1 Influenza activity in the Southern Hemisphere Ian Barr WHO CC for Reference & Research on Influenza Melbourne The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health and Ageing.

Recap 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 Australian Influenza Surveillance Report

Influenza 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 Australia Pandemic H1N 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 influenza As at Sth Hemisphere 7 Sth American Sth Africa Australia New Zealand

Google flu trends Australia and NZ As at

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Also now Google Dengue Trends As at Brazil Brazilian data Google Dengue trends Currently: Brazil Bolivia Indonesia India Singapore

ILI in Australia ( )

ILI in NZ ( ) Source: ESR: Influenza Weekly Update May 2011

Lab confirmed influenza cases in Australia (NNDSS) November 2010-May 2011 x4 influenza cases of 2010

Flunet data for Southern Hemisphere

Samples types received by Melbourne CC YearOCSVirus Isolates Ratio Isolates:OCS

Influenza viruses received and analysed at WHO CC for influenza – 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

A/California/7/ Vaccine strain A/Brisbane/70/2011-like Main group in 2011 A/Christchurch/16/2010-like Main group in 2010 A/Perth/30/2011-like Regional group in 2011 H1N1pdm HA genes

A/Perth/16/ Vaccine strain A/Perth/10/2010-like Main group in A/Victoria/2008-like Common in 2010 A/Perth/16/2009-like Few viruses in 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/ Oct NewYork/05/10cdc Mar 11S0802 Sep Brisbane/210/10e Singapore/11/11 Jan Perth/501/10e May Brisbane/220/10e NewCaledonia/2/11 Feb Chrischurch/25/10 Aug Victoria/210/09e Jun 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 Singapore/521/10 Apr 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 NewCaledonia/3/11 Feb 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 NewCaledonia/4/11 Feb Darwin/14/11 Feb NewCaledonia/5/11 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/208/10 Victoria/500/11 Jan Townsville/93/10 Dec Victoria/1034/10 Oct Singapore/512/10 Apr Victoria/563/10e Chrischurch/49/10 Sept RhodeIsland/1/10e Jan Cambodia/15/09 Jun Victoria/4/10 May Townsville/106/10 Nov Townsville/48/11 Mar BRISBANE/11/10e May Townsville/104/10 Nov Fiji/38/10 Oct cdc Kenya/1632/10 Apr Perth/673/09 Nov Christchurch/3/11 Feb cdcWyoming/09/10 Dec Townsville/117/10vax Dec Nauru/3/11 Jan Newcastle/4/10 Jun Townsville/92/10vax Dec 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 Townsville/102/10 Nov Victoria/1201/10vax Sep Singapore/617/10 jul Townsville/86/10 Nov Brisbane/252/10 Sept SthAustralia/414/10 Oct Brisbane/100/09 Jul H3 4May11 H3N2 HA genes

B Viruses Virus type B/Brisbane/60/2008-like52387 B/Brisbane/60/2008-like Low Reactor 120 B/Malaysia/2506/2004-like116 B/Malaysia/2506/2004-like Low Reactor 050 B/Florida/4/2006-like13 Low Reactor 614

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