Influenza activity in the Southern Hemisphere

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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 The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian and Research on Influenza is supported by the Australian

Government Department of Health and Ageing.Government Department of Health and Ageing.

Recap on the 2010 Australian seasonRecap 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

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

Influenza vaccines used in Australia and NZ in 2010Influenza 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)

Vaccine breakthroughs in 2010 in AustraliaVaccine 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

Google flu trends mapping world influenzaGoogle flu trends mapping world influenzaAs at 3.6.11As at 3.6.11

www.google.org/flutrendswww.google.org/flutrends

www.google.org/flutrendswww.google.org/flutrends

Sth Hemisphere7 Sth American

Sth AfricaAustralia

New Zealand

Google flu trends Australia and NZGoogle flu trends Australia and NZAs at 3.6.11As at 3.6.11 www.google.org/flutrendswww.google.org/flutrends

Google flu trends South AfricaGoogle flu trends South AfricaAs at 6.6.11As at 6.6.11 www.google.org/flutrendswww.google.org/flutrends

Also now Google Dengue TrendsAlso now Google Dengue TrendsAs at 6.6.11As at 6.6.11 www.google.org/fdenguetrendswww.google.org/fdenguetrends

Brazil Brazilian dataGoogle Dengue trends

Currently:Brazil

BoliviaIndonesia

IndiaSingapore

ILI in Australia (2008-11)ILI in Australia (2008-11)

ILI in NZ (2009-11)ILI in NZ (2009-11)

Source: ESR: Influenza Weekly Update23-29 May 2011

Lab confirmed influenza cases in Australia Lab confirmed influenza cases in Australia 2005-11 (NNDSS)2005-11 (NNDSS)

November 2010-May 2011 x4 influenza cases of 2010

Flunet data for Southern Hemisphere

Samples types received by Melbourne CCSamples types received by Melbourne CC

Year OCS VirusIsolates

RatioIsolates:OCS

2006 221 802 3.6

2007 440 1355 3.1

2008 280 1413 5.1

2009 1944 1210 0.62

2010 1235 1013 0.82

2011 278 369 1.32

Macau

Singapore

Fiji

New Caledonia

Thailand

New Zealand

Australia

Influenza viruses received and analysed at WHO CC for influenza Influenza viruses received and analysed at WHO CC for influenza 1.1.2011 – 31.5.20111.1.2011 – 31.5.2011

Type B

Type A(H3)

Type A(H1)

Countries supplying samples in 2011

n=393

n=3

n=25

n=18

n=6

Pandemic (H1N1) 2009

n=27

n=16

0.0010

Victoria/663/10 Dec

Sydney/5/11 Feb

CHRISTCHURCH/16/10e Jul

Sydney/217/10LR Sep

NewCaledonia/6/11 Feb

Sydney/511/10 Sep

Perth/223/10dec Sept

Singapore/589/10 Sep vax

Brunei/1/11 JanPerth/219/10e dec Sep

SthAustralia/18/10 Jul

SthAustralia/397/10e Sep

Darwin/52/11 Mar

Philippines/3334/10 Jul

Goroka/16/10e May

BAYERN/69/09

Townsville/13/10 Aug

Brisbane/67/11 Feb

Christchurch/7/10e Jul

Philippines/5232/10 Nov

Philippines/824/10 Feb

Brisbane/112/11 Mar LRCambodia/72/10 Nov

Perth/29/11 ICU Mar

Sydney/27/10 Sep

SriLanka/23/10 Nov

Victoria/571/10 Sep

Brisbane/12/10e Jun

Townsville/56/10e Sep

Darwin/17/10 Jun

Victoria/918/10 Oct

Canberra/18/10 Aug

Darwin/55/10e Sep

Perth/345/10 Oct

Sydney/4/10 Jul

SthAustralia/19/10 Jul

Victoria/670/10 Nov

Victoria/891/10 Sep

Victoria/663/10e Dec

Victoria/501/10e Jun

2010 pdm Consensus

Victoria/1026/10 Sep

Singapore/7/11 Jan

Wellington/51/10 Aug

Singapore/595/10 May


Victoria/512/11 Feb

Darwin/92/10 Sep

Brunei/28/10

SthAustralia/404/10e Sep

SriLanka/21/10 Oct

Vanimo/3/10 May

Brisbane/69/11 Feb

Victoria/508/11 Jan

Brisbane/32/11 Feb

Townsville/72/10 Oct

Brunei/218/10

Victoria/817/10 Aug

Macau/600129/11 Feb

Darwin/2/11 Jan

SthAustralia/34/10 Aug

Townsville/58/11LR Mar



Perth/272/10 Sep

Canberra/8/10 Aug

Victoria/516/11 Apr

Singapore/567/10e Apr

Darwin/143/10 Oct

Darwin/86/10 Sep

Singapore/587/10 May vax

Guam/2/10e Mar

Perth/33/11 Jan

Wellington/94/10LR Aug

Sydney/47/10 Sep

Darwin/75/11 mar

Townsville/47/11 Mar

SthAustralia/346/10 Sep

cdcStPetersburg/100/11e Mar

Brisbane/72/10 Aug

Singapore/592/10 Sep

Brisbane/15/11 JanPerth/31/11 Mar

Canberra/1/10 Feb

Victoria/502/11 Jan

Brisbane/46/11 Feb

Victoria/866/10 Sep

cdcVoronezh/1/11e Mar

Fiji/40/10 Nov

SthCarolina/02/10e Mar cdc

Perth/382/10 Dec

Brisbane/70/11 feb

Fiji/45/10 Nov

Victoria/662/10 Nov

Brisbane/69/10 Jul

Darwin/178/10 Dec

Fiji/22/10 Sept

Fiji/1/11 Mar

Brunei/10/11 Jan

Townsville/10/10 Aug

Brisbane/72/11 Mar

Darwin/165/10 Nov

Brisbane/76/10 Aug

Sydney/31/10 Oct

Victoria/1008/10 Sep

Victoria/850/10 Sep

LVIV/N6/09nimr Oct

Brisbane/18/11 Jan

cdcKentucky/09/10e Nov


Perth/198/10e dec Sep

Perth/518/10 Aug

SriLanka/31/10 Nov



Fiji/27/10 Sept

Cambodia/9/10 Jul


Darwin/47/10 Aug

Singapore/9/11 Jan

Wellington/39/10 Aug

Singapore/6/11 Jan

Darwin/82/11 Mar

Brisbane/209/10e Aug

Darwin/150/10 Oct

Sydney/16/10 Aug

EastSepik/1/10 Feb

Perth/30/11 Mar

Darwin/53/11 Mar

Sydney/23/10 Sep

Victoria/1204/10vax Oct

Victoria/522/10 Aug

Fiji/1/10 May

SriLanka/32/10 Nov

Brunei/26/10

Grafton/2/10 Aug


Brisbane/10/10e Apr

BRISBANE/2013/09c 7/09

Brunei/237/10

Darwin/64/10 Sept

Victoria/917/10 Oct

Macau/200018/10 Jan

Vanimo/7/10 May

Darwin/118/10e Sep

Darwin/10/11

Darwin/1/11 Jan

Victoria/1036/10 Nov

Wellington/100/10LR Aug

Townsville/24/11 Jan

Victoria/504/11 Jan

Townsville/28/10 Sep

Perth/12/10 Jun

Victoria/1202/10vax SepTownsville/31/11 Feb

Darwin/70/11 Mar

Singapore/591/10 Sep

Darwin/156/10 Oct

Brisbane/76/11 Feb

Macau/306491/10 Mar

Darwin/46/10 Jul

Brisbane/1/10 Jan

Sydney/202/10 Jul

Auckland/146/10Vac Aug

Darwin/74/11 Mar

Christchurch/23/10 Jul


Townsville/64/10e Oct

Sydney/517/10 Oct

CALIFORNIA/07/09eAUCKLAND/1/09e Apr

Brisbane/107/10 Aug

Brisbane/7/10 Mar

Victoria/906/10LR ICU Sep

pdmH130May11

A/California/7/2009 - Vaccine strain

A/Brisbane/70/2011-likeMain group in 2011

A/Christchurch/16/2010-likeMain group in 2010

A/Perth/30/2011-likeRegional group in 2011

H1N1pdmHA genes

A/Perth/16/2009 - Vaccine strain

A/Perth/10/2010-likeMain group in 2010-11

A/Victoria/2008-likeCommon in 2010

A/Perth/16/2009-likeFew viruses in 2010

0.01

SriLanka/7/10 May

Nauru/17/11 Feb

Guadeloupe/202/10e Aug

Victoria/552/10 Aug

Victoria/506/11 Jan

Victoria/650/10 Oct

Brisbane/1/11 Jan

Singapore/630/10 May vax

Singapore/616/10 Jul vax

Perth/49/10 Aug

cdc Wisconsin/15/09e Jun

Brisbane/217/10 Aug

SriLanka/9/09 Jul

Townsville/105/10 Nov

Townsville/34/11 Feb

SuratThani/269/10 Mar

Victoria/103510 Oct

NewYork/05/10cdc Mar

11S0802 Sep

Brisbane/210/10eSingapore/11/11 Jan

Perth/501/10e May

Brisbane/220/10e


Chrischurch/25/10 Aug


cdc Bolivia/317/10 May

Alaska/5/10e Aug

Nothaburi/488/10 Aug

cdcMaine/02/10 Dec

VICTORIA/208/09e Jun

Perth/56/10 Aug

Brisbane/258/10 Oct

Singapore/516/10 Apr

Fiji/52/10 Dec

Townsville/3/11 Jan

PERTH/16/09e Apr

WestSepik/12/09 Aug

SthAuckland/15/10 Jul

Darwin/6/11 Jan

Brunei/204/10

Nauru/19/11 Feb

PortMoresby/2/09e Jun

Townsville/60/10

Philippines/5229/10 Nov

Nauru/5/11 Jan

Canberra/11/10 Aug

Townsville/87/10e Nov

cdc Italy/540/10 May

Victoria/1031/10 Oct

Christchurch/1/11 Feb

Victoria/8/10e Aug

PHILIPPINES/16/09 Mar


Townsville/7/11 Jan

Kiribati/6/09 Jul

Sydney/13/10 Aug

Iowa/19/10e Dec

SriLanka/3/10 Jul

Brunei/203/10

Brisbane/253/10 Sep


Tasmania/2/11 Feb

Townsville/97/10vax Dec

Bangkok/132/09 May

Johannesburg/50/10 Jul

BRISBANE/10/07e Feb

cdc Panama/307149/10 Jun


Darwin/14/11 Feb


cdc Iowa/07/10 Jul

Arizona/13/10e Jun

Townsville/20/11 Jan

Cambodia/1/10 Jun

Townsville/100/vax Dec

PERTH/10/10e

Brisbane/31/10 Jul

Fiji/41/10 Nov

Canberra/20/09 Jul

Canberra/2/10 Jun

Townsville/98/10 Dec

cdc Honduras/6065/10 Apr

2010 H3 Consensus

Singapore/13/11 Jan

SuratThani/116/10 Feb

Brunei/208/10Victoria/500/11 Jan

Townsville/93/10 Dec

Victoria/1034/10 Oct


Victoria/563/10e

Chrischurch/49/10 Sept

RhodeIsland/1/10e Jan

Cambodia/15/09 Jun

Victoria/4/10 May


Townsville/48/11 Mar

BRISBANE/11/10e May


Fiji/38/10 Oct

cdc Kenya/1632/10 Apr

Perth/673/09 Nov

Christchurch/3/11 Feb

cdcWyoming/09/10 Dec


Nauru/3/11 Jan

Newcastle/4/10 Jun


Perth/324/09 Jul

Chuuk/3/09 Jun

Darwin/25/11 Feb

WestSepik/20/09 Sep

Christchurch/50/10 Sep

cdc Alabama/5/10 Jul

Singapore/534/09 Nov

Tasmania/8/09 Jun


Victoria/1201/10vax SepSingapore/617/10 jul


Brisbane/252/10 Sept

SthAustralia/414/10 Oct

Brisbane/100/09 Jul

H34May11H3N2

HA genes

B Viruses 2010-2011

Virus type 2011 2010

B/Brisbane/60/2008-like 52 387

B/Brisbane/60/2008-like Low Reactor

1 20

B/Malaysia/2506/2004-like 1 16

B/Malaysia/2506/2004-likeLow Reactor

0 50

B/Florida/4/2006-like 1 3

B/Florida/4/2006-like Low Reactor

6 14

Summary of Southern Hemisphere influenza Summary of Southern Hemisphere influenza activity in 2011activity 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……………….

Documents

Influenza activity in the Southern Hemisphere