An overview of the 2016 SH influenza season & 2016-7 NH season to date

Ian Barr Deputy Director

WHO Collaborating Centre for Reference and Research on Influenza

www.influenzacentre.org

The  Melbourne  WHO  Collabora1ng  Centre  for  Reference  and  Research  on  Influenza  is  supported  by  the  Australian  Government  Department  of  Health    

How was the 2016 SH influenza season for you?

•  Normal season – nothing much different from any other

•  Low season – similar to 2010

•  Medium season – similar to 2011, 2013 •  Big season – similar to 2012, 2014, 2015

2016 Australian Influenza season •  A big “Influenza” season by some accounts

–  NNDSS Lab confirmed influenza data –  High “interseasonal” influenza activity (Jan-April) on record (again) –  2nd highest no. of lab confirmed cases 90,837 (2015:100592)

–  Normal start to main season with increased cases reported by NNDSS in mid-June, slight delay in peak (Wk 35 w/e Sept 4) continued to Nov.

–  ASPREN-VIDRL ILI figures showed moderate levels to < 2012,14,15 –  Low-Moderate level press coverage during main season

•  Characteristics of season –  Australia mainly A(H3N2), followed by A(H1N1)pdm09 & some B’s –  FluCan data; 1860 admissions; similar to 2015 (2070); cases admitted

directly to ICU 10% in 2016 vs 6.9% in 2015 ; 18% kids and 45% cases >65y, 74% cases had co-morbidities

–  Deaths; 92 influenza associated (to 28 Oct); (range 0-99 years) –  Paediatric surveillance – 21 hospitalizations (median 1.9y), no deaths

Influenza in 2016 in Australia SENTINEL GP ILI SURVEILLANCE

ASPREN GP SURVEILLANCE TYPING

Lab confirmed influenza in Australia 2011-16 (NNDSS)

Lab confirmed influenza in Australia 2016 by State - Similar timing but some prolonged eg Sth Aus

NNDSS Laboratory confirmed influenza cases by state 2016

State # Rate/ 100K

ACT 1603 409 NSW 35560 466 NT 704 287

QLD 23284 487 SA 7863 462 Tas 1052 203 Vic 12941 217 WA 7840 302

Total 90837 381

NNDSS – Influenza subtyping for 2016

Type 2014 %

2015 %

2016 %

2016 WHOCC

A(H1N1)pdm 11 2 6 39

A(H3N2) 8 7 11 52 A (untyped) 70 29 73 -

B 11 61 10 9

NNDSS Laboratory confirmed influenza cases by age 2016

Nationally Notified Influenza Associated Deaths (Aust. Influenza Report)

Year Deaths #

Median age y

Virus type/subtype

2011 14 47 83% A(H1N1)pdm

2012 60 78 88% A(H3N2)

2013 28 63 86% Influenza A

2014 72 72 100% Influenza A

2015 97 85 B and A(H3N2)

2016 92 80 87% Influenza A

Influenza vaccines used in Australia and NZ in 2016

•  H1N1pdm – A/California/7/2009-like (circulating strain: A/Cal/7/2009 / A/Michigan/45/2015-like)

•  H3 – A/Hong Kong/4801/2014-like (circulating strain: A/Hong Kong/4801/2014-like) - ? Effectiveness of egg grown virus

Trivalent vaccine: • B – B/Phuket/3073/2013 (B/Yam)

•  (co-circulating B/Vic & B/Yam) Yam=B/Phuket

Quadrivalent vaccine: • B – B/Phuket/3073/2013 (B/Yam)

•  (circulating strain: B/Phuket/3703/2013-like) • B – B/Brisbane/60/2008 (B/Vic)

•  (circulating strain: B/Brisbane/60/2008)

Influenza vaccines for Australia and NZ in 2017

•  H1N1pdm – A/Michigan/45/2014-like*

•  H3 – A/Hong Kong/4801/2014-like

Trivalent vaccine: •  B – B/Brisbane/60/2008-like (B/Vic)

Quadrivalent vaccine:

•  B – B/Phuket/3073/2013-like (B/Yam) •  B – B/Brisbane/60/2008-like (B/Vic)

*Changes to 2016 recommendations

The NH 2016-7 influenza season (so far)

Fluview: Influenza in the USA in 2016-7

CDC ILI activity

ILI in USA by year

US influenza cases in 2016-7 by type/subtype

US CDC data on 2016-7 season

USA Influenza Hospitalization Surveillance Network (FluSurv-NET) for 2016-7

Hospitalizations in children and adults in 13 U.S. states. Cumulative incidence rates are calculated using the National Center for Health Statistics’ (NCHS) population estimates for

the counties included in the surveillance catchment area.

Zoonotic Influenza

A(H7N9) and A(H5N6) human cases in China in 2016-7 (to Jan 21 2017)

A(H7N9) human cases in China 2013-7

A(H7N9) cases in China

H7N9 cases in past 5 years now exceed 15 years of H5Nx cases (856 cases 452 deaths CFR=52%)

Recent A(H5N6) human cases in China

Case fatality rate 12/17=71%

Summary of influenza seasons

•  Med-High season in Australia (2nd highest on record by NNDSS) •  Low season in NZ; LC ILI below baseline (40 cases/100,000 population) •  Influenza H3 predominant in Aus + NZ •  Both influenza B lineages co-circulated in Aus., Very low levels of B in NZ •  Vaccine match – good for H1N1pdm and B’s, A(H3N2) - fair •  Very few oseltamivir resistant viruses detected •  Hospital admissions & deaths in Australia similar to 2015 •  Australian/NZ SH Vaccine Effectiveness: Stayed tuned for Sheena’s talk!! •  Update of the A(H1N1)pdm based mainly on US data no evidence of similar population in

Australia (?different exposures in populations/?numbers too low to detect) •  Influenza activity 2016-7 in Nth Hemisphere; moderate in USA, low-moderate in EU •  A(H3N2) the predominant virus in NH (to date); very similar to 2016 viruses in Aus •  B viruses circulating at low levels

•  2016-7 saw a spike in A(H7N9) cases in Sth China; highest number of cases since 2013 •  Human cases of H5N6 continuing in China (most common H5 virus in poultry)

Acknowledgments

•  Various influenza reports –  Australian influenza surveillance report –  ESR Influenza weekly update –  CDC Fluview –  ECDC –  WHO reports

•  NICs and labs that have sent us samples

•  Staff at Melbourne WHO CC

•  Sheena Sullivan for data analysis of CC samples

•  Other WHO CC’s especially CNIC for zoonotic reports

•  WPRO and WHO HQ Geneva

H7N9 HA phylogenetic analysis 2013-7

0.004

A/shanghai/05/2013

A/Hangzhou/10-1/2014

A/Quzhou/1/2015

A/Guangdong/15SF018/2015

A/Wuxi/4/2013

A/Hubei/34007/2015

A/Hangzhou/118/2014

A/Guangdong/02125/2014 A/Guangdong/0071/2014

A/Hong_Kong/8130773/2015

A/Shenzhen/SP26/2014

A/Fujian/2/2015 A/Fujian/22/2015

A/Suzhou/5/2013

A/Jiangsu/22184/2015

A/Guangdong/60923/2016 A/Hong_Kong/VB16189623/2016

A/Nanjing/1/2013 A/GD-124/2014/H7N9/2014-03-06

A/GD-51/2015/H7N9/2015-01-30

A/Shanghai/PD-02/2014

A/Xinjiang/73030/2014

A/Fujian/27/2015

Influenza_A_Virus_(A/Malaysia/228/2014(H7N9))_segment_4_hemagglutinin_(HA)_gene

A/Zhejiang/14/2014

A/Hangzhou/327/2013

A/Jiangsu/60466/2016

A/Fujian/8/2014

A/Guangzhou/1/2014 A/Anhui/09188/2014

A/Shandong/02/2014

A/Hangzhou/39/2014

A/Fujian/03/2013

A/Shenzhen/SP48/2014

A/Shantou/2011/2015

A/Guangdong/0024/2014 A/GD-33/2014/H7N9/2014-01-12

A/Zhejiang/24/2014

A/Anhui/60926/2016

A/Guizhou/03240/2015

A/ANHUI/1/2013

A/Hong_Kong/734/2014 A/Anhui/02/2013

A/Taiwan/1/2013

A/GD-17/2015/H7N9/2015-01-11 A/GD-1/2015/H7N9/2015-01-03

A/Hangzhou/3/2013

A/Hong_Kong/VB16021618/2016 A/XinjiangBintuan/99118/2014

A/Shanghai/14/2013

A/Guangdong-Guangzhou/XN00429/2014

A/Fujian/8/2015

A/Fujian/54840/2016 A/Shanghai/4664T/2013

A/Hunan/12173/2014

A/Shandong-Taian/01/2015

A/Guangdong/0066/2014

A/Anhui/03/2013

A/GD-103/2014/H7N9/2014-02-10

A/Fujian/6/2015

A/GD-46/2014/H7N9/2014-01-16

A/Quzhou/2/2015 A/Anhui/40094/2015

A/Zhejiang/20/2014

A/Fujian/19/2015

A/Shenzhen/SP116/2014 A/Hong_Kong/214/2017

A/Nanjing/3/2013

A/Anhui/01887/2014

A/Fujian/14/2015

A/Taiwan/3/2013 A/Shantou/2009/2015

A/Fujian/1/2014

A/Hong_Kong/5731/2014

A/GD-80/2015/H7N9/2015-02-10 A/Fujian/1/2016

A/GD-81/2014/H7N9/2014-01-30

A/Jiangsu/1/2013

A/Jiangsu/08/2013

A/Nanjing/7/2013 A/Hunan/08963/2014

A/Anhui/33227/2015

A/Anhui/09186/2014

A/Guangdong/0019/2014 A/Hunan/09191/2014

A/Anhui/33228/2015

A/Changsha/1/2013

A/Huai an/001/2015' A/Zhejiang/7/2015

A/Guangdong/DG-02/2013

A/Guangdong/15SF050/2015

A/Zhejiang/6/2016

A/GD-120/2015/H7N9/2015-03-10 A/GD-120/2014/H7N9/2014-02-19

A/Taiwan/4-CGMH2/2014 A/Shantou/1003/2014

A/Guangdong/02497/2014 A/Zhejiang/3/2015

A/Hunan/02285/2017 A/Fujian/3/2016

A/Fujian/11/2014

A/Guangdong-Guangzhou/XN00175/2014

A/GD-139/2014/H7N9/2014-04-06 A/fujian/16/2014

A/Guangdong/04/2013

A/Hong_Kong/VB17002884/2017 A/Fujian/1/2013

A/Hunan/26937/2014

A/Fujian/16/2015 A/Zhejiang/9/2015

A/Zhejiang/2/2014

A/Nanchang/1/2013

A/Fujian/25/2015

A/Shanghai/Patient4/2013

A/Jiangsu/01/2013

A/Fujian/18/2015

A/Shandong/0068A/2013

A/Zhejiang/07803/2014 A/Jiangsu/09049/2014

A/Taiwan/S02076/2013 A/Fujian/15/2014

A/Jiangsu/09041/2014

A/Beijing/40610/2015 A/Hong_Kong/VB16184091/2016

A/Huai an/002/2015'

A/Zhejiang/8/2014

A/Fujian/20/2015

Year sampled

2013-4 2015 2016 2017