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Influenza activity in the Southern Hemisphere

Influenza activity in the Southern Hemisphere. Ian Barr WHO CC for Reference & Research on Influenza Melbourne www.influenzacentre.org. The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health and Ageing.

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Influenza activity in the Southern Hemisphere

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  1. Influenza activity in the Southern Hemisphere Ian Barr WHO CC for Reference & Research on Influenza Melbourne www.influenzacentre.org The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health and Ageing.

  2. Recap on the 2010 Australian season • More normal “Influenza” season • High levels of vaccination/exposure to H1N1pdm pre-season • Season began in June-July (2009 May-June) • Peaked in September (2009 Aug) • Late season cases seen in Dec 10 and Jan 11 • Characteristics of season • Mainly Pandemic H1N1 viruses in Aus/ (& NZ) • Milder than 2009 season • Fewer admissions to ICU and deaths • Some vaccine breakthroughs recorded

  3. Pandemic H1N1 severity up to November 5 2010Australian Influenza Surveillance Report

  4. Influenza vaccines used in Australia and NZ in 2010 • H1N1pdm – A/California/7/2009 • (circulating strain: A/California/7/2009-like) • H3 – A/Perth/16/2009 • (circulating strain: A/Perth/16/2009-like) • B - B/Brisbane/60/2008 (B/Victoria lineage) • (circulating strain: B/Brisbane/60/2008-like – B/Victoria lineage)

  5. Vaccine breakthroughs in 2010 in Australia • Pandemic H1N1 2009 cases • Outbreak at HMS Cerebus (Victoria) in October 2010 • >30 cases (24 influenza proven positive H1N1pdm) • First 30 hospitalized (precautionary), no deaths, ICU • All vaccinated (?seasonal or pandemic) • Formed a distinct genetic clade (only one other virus seen in this group from Canberra) • Unable to determine antigenic characteristics as only RNA available • H3N2 cases • Multiple reports (Nov/Dec) from Qld aboriginal settlements eg Townsville • ? Hospital admissions, ? ICU, ? deaths • All vaccinated with 2010 seasonal vaccine • Genetically fell into A/Perth/10/2010 group (same as most Aus, H3’s) • Antigenically similar to A/Perth/16/2009 viruses (ie vaccine strain) • B cases • None reported • n

  6. Google flu trends mapping world influenzaAs at 3.6.11 www.google.org/flutrends Sth Hemisphere 7 Sth American Sth Africa Australia New Zealand www.google.org/flutrends

  7. Google flu trends Australia and NZAs at 3.6.11 www.google.org/flutrends

  8. Google flu trends South AfricaAs at 6.6.11 www.google.org/flutrends

  9. Also now Google Dengue TrendsAs at 6.6.11 www.google.org/fdenguetrends Currently: Brazil Bolivia Indonesia India Singapore Brazil Google Dengue trends Brazilian data

  10. ILI in Australia (2008-11)

  11. ILI in NZ (2009-11) Source: ESR: Influenza Weekly Update 23-29 May 2011

  12. Lab confirmed influenza cases in Australia 2005-11 (NNDSS) November 2010-May 2011 x4 influenza cases of 2010

  13. Flunet data for Southern Hemisphere

  14. Samples types received by Melbourne CC

  15. Influenza viruses received and analysed at WHO CC for influenza 1.1.2011 – 31.5.2011 n=27 n=25 n=16 n=6 Countries supplying samples in 2011 n=18 Type A(H3) Type A(H1) Type B n=3 Pandemic (H1N1) 2009 n=393

  16. Victoria/502/11 Jan Singapore/6/11 Jan Brisbane/70/11 feb pdmH1 30May11 Townsville/47/11 Mar cdcStPetersburg/100/11e Mar Sydney/5/11 Feb Brunei/218/10 Brunei/237/10 Victoria/516/11 Apr Townsville/72/10 Oct Fiji/1/11 Mar Brisbane/76/11 Feb Brisbane/67/11 Feb Townsville/24/11 Jan Brisbane/112/11 Mar LR Darwin/82/11 Mar Singapore/9/11 Jan Cambodia/72/10 Nov Brisbane/18/11 Jan Singapore/7/11 Jan Brunei/10/11 Jan Victoria/504/11 Jan Sydney/217/10LR Sep Victoria/512/11 Feb Singapore/592/10 Sep Brisbane/69/10 Jul Brisbane/209/10e Aug Perth/382/10 Dec Brisbane/69/11 Feb Sydney/31/10 Oct Victoria/1026/10 Sep Victoria/670/10 Nov Victoria/663/10 Dec Victoria/1036/10 Nov Darwin/178/10 Dec Victoria/663/10e Dec Sydney/47/10 Sep Sydney/511/10 Sep Brisbane/15/11 Jan Perth/31/11 Mar Brisbane/46/11 Feb cdcKentucky/09/10e Nov Perth/198/10e dec Sep Darwin/52/11 Mar Darwin/53/11 Mar Brunei/1/11 Jan Singapore/591/10 Sep NewCaledonia/6/11 Feb Perth/219/10e dec Sep Cambodia/9/10 Jul Canberra/1/10 Feb Fiji/1/10 May Brunei/26/10 SthAustralia/34/10 Aug Macau/200018/10 Jan Wellington/39/10 Aug Sydney/23/10 Sep Christchurch/2/10e Jul CHRISTCHURCH/16/10e Jul Sydney/16/10 Aug Townsville/64/10e Oct Sydney/27/10 Sep Townsville/56/10e Sep Wellington/51/10 Aug Victoria/522/10 Aug SthAustralia/19/10 Jul Christchurch/23/10 Jul Fiji/40/10 Nov Fiji/45/10 Nov Fiji/22/10 Sept Christchurch/8/10e Jul Victoria/817/10 Aug Christchurch/7/10e Jul Brisbane/72/10 Aug Christchurch/6/10e Jul Sydney/202/10 Jul Victoria/502/10e Jun Singapore/567/10e Apr Singapore/572/10 May Perth/12/10 Jun Brisbane/10/10e Apr Singapore/575/10 May Darwin/17/10 Jun Darwin/46/10 Jul Darwin/86/10 Sep Canberra/18/10 Aug SthAustralia/397/10e Sep Perth/518/10 Aug Townsville/13/10 Aug Townsville/28/10 Sep Brisbane/12/10e Jun Darwin/47/10 Aug SthAustralia/81/10 Aug Brisbane/32/11 Feb Grafton/2/10 Aug Victoria/501/10e Jun Perth/223/10dec Sept Perth/345/10 Oct SthAustralia/64/10 Aug SthAustralia/404/10e Sep Perth/272/10 Sep Victoria/662/10 Nov 2010 pdm Consensus Darwin/143/10 Oct Darwin/118/10e Sep Darwin/150/10 Oct Darwin/55/10e Sep Darwin/92/10 Sep Darwin/156/10 Oct Darwin/165/10 Nov Victoria/866/10 Sep Victoria/906/10LR ICU Sep Victoria/917/10 Oct Victoria/891/10 Sep Brisbane/76/10 Aug Wellington/94/10LR Aug Darwin/64/10 Sept Fiji/27/10 Sept Wellington/100/10LR Aug Christchurch/5/10e Jul Victoria/1008/10 Sep Townsville/10/10 Aug Brisbane/107/10 Aug Auckland/146/10Vac Aug Victoria/571/10 Sep Sydney/517/10 Oct Singapore/587/10 May vax SthAustralia/18/10 Jul Brisbane/7/10 Mar Singapore/595/10 May Victoria/850/10 Sep Darwin/74/11 Mar Darwin/75/11 mar Darwin/10/11 Perth/29/11 ICU Mar Perth/30/11 Mar Darwin/2/11 Jan Darwin/70/11 Mar Darwin/1/11 Jan SriLanka/31/10 Nov SriLanka/21/10 Oct SriLanka/23/10 Nov SriLanka/32/10 Nov cdcVoronezh/1/11e Mar Townsville/58/11LR Mar Guam/2/10e Mar Philippines/3334/10 Jul Sydney/4/10 Jul SthAustralia/346/10 Sep Perth/33/11 Jan Macau/600129/11 Feb Victoria/508/11 Jan Vanimo/7/10 May Philippines/824/10 Feb Townsville/31/11 Feb Victoria/918/10 Oct Victoria/1202/10vax Sep Victoria/1204/10vax Oct Canberra/8/10 Aug Philippines/5232/10 Nov Brisbane/72/11 Mar Singapore/589/10 Sep vax Macau/306491/10 Mar Brunei/28/10 LVIV/N6/09nimr Oct Brisbane/1/10 Jan Vanimo/3/10 May Goroka/16/10e May EastSepik/1/10 Feb SthCarolina/02/10e Mar cdc BRISBANE/2013/09c 7/09 AUCKLAND/1/09e Apr BAYERN/69/09 CALIFORNIA/07/09e 0.0010 H1N1pdm HA genes A/Brisbane/70/2011-like Main group in 2011 A/Christchurch/16/2010-like Main group in 2010 A/Perth/30/2011-like Regional group in 2011 A/California/7/2009 - Vaccine strain

  17. Townsville/104/10 Nov Townsville/105/10 Nov H3 4May11 H3N2 HA genes Brisbane/252/10 Sept Brisbane/220/10e Townsville/102/10 Nov Townsville/93/10 Dec Townsville/97/10vax Dec Townsville/48/11 Mar Townsville/100/vax Dec Townsville/7/11 Jan Townsville/34/11 Feb Chrischurch/49/10 Sept Townsville/87/10e Nov Townsville/86/10 Nov Townsville/98/10 Dec Townsville/106/10 Nov A/Perth/10/2010-like Main group in 2010-11 Philippines/5229/10 Nov Townsville/117/10vax Dec Townsville/92/10vax Dec Brunei/208/10 Victoria/500/11 Jan Victoria/506/11 Jan Brisbane/1/11 Jan Alaska/5/10e Aug Iowa/19/10e Dec Arizona/13/10e Jun Guadeloupe/202/10e Aug cdc Panama/307149/10 Jun Townsville/20/11 Jan Singapore/11/11 Jan Townsville/60/10 Brisbane/210/10e PERTH/10/10e NewCaledonia/4/11 Feb NewCaledonia/3/11 Feb Townsville/3/11 Jan NewCaledonia/2/11 Feb NewCaledonia/5/11 Feb Fiji/38/10 Oct Tasmania/2/11 Feb Victoria/650/10 Oct SthAuckland/15/10 Jul Sydney/13/10 Aug Singapore/616/10 Jul vax Singapore/617/10 jul Victoria/1201/10vax Sep Cambodia/1/10 Jun cdc Alabama/5/10 Jul Victoria/563/10e Perth/56/10 Aug 2010 H3 Consensus Nauru/3/11 Jan Nauru/5/11 Jan Nauru/19/11 Feb Nauru/17/11 Feb Christchurch/3/11 Feb Darwin/6/11 Jan Singapore/13/11 Jan Christchurch/1/11 Feb Darwin/14/11 Feb Darwin/25/11 Feb cdcMaine/02/10 Dec cdcWyoming/09/10 Dec SriLanka/3/10 Jul RhodeIsland/1/10e Jan Singapore/512/10 Apr Singapore/521/10 Apr Singapore/516/10 Apr Canberra/2/10 Jun A/Victoria/2008-like Common in 2010 Victoria/1031/10 Oct Victoria/1034/10 Oct Victoria/103510 Oct 11S0802 Sep Victoria/552/10 Aug Victoria/8/10e Aug Christchurch/50/10 Sep Brisbane/217/10 Aug Fiji/41/10 Nov Fiji/52/10 Dec SriLanka/7/10 May Newcastle/4/10 Jun Brunei/203/10 cdc Iowa/07/10 Jul Chrischurch/25/10 Aug Canberra/11/10 Aug SthAustralia/414/10 Oct BRISBANE/11/10e May Perth/501/10e May Nothaburi/488/10 Aug Brunei/204/10 Singapore/630/10 May vax Bangkok/132/09 May SriLanka/9/09 Jul cdc Bolivia/317/10 May VICTORIA/208/09e Jun WestSepik/12/09 Aug WestSepik/20/09 Sep cdc Kenya/1632/10 Apr cdc Italy/540/10 May Brisbane/31/10 Jul Johannesburg/50/10 Jul Perth/49/10 Aug Brisbane/253/10 Sep Brisbane/258/10 Oct Singapore/534/09 Nov Perth/324/09 Jul Victoria/210/09e Jun A/Perth/16/2009 - Vaccine strain SuratThani/116/10 Feb A/Perth/16/2009-like Few viruses in 2010 SuratThani/269/10 Mar PortMoresby/2/09e Jun cdc Honduras/6065/10 Apr NewYork/05/10cdc Mar PHILIPPINES/16/09 Mar PERTH/16/09e Apr Victoria/4/10 May Kiribati/6/09 Jul Tasmania/8/09 Jun cdc Wisconsin/15/09e Jun Chuuk/3/09 Jun Brisbane/100/09 Jul Canberra/20/09 Jul Perth/673/09 Nov Cambodia/15/09 Jun BRISBANE/10/07e Feb 0.01

  18. B Viruses 2010-2011

  19. Summary of Southern Hemisphere influenza activity in 2011 • 2011 early in the SH season so far (peaks June-August) • Increased out of season activity in Australia in early 2011 • Increased H3N2 activity in 2011 vs 2010 in Australia • Mostly A/Perth/10/2010 genetically, still A/Perth/16/2009-like antigenically • Pandemic H1N1 still common • Mostly A/Brisbane/70/2011 genetically, still A/California/7/2009-like antigenically • Few B viruses (mainly B/Brisbane/60/2008-like – B/Victoria lineage) • Currently 100% of H3N2H1N1pdm viruses are adamantane resistant • Low levels of neuraminidase inhibitor resistance • <1% viruses currently oseltamivir (Tamiflu) resistant – mainly treatment/prophylactic use • Little activity in NZ, Sth Africa or Sth America so far • 2011 vaccine match so far so good……………….

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