1887
Surveillance Open Access
Like 0

Abstract

Background

Annual seasonal influenza activity in the northern hemisphere causes a high burden of disease during the winter months, peaking in the first weeks of the year.

Aim

We describe the 2019/20 influenza season and the impact of the COVID-19 pandemic on sentinel surveillance in the World Health Organization (WHO) European Region.

Methods

We analysed weekly epidemiological and virological influenza data from sentinel primary care and hospital sources reported by countries, territories and areas (hereafter countries) in the European Region.

Results

We observed co-circulation of influenza B/Victoria-lineage, A(H1)pdm09 and A(H3) viruses during the 2019/20 season, with different dominance patterns observed across the Region. A higher proportion of patients with influenza A virus infection than type B were observed. The influenza activity started in week 47/2019, and influenza positivity rate was ≥ 50% for 2 weeks (05–06/2020) rather than 5–8 weeks in the previous five seasons. In many countries a rapid reduction in sentinel reports and the highest influenza activity was observed in weeks 09–13/2020. Reporting was reduced from week 14/2020 across the Region coincident with the onset of widespread circulation of SARS-CoV-2.

Conclusions

Overall, influenza type A viruses dominated; however, there were varying patterns across the Region, with dominance of B/Victoria-lineage viruses in a few countries. The COVID-19 pandemic contributed to an earlier end of the influenza season and reduced influenza virus circulation probably owing to restricted healthcare access and public health measures.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2021.26.40.2100077
2021-10-07
2024-12-22
/content/10.2807/1560-7917.ES.2021.26.40.2100077
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/26/40/eurosurv-26-40-2.html?itemId=/content/10.2807/1560-7917.ES.2021.26.40.2100077&mimeType=html&fmt=ahah

References

  1. Nair H, Brooks WA, Katz M, Roca A, Berkley JA, Madhi SA, et al. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet. 2011;378(9807):1917-30.  https://doi.org/10.1016/S0140-6736(11)61051-9  PMID: 22078723 
  2. Fineberg HV. Pandemic preparedness and response--lessons from the H1N1 influenza of 2009. N Engl J Med. 2014;370(14):1335-42.  https://doi.org/10.1056/NEJMra1208802  PMID: 24693893 
  3. Hurt AC, Chotpitayasunondh T, Cox NJ, Daniels R, Fry AM, Gubareva LV, et al. Antiviral resistance during the 2009 influenza A H1N1 pandemic: public health, laboratory, and clinical perspectives. Lancet Infect Dis. 2012;12(3):240-8.  https://doi.org/10.1016/S1473-3099(11)70318-8  PMID: 22186145 
  4. Hayward AC, Fragaszy EB, Bermingham A, Wang L, Copas A, Edmunds WJ, et al. Comparative community burden and severity of seasonal and pandemic influenza: results of the Flu Watch cohort study. Lancet Respir Med. 2014;2(6):445-54.  https://doi.org/10.1016/S2213-2600(14)70034-7  PMID: 24717637 
  5. Nicholson KG, Wood JM, Zambon M. Influenza. Lancet. 2003;362(9397):1733-45.  https://doi.org/10.1016/S0140-6736(03)14854-4  PMID: 14643124 
  6. Troeger CE, Blacker BF, Khalil IA, Zimsen SRM, Albertson SB, Abate D, et al. Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017. Lancet Respir Med. 2019;7(1):69-89.  https://doi.org/10.1016/S2213-2600(18)30496-X  PMID: 30553848 
  7. Cassini A, Colzani E, Pini A, Mangen MJ, Plass D, McDonald SA, et al. Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013. Euro Surveill. 2018;23(16):17-00454.  https://doi.org/10.2807/1560-7917.ES.2018.23.16.17-00454  PMID: 29692315 
  8. Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2018;391(10127):1285-300.  https://doi.org/10.1016/S0140-6736(17)33293-2  PMID: 29248255 
  9. European Centre for Disease Prevention and Control (ECDC). Flu News Europe: weekly influenza updates. Stockholm: ECDC. [Accessed: 1 Jun 2021]. Available from: https://www.ecdc.europa.eu/en/seasonal-influenza/surveillance-and-disease-data/flu-news-europe
  10. Snacken R, Brown C. New developments of influenza surveillance in Europe. Euro Surveill. 2015;20(4):21020.  https://doi.org/10.2807/ese.20.04.21020-en  PMID: 25655056 
  11. Aymard M, Valette M, Lina B, Thouvenot D. Surveillance and impact of influenza in Europe. Groupe Régional d’Observation de la Grippe and European Influenza Surveillance Scheme. Vaccine. 1999;17(Suppl 1):S30-41.  https://doi.org/10.1016/S0264-410X(99)00103-6  PMID: 10471178 
  12. World Health Organization (WHO). Influenza - Surveillance and monitoring. Geneva: WHO. [Accessed: 1 April 2021]. Available from: https://www.who.int/influenza/surveillance_monitoring/en
  13. Meerhoff TJ, Meijer A, Paget WJ, EISS. Methods for sentinel virological surveillance of influenza in Europe - an 18-country survey. Euro Surveill. 2004;9(1):34-8.  https://doi.org/10.2807/esm.09.01.00442-en  PMID: 14762319 
  14. Boon AC, French AM, Fleming DM, Zambon MC. Detection of influenza a subtypes in community-based surveillance. J Med Virol. 2001;65(1):163-70.  https://doi.org/10.1002/jmv.2016  PMID: 11505459 
  15. Snacken R, Lion J, Van Casteren V, Cornelis R, Yane F, Mombaerts M, et al. Five years of sentinel surveillance of acute respiratory infections (1985-1990): the benefits of an influenza early warning system. Eur J Epidemiol. 1992;8(4):485-90.  https://doi.org/10.1007/BF00146364  PMID: 1397213 
  16. Influenza surveillance: Why? Vaccine. 2006;24(44-46):6770-5.  https://doi.org/10.1016/j.vaccine.2006.06.073  PMID: 17167881 
  17. Fleming DM, van der Velden J, Paget WJ. The evolution of influenza surveillance in Europe and prospects for the next 10 years. Vaccine. 2003;21(16):1749-53.  https://doi.org/10.1016/S0264-410X(03)00066-5  PMID: 12686088 
  18. World Health Organization (WHO). Pandemic influenza risk management. WHO Interim Guidance 2013. Geneva: WHO; 2013. Available from: https://www.who.int/influenza/preparedness/pandemic/GIP_PandemicInfluenzaRiskManagementInterimGuidance_Jun2013.pdf
  19. Olsen SJ, Chen MY, Liu YL, Witschi M, Ardoin A, Calba C, et al. early introduction of severe acute respiratory syndrome coronavirus 2 into Europe. Emerg Infect Dis. 2020;26(7):1567-70.  https://doi.org/10.3201/eid2607.200359  PMID: 32197059 
  20. Spiteri G, Fielding J, Diercke M, Campese C, Enouf V, Gaymard A, et al. First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020. Euro Surveill. 2020;25(9):2000178.  https://doi.org/10.2807/1560-7917.ES.2020.25.9.2000178  PMID: 32156327 
  21. World Health Organization Regional Office for Europe (WHO/Europe), European Centre for Disease Prevention and Control (ECDC). Flu News Europe. Joint ECDC-WHO/Europe weekly influenza update. System. Geneva, Stockholm: WHO/Europe, ECDC. [Accessed: 18 Sep 2021]. Available from: http://flunewseurope.org/System
  22. Meerhoff TJ, Simaku A, Ulqinaku D, Torosyan L, Gribkova N, Shimanovich V, et al. Surveillance for severe acute respiratory infections (SARI) in hospitals in the WHO European region - an exploratory analysis of risk factors for a severe outcome in influenza-positive SARI cases. BMC Infect Dis. 2015;15(1):1.  https://doi.org/10.1186/s12879-014-0722-x  PMID: 25567701 
  23. Broberg E, Melidou A, Prosenc K, Bragstad K, Hungnes O, WHO European Region and the European Influenza Surveillance Network members of the reporting countries. Predominance of influenza A(H1N1)pdm09 virus genetic subclade 6B.1 and influenza B/Victoria lineage viruses at the start of the 2015/16 influenza season in Europe. Euro Surveill. 2016;21(13):30184.  https://doi.org/10.2807/1560-7917.ES.2016.21.13.30184  PMID: 27074657 
  24. Adlhoch C, Broberg E, Beauté J, Snacken R, Bancroft E, Zucs P, et al. Influenza season 2013/14 has started in Europe with influenza A(H1)pdm09 virus being the most prevalent subtype. Euro Surveill. 2014;19(4):20686.  https://doi.org/10.2807/1560-7917.ES2014.19.4.20686  PMID: 24507465 
  25. Adlhoch C, Snacken R, Melidou A, Ionescu S, Penttinen P, The European Influenza Surveillance Network. Dominant influenza A(H3N2) and B/Yamagata virus circulation in EU/EEA, 2016/17 and 2017/18 seasons, respectively. Euro Surveill. 2018;23(13):18-00146.  https://doi.org/10.2807/1560-7917.ES.2018.23.13.18-00146  PMID: 29616611 
  26. Jegaskanda S, Laurie KL, Amarasena TH, Winnall WR, Kramski M, De Rose R, et al. Age-associated cross-reactive antibody-dependent cellular cytotoxicity toward 2009 pandemic influenza A virus subtype H1N1. J Infect Dis. 2013;208(7):1051-61.  https://doi.org/10.1093/infdis/jit294  PMID: 23812238 
  27. Barr IG, Vijaykrishna D, Sullivan SG. Differential age susceptibility to influenza B/Victoria lineage viruses in the 2015 Australian influenza season. Euro Surveill. 2016;21(4):30118.  https://doi.org/10.2807/1560-7917.ES.2016.21.4.30118  PMID: 26848118 
  28. Buda S, Dürrwald R, Biere B, Buchholz U, Tolksdorf K, Schilling J, et al. Influenza - Wochenbericht, Kalenderwoche 20/2020 (9.5. bis 15.5.2020). [Influenza weekly report, calendar week 20/2000 (9–15 May 2020)]. Berlin: Robert Koch Institut; 2020. German. Available from: https://influenza.rki.de/Wochenberichte/2019_2020/2020-20.pdf
  29. Santé publique France. Bulletin épidémiologique grippe. Bilan de la surveillance, saison 2019-2020. [Influenza epidemiological bulletin. Surveillance report, season 2019/20]. Saint-Maurice cedex: Santé Publique France; 2020. French. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/grippe/documents/bulletin-national/bulletin-epidemiologique-grippe.-bilan-de-la-surveillance-saison-2019-2020
  30. European monitoring of excess mortality for public health action (EuroMOMO). Graphs and maps. Pooled number of deaths by age group. Copenhagen: EuroMOMO. [Accessed: 8 Sep 2021]. Available from: https://www.euromomo.eu/graphs-and-maps
  31. European Centre for Disease Prevention and Control (ECDC). Weekly COVID-19 country overview. Stockholm: ECDC. [Accessed: 8 Sep 2021]. Available from: https://www.ecdc.europa.eu/en/covid-19/country-overviews
  32. Adlhoch C, Pebody R. What to expect for the influenza season 2020/21 with the ongoing COVID-19 pandemic in the World Health Organization European Region. Euro Surveill. 2020;25(42):2001816.  https://doi.org/10.2807/1560-7917.ES.2020.25.42.2001816  PMID: 33094719 
  33. Emborg H-D, Carnahan A, Bragstad K, Trebbien R, Brytting M, Hungnes O, et al. Abrupt termination of the 2019/20 influenza season following preventive measures against COVID-19 in Denmark, Norway and Sweden. Euro Surveill. 2021;26(22):2001160.  https://doi.org/10.2807/1560-7917.ES.2021.26.22.2001160  PMID: 34085632 
  34. World Health Organization (WHO). Influenza update – 377. Geneva: WHO; 2020.Available from: https://www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en
  35. Jones N. How coronavirus lockdowns stopped flu in its tracks. Nature. 2020.  https://doi.org/10.1038/d41586-020-01538-8  PMID: 32440021 
  36. Olsen SJ, Azziz-Baumgartner E, Budd AP, Brammer L, Sullivan S, Pineda RF, et al. Decreased influenza activity during the COVID-19 pandemic - United States, Australia, Chile, and South Africa, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(37):1305-9.  https://doi.org/10.15585/mmwr.mm6937a6  PMID: 32941415 
  37. Sullivan SG, Carlson S, Cheng AC, Chilver MB, Dwyer DE, Irwin M, et al. Where has all the influenza gone? The impact of COVID-19 on the circulation of influenza and other respiratory viruses, Australia, March to September 2020. Euro Surveill. 2020;25(47):2001847.  https://doi.org/10.2807/1560-7917.ES.2020.25.47.2001847  PMID: 33243355 
  38. European Centre for Disease Prevention and Control (ECDC), WHO Regional Office for Europe (WHO/Europe). Operational considerations for influenza surveillance in the WHO European Region during COVID-19: interim guidance. Stockholm, Geneva: ECDC, WHO/Europe; 2020. [Available from: https://www.ecdc.europa.eu/en/publications-data/operational-considerations-influenza-surveillance-european-region-during-covid-19
  39. Adlhoch C, Mook P, Lamb F, Ferland L, Melidou A, Amato-Gauci AJ, et al. Very little influenza in the WHO European Region during the 2020/21 season, weeks 40 2020 to 8 2021. Euro Surveill. 2021;26(11):2100221.  https://doi.org/10.2807/1560-7917.ES.2021.26.11.2100221  PMID: 33739256 
  40. European Centre for Disease Prevention and Control (ECDC). Seasonal influenza vaccination and antiviral use in EU/EEA Member States. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/seasonal-influenza-vaccination-antiviral-use-eu-eea-member-states
  41. Wang X, Kulkarni D, Dozier M, Hartnup K, Paget J, Campbell H, et al. Influenza vaccination strategies for 2020-21 in the context of COVID-19. J Glob Health. 2020;10(2):021102.  https://doi.org/10.7189/jogh.10.0201102  PMID: 33312512 
  42. Morales KF, Brown DW, Dumolard L, Steulet C, Vilajeliu A, Ropero Alvarez AM, et al. Seasonal influenza vaccination policies in the 194 WHO Member States: The evolution of global influenza pandemic preparedness and the challenge of sustaining equitable vaccine access. Vaccine X. 2021;8:100097.  https://doi.org/10.1016/j.jvacx.2021.100097  PMID: 34041476 
/content/10.2807/1560-7917.ES.2021.26.40.2100077
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error