During week 6 2009 (February 2nd to 8th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland decreased to 15.9 per 100,000 population. This rate is below the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland). The use of antivirals drugs for the prevention or treatment of influenza in at-risk groups is no longer recommended as per the National Institute of Clinical Excellence (NICE) guidelines, UK Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 6 is available here.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
During week 5 2009 (January 26th to February 1st), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland decreased to 34.6 per 100,000 population from a rate of 42.9 per 100,000 during week 4. These rates remain higher than the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The ILI rate decreased in all age groups except in those aged 5 to 14 years where the rate remained stable. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 5 is available here.
Due to the current level of influenza activity seen in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
During week 4 2009 (January 19th to 25th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland decreased to 43.4 per 100,000 population from a rate of 100.6 per 100,000 during week 3. These rates remain higher than the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The ILI rate decreased in all age groups. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 4 is available here.
Due to the current level of influenza activity seen in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
During week 3 2009 (January 12th to 18th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland decreased to 103.1 per 100,000 population from a rate of 120.5 per 100,000 during week 2. These rates are significantly higher than the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The ILI rate decreased in all age groups except for the 5 to 14 year age group where a slight increase was noted. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 3 is available here
Due to the current level of influenza activity seen in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community. http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine As influenza-like illness rates are increasing and influenza A is circulating, it is also important that persons in at-risk groups for influenza are vaccinated as these groups are at higher risk of developing complications from influenza.
Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
During week 2 2009 (January 5th to 11th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland increased to 120.5 per 100,000 population from a rate of 100.2 per 100,000 during week 1. Both rates are significantly higher than the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The rate of increase was most pronounced in the 15-64 year age group with increases also noted in those aged 65 years and over. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 2 is available here
Due to the current level of influenza activity seen in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community. http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine As influenza-like illness rates are increasing and influenza A is circulating, it is also important that persons in at-risk groups for influenza are vaccinated as these groups are at higher risk of developing complications from influenza.
Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
The Health Protection Surveillance Centre urges people in high-risk categories to get vaccinated against influenza, as the number of reported cases of influenza-like illness (ILI) in Ireland continues to rise.
ILI rates have risen from 72.8 per 100,000 in the last week of December 2008 to 100.6 per 100,000 in the first week of January 2009. This is the highest rate seen since the 2000/2001 influenza season.
"As influenza continues to circulate in the community, it is important that people in high-risk categories get vaccinated against influenza," says HPSC specialist in public health medicine, Dr Derval Igoe.
“High-risk groups are:
The over 65s
People including children with chronic illness requiring regular medical follow-up such as chronic lung disease, chronic heart disease, and diabetes
Those with lower immunity due to disease or treatment, including those who have had their spleens removed
Children or teenagers on long-term aspirin therapy
Residents of nursing homes, old people's homes and other long stay facilities
Health care workers and carers of those in risk groups.
“Health Professionals should use antiviral drugs for the treatment or prevention of influenza in high-risk groups.
“The symptoms of influenza usually develop over a matter of a few hours and include a high temperature, sore muscles, dry cough, headache and sore throat. This is different from the common cold, which tends to come on more gradually and usually includes a runny nose and a normal temperature.
“Anyone who gets flu should stay at home, rest, drink plenty of fluids and use over-the-counter remedies like paracetamol to ease symptoms. People in high-risk categories should contact their GP if they develop influenza symptoms.
“Covering your nose and mouth with a tissue when you cough and sneeze, disposing of the tissue as soon as possible and washing your hands with soap and water as soon as you can are important measures in helping prevent the spread of flu,†added Dr Igoe.
ILI rates give an indication of the overall level of influenza activity in Ireland and are reported by selected GPs as part of a surveillance system jointly run by the Irish College of General Practitioners, the National Virus Reference Laboratory and the Health Protection Surveillance Centre.
Increase in Influenza-like illness
During week 51 2008 (week ending December 21st), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland increased to 61.6 per 100,000 population from a rate of 38.1 per 100,000 during week 50 (week ending December 14th). This rate continues to exceed the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The rate of increase was most pronounced in the 0-4 years and the 5-14 years age categories. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007 which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 51 is available here.
Due to the levels of influenza activity seen last week in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
In line with the National Institute of Clinical Excellence (NICE) UK guidelines, the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is now recommended.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance are outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community. http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine As influenza-like illness rates are increasing and influenza A is circulating, it is also important that persons in at-risk groups for influenza are vaccinated as these groups are at higher risk of developing complications from influenza.
Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenzas season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
The National Virus Reference Laboratory (NVRL) has identified the first case of influenza A virus this winter. The case was detected by a network of 54 sentinel general practices who report weekly on the number of patients with influenza-like illness.
The network was established by the Health Protection Surveillance Centre, in partnership with the Irish College of General Practitioners and the NVRL in 2000.
Commenting on the cases, HPSC Specialist in Public Health Medicine, Dr Joan O Donnell said that the first two confirmed cases of influenza this season have been detected even though overall influenza activity is low. In total, 150 laboratory confirmed cases of influenza were detected through the sentinel network during the 2007/2008 season, peaking in January 2008.
“As we enter the influenza season it is recommended that people in high-risk groups get vaccinated against influenza. These include:
The over 65s
People including children with severe illness such as chronic heart disease, chronic lung disease and diabetes
Those with lower immunity due to disease or treatment including those who have had their spleens removed
Children or teenagers on long-term aspirin therapy
Residents of nursing homes, old people’s homes and other long stay facilities
Health care workers
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as influenza puts them at risk of co-infection with avian influenza)
“The symptoms of influenza infection usually develop over a matter of a few hours and include a high temperature, sore muscles, dry cough, headache and sore throat. This is different from the common cold, which tends to come on more gradually and usually includes a runny nose and a normal temperature. Anyone in the high risk categories who develops influenza symptoms should contact their GP.â€
The weekly influenza surveillance reports are available to view here.
2008/2009 Influenza Season - FAQs from ECDC
Frequently asked questions from ECDC on the start of the Influenza Immunisation and Surveillance Season Week 40 (October) 2008 are available here.
The Influenza Season 2008/2009 commenced last week (Week 40 29/9/08). The first Influenza Surveillance Report of the season will be published by HPSC on Thursday 9th October 2008 and available to view here.
For more information from HPSC on seasonal influenza click here.
Resistance to oseltamivir (Tamiflu) found in some European influenza virus samples
Preliminary results from the National Virus Reference Laboratory (NVRL) on antiviral drug susceptibility among seasonal influenza viruses circulating in Ireland has revealed that some of the A (H1N1) viruses in circulation this winter are resistant to the antiviral drug, oseltamivir (also know by the brand name Tamiflu). The NVRL conducted nucleotide sequencing on specimens taken by sentinel GPs between December 2007 and January 2008. As of February 20th 2008, three of 29 specimens (10.3%) tested by the NVRL have shown resistance to oseltamivir. The NVRL is currently arranging for further Irish samples to be tested. To date, oseltamivir resistant viruses have been detected in 15 European countries (including Ireland), the USA, Canada, Australia and Hong Kong. In Europe, the highest proportion of resistant viruses to date has been in Norway where 63 (66%) of the 95 samples tested positive for resistance to oseltamivir. The second highest proportion was noted in France with 80 (39%) of 207 specimens showing oseltamivir resistance. The latest European data is available from the European Centre for Disease Prevention and Control (ECDC).
Experts from ECDC, the European Commission, the European Influenza Surveillance Scheme (EISS) and the World Health Organization (WHO) are currently assessing the significance of this information. An interim risk assessment has been published by ECDC.
The current influenza vaccine provides good protection against A/H1N1 viruses. Current national guidance on use of antivirals for treatment and prophylaxis of influenza remain in place though they are being kept under review. For information on seasonal influenza and how to protect yourself against it click here.
Resistance to oseltamivir (Tamiflu) found in some European influenza virus samples
Preliminary results from a survey of antiviral drug susceptibility among seasonal influenza viruses circulating in Europe has revealed that some of the A(H1N1) viruses in circulation this winter are resistant to the antiviral drug, oseltamivir (also known by the brand name Tamiflu). So far, 437 influenza A(H1N1) viruses isolated during November 2007 to January 2008 from eighteen European countries have been tested. Of these 59 (13.5%) have shown evidence of resistance to oseltamivir. The highest level of resistance has been seen in Norway, where 26 of 37 samples (70%) have been resistant. In the UK, 8 of 162 samples (4.9%) have been resistant. The National Virus Reference Laboratory is currently arranging for Irish samples to be tested. This information is published in Eurosurveillance.
Experts from the European Centre for Disease Prevention and Control (ECDC), the European Commission, and WHO are currently assessing the significance of this information. An interim risk assessment, prepared by ECDC, and based on the limited data currently available, is available here. Frequently Asked Questions, prepared by WHO/ECDC are available here.
The current influenza vaccine provides good protection against A/H1N1 viruses. Current national guidance on use of antivirals for treatment and prophylaxis of influenza remain in place though they are being kept under review. For information on seasonal influenza and how to protect yourself against it click here.
Increase in Influenza-like illness
Influenza Season 2007/2008 During week 1 2008 (week ending January 6th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland increased to 52.4 per 100,000 population from a rate of 16.3 per 100,000 for week 52, 2007. This rate exceeds the threshold at which the UK National Institute of Clinical Excellence (NICE) guidelines (2003) for the use of antiviral drugs is triggered. ILI rates increased in all age groups and are highest in the 15 to 64 year age group. Much of the increase is from cases of influenza A in the 15 to 64 year age group. A small number of influenza B cases have also been reported.
In line with the NICE guidelines, the use of antiviral drugs for the prevention or treatment of influenza in at-risk groups is now recommended.
A summary of the NICE guidance is given below for ease of reference:
Antivirals
Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community
Algorithm for the use of antiviral drugs for the prevention (prophylaxis) of influenza
Note: The NICE algorithm on prescribing oseltamivir (Tamiflu) for prophylaxis refers to using oseltamivir (Tamiflu) in persons aged 13 years and older. In January 2006, oseltamivir was licensed for prophylactic use in children aged one year and over. NICE are reviewing their current guidelines at present. In the meantime until NICE completes its review, it would be appropriate to use oseltamivir (Tamiflu) for prophylaxis in persons aged 1 year and over according to the other conditions laid out in the above NICE algorithm for prophylaxis of influenza. Prescribers should also note a concomitant change to the licensed duration of post-exposure prophylaxis in children and adults which is now ten (10) days (as opposed to the previous seven (7) days).
Influenza Vaccine As influenza-like illness rates are increasing and influenza A and B are circulating, it is also important that persons in at-risk groups for influenza are vaccinated as these groups are at higher risk of developing complications from influenza.
Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2002 (Chapter 7)
All persons aged 65 years or older
Persons with chronic illness requiring regular medical follow-up such as chronic heart disease, chronic lung disease, chronic renal disease, diabetes mellitus etc.
Persons who are immunosuppressed due to disease or treatment, including asplenia or splenic dysfunction
Children and teenagers on long-term aspirin therapy
Residents of nursing homes, old people's homes and other long stay facilities where rapid spread is likely to follow introduction of infection
Health care workers and carers of those in at risk groups.
The National Virus Reference Laboratory (NVRL) has identified the first case of influenza A virus this winter. The case was detected by a network of 49 sentinel general practices who report weekly on the number of patients with influenza-like illness.
The network was established by the Health Protection Surveillance Centre, in partnership with the Irish College of General Practitioners and the NVRL in 2000.
Commenting on the case, HPSC Specialist in Public Health Medicine, Dr Derval Igoe said that the first confirmed case of influenza in Ireland this season is a reminder to all people in high-risk groups get vaccinated against influenza now.
"These include:
The over 65s
People with severe illness such as chronic heart disease, chronic lung disease and diabetes
Those with lower immunity due to disease or treatment including those who have had their spleens removed
Children or teenagers on long-term aspirin therapy
Residents of nursing homes, old people's homes and other long stay facilities
Health care workers and carers of those in risk groups.
"The symptoms of influenza infection usually develop over a matter of a few hours and include a high temperature, sore muscles, dry cough, headache and sore throat. This is different from the common cold, which tends to come on more gradually and usually includes a runny nose and a normal temperature. Anyone in the high risk categories who develops influenza symptoms should contact their GP."
Influenza has been detected slightly earlier this year than last year's influenza season, when the first case was reported in November 2006. Overall a total of 126 laboratory confirmed cases of influenza were detected through the sentinel network during the 2006/2007 season, peaking in February 2007.
The weekly influenza surveillance reports along with further information on influenza and flu vaccine are available at www.hpsc.ie and www.immunisation.ie.
Addendum to Mortality Data reported in 'Summary Report of Influenza Season 2005/2006'
The HPSC ‘Summary Report of Influenza Season 2005/2006’ stated that “3,567 pneumonia and influenza deaths (20.0% of all deaths) were registered with the General Register Office (GRO) during the 2005/2006 season’. These “pneumonia and influenza” deaths included all deaths where either influenza or pneumonia was listed as the disease or condition leading to death, or the antecedent cause(s) or other significant conditions. (Aspiration pneumonia, pneumonitis and pneumococcal meningitis were excluded).
International studies have shown that influenza causes significant morbidity and mortality every year. This mortality occurs mainly in the elderly. However, excess deaths (deaths over and above the expected number of deaths for the particular season, place and time) are often not registered specifically as influenza deaths. Only a small number of deaths are registered each year as being due to influenza. It has been shown that the increase in respiratory deaths correlate closely with the increase in deaths due to influenza. Therefore monitoring trends in pneumonia and influenza deaths can be used as a proxy for monitoring trends in influenza-non-attributed deaths. HPSC currently monitors all cause mortality, and mortality due to pneumonia and influenza on a weekly basis using national non-coded death registration data from the GRO.
The current best Irish national estimate of the number of deaths annually from influenza and its complications is 300-400 deaths per year and is based on extrapolation of studies done in the UK and the US.
Further information on influenza is available on the HPSC website www.hpsc.ie
References available on request
Increase in Influenza-like illness
During week 5 2007 (week ending February 4th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland increased to 44.5 per 100,000 population from a rate of 22.5 per 100,000 for week 4. This rate exceeds the threshold at which the UK National Institute of Clinical Excellence (NICE) guidelines (2003) for the use of antiviral drugs is triggered. Much of the increase is from cases of influenza A (H3, H1 and unsubtyped) in the 15 to 64 year age group and in 0 to 4 year olds.
In line with the NICE guidelines, the use of antiviral drugs for the prevention or treatment of influenza is now recommended. A summary of the NICE guidance is given below:
Antivirals
Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community may be found here
Algorithm for the use of antiviral drugs for the prevention (prophylaxis) of influenza may be found here
Note: The NICE algorithm on prescribing oseltamivir (Tamiflu) for prophylaxis refers to using oseltamivir (Tamiflu) in persons aged 13 years and older. In January 2006, oseltamivir was licensed for prophylactic use in children aged one year and over. In the meantime until NICE completes its review, it would be appropriate to use oseltamivir (Tamiflu) for prophylaxis in persons aged 1 year and over according to the other conditions laid out in the NICE algorithm for prophylaxis of influenza. Prescribers should also note a concomitant change to the licensed duration of post-exposure prophylaxis in children and adults which is now ten (10) days (as opposed to the previous seven (7) days).
Influenza Vaccine As influenza like illness rates are increasing and influenza A is circulating, it is also important that persons in at-risk groups for influenza are vaccinated as these groups are at higher risk of developing complications from influenza.
Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2002 (Chapter 7) :
• All persons aged 65 years or older • Persons with chronic illness requiring regular medical follow-up such as chronic heart disease, chronic lung disease, chronic renal disease, diabetes mellitus etc. • Persons who are immunosuppressed due to disease or treatment, including asplenia or splenic dysfunction • Children and teenagers on long-term aspirin therapy • Residents of nursing homes, old people's homes and other long stay facilities where rapid spread is likely to follow introduction of infection • In addition to these groups, vaccination should also be considered for health care workers both for their own protection, as these are a group likely to come into contact with influenza during outbreaks, and for the protection of their patients.
