Ian Barr WHO Collaborating Centre for Reference & Research on Influenza, Melbourne (Now finally re-located at VIDRL) Influenza surveillance in Australia,

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Presentation transcript:

Ian Barr WHO Collaborating Centre for Reference & Research on Influenza, Melbourne (Now finally re-located at VIDRL) Influenza surveillance in Australia, NZ & other Southern Hemisphere countries The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health and Ageing.

Useful publications on influenza Australian Influenza report NZ Influenza update

Influenza like illness in 2009 in Australia Source: ASPREN Source: VIDRL Victoria Australia 2009

Laboratory confirmed influenza in Australia (NNDSS figures) 2009 cases by state Australian cases

Pandemic H1N1 is the dominant strain circulating – Sentinel surveillance in Victoria Data source VIDRL Sentinel median age 21y vs all Aus. 16y

Australian NNDSS lab confirmed influenza by age group; 2009 vs

Australian data on Pandemic (HN1) 2009 as at 15 August ,833 Confirmed cases 29,833 Confirmed cases 3562 people hospitalized 3562 people hospitalized 451 people currently in ICU 451 people currently in ICU Total 108 deaths Total 108 deaths Hospitalised Pregnancy 3% of hospitalised 8/47 to ICU (17%)

Time in hospital with H1N1pdm (Queensland by age; up to )

Age of Australian fatal cases with Pandemic H1N infections Most deaths have had underlying medical conditions; cancer, diabetes, morbid obesity

Australian seasonal deaths due to influenza & pneumonia appear to be normal (to July 09)

How are alternative influenza monitoring systems performing in the pandemic? Google Flu Trends (as at )

And in NZ….. ILI 3051 Confirmed cases H1N1pdm 3051 Confirmed cases H1N1pdm 914 people hospitalized 914 people hospitalized 225 cases pneumonic, 35 ARDS 225 cases pneumonic, 35 ARDS Total 10 deaths Total 10 deaths Data: ESR, up to 9 August

Pandemic H1N is the predominant strain in NZ this year Data: ESR, up to 9 August Sentinel surveillance

Samples received from the region & tested at the WHO CC Melbourne in 2009

CDC (USA) analysis of SH H1N1 activity

Summary of virus analysis from samples received and tested at Melb. CC Pandemic H1N – All very similar to the A/California/7/2009 reference strain Pandemic H1N – All very similar to the A/California/7/2009 reference strain Seasonal H1N1 – All very similar to current vaccine strain A/Brisbane/59/2009 Seasonal H1N1 – All very similar to current vaccine strain A/Brisbane/59/2009 H3N2 viruses – Most recent viruses from Australia, Singapore, Philippines are low reactors to A/Brisbane/10/2009 & more A/Perth/16/2009-like H3N2 viruses – Most recent viruses from Australia, Singapore, Philippines are low reactors to A/Brisbane/10/2009 & more A/Perth/16/2009-like B viruses have been very few, mostly B Victoria-like B viruses have been very few, mostly B Victoria-like 2009 vaccine strains 2009 vaccine strains –H1 – A/Brisbane/59/2007-like –H3 – A/Brisbane/10/2007-like (A/Uruguay/716/2007) –B – B/Florida/4/2006-like (B/Yamagata lineage–also B/Brisbane/3/2007)

Phylogenetic analysis of H1N viruses Common swine ancestor Common swine ancestor Homogeneous so far, few differences (nt or aa) in H1N viruses Homogeneous so far, few differences (nt or aa) in H1N viruses Distinct from previous swine & human swine viruses Distinct from previous swine & human swine viruses Distinct from seasonal H1N1 viruses Distinct from seasonal H1N1 viruses Reference and vaccine virus is A/California/7/2009 Reference and vaccine virus is A/California/7/2009 Victoria/2025/09 PortMoresby/2001/09 Darwin/2001/09 Victoria/2001/09 Darwin/2004/09 Darwin/2001/09 StAustralia/2001/09 Darwin/2008/09 Brisbane/17/09 Victoria/2029/09 Brisbane/2011/09 Victoria/2024/09 SthAustralia/2002/09dec Canberra/2006/09 Brisbane/2008/09 Shanghai/1/09 Ohio/7/09 NewYork/18/09e Canada-AB/RV1532/09 Victoria/2004/09 Philippines/2003/09 Philippines/2009/09 Victoria/2004/09c Auckland/1/09 Mexico/4482/09e Auckland/4/09 Auckland/3/09 Auckland/2/09 Perth/29/09c Korea/01/09 Philippines/2001/09c England/195/09 Palau/1/09 Mexixo/4176/09 Osaka/1/09 Texas/05/09 NewJersey/02/09 Christchurch/2/09 Philippines/2006/09 California/07/09 California/04/09 Wisconsin/10/98 sw/Ohio/891/01 H1N2 sw/Indiana/9K035/99 H1N2 Philippines/344/04 H1N2 sw/Iowa/31483/88 NewJersey/8/76 Thailand/271/05 Brisbane/1/09 Townsville/1/09 Brisbane/13/09 Brisbane/59/07 Perth/1/09 Darwin/8/08 Brisbane/12/09 Sydney/601/09 SthAustralia/28/08 Guam/1/07 Malaysia/213/08 SolomonIslands/3/06 NewCaledonia/20/ Swine H1N Swine H1N1/H1N Seasonal H1N Vaccine H1 Haemagglutinin gene

Few antigenic differences in H1N (by HI or virus neutralization assays) All H1N viruses similar to the vaccine strain A/California/7/2009 Virus Ferret sera Brisb Cal 7 Auck A/Brisb/59/2007 H1 seasonal 640<80<20 A/Cal/7/2009 H1N1 pandemic < A/Auck/1/2009 H1N1 pandemic < A/Perth/36/2009< A/Brisbane/51/2009< A/Canberra/2023/2009< A/Darwin/2003/2009< A/Tasmania/2002/2009< A/Victoria/2022/2009<

February 2009 March 2009 April 2009 May 2009 June 2009 vaccine strain e: egg isolate HI reference antigen Victoria/505/09 5/09 Sydney/31/08 6/09 Sydney/25/09 6/09 Sydney/45/09 6/09 Guam/2/09 5/09 Guam/1/09 5/09 Chuuk/3/09 6/09 Johannesburg/883/09 6/09 CapeTown/783/09 5/09 Perth/26/09 5/09 PortMoresby/9/09 6/09 PtMoresby/2/09 6/09 Malaysia/542/09 3/09 Philippines/40/09 4/09 Malaysia/788/09 5/09 PHILIPPINES/16/09 3/09 Philippines/5/09 3/09 Malaysia/614/09 4/09 Perth/15/09 4/09 PERTH/16/09e 4/09 Perth/14/09 4/09 Brisbane/52/09 5/09 Singapore/34/09 6/09 Singapore/39/09 3/09 Victoria/209/09e 6/09 Darwin/7/09 6/09 Singapore/22/09 3/09 Johannesburg/1006/09 6/09 WesternSepik/109/09 6/09 Victoria/206/09 6/09 Malaysia/720/09 5/09 Brisbane/14/09 2/09 Victoria/231/08 10/08 SthAustralia/59/08 10/08 Victoria/542/08 12/08 Singapore/619/08 11/08 Sydney/301/09 2/09 Philippines/3688/08 11/08 Taiwan/724/09 4/09 Perth/13/09 Singapore/32/09 3/09 Durban/863/09 6/09 Johannesburg/753/09 6/09 Perth/109/08res 9/08 Sydney/29/08 8/08 Singapore/631/08 12/08 SriLanka/21/08 5/08 Darwin/1/08res 8/08 Auckland/121/08 8/08 Sydney/31/08 7/08 Waikato/6/08 5/08res Tasmania/4/08res 6/08 Victoria/530/08 10/08 NewYork/09/08cdc 4/08 Philippines/3803/08 11/08 Victoria/500/08 Sydney/602/09 Sydney/603/09 2/09 Montana/02/08cdc 12/08 Townsville/2/09 2/09 Darwin/7/08 10/08 Victoria/502/09res 1/09 SURATTHANI/72/09 2/09 Macau/1343/08 7/04 Tasmania/201/08 9/08 Virginia/4/07e 1/08 BRISBANE/24/08e 6/08 Thailand/519/08 5/08 Perth/201/08e 7/08 Thailand/508/08 5/08 Cambodia/3/08res Thailand/561/08 6/08 Singapore/215/08 Singapore/21/08 Philippines/1713/08 4/08 Taiwan/471/08niid 4/08 Victoria/500/09 1/09 Wisconsin/3/07e cdc 1/07 URUGUAY/716/07e cdc Malaysia/0032/0res9 1/09 Thailand/563/08res 6/08 Singapore/241/08 6/08 Malaysia/306/08 BRISBANE/10/07e 2/07 PERTH/27/07 7/07 BRISBANE/9/06e 6/06sen Nepal/921/06e 7/06 sen Thailand/31/07 1/07 sen Brisbane/4/07e 1/07res WISCONSIN/67/05e res California/7/04 9/04 sen NEWYORK/55/04 11/ S193F D225N G50E K140I K173Q N144K T212A I260M R261Q E62K K158N N189K I214S V213A A/Brisbane/10/2007 A/Uruguay/617/2007 A/Perth/16/2009-like H3 HA genes

Summary Australia, NZ and other Sth Hemisphere countries dominated by Pandemic H1N1 Australia, NZ and other Sth Hemisphere countries dominated by Pandemic H1N1 Outbreaks have been short/sharp but cases still persist in most countries Outbreaks have been short/sharp but cases still persist in most countries Children & young adults most infected Children & young adults most infected Disease has been relatively mild but has affected some groups disproportionally eg. Pregnant women, aboriginals, obese patients Disease has been relatively mild but has affected some groups disproportionally eg. Pregnant women, aboriginals, obese patients Pandemic H1N1 viruses very similar to A/California/7/2009 reference/vaccine virus Pandemic H1N1 viruses very similar to A/California/7/2009 reference/vaccine virus Emergence of a H3N2 variant – A/Perth/16/2009-like Emergence of a H3N2 variant – A/Perth/16/2009-like WHO Sth Hem. Formulation meeting in Melbourne Sept. 2009, followed by 5 th AIS Sept. WHO Sth Hem. Formulation meeting in Melbourne Sept. 2009, followed by 5 th AIS Sept.

Melbourne WHO Influenza Centre Staff and collaborators Other collaborators Heath Kelly Paul Selleck Deb Middleton Sue Lowther Lori Brown Steve Rockman Peter Schoofs Phil Franchina Malik Peiris Wilina Lim Other CC’s Other Labs WPROVIDRLAAHLAAHLAAHLUMCSLCSLCSLHKU HK PKL NIC’sNHMRCDoHA