1. Influenza Branch Division of Viral and Rickettsial Diseases National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta, GA 30333 Bethesda, MD February 20, 2003 INFORMATION FOR THE VACCINES AND RELATED BIOLOGICAL PRODUCTS ADVISORY COMMITTEE, CBER, FDA WHO COLLABORATING CENTER FOR SURVEILLANCE, EPIDEMIOLOGY AND CONTROL OF INFLUENZA

3. U.S. SURVEILLANCE

4. WHO/NREVSS Collaborating Laboratories National Summary, 2002-03

5. Percentage of Visits for ILI Reported by Sentinel Providers National Summary, 2002-03

6. Weekly Influenza Activity Estimates Reported by State & Territorial Epidemiologists No Report Sporadic Regional Widespread No Activity Week ending February 8, 2003 - Week 6

7. Pneumonia and Influenza Mortality for 122 U.S. Cities Week Ending 02/08/03 1999 20002001 2002 “Epidemic” Threshold Seasonal Baseline 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10 2003

8. INFLUENZA A(H1) VIRUSES

12. Canada/649/2002* Michigan/2/2003 New York/3/2003 Washington/8/2002 Canada/642/2002(LR) North Carolina/7/2002 Peru/3084/2002 New York/2/2003 Pennsylvania/1/2003 New York/26/2002 Hawaii/10/2002# South Dakota/2/2002 Jilin/5/2002# Florida/7/2002 Peru/3090/2002(LR)* Colombia/3575/2002 Wuhan/6/2002 Neimongol/31/2002# Neimongol/43/2002# Hong Kong/841/2002 Alaska/1/2002 Texas/49/2002 Hubei/18/2002(LR)# Sichuan/656/2002 Mexico/935/2002 Wisconsin/12/2002 Guatemala/48/2002 Texas/52/2002 Guizhou/198/2002 Massachussetts/5/2002* Oklahoma/3/2002 Texas/1/2003 bafb Korea/1136/2002 New Jersey/5/2002 Michigan/1/2003 New York/1/2003 Chile/10751/2002# Chile/8196/2002# Chile/13309/2002# Chile/8829/2002(LR)# nihj Akita/25/2002# Chile/8885/2002(LR)# Alaska/3/2002 Arizona/13/2002 Yamaguchi/12/2002 Georgia/8/2002 Hawaii/15/2001(LR) Russia/2187/2002(LR)# New Caledonia/20/99#* E125bG, K166M D275G E82G V169A W255R A193T, A218T, V178I T96A H1N2 * serology antigen # egg isolate (LR) low reactor to A/New Caledonia/20/99 vaccine strain EVOLUTIONARY RELATIONSHIPS AMONG INFLUENZA A(H1) HA1 GENES

15. Hong Kong/1252/2000 Wuhan/251/2000# Hong Kong/241/2000 Wuhan/292/2000# Russia/11/2001 Shenzhen/201/2000# Hawaii/18/99 Fujian/156/2000# Hawaii/1/2000 Nanchang/8/2000# nimr- Hong Kong/1799/2000 Taiwan/1486/2001 Hubei/288/2001*# Hong Kong/747/2001* Brazil/821/2001* Pusan/124/99 New Caledonia/20/99* # aus -New Caledonia/11/2000 nimr- Ishikawa/42/98 Colorado/2/2001 Hawaii/15/2001* Bangkok/255/2001*# Washington/6/2001 nimr- Asuncion/1041/2000 nimr -Brazil/202/2000 Bangkok/163/2000 California/26/99 Peru/1261/99 Peru/1798/99 nimr -Moscow/17/98 nimr- Hong Kong/4859/98 Beijing/262/95 New York/14/2000 Colorado/1/2001 Chile/5255/2000 Chile/5724/2000 nimr -Oslo/1734/98 Bayern/7/95 Taiwan/1/86 V75I R222Q D344N D386N Vaccine strain *Serology Antigen # Egg isolate 10 nucleotides EVOLUTIONARY RELATIONSHIPS AMONG INFLUENZA A(N1) NA GENES

16. Summary: Influenza A(H1N1 and H1N2) Viruses Since last winter, H1N1 and H1N2 viruses have been reported primarily from the Americas (Canada, Chile and the U.S.). Most (>95%) of recent H1 viruses have HAs that are antigenically and genetically similar to that of the current vaccine strain, A/New Caledonia/20/99 The NAs of current H1N1 viruses are similar antigenically and genetically to the N1 of A/New Caledonia/20/99 The NAs of current H1N2 viruses are similar to to those of currently circulating H3N2 viruses

17. INFLUENZA A(H3N2) VIRUSES

20. Moscow/5/2000 # Panama/2007/99 # ** Fujian/140/2000 # Beijing/144/2001 Hong Kong/1550/2002 # Moscow/10/99 # Sydney/5/97 # R 50 G E 83 K V 202 I W 222 R G 225 D 10 nucleotides NIMR -Madagascar/66213/2002 New York/28/2002 Aus -Victoria/241/2002 Hawaii/4/2002 New York/55/2001 (LR) Utah/6/2002 NIID -Fukuoka/15/2002 Aus -Sydney/23/2002 Hawaii/11/2002 Louisiana/2/2002 New York/21/2002 England/449/2002 North Carolina/8/2002 Chile/6416/2001 # Turkey/1035/2002 NIMR -Dakar/50/2002 ** Brazil/1727/2002 (LR) # Brazil/2458/2002 Connecticut/1/2002 Illinois/1/2002 Texas/4/2002 Aus -Bangkok/109/2002 (LR) # Washington/3/2002 Wisconsin/17/2001 Oklahoma/2/2002 Arizona/1/2002 England/1/2003 NIID -Akita/69/2002 # A 106 V N 144 D A 304 P Aus -Brisbane/5/2002 (LR) # NIID -Hyogo/3/2002 Aus -Perth/200/2002 (LR) # Zhejiang/8/2002 (LR) India/25502/2002 Hubei/61/2002 (LR) Guangzhou/405/2002 Q 156 H L 25 I H 75 Q H 155 T A 131 T Hawaii/13/2002 Aus -Taiwan/8/2002 NIID -Shiga/41/2002 Can -Canada/rv6222/2002 Aus -Singapore/44/2002 (LR) Hong Kong/1554/2002 Hong Kong/1143/2002 (LR) Philippines/160283/2002 (LR) Taiwan/1521/2002 (LR) Guam/228/2002 (LR) NIMR -Switzerland/7494/2002 New Jersey/4/2002 (LR) ** NIMR -Egypt/151/2002 Beijing/178/2002 (LR) Fujian/411/2002 ** Anhui/550/2002 (LR) Beijing/301/2002 (LR) Japan/910/2002 (LR) Alaska/4/2002 California/9/2002 Korea/770/2002 (LR) Hunan/407/2002 Hawaii/19/2002 (LR) Massachusetts/1/2003 (LR) NIID -Toyama/29/2002 PHLS -England/448/2002 (LR) Memphis/4/2003 (LR) Memphis/1/2003 (LR) Washington/3/2003 NIID -Osaka-c/70/2002 NIID -Ishikawa/102/2002 ** Georgia/1/2003 (LR) BAFB -Korea/172/2003 Vaccine Strain Egg-Grown Isolate # Serology Antigen ** Low Reactor (LR) EVOLUTIONARY RELATIONSHIPS AMONG INFLUENZA A(H3) HA1 GENES

22. EVOLUTIONARY RELATIONSHIPS AMONG INFLUENZA A(N2) NA GENES Wuhan/396/2001 Wuhan/388/2001 CNIC/114/2001 Hong Kong/1307/2001 Guangzhou/1191/2001 Singapore/54/2001 Shenzhen/499/2000# Hong Kong/1269/2001 Singapore/41/2001 Nepal/1610/2001 Singapore/15/2001* Thailand/80891/2001 Hawaii/23/2001 Wisconsin/12/2001 nimr-Moscow/10/2001# Hong Kong/762/2001* Hong Kong/648/2001*# Hawaii/21/2001* Philippine/78890/2001* Hawaii/29/2001 Alaska/14/2001* Alaska/8/2001 Chile/6416/2001*# Argentina/302/2001 Argentina/10/2001 Argentina/3758/2001# Argentina/3759/2001*# Massachusetts/2/2001 North Carolina/1/2001 South Australia/102/2001* Florida/6/2001 Panama/2007/99*# Sydney/5/97 A18S, L23F, V307I V30T, C42F G414S S332F, Q432E K172R 10 nucleotides *Serology antigen # Egg isolate Vaccine Strain

23. Summary: Influenza A(H3N2) Viruses H3N2 viruses have caused recent outbreaks in Japan, Korea and China An increasing proportion of recent H3N2 isolates are not well inhibited by post-infecton and post- immunization antiserum H3N2 viruses with aa changes at 155 and 156 (Site B) tend to be poorly inhibited by antibodies to the vaccine virus Low reacting viruses with aa changes at 155 and 156 have been detected in Asia, Europe and the Americas

24. INFLUENZA B VIRUSES

27. Currently Circulating Type B HA Lineages Hong Kong/330/2001 25 nucleotides Victoria Lineage Yamagata Lineage

28. EVOLUTIONARY RELATIONSHIPS AMONG INFLUENZA B HA1 GENES (YAMAGATA LINEAGE) Egg-Grown Isolate # Serology Antigen ** Low Reactor (LR) NIID -Fukushima/24/2002 Harbin/7/94 # Taiwan/143999/2002 (LR) NIMR -Madagascar/65186/2002 Moscow/16/2002 # NIID -Astrakhan/10/2002 # California/2/2002 NIID -Ulan Ude/4/2002 # Russia/4/2002 (LR) # NIID -Yunnan/406/2001 # Colorado/3/2002 (LR) Fujian/407/2001 # NIMR -St. Petersburg/1/2002 NIMR -Finland/141/2002 Nevada/1/2002 NIMR -Hong Kong/293/2002 NIID -Yunnan/8/2002 # Yunnan/9/2002 (LR) # Yunnan/163/2002 # Aus -Bangkok/60/2002 Ohio/2/2002 Brazil/2459/2002 (LR) Gaughwa/19/2002 (LR) Aus -Sydney/200/2002 Aus -Sydney/3/2002 NIID -Sendai/h1754/2001 (LR) #** NIPH -Oslo/668/2002 NIID -Akita/2/2002 # NIID -Sapporo/7/2002 (LR) Hong Kong/1470/2002 (LR) # NIPH -Oslo/1870/2002 Tennessee/4/2002 (LR) Arizona/4/2002 (LR) Chile/3162/2002 (LR) # New York/44/2002 NIID -Shizuoka/15/2001 #** NIMR -Lazio/1/2002 NIMR -Lyon/125/2002 Peru/3132/2002 (LR) NIMR - Barcelona/460/2002 Colombia/3438/2002 Mexico/418/2001 (LR) Fujian/141/2001 # Aus-Victoria/504/2000 # NIID-Shizuoka/480/2000 # NIMR -Perm/3/2002 Sichuan/379/99 #** Yamanashi/166/98 # Beijing/184/93 # R 69 G T 121 A R 136 K N 165 D T 182 A K 183 N L 58 F N 126 D H 40 Y K 48 R T 168 N N 126 D Shanghai/361/2002 # 10 nucleotides

29. Thailand/163343/2002 (LR) Aus -Brisbane/17/2002 # Iowa/3/2002 (LR) # Idaho/4/2002 (LR) Aus -Auckland/14/2002 Aus -Brisbane/32/2002 (LR) #** Aus -Brisbane/28/2002 # Aus -Perth/82/2002 NIMR -Lisbon/190/2002 Louisiana/1/2002 (LR) NIMR -Madagascar/67860/2002 #** Tianjin/130/2002 Oman/16291/2001 (LR) California/5/2002 Taiwan/1519/2002 (LR) Brazil/1730/2002 # Nevada/5/2002 New York/43/2002 Texas/57/2002 (LR) ** Wisconsin/1/2003 Missouri/12/2002 NIMR -Hong Kong/302/2002 Hawaii/5/2002 (LR) Hong Kong/1351/2002 # Panama/486105/2002 Chile/13677/2002 # Mexico/963/2002 (LR) Argentina/mc16/2002 (LR) Brazil/1733/2002 (LR) # Guatemala/20/2002 (LR) New Hampshire/1/2002 Beijing/243/97 # Shandong/7/97 #** Guam/345/2002 NIID -Saitama/22/2002 # NIID -Sendai/h1023/2002 # NIID -Tokyo/127/2002 # NIID -Shiga/20/2002 # Hong Kong/1115/2002 (LR) # Hong Kong/167/2002 # Hong Kong/1345/2002 # Hong Kong/1434/2002 #** Wisconsin/7/2002 Guangzhou/332/2002 (LR) # Taiwan/1507/2002 (LR) Hong Kong/330/2001 #** Hong Kong/335/2001 # NIID -Akita/27/2001 # Taiwan/217/97 South Carolina/8/2002 (LR) I 121 T H 116 R E 121 N D 164 E 5 nucleotides Vaccine Strain Egg-Grown Isolate # Serology Antigen ** Low Reactor (LR) EVOLUTIONARY RELATIONSHIPS AMONG INFLUENZA B HA1 GENES (VICTORIA LINEAGE)

32. Victoria/504/2000* Shizuoka/480/2000 Alaska/16/2000 Shenzhen/804/2001# Brazil/956/2001*# Hong Kong/692/2001* nimr -Yamanashi/166/98 Brazil/952/2001# P42S, R69E Niid- Shizuoka/15/2001*# E148G Texas/22/20001* Argentina/132/2001 Argentina/69/2001 Wuhan/2/2001# Johannesburg/69/2001*# Fujian/407/2001 Wuhan/356/2001# Sichuan/317/2001*# Sichuan/776/2001# Osaka/18/2001 Shenzhen/306/2001# Harbin/7/94 D329N P42Q, N219K, D392E Hawaii/36/2001 Hawaii/10/2001# Hong Kong/28/2001 Hong Kong/6/2001 Hong Kong/330/2001* Canada/464/2001 Hong Kong/22/2001 Bangkok/34/99 Bangkok/54/99 Shandong/7/97 Yamagata/16/88 M50T, C54S, V60F, R436K *Serology Antigen # Egg isolate 10 nucleotides Vaccine Strain Sichuan/379/99*# Johannesburg/5/99 EVOLUTIONARY RELATIONSHIPS AMONG INFLUENZA B NA GENES

33. Summary: Influenza B Viruses Influenza B viruses are predominating in the U.S. and much of Europe during the current season Influenza B viruses on the “Victoria lineage have predominated worldwide; B viruses on the Sichuan lineage were isolated infrequently Most recent influenza B viruses have NAs most closely related antigenically and genetically to that of the B/Sichuan ref. Virus The influenza B viruses have remained stable genetically and antigenically since last September