HPA: Flu Activity In The UK

 

 

# 6820

 

While the United States and Canada have reported an early start to the flu season this year, influenza has yet to take off in Hong Kong (see latest Flu Express (Week 52, 2012), and in the UK and parts of Europe the flu season is just now starting to pick up. 

 

 

The RED LINE indicates this year’s activity, compared to previous years.  The Blue Line indicates the unusually severe 1999-2000 flu season.

 

 

This latest flu updates from the HPA.

 

HPA National Influenza Report

Report published 3 January 2013

Figures (including all those found in this report) displaying data from these schemes are available to download as a pdf file:

HPA Weekly National Influenza Graphs (PDF, 713 KB)

PDF versions of previous reports are available on the archive page.

This week's report is available as a pdf:

HPA National Influenza Report - week 1 (2013) (PDF, 665 KB)

A summary report will be published weekly. For further information on the surveillance schemes mentioned in this report, please see the Sources of UK Flu Data page.

Increases continue to be seen for several indicators of influenza activity. A letter has been issued to the NHS that GPs may now prescribe antiviral medicines for the prophylaxis and treatment of influenza in accordance with NICE guidance.

 

Flu activity update: 3 January 2013

3 January 2013

Latest figures from the Health Protection Agency (HPA) up to 30 December 2012 show that flu activity continues to increase based on a number of indicators, including GP consultation rates in England and the proportion of calls to NHS Direct.

 

The latest figures show that GP consultation rates have increased slightly from 27.4 per 100,000 in week 51 to 32.7 per 100,000 in week 52 ending on 30 December. Meanwhile, 2.1% of the calls received by NHS Direct concerned influenza compared to 1.6% in week 51.

 

Professor John Watson, head of the respiratory disease department at the HPA said:

 

“Over the Christmas period we have seen a slight rise in flu activity across several of our indicators in line with the trend we expect to see at this time of year.

 

“However, the latest data should be interpreted with caution due to GP practices being closed on the bank holidays which may have impacted on GP consultation rates.

(Continue . . . )

 

 

Elsewhere in Europe, the most recent EuroFlu report states:

 

Influenza activity is increasing slowly in the WHO European Region

Summary, week 51/2012

Influenza activity is slowly increasing with more countries in different parts of the Region reporting sporadic co-circulation of influenza A(H1N1)pdm09, A(H3N2) and type B viruses. This week the reporting of influenza surveillance data is incomplete due to the Christmas holidays. This is reflected in the lower number of testing performed. However the percentage of influenza-positive samples from both sentinel and non-sentinel sources are similar to last week. The number of reported hospitalizations due to severe acute respiratory infection (SARI) remains similar to that seen in the previous several weeks: 1 influenza detection was reported (influenza B).

»» Read More

WHO Europe: Revising Pandemic Preparedness Plans

 

The current WHO phase of pandemic alert for avian influenza H5N1 is 3.

 

# 6725

 

 

While not the damp squib that many pundits have mistakenly called it (see Lancet: Estimating Global 2009 Pandemic Mortality), the 2009 H1N1 influenza pandemic could have been worse.

 

A lot worse.

 

As it was, the Lancet study mentioned above found:

 

We estimate that globally there were 201 200 respiratory deaths (range 105 700—395 600) with an additional 83 300 cardiovascular deaths (46 000—179 900) associated with 2009 pandemic influenza A H1N1. 80% of the respiratory and cardiovascular deaths were in people younger than 65 years and 59% occurred in southeast Asia and Africa.

 

As we’ve seen with some previous pandemics, the greatest burden of illness and death was shifted to those under 65, a reversal of what we normally see with seasonal influenza. 

 

Still, when compared to 1918 – where between 50 and 100 million people died – the pandemic of 2009 was relatively mild.

We may not be nearly so lucky the next time around.

 

Preparations for an H5N1 pandemic – which began in earnest in 2005 – undoubtedly helped the world respond in 2009, but it is quite clear the world remains poorly equipped to deal with a major global health crisis.

 

Earlier this year the World Health Organization  published a 16-page document that looked at the lessons learned from the 2009 pandemic, called:

 

 

While the document goes into considerable detail, the following excerpt lists key areas where changes are recommended.

 

Key changes to national pandemic preparedness plans

 
The changes being made to pandemic plans follow to a large extent the findings from some evaluations performed by countries, as well as the two EU-wide assessments (TOR1 and TOR2) (7), the WHO/Europe evaluation of pandemic preparedness (8), the external review of the IHR (1) and of ECDC’s response to the pandemic (9). The changes address primarily the following areas:

• intersectoral cooperation, collaboration and leadership
• flexibility and adaptability of plans
• strategies for vaccines and antivirals 
• disease surveillance and monitoring of countermeasures
• strategies for exchanging information and communicating risk
• evaluation of the pandemic response and the transition to seasonal influenza.

 

Four countries (France, UK, Czech Republic, Finland) have updated their pandemic response plans since 2009, while many other countries are in the process of working on revisions.

 

You can view the latest versions of European national plans at this WHO Europe web address:

 

National preparedness plans

Follow the links below to view country-specific national pandemic preparedness plans.

• Finland
  Updated in 2012 (in Finnish)
• Czech Republic
  Updated in 2011 (in Czech and English)
• France
  Updated in 2011 (in French)
• United Kingdom
  Updated in 2011 (in English)

(Continue . . . )

 

European pandemic guidance recommendations are being revised to more closely match the WHO global pandemic guidance. These new guidance recommendations will be presented at a WHO workshop in Copenhagen next month for countries of the South-eastern Europe Health Network (SEEHN), newly independent states, Switzerland and Turkey.

 

This from the World Health Organization:

 

 

 

Revising pandemic influenza preparedness strategies

16-11-2012

Evaluations of the response to the 2009 pandemic have shown that the world is ill-prepared to respond to a severe influenza pandemic or to any similar global, sustained and threatening public health emergency.

 

From the lessons learned it can be concluded that existing country pandemic plans have a number of gaps. Member States are in the process of revising their pandemic plans and 4 countries of the WHO European Region have published their revised plans.

 

A key activity of WHO/Europe in collaboration with the European Centre for Disease Prevention and Control (ECDC) is to provide a strong and clear guide, so that all countries of the Region can revise their pandemic influenza preparedness strategies. To this end, the existing European guidance is being revised in line with revisions from the WHO global pandemic guidance. This new version of the European guide will be discussed during a workshop on pandemic preparedness that will be held 5-7 December 2012 in Copenhagen, Denmark for countries of the South-eastern Europe Health Network (SEEHN), newly independent states, Switzerland and Turkey.

 

The meeting is organized in collaboration with the SEE Regional Health Development Centre for Communicable Diseases Surveillance in Tirana, Albania and will be facilitated by experts from WHO collaborating centres at the University of Nottingham, United Kingdom and the University of Geneva, Switzerland as well as WHO headquarters.

 

Experts from ECDC and Centers for Disease Control and Prevention (CDC) Central Asian Region, Almaty, Kazakhstan will also participate.

»» Read More

ECDC: Multidrug Resistant Infections Increasing In Europe

Consumption of antibiotics for systemic use in the community in EU/EEA countries, 2010 - Source

# 6721

 

November 18th is set aside each year by the ECDC and their partners as European Antibiotic Awareness Day. For the past 5 years they have mounted coordinated events to get the message out on the safe and sane use of antibiotics in the face of increasingly resistant bacteria.

 

You’ll find an excellent infographic, along with a number of other resources, available on the ECDC’s Antibiotics Awareness Day web page.

 

Coinciding with the 2012 observance, we have the release of new data on the consumption of antibiotics in the EU, along with numbers showing the rise in multi-drug resistant organisms.

 

A few excerpts from the ECDC news release, followed by links to the reports.  Follow the link for more.

 

 

Multidrug antibiotic resistance increasing in Europe

16 Nov 2012

On the occasion of the 5th edition of the European Antibiotic Awareness Day, ECDC releases new EU-wide data on antibiotic resistance and consumption. Antibiotic resistance still remains a major European and global public health problem and is, for a large part, driven by misuse of antibiotics. ECDC data show that over the last four years there has been a significant increasing trend of combined resistance to multiple antibiotics in both Klebsiella pneumoniae and E. coli in more than one-third of the EU/EEA countries. In several Member States, between 25 percent and up to more than 60 percent of Klebsiella pneumoniae from bloodstream infections show combined resistance to multiple antibiotics. Options for treatment of patients who are infected with such multidrug-resistant bacteria are limited to only few last-line antibiotics.

 

Antibiotic resistance is still a very serious threat to the health of European citizens, because it leads to increasing healthcare costs, extra length of stay in the hospital, treatment failures, and sometimes death. Speaking at a press event organised by ECDC and the European Commission in Brussels, ECDC Director Marc Sprenger said: “ECDC data show that over the last several years, there has been a Europe-wide increase of antibiotic resistance and of multidrug resistance in Gram-negative bacteria such as Klebsiella pneumoniae and Escherichia coli (E. coli). This means that, for patients who are infected with these bacteria, few last-line antibiotics, like carbapenems, remain available”.

 

Furthermore, ECDC data show that consumption of carbapenems – a major last-line class of antibiotics – increased significantly in EU/EEA countries from 2007 to 2010. This is the likely consequence of increasing multidrug resistance in Gram-negative infections, such as bloodstream infections or pneumonia, since carbapenems are often used to treat such infections. However, the percentage of carbapenem-resistant Klebsiella pneumoniae is already high and increasing in some countries in the EU.

 

He added: “There are, in contrast, some good news: in the past few years, meticillin-resistant Staphylococcus aureus (MRSA), has shown either a decrease or a stabilisation in most EU countries. Nevertheless, we must remain vigilant, as the percentage of Staphylococcus aureus resistant to meticilin remains above 25% in more than one fourth of the reporting countries, mainly in Southern and Eastern Europe”.

(Continue . . .)

 

News release
European Antibiotic Awareness Day 2012 – Latest data
European Antibiotic Awareness Day 2012 website
Antimicrobial resistance surveillance in Europe 2011

 

 

ECDC Infographic – Click to enlarge

 

For a look at the CDC’s Get Smart About Antibiotics Week here in the United States, you wish to revisit:

 

A Health Crisis In Slow Motion

»» Read More

ECDC: Climatic Suitability For Dengue Transmission in Europe

 

Credit ECDC

 

# 6452 

 

In 2007 Chikungunya made headlines as it spread rapidly across the Indian Ocean, hitting Reunion Island particularly hard.  A tropical disease - Chikungunya is spread by the bite of Aedes mosquitoes  - and until recently was found only in Africa and parts of the Indian Ocean.

 

So the unexpected outbreak of Chikungunya in September of 2007 in Northern Italy took many by surprise. 

 

I told the story in It's A Smaller World After All, but briefly: a traveler returning from India brought the virus back to the northeast Italian province of Ravenna, and before the outbreak had run its course, more than 290 people were infected.

 

This importation and subsequent spread of a rare tropical disease was a bit of a wake up call for Europe, and since then we’ve seen a good deal of study and concerns on the future of vector-borne diseases across Europe.

 

In 2010 the journal Eurosurveillance devoted an entire issue to The Threat Of Vector Borne Diseases, with perhaps the biggest threat outlined in Yellow fever and dengue: a threat to Europe? by P Reiter (excerpt below).

 

The history of dengue and yellow fever in Europe is evidence that conditions are already suitable for transmission. The establishment of Ae. albopictus has made this possible, and the possibility will increase as the species expands northwards, or if Ae. aegypti is re-established.

 

Last year in ECDC: Local Malaria Acquisition In Greece we saw more reasons for concern in the return of a scourge that had – due to diligent mosquito control measures over the past 50 years – been all but eliminated across Europe.

 

As global climate change occurs, and as mosquito species are spread inadvertently through the movement of trade goods, ships, and airplanes, the potential of new – potentially invasive – mosquito species setting up shop in Europe increases.

 

Which was the subject of an ECDC Review of status and public health importance of invasive mosquitoes in Europe last April.

 

While Malaria and Yellow Fever are of concern, the big worry has been the rapid global spread of Dengue fever over the past couple of decades might soon reach into Europe.

 

This explosive growth of Dengue around the world is well illustrated by the following graph from the World Health Organization.

 

What this graph doesn’t indicate is another doubling of dengue cases has taken place over the past 5 years.

 

All of which serves as prelude to  a 27-page technical report published by the ECDC today on the potential of Dengue Fever getting a foothold in continental Europe.

 

Below you’ll find the summary, and a link to the report.

 

ECDC report: Low risk of dengue transmission in Europe, while some areas climatically suitable

26 Jul 2012

ECDC

Europe appears to be at little risk from dengue transmission in comparison with other global locations, even though climatic conditions exist in some parts, new ECDC report concludes.

 

The report, entitled‘Climatic suitability for dengue transmission in continental Europe‘, summarises the key findings of a project, which developed a series of risk maps demonstrating the current and potential distribution of dengue in continental Europe.

 

The maps explore the geographical distribution and the climate suitability of dengue and the dengue mosquito vectors - Aedes aegyptiand Aedes albopictus - in Europe to assess which areas could be most suitable for dengue transmission.

 

The current risk to Europe appears to be minimal, yet some areas are more climatically suitable than others. However, the report provides a relative but not absolute calculation of the risk of dengue transmission.

 

Much of central and Mediterranean Europe is climatically suitable for Aedes albopictus, states the report; the VBORNET maps on current known distribution of Aedes albopictus show that this mosquito species is already present in many places in Mediterranean Europe. In addition, some areas could potentially be a suitable habitat for Aedes aegypti (the Mediterranean areas of Spain, France and Italy, south-eastern Europe).

 

The climatic suitability maps can be used as a tool for public health planning. A sensible strategy is to continue to monitor the spread of dengue mosquito vectors in Europeand expand vector surveillance in areas climatically suitable for these vectors.

In 2012 ECDC will produce guidelines to assist the Member States to implement invasive mosquito vector surveillance and improve coverage and harmonisation of data collection within the EU.

 

Technical report ‘Climatic suitability for dengue transmission in continental Europe‘

 

While the current risk of Dengue spread in Europe is considered minimal, the executive summary’s conclusion cautions that:

 

Suitability maps can be a useful tool for public health planning, but there are many potential sources of error that need to be properly understood.

 

The current risk to Europe from the transmission of dengue appears to be minimal, yet some areas of Europe are more suitable for transmission than others.

 

A sensible strategy is to continue to monitor the spread of Ae. albopictus across Europe, to maintain vigilance for Ae. aegypti, and to consider expanding vector surveillance in areas particularly suitable for these vectors.

 

Additional research is needed to better understand the ecology of dengue in a European context, and to assess the possible impacts of climate change and other important drivers of dengue on the risk of dengue in Europe.

 

 

For additional background on a variety of vector-borne diseases in Europe, and around the world, you may wish to revisit these earlier blogs.

 

A Pathogen That Still Plagues Mankind

ECDC: Mapping Disease Vectors

tick . . . tick . . . tick . . .

Tracking West Nile Virus In Europe

Borne In The USA

EID Journal:Vector-Borne Infections

»» Read More

5.8 Mag. Quake Rocks Northern Italy

 

 

# 6353

 

 

For the second time in 10 days, a strong temblor has rocked northern Italy, and early reports indicate at least ten people have died as a result. In the hours since the 5.8 quake struck, there have been several lesser aftershocks.

 

 

 

If you say `earthquake’ and `Europe’ in one sentence, most people would naturally assume you are talking about Italy, or perhaps Greece. Eastern and central Mediterranean regions after all, are well known for seismic activity.

 

But two of the strongest earthquakes to strike Europe over the past millennium occurred in Switzerland  and Portugal.

 

And as the following Seismic Hazard Map (produced by GSHAP – Global Seismic Hazard Assessment Program) shows, other areas of western, central and northern Europe are vulnerable as well.

 

 

Last year in A Look At Europe’s Seismic Risks, we took look at some of the devastating earthquakes to strike Europe over the past 700 years, including the quake that leveled the Swiss town of Basel in 1356 and the horrific earthquake and tsunami that struck Portugal in 1755 on November 1st (All Saint’s Day).

 

In December of last year, in WHO e-Atlas Of Natural Disaster Risks To Europe, we looked at some of the seismic risks to Europe. And in April of 2011 (see UNDP: Supercities At Seismic Risk) we saw a report that stated that half of the world’s supercities (urban areas with 2 million – 15 million inhabitants) are at high risk for seismic activity.

 

And more recently, in January of this year (see UN Agency Warns On Global Seismic Risks), the United Nations International Strategy For Disaster Reduction (UNIDSR.Org) issued a cautionary warning about ignoring seismic threats.

 

UNISDR warns against ignoring seismic threats as quakes wreak havoc for second year

302 human impact disasters claimed 29,782 lives; affected 206 million and inflicted record economic damages of $366 billion in 2011

Geneva, 18 January 2012 – For two consecutive years the long-term disasters trend has been bucked by major earthquakes which claimed thousands of lives and affected millions in both 2010 and 2011, according to new statistics published today by CRED and the UN office for disaster risk reduction, UNISDR.

 

UNISDR Chief, Margareta Wahlström, said today: “The Great East Japan Earthquake and the accompanying tsunami is a reminder to us all that we cannot afford to ignore the lessons of history no matter how forgotten. The many major cities located in seismic zones need to take seriously the probability of return events even if many years have passed since the last seismic event of major magnitude.

(Continue . . . )

 

 

 

While we can’t predict where the next earthquake will strike, or do anything to stop it, we can prepare to deal with one when it happens.

 

For good, solid information on how prepare for `the big one’ (even if you live someplace other than Los Angeles), I would recommend you download, read, and implement the advice provided by the The L. A. County Emergency Survival Guide.

 

While US-centric, FEMA  has an earthquake hazard webpage with a lot of resources that would be of use to just about anyone, including the following preparedness information.

 

Emergencies happen every day.  Disasters, admittedly, less often. But in either event, preparedness is key.

 

At a bare minimum, every household should have a disaster plan, a good first aid kit (and the knowledge to use it), and emergency supplies to last a minimum of 72 hours during a disaster.

 

Personally, I’d be uncomfortable with anything less than a week.

 

To become better prepared as an individual, family, business owner, or community to deal with these types of disasters: visit the following preparedness sites.

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

»» Read More

ECDC: Mapping Disease Vectors

 

 

# 6332

 

 

While unlikely to gladden the hearts of travel agents around the globe, the ECDC, through the European Network for Arthropod Vector Surveillance for Human Public Health (VBORNET), has released a new set of maps showing the prevalence of various tick species in Europe.

 

These maps, along with similar maps generated for exotic and invasive mosquitoes and for Plebotomine sandflies, gain new importance as the threat of vector-borne illnesses increase across Europe.

 

First the release information and links to the maps, and then I’ll return with more on the growing threat of arthropod carried diseases in Europe.

 

ECDC launches maps on the distribution of tick species in Europe

17 May 2012

ECDC

ECDC, through the VBORNET network, publishes regularly on its website maps on exotic mosquitoes and on phlebetomines  - to provide the ECDC stakeholders and the general public with the most updated information on vector distribution. The maps are updated and improved quarterly.

 

For the first time maps on the distribution of tick species are presented, covering four tick species: Dermacentor reticulates, Hyalomma marginatum, Ixodes persulcatus, Ixodes ricinus. Another improvement is that from now on the maps on phlebotomines are provided at a finer level of geographical detail:  at the administrative level NUTS3 instead of NUTS1 level.

 

The vector distribution maps are the outcome of collaborative work of the VBORNET network and are based on collecting existing data by the network members. VBORNET is a network of medical entomologists and public health experts, funded by the European Centre for Disease Prevention and Control (ECDC).

 

ECDC, through the VBORNET network, continues to  improve the data collection for the maps: the VBORNET network is therefore looking for vector-borne disease experts who are interested in data sharing and networking (experts can contact VBORNET at vbornet@ecdc.europa.eu).

See and download latest maps on vector distribution (updated 16 May 2012):
VBORNET maps – Tick species
VBORNET maps - Mosquitoes
VBORNET maps – Phlebotomines/Sandflies

 

 

In Europe ticks are known to carry and transmit a variety of diseases, including Crimean Congo hemorrhagic fever, Borreliosis, Tick-borne encephalitis, Tick-borne relapsing fever, Tularaemia, and Rickettsios.

 

And with changes in the climate, the range of ticks and the pattern of disease spread is likely to evolve over time.

 

The ECDC provides communication toolkits, designed for a variety of recipients, on tick-borne illnesses.

 

Communication toolkit on tick-borne diseases

This communication toolkit, developed by ECDC, includes template materials such as posters, leaflets, factsheets, etc. for different audiences with information on tick-borne diseases and preventive measures. The aim of the toolkit is to assist public health authorities in Member States in the development of strategies and communication materials to raise awareness on prevention and control of tick-borne diseases.

One of the ECDC toolkits available for download

 

And it isn’t just ticks.

 

The list of mosquito-borne diseases that could in the future (or already do) threaten parts of Europe includes West Nile Virus, Dengue, Malaria, Yellow Fever, Chikungunya, Zika Virus, Yellow Fever, Ockelbo virus, and even Rift Valley Fever.

In 2010 the journal Eurosurveillance devoted an entire issue to The Threat Of Vector Borne Diseases, with perhaps the biggest threat outlined in Yellow fever and dengue: a threat to Europe? by P Reiter.

 

For more on the mosquito-borne threat to Europe you may wish to revisit last April’s ECDC: Status & Importance Of Invasive Mosquito Breeds In Europe and from last year, ECDC: Local Malaria Acquisition In Greece.

 

And while less commonly known, Visceral Leishmaniasis (VL) is the most serious of the sandfly-borne diseases in Europe. While it rarely causes symptoms in healthy individuals - it can pose a deadly threat to those with HIV or compromised immune systems.

 

With these new maps the ECDC not only hopes to alert the public as to how to prevent vector borne illness but to track the changes in their geographic range over time.

 

All of this highlights the fact that you don’t have to travel thousands of miles to some exotic tropical clime in order to be exposed to Dengue, Malaria, Borreliosis, or West Nile Virus.

 

While still relatively rare in Europe (and North America, as well), these diseases continue to make inroads, and over time are likely to  increase as serious threats to public health.

»» Read More

WHO e-Atlas Of Natural Disaster Risks To Europe

 

 

# 6024

 

 

Natural disasters can strike anywhere, and just about anytime, but there are some times and places when the likelihood of disaster is greater than others.

 

To help nations, communities, and individuals to prepare, the World Health Organization’s  Regional Office for Europe (WHO/Europe) has released an online-only, interactive e-Atlas of disaster risks for Europe.

 

 

Focusing on five major natural disaster threats (seismic activity, floods, landslides, heat-waves and winds), this e-Atlas maps the relative risks of their occurrence across 32 countries of the European Region.

 

The WHO e-atlas of disaster risk for the European Region. Volume 1. Exposure to natural hazards. Version 2.0

Available in:

English (HTML)

2011
ISBN 978 92 890 0243 1
This publication is only available online.

This e-atlas models the distribution of five natural hazards – seismic activity, floods, landslides, heat-waves and winds – and populations’ exposure to them in 32 countries of the European Region. It provides the baseline data and maps needed to assess where the potential for damage may be the greatest and to underpin the call for more resources to improve emergency preparedness, reduce the health risks to vulnerable populations and aid the emergency response. This information also supports the identification, planning and prioritization of areas for prevention and mitigation activities.

The aim of the e-atlas is to raise awareness of disaster risk among ministries of health and other health stakeholders, and so stimulate improvement in their disaster-management capacity.

 

 

Inside you’ll find interactive maps, like the one below showing relative seismic risks, that allows you to pan, or drill down closer to view areas at most risk.

 

Photo Credit – WHO/Europe

 

You can find similar online e-Atlases available for the Eastern Mediterranean region and for Africa. 

 

 

The WHO e-atlas of disaster risk for the Eastern Mediterranean Region (HTML)

The WHO e-atlas of disaster risk for the African Region (HTML)

»» Read More

Europe: Online Flu Monitoring Survey

 

 

 

# 5950

 

 

Every year scientists and statisticians work to quantify and identify the spread of influenza around the globe.

 

They have many tools available – such as reports from sentinel laboratories and clinics, hospital surveillance, and P&I mortality statistics -  although none provides a complete picture.

 

We’ve seen other attempts to monitor influenza and influenza-like-illnesses, such as Google’s Flu Trends, that analyses searches for `influenza’ related symptoms. 

 

Although covering more than just influenza, other web surveillance projects include Healthmap, and Episider.

 

In Europe, the internet has been used to survey and monitor patterns of influenza-like-illness (ILI) since 2003, first in the Netherlands and Belgium, followed by Portugal 2005 and Italy in 2007. 

 

The UK online flu survey began in the summer of 2009, and this year they are joined Austria, France, Germany, Sweden  and Switzerland.

 

This year, these surveillance sites are hoping that even more people will volunteer a few minutes each week to take part in the survey.

The following is a press release from the London School of Hygiene & Tropical Medicine, one of the sponsors of this project.

 

Seasonal flu monitoring system launches

Public release date: 8-Nov-2011

 

A powerful monitoring tool that will allow researchers to track the spread of seasonal flu launches today. This year the UK Flusurvey will, for the first time, join a European network of online surveys, gathering information on how the illness spreads across the continent and enabling comparison between the different countries.

 

Seasonal flu affects millions of people every year. The Flusurvey is being used to monitor flu across Britain, and to flag up severity and trends early in the season. It could also provide early indications of flu vaccine uptake and effectiveness, and whether the Government's decision not to run a national advertising campaign in England has had any impact.

 

The Flusurvey – launching today for the 2011-12 season - is the brainchild of scientists John Edmunds, Ken Eames and Sebastian Funk, of the London School of Hygiene & Tropical Medicine.

 

Latest box office hit "Contagion" tells of a deadly virus that spreads like wildfire and causes widespread chaos as society breaks down. Seasonal flu might not be as dangerous as the fictional virus depicted in "Contagion", but how can we know how bad the next flu strain will be and how would we cope with an unexpectedly virulent outbreak? Surveillance is the key.

 

"Being able to detect a flu epidemic before hospitals and GPs are snowed under with patients is vital," says Professor Edmunds. "We set up the Flusurvey (http://www.flusurvey.org.uk) to allow the public to report their illness directly. Anyone can take part, just log on and do your bit to help us deal with the next epidemic."

 

In previous years, the voluntary online survey has attracted up to 5,000 participants. This year, the researchers hope that they can top this number.

 

Dr Eames says: "The more people who join the better. Being part of the Flusurvey just takes a couple of minutes each week. We're looking for thousands of volunteers to take up this opportunity to join in with an exciting scientific project to aid health research."

 

A standard online questionnaire agreed and translated in the relevant languages will now make it possible to compare the data collected in 10 participating countries. Thanks to a set of interactive maps, everyone can see how the infection is spreading in the UK and Europe.

 

Dr Funk says: "We have never been able to do this before. Each country measures flu in a different way. Now, for the first time, we will be able to compare cases across the continent as flu spreads through Europe. This provides a fascinating opportunity to understand the dynamics of seasonal flu on a large scale."

 

Each week, participants report any flu-like symptoms they have experienced since their last visit to the website. The Flusurvey data is also supplied to the Health Protection Agency's national surveillance programmes. This direct information from the public is particularly useful because many people with flu symptoms do not visit a doctor and traditional surveillance methods rely on data from external sources such as GPs or hospitals.

(Continue . . . )

»» Read More

ECDC: Local Malaria Acquisition In Greece

 

 

 

# 5775

 

 

While malaria was once common across much of Europe, by the middle of the last century better mosquito control measures had nearly eliminated the scourge from almost all of Europe.

 

In recent years most reported cases have been imported by travelers returning from regions where the parasite is endemic, or in a few cases were the result of what is termed `airport malaria’.

 

Airport Malaria (see report `Airport malaria' -- cause for concern in the US) occurs when an infected mosquito is transported aboard an airliner from a malaria-endemic country and it survives long enough to seek blood meals from and transmit the disease to ,those in or around an airport.

 

There remain a few European countries where malaria remains endemic, and the World Health Organization  hopes to eliminate the disease by the 2015.

 

 

Elimination from the WHO European Region by 2015

The WHO European Region aims to interrupt the transmission of malaria and eliminate the disease from the remaining 5 countries affected by malaria by 2015: Azerbaijan, Kyrgyzstan, Tajikistan, Turkey, and Uzbekistan. The number of reported cases has dropped dramatically, from 90 712 in 1995 to only 176 in 2010.

 

Eliminating malaria from the Region by 2015 is a realistic and attainable goal. Turkmenistan attained malaria-free status in 2010, and Armenia is expected to follow in 2011.

 

But every once in awhile, a few cases of malaria show up in areas where the disease has been declared eradicated, as is the case this summer in Greece.

 

While not considered to be an area at high risk, earlier this week the CDC issued a travel announcement regarding a few cases of autochthonous P. Vivax malaria transmission that have been reported over the past couple of months.

 

Announcement Malaria Cases: Greece

The Centers for Disease Control and Prevention (CDC) has received a report, from the GeoSentinel Surveillance system of a confirmed case of Plasmodium vivax malaria in a person who traveled to Elos and Skala in southern Greece around the last week of July.  The traveler had no history of travel to any malaria-endemic areas.

 

Greece has been malaria free since 1974; however according to Greek health authorities, since June 2011, a total of 6 malaria cases have been reported in persons with no history of travel to a malaria-endemic area.  All cases were confirmed to be P. vivax and occurred in the southern region (Peloponnesus) of the country, specifically in Laconia and Evoia districts.

 

The Hellenic CDC of Greece has responded by enhancing its surveillance system and intensifying mosquito control in affected areas, raising awareness among health care providers and hospitals about early malaria diagnosis and treatment, and educating the public about prevention of mosquito bites.

 

Because malaria risk in Greece is limited, and the country has implemented control measures, at this time CDC is not recommending that travelers to Greece take an antimalarial drug.  However, measures to prevent mosquito bites should be taken, such as using insect repellent when outdoors, and staying in an air-conditioned or well-screened area, or sleeping under an insecticide treated bed net during the peak biting period for mosquitoes (dusk and dawn).

 

This notice will be updated as new information becomes available.

 

 

Today, the ECDC issued a four-page risk assessment on these cases, and concurs that the risk is relatively low, and pretty much confined to Evrotas in the district of Lakonia (and potentially Chalkida in Evoia).

 

 

Technical reports - 23 Aug 2011

Available as PDF 

ABSTRACT

Greece reports six cases of Plasmodium vivax infection in Evrotas, Lakonia, Peloponnese region, and Chalkida in Evoia since June 2011. The main risk related to the current event is to persons living in, visiting and working in the particular area of Evrotas in the district of Lakonia (and potentially Chalkida in Evoia, though more information is needed) in Greece. The local transmission of P. vivax malaria to humans is believed to have occurred here over the last three years and is likely to continue producing annual clusters of human cases. However, the risk for further extension of malaria transmission into the EU related to this event is considered low at present.

 

 

In recent years we’ve also seen a few scattered cases of locally acquired malaria in places like Germany, France, and Spain.

 

Given the repeated introductions of the malaria parasite into Europe via international travel, and the availability of reasonably competent vectors across the region, rare local transmission is not completely unexpected.

 

And it isn’t just malaria.

 

Dengue, West Nile Virus, Chikungunya, and yellow fever all have the potential for limited spread in Europe.

 

You may recall, in 2007 we saw an outbreak of Chikungunya in Northern Italy.

 

I told the story in It's A Smaller World After All, but the crux of the story was a traveler, returning from India, brought the virus back to Italy which led to more than 290 cases being reported in the province of Ravenna, which is in northeast Italy.

 

In March of 2010 the journal Eurosurveillance carried a series of articles on vector borne diseases and their potential to impact those living in Europe. One of the articles, Yellow fever and dengue: a threat to Europe? by P. Reiter, had this to say about the future of vector-borne illnesses in Europe.

 

The history of dengue and yellow fever in Europe is evidence that conditions are already suitable for transmission. The establishment of Ae. albopictus has made this possible, and the possibility will increase as the species expands northwards, or if Ae. aegypti is re-established.

 

The epidemic of chikungunya in northern Italy in 2007 [8,49] confirms that Ae. albopictus is capable of supporting epidemic transmission, although laboratory studies indicate that the strain of virus involved was particularly adapted to this species [50,51].

 

Nevertheless, it is not unreasonable to assume that climatic conditions that permit malaria transmission will also support transmission of yellow fever and dengue, in which case transmission could extend into northern Europe [52].

As these tropical viruses and parasites are continually being introduced back into the EU (along with the United States, and many other countries) by way of international travel, that increases the chances that one could someday become established in a new territory.

 

Reason enough to take basic precautions against mosquitoes, no matter where you are in the world.

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Tracking West Nile Virus In Europe

 

Map credit – ECDC 

 

# 5761

 

A dozen years ago the West Nile Virus (WNV) suddenly, and quite unexpectedly, appeared in New York City. And over the next few years it spread rapidly across the United States.

 

WNV is enzootic throughout much of Africa, parts of Europe, Asia and Australia.

 

Exactly how the virus was imported into the United States remains a mystery, although interhemispheric migration bird migration, birds carried by tropical storms, legal or illegal importation of birds from countries where the virus is endemic, or even infected mosquitoes hitching a ride on an international flight have been suggested as possibilities.

 

But no matter how it arrived, it flourished and spread.

 

From the USGS Factsheet on West Nile Virus

 

As you can see, the virus managed to rapidly expand its range during the first three years of its introduction into North America.

 

In 2002, however, the virus really exploded across the nation’s landscape.

 

 

Most people infected with WNV experience only mild, or sub-clinical symptoms. A very small percentage develop WNV neuroinvasive disease (WNND), a form of encephalitis.

 

For every serious presentation, there are probably 100 mild, or asymptomatic cases.

 

Last year, it turns out, was another banner year for West Nile Virus (WNV) cases in the United States, with 1,021 cases reported - up sharply over 2009 - and 62% of those producing neuroinvasive disease (i.e., meningitis, encephalitis, or acute flaccid paralysis) - Cite.

 

And in 2010 the West Nile Virus also made headlines in Europe; with Romania, Hungary, Italy, Spain and Greece all reporting human cases. In Greece, a large outbreak affecting the northern part of the country resulted in 262 human cases and 35 deaths being reported.

 

According, the ECDC now maintains an extensive West Nile Virus surveillance page and issues weekly updates and maps.

 

The latest update reads:

 

SITUATION UPDATE

As of 16 August 2011, a total of 21 confirmed human cases of West Nile fever have been reported in the EU (20 cases in Greece and 1 in Romania) and 26 in the neighbouring countries: 19 in the Russian Federation, 2 in Albania and 5 in Israel.

 

Between 09 and 16 August 2011, 14 new confirmed human cases have been reported from Greece, including 2 cases in new prefectures: Serres (1 case) and Trikala (1 case). In Attiki prefecture, all cases are still located in East Attica sub-prefecture.

• More information on West Nile infection in Greece is available from the Hellenic Center for Disease Control and Prevention website.
• Additional information on West Nile infection in horses in Greece, both in Attiki and Serres prefectures, is available from the World Organisation for Animal Health (OIE).

Since last week’s update, in the Russian Federation, ten new laboratory confirmed human cases have been reported from oblasts where cases occurred previously (Voronezhskaya and Volgogradskaya). In addition, three cases have been reported from an adjacent area, Rostovskaya oblast, for the first time this season.

 

In Albania, two cases have been reported in Lezhe prefecture. In Israel, 5 cases have been declared since June including two in the Northern district and two in Haifa district.

 

Yesterday the World Health Organization’s  GAR (Global Alert and Response) network issued an advisory on the virus as well.

 

 

West Nile Virus Infection (WNV) in Europe

16 August 2011 - Laboratory confirmed cases of West Nile Virus infection (WNV) have been reported in a number of European countries. From the beginning of July 2011 to 11 August 2011, WNV infection has officially been reported by Albania (2 cases), Greece (22 cases) Israel (6 cases), Romania (1 case) and the Russian Federation (11 cases). The reporting reflects higher awareness among healthcare workers, enhanced laboratory capacities and favourable weather conditions with rainfall and high temperatures leading to a substantial increase in mosquitoes such as Aedes and Culex species.

 

The WHO Regional Office for Europe, together with key partners − such as the European Centre for Disease Prevention and Control (ECDC), the European Network for Diagnostics of “Imported” Viral Diseases (ENIVD) and the Network for Communicable Disease Control in Southern Europe and Mediterranean Countries (EpiSouth) − have been closely monitoring the regional situation of WNV.

 

WHO encourages the Member States to consider implementing relevant public health measures in order to minimize the impact of a potential WNV outbreak in countries at risk.

 

(Continue . . . )

 

 

The WHO maintains a West Nile Virus fact sheet, which lists the following key facts.

 

• West Nile virus can cause a fatal neurological disease in humans.
• However, approximately 80% of people who are infected will not show any symptoms.
• West Nile virus is mainly transmitted to people through the bites of infected mosquitoes.
• The virus can cause severe disease and death in horses.
• Vaccines are available for use in horses but not yet available for people.
• Birds are the natural hosts of West Nile virus.

 

 

And it isn’t just WNV that Europe is concerned over. The mosquito vectors for Malaria, Dengue, Chikungunya, WNV, even Yellow Fever all are found in parts of the EU. 

 

Increasingly, globalization, international travel and climate change are providing fresh opportunities for vector borne illnesses to spread to regions where they are not normally seen.

 

Given the rapid dissemination of the WNV in North America, it is understandable that the ECDC and the WHO are concerned, and are urging countries to get ahead of this virus before it becomes a larger threat.

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A Look At Europe’s Seismic Risks

 

 

Note: Yesterday in Divining Japan’s Seismic Future I discussed the potential for future seismic events in Japan.

 

While the earthquake risks in Japan and the United States are oft discussed, for Europe it is less so. Yet Europe is hardly immune from the threat.

 

# 5481

 

 

If you say `earthquake’ and `Europe’ in one sentence, most people would assume you were talking about Italy, or perhaps Greece.  Eastern and central Mediterranean regions after all, are well known for seismic activity.

 

But two of the strongest earthquakes to strike Europe over the past millennium occurred in Switzerland  and Portugal.

 

And as the following Seismic Hazard Map (produced by GSHAP – Global Seismic Hazard Assessment Program) shows, other areas of western, central and northern Europe are vulnerable as well.

 

 

 

 

Minor earthquakes are not uncommon in Europe.

 

According to the Centre Sismologique Euro- Méditerranéen (CSEM) there have been over 600 (mostly minor) Euro-Med earthquakes recorded over the past two weeks. 

 

 

Large earthquakes are rare in central, western, or northern Europe.

 

But they are not unheard of.

In 1356, on the evening October 18th - the Feast day of Saint Luke the Evangelist – perhaps the strongest quake in central Europe’s history struck in the evening, destroying the Swiss town of Basel and leveling practically every major structure within 30 kilometers of the city.

The quake was preceded by a foreshock between 7 and 8 pm, with the main quake striking around 10pm.  It was felt as far away as  Zürich, Konstanz and even in Île-de-France.

 

While seismographs were not invented 650 years ago, estimates put this quake at between 6.2 and 6.5 on the modern Richter scale.

 

Le tremblement de terre qu a eu lieu en 1356. - Karl Jauslin (1842–1904)

 

The Swiss take the threat of another major earthquake seriously, and in 2006 – on the 650th anniversary of the Basel quake, they (along with neighbors Austria and Liechtenstein) conducted a 3-day disaster drill that simulated a 6.0+ earthquake in the Rhine Valley.

 

Switzerland prepares for seismic calamity

Oct 18, 2006 - 07:56

Swiss emergency officials have been participating in a huge cross-border earthquake preparedness exercise to learn how to deal with strong tremors.

 

 

In 1755, on November 1st (All Saint’s Day), what would prove to be one of the deadliest earthquakes to ever strike Europe literally destroyed Lisbon, Portugal along with dozens of fishing villages along the coast, and sent Tsunami waves crashing into the UK, Northern Africa, and the Caribbean.

 

Most of the city’s 250,000 residents were gathered in churches and cathedrals on that Sunday morning, when a little after 9:30 am a terrible rumbling noise was followed moments later by intense shaking that lasted several minutes, collapsing most of the city’s buildings.

 

The quake, which occurred a couple of hundred kilometers offshore, was estimated to have been 8.2 or greater on the Richter scale.

 

1755_Lisbon_earthquake.jpg‎

 

The worst, however, was yet to come. 

 

Fires spread quickly among the ruins, engulfing the city of Lisbon, turning the city into an inferno that would burn for days.

Minutes after the quake, a tsunami struck along the south coast of Portugal, reportedly washing over the tall cliffs of Sagres .

 

Fishing boats, and entire villages, were swept away.

Around 11am the first of three  tsunami waves struck Lisbon, farther north along the coast.

 

Although considerably reduced in height (estimated at 5 meters), they funneled into the city via the Tagus river estuary causing great damage and loss of life.

 

For a fascinating contemporaneous eye-witness account of the destruction of Lisbon, I would direct you to:

 

Modern History Sourcebook: Rev. Charles Davy: The Earthquake at Lisbon, 1755

 

Farther north, a 3-meter tsunami struck at Cornwall on the Southern English coast. And in Galway, Ireland waves damaged the `Spanish Arch’ section of the city wall. 

 

Tremendous tsunamis (20+ meters) were reported in Northern Africa, and smaller waves washed ashore in the Caribbean and the Atlantic Coast of the New World many hours later. 

 

Tsunami Travel Times from the 1755 Quake

 

Although accurate numbers are impossible to come by, in Lisbon alone the death toll is estimated at between 10,000 and 100,000.  Most historians place the number at the high end of that range.

 

 

Lest anyone think this is simply `ancient history’ -  never to be repeated - a somewhat smaller quake (7.8 magnitude) struck in roughly the same area in 1969.

 

While damage was moderate, and only a minor (1+ meter) tsunami was generated, 13 people were killed and many more injured. 

 

 

 

The bottom line is that earthquakes (and tsunamis) can and do occur in Europe.  While rare, they can produce catastrophic results.   

 

Places that seldom see seismic activity tend not to mandate the construction of earthquake resistant buildings and infrastructures. Meaning that a lesser quake could conceivably do more damage than a stronger quake in a better prepared region.

Of course, a quake of the magnitude of Lisbon in 1755 or Basel in 1356 may not happen in our lifetimes.  

 

They are, after all, exceedingly rare events. 

 

But there are enough uncertainties in life on this spinning orb to make preparation for any kind of disaster – regardless of its origin or cause – time and money well spent.

 

Today there are millions of people in safe and comfortable homes all around the world watching the awful events in Japan, naively thankful that `it can’t happen here’.

 

The trouble, of course, is . . .  that it can.

 

Bad things happen somewhere practically everyday. Sometimes to just a few, and sometimes to a lot of people at once.

 

And when they do, the advantage goes to those who are prepared to deal with them.

 

 

To access my essays on personal, community, and business preparedness click here  or select the PREPAREDNESS link on the quick search atop my sidebar. 

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Study: Incoherent Public Health Laws And The Pandemic Response

 

 

 

 

# 4868

 

 

Few observers would deny that the world got off pretty easy with the pandemic of 2009.  As  bad as it was for some people, and as difficult as it was to manage in some regions, as pandemics go . . . novel H1N1 was relatively mild.

 

The next time, of course, we may not be so lucky.

Which is why it is imperative that we take lessons from the past 15 months, and use them to improve our response to the next global health threat.

 

We saw differing containment and mitigation responses around the world. 

 

In some regions, tough – some would say `draconian’ – measures were taken, particularly early in the outbreak. 

 

Other countries mounted a far less vigorous response.

 

These differing approaches give us an opportunity to see what worked, and what didn’t.   And reviews of that data are underway.

 

But should the next pandemic prove more severe, a more coordinated response may prove desirable. 

 

One of the major obstacles to such a coordinated response are the widely varying public health laws, regulations, infrastructures, and agencies around the world.

 

In an attempt to better understand these barriers, researchers have recently conducted a survey of the pandemic plans, policies, and public health laws of a number of European states. 

 

Representatives of 32 states were sent questionnaires, of which 23 responded. 

 

Austria, Belgium, Bulgaria, Croatia, Cyprus, Estonia, Finland, France, Germany, Hungary, Iceland, Ireland, Latvia, Lithuania, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Sweden and Turkey

 

We’ve an open access study appearing in BMC Public Health that calls these disparate approaches in the law and public policy `incoherent’, and cites them as a being  seriously problematic when dealing with a global health crisis.

 

Admittedly a bit data-heavy, and probably of greatest interest to  public health wonks, but this study is eye-opening just the same.

 

A few excerpts from the abstract.  Follow the link to read the study in its entirety.

 

Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws

Robyn Martin, Alexandra Conseil , Abie Longstaff , Jimmy Kodo , Joachim Siegert , Anne-Marie Duguet , Paula Lobato de Faria , George Haringhuizen, Jaime Espin  and Richard Coker

BMC Public Health 2010, 10:532doi:10.1186/1471-2458-10-532

(EXCERPTS)

Methods

We undertook a survey of national public health laws across 32 European states using a questionnaire designed around a disease scenario based on pandemic influenza. Questionnaire results were reviewed in workshops, analysing how differences between national laws might support or hinder regional responses to pandemic influenza. Respondents examined the impact of national laws on the movements of information, goods, services and people across borders in a time of pandemic, the capacity for surveillance, case detection, case management and community control, the deployment of strategies of prevention, containment, mitigation and recovery and the identification of commonalities and disconnects across states.

Results

Results of this study show differences across Europe in the extent to which national pandemic policy and pandemic plans have been integrated with public health laws. We found significant differences in legislation and in the legitimacy of strategic plans. . States differ in the range and the nature of intervention measures authorized by law, the extent to which borders could be closed to movement of persons and goods during a pandemic, and access to healthcare of non-resident persons. Some states propose use of emergency powers that might potentially override human rights protections while other states propose to limit interventions to those authorized by public health laws.

Conclusion

These differences could create problems for European strategies if an evolving influenza pandemic results in more serious public health challenges or, indeed, if a novel disease other than influenza emerges with pandemic potential. There is insufficient understanding across Europe of the role and importance of law in pandemic planning. States need to build capacity in public health law to support disease prevention and control policies. Our research suggests that states would welcome further guidance from the EU on management of a pandemic, and guidance to assist in greater commonality of legal approaches across states.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

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