Ireland the combined influenza and influenza like illness consultation
rate increased during week 27 from 20.6 per 100,000 to 25.5 per 100,000 (thresholds have
not yet been set). In Scotland during week 27 the GP influenza consultation rate decreased to
15 from 27 consultations per 100,000 which is well within baseline levels (below 50
consultations per 100,000).

 Latest data (week 27) from European Influenza Surveillance Scheme (EISS) indicates low
levels of influenza activity throughout Europe, with only England reporting high intensity
activity. Although a considerable number of influenza detections were reported, mainly due to
pandemic A(H1N1)v, influenza activity remains at or below baseline levels in Europe.

 As at 3pm 10/07/09 60 laboratory-confirmed cases of swine influenza A(H1N1)v have been


reported by NPHS Wales Health Protection Teams in 18 LHB areas (table 4). Four cases
have been admitted to hospital, three have now been discharged.

 As at 10/07/2009, there have been 9718 confirmed cases of swine influenza A(H1N1)v in the
UK (England- 8204, Scotland- 1409, Wales-60 and Northern Ireland-45), including 379
hospitalisations. Fourteen deaths have been reported in the UK all of which had underlying
health conditions.

 ECDC report that as of 07 July, the cumulative number of swine influenza cases in the EU
and EFTA countries is 11,020. 30 of the 31 EU and EEA/EFTA countries have reported cases
with the UK accounting for more than half of all reported cases in Europe.

 The World Health Organisation (WHO) report that as at 07:00 GMT, 6 July 2009, 135
countries have officially reported 64,512 cases of influenza A(H1N1)v infection, including 429
deaths.

 Further updates and guidance for Wales are available from the NPHS Wales internet site and
the NPHS Wales Swine Influenza intranet page.

 NPHS Wales now publishes daily updates of the influenza consultation rate in Wales, these
summaries are available from NPHS Wales internet site:
http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=38241

-1-
Figure 1. Clinical consultation rate per 100,000 practice population in Welsh sentinel
practices (as of 10/07/09).
1
1999 - 2000 2007 - 2008 2008 - 2009
200

180

160

Consultation rate per 100,000


Higher than average seasonal activity
140

120

100
Normal seasonal activity
80

60

40

20 Baseline activity
0
40
42
44
46
48
50
52
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
Week

Table 1. Age specific consultations (per 100,000) for influenza in Welsh sentinel
practices, week 22 2009 – week 27 2009 (as of 10/06/09).
Age Week
group 22 23 24 25 26 27
0-4 0.00 0.00 0.00 0.00 0.00 0.00
5 - 14 0.00 0.00 0.00 2.90 0.00 6.30 Age specific
consultation rate
15 - 24 0.00 0.00 3.20 2.70 0.00 11.70
during week 27
25 - 34 6.20 2.70 0.00 5.60 5.90 9.20 were highest
35 - 44 0.00 0.00 0.00 0.00 0.00 7.50 among patients
45 - 64 4.40 4.40 0.00 0.00 2.90 1.80 aged 15-24
65 + 0.00 0.00 0.00 1.70 0.00 1.90
Total 1.85 0.33 0.4 1.68 1.43 5.1

Figure 2. Historical clinical consultation rate per 100,000 practice population in Welsh
sentinel practices (week 41 1996 – week 27 2009).

450
Epidemic activity
400
Consultation rate per 100,000

350

300

250 Higher than average


seasonal activity
200

150

100
Normal seasonal
50 activity

0
October 1996
April 1997
October 1997
April 1998
October 1998
April 1999
October 1999
April 2000
October 2000
April 2001
October 2001
April 2002
October 2002
April 2003
October 2003
April 2004
October 2004
April 2005
October 2005
April 2006
October 2006
April 2007
October 2007
April 2008
October 2008
March 2009

-2-
Enhanced virological surveillance for seasonal respiratory illness
Table 2. Specimens submitted for virological surveillance (as of 10/07/09, by week of
sample collection). Out of hours service samples indicated by parenthesis.

Week Specimens Specimens Positive identifications


submitted tested influenza A
influenza B RSV parainfluenza rhinovirus adenovirus
Total A A(H1N1)v*
40-17 96 (3) 93 (3) 15 0 2 1 3 0 0
18 3 3 0 0 1 0 1 0 0
19 3 3 0 0 0 0 0 1 0
20 2 2 0 0 0 0 0 0 0
21 1 1 0 0 0 0 0 0 0
22 3 3 0 0 0 0 0 1 0
23 2 2 0 0 0 0 0 1 0
24 2 2 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0
26 3 (1) 3 (1) 0 0 0 0 0 0 0
27 4 4 1 1 0 0 0 0 0
Total 119 (4) 116 (3) 16 1 3 1 4 2 0

During week 27 four samples were submitted for testing by sentinel GPs, one of which tested
positive for swine influenza A(H1N1)v (patient aged 25 – 34yrs from the Cardiff area, with a
recent history of travel to Spain). Since week October 2009 (week 40) 119 samples have been
received (including 4 Out of Hours GP Service samples), 116 of these have been tested. Sixteen
samples have tested positive for influenza A, one of which was due to swine influenza A(H1N1)v
(patient from the Cardiff area, aged 25 – 34yrs with a recent history of travel to Spain). Two
samples have tested positive for influenza B, three have tested positive for parainfluenza, one
has tested positive for RSV and two samples tested positive for rhinovirus. Of the 16 influenza A
positive samples, seven were characterized as influenza A(H3), two as influenza A(H1), one as
swine influenza A(H1N1)v and six were not further characterized.

-3-
Summary of Confirmed and Clinically presumed H1N1 Swine influenza cases in
Wales
Table 3. Confirmed Swine influenza A(H1N1)v cases reported NPHS Wales, as at
10/07/09, by LHB area of residence.
Laboratory confirmed
LHB
cases
Anglesey 2
Blaenau Gwent 2
Bridgend 1
Caerphilly 5
Cardiff 13
Carmarthenshire 0
Ceredigion 2
Conwy 2
Denbighshire 1
Flintshire 0
Gwynedd 0
Merthyr Tydfil 3
Monmouthshire 3
Neath Port Talbot 0
Newport 11
Pembrokeshire 1
Powys 3
Rhondda Cynon Taf 1
Swansea 5
Torfaen 3
Vale of Glamorgan 1
Wrexham 1
Total 60

Table 4. Confirmed H1N1 Swine influenza cases reported NPHS Wales, as at 10/07/09,
by reporting week.
Laboratory Number
Reporting week
confirmed hospitalised
17-21 0 0
22 1 0
23 1 0
24 1 0
25 2 0
26 12 1
27 33 1
28 10 2
Total 60 4

Table 5. Confirmed H1N1 Swine influenza cases reported NPHS Wales, as at 10/07/09,
by age group.
Laboratory confirmed
Agegroup
cases
<1 0
1-4 2
5 - 14 3
15 - 24 32
25 - 34 9
35 - 44 2
45 - 64 10
65 - 74 2
75+ 0
Total 60
As at 10/07/2009 there have been 60 laboratory confirmed cases in Wales, four of which have
been hospitalized. The age group most currently with the highest numbers of cases are 15 to 24
year olds. Confirmed cases have been reported in 18 out 22 LHB areas in Wales.

-4-
Other indices of influenza activity in Wales
Figure 4. Rapid surveillance of influenza in Wales using AuditWeb to week 27 2009
(as at 10/07/09).
400

Consultation rate per 100,000 350

300

250

200

150

100

50

0
01/05/2009
03/05/2009
05/05/2009
07/05/2009
09/05/2009
11/05/2009
13/05/2009
15/05/2009
17/05/2009
19/05/2009
21/05/2009
23/05/2009
25/05/2009
27/05/2009
29/05/2009
31/05/2009
02/06/2009
04/06/2009
06/06/2009
08/06/2009
10/06/2009
12/06/2009
14/06/2009
16/06/2009
18/06/2009
20/06/2009
22/06/2009
24/06/2009
26/06/2009
28/06/2009
30/06/2009
02/07/2009
04/07/2009
06/07/2009
08/07/2009
10/07/2009
12/07/2009
14/07/2009
16/07/2009
18/07/2009
20/07/2009
22/07/2009
24/07/2009
26/07/2009
28/07/2009
30/07/2009
Figure 5. Rapid surveillance of influenza in Wales LHB influenza consultation rates
(per 100,000 practice population), using AuditWeb to week 28 2009 (as at 10/07/09).

Surveillance for influenza consultations in Wales using Audit+, shows the rolling 7 day
consultation rate for influenza is increasing. As at 10/07/09 the consultation rate for Wales as a
whole was 14.2 per 100,000. Consultation rates were highest in the Gwent region, with
consultation rates in Caerphilly LHB exceeding 25 per 100,000 (25.9 per 100,000 as at 09/07/09)

-5-
1
Figure 6. Influenza related calls to NHS direct Wales (as a percentage of total calls)
to week 27 2009 (as of 10/07/09).

30.0
Percentage 25.0

20.0

15.0

10.0

5.0

0.0 24-Apr-06

19-Jun-06
17-Jul-06
14-Aug-06

09-Oct-06
06-Nov-06

23-Apr-07

18-Jun-07
16-Jul-07
13-Aug-07

08-Oct-07
05-Nov-07

21-Apr-08

16-Jun-08
14-Jul-08
11-Aug-08

06-Oct-08
03-Nov-08

20-Apr-09

15-Jun-09
06-Dec-05
03-Jan-06
31-Jan-06
27-Feb-06
27-Mar-06

22-May-06

11-Sep-06

04-Dec-06
01-Jan-07
29-Jan-07
26-Feb-07
26-Mar-07

21-May-07

10-Sep-07

03-Dec-07
31-Dec-07
28-Jan-08
25-Feb-08
24-Mar-08

19-May-08

08-Sep-08

01-Dec-08
29-Dec-08
26-Jan-09
23-Feb-09
23-Mar-09

18-May-09
Week commencing

During week 27 (latest data), the percentage of total calls to NHS Direct Wales which were
influenza related increased to 20.6 from 18.9% in week 26 (figure 6).
1
Data supplied by Health Statistics and Analysis Unit, Welsh Assembly Government.
Flu related calls are the sum of calls recorded as 'cold/flu', 'cough', 'headache', 'fever' and 'sore throat'.

NPHS Wales carry out daily surveillance for influenza consultations using the Audit+ Data Quality
System. These surveillance data are available for health professionals from the NPHS Wales
swine flu influenza intranet webpage:
http://howis.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=28942

Links:

NPHS Wales Swine influenza webpage:


http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=37250
HPA Swine influenza webpage:
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1240732818210?p=12
31252394302
NICE influenza antiviral usage guidance:
http://www.nice.org.uk/Guidance/TA158
Wales influenza information:
http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=27922
England influenza information:
http://www.hpa.org.uk/infections/topics_az/influenza/seasonal/default.htm
Scotland influenza information:
http://www.hps.scot.nhs.uk/search/atozdetail.aspx?subject=95
Northern Ireland influenza information:
http://www.cdscni.org.uk/publications/default.asp
European influenza information:
http://www.eiss.org/index.cgi
Avian influenza in the UK:
http://www.hpa.org.uk/infections/topics_az/influenza/avian/default.htm
Avian influenza/ pandemic information:
http://www.who.int/csr/disease/avian_influenza/en/index.html

-6-