Report No. 10: December 3 2003 (week 49)
Summary:
The early increase in influenza activity in the UK appears now to have levelled off. Consultation rates for influenzalike
illness show little change from the level seen last week in England and continue to fall in Scotland and Northern
Ireland. In Wales the rate is still rising but within the base line level. Young children continue to make up the highest
proportion of the age groups affected with influenza-like illness and the rate in this age group remains high and has
shown a small increase from last weeks figure. Whether activity will decline over the next few weeks or will increase
again cannot be predicted. In North America and Western Europe the picture has been similar to that in the UK with
early activity and the influenza A H3N2 Fujian strain as the major circulating influenza virus. France is the latest
European country to report detection of the Fujian strain in common circulation and has reported rising influenza
activity.
In light of the concern about influenza deaths in young children, a meeting of a subgroup of the Joint Committee on
Vaccination and Immunisation (JCVI) was convened to discuss current policy for influenza vaccination. The group
endorsed current immunisation policy and recommended that better uptake be sought in young children with
conditions putting them at high risk of the complications of influenza. The group agreed that the current vaccine is
expected to offer some cross protection against the Fujian-like strain which is currently circulating in the
UK:http://www.doh.gov.uk/jcvi/mins10nov03.htm.

An influenza update will be provided in this weeks Communicable Disease Report (CDR) published on Thursday 3
December on the HPA website at http://www.hpa.org.uk/cdr/
http://www.hpa.org.uk/infections/topics_az/influenza/sourcesofdata.htm
http://www.hpa.org.uk/infections/topics_az/influenza/graphmenu0304.htm
Clinical indices of acute respiratory illness (England, Wales, Scotland and N. Ireland
RCGP (England): GP consultations for influenza-like illness show little change from a rate of 54.5 per 100 000 in
week 47 (week ending 23 Nov) to a rate of 53.2 in week 48
http://www.hpa.org.uk/infections/topics_az/influenza/Activity0304/graph_3.pdf. The breakdown by age group for
influenza-like illness in week 48 is 139.9 in the 0-4 year old age group: 44.9 in the 5-14 year old age group, 58.4 in
the 15-44 year old age group, 40.76 in the 44-65 year old age group: and 34.59 in the over 65 year old age group.
The regional breakdown for week 48 is as follows: Northern region 53 per 100 000, Central region 52 per 100 000,
Southern region 55 per 100 000. The consultation rate for acute bronchitis has decreased slightly from a rate of
144.1 in week 47 to a rate of 140.0 in week 48. The highest rates are in the 0-4 year old age group at 368.69 per
100 000 and the over 65 year old age group at 272.13 per 100 000 These rates for acute bronchitis remains within
the range expected for this time of year and are increasing in these two age groups.
http://www.hpa.org.uk/infections/topics_az/influenza/Activity0304/graph_1.pdf
Wales (CDSC Wales): The consultation rate in the sentinel GP scheme co-ordinated by CDSC Wales has increased
from 9.74 in week 47 (week ending 19 November) to 12.1 in week 48 (week ending 26 November). This is well within
the upper level set for baseline activity of 25 per 100 000 population.
Scotland (SCIEH): In the sentinel GP scheme co-ordinated by the Scottish Centre for Infection and Environmental
Health (SCIEH), the consultation rate decreased from 116 per 100 000 in week 47 (week ending 23 November) to 86
per 100 000 in week 48 (week ending 30 November). This is in the range considered as normal seasonal activity.
Northern Ireland (CDSC N. Ireland): The consultation rate for combined influenza and ‘influenza like illness’ has
decreased from a rate of 126.0 consultations per 100 000 in week 47 to 90.9 in week 48. A winter rise in paediatric
bronchiolitis cases has also been observed. This is the fourth year of the influenza surveillance scheme and baseline
values have not yet been established
Medical Officers of Schools Association (MOSA): In MOSA schools the overall rates for influenza like illness has
been increasing in recent weeks and CDSC continues to receive reports of outbreaks of influenza like illness in
schools in South and Central England. Laboratory investigations are in process.
Outbreak reports: CDSC has received a small number of reports of outbreaks of influenza in schools and nursing
homes. CDSC would welcome any documented reports of influenza outbreak investigations particularly in youngchildren and the elderly. The reference laboratory at Colindale can provide laboratory support to such investigations
when it is requested and are happy to receive specimens for strain typing and further chacterisation as well as being
able to provide a rapid diagnostic service.
Mortality. In week 47, 11139 deaths due to all causes were registered with the Office for National Statistics. This
figure is lower than the previous weeks figure of 11211 but still higher than average for the same week in the last five
years. Five deaths, four in the age range 85 yrs and over and one in age group 45-64 were registered as attributed
to influenza during week 46.
http://www.hpa.org.uk/infections/topics_az/influenza/Activity0304/graph_11.pdf
http://www.hpa.org.uk/infections/topics_az/influenza/Activity0304/graph_12.pdf
NHS Direct total call activity:
The NHS Direct England and Wales total call rate dropped slightly from 261 per 100,000 persons in week 47/03, to
241.9 per 100,000 in week 48/03. This is at the expected level for this time of year. The national proportions of
‘cold/flu’ calls and fever calls have also dropped slightly from last week but are at a level higher than for the same
week last year. (‘cold/flu’: 2.2% in week 47 to 2.0% in week 48, fever: 7.3% in week 47 to 6.4% in week 48).
http://www.hpa.org.uk/infections/topics_az/influenza/Activity0304/graph_13.pdf
Laboratory indices of acute respiratory illness:
ERNVL Influenza Reference Laboratory
Table 1 ‘Detections’ PCR and isolation of influenza and RSV made by ERNVL Reference Laboratory. Data for
England and Wales, by week of report.
Total for week 48 PCR (Isolation)
Source
A H1 A H1N1 A H1N2 A H3 AH3N2 Inf B RSV*
(0) (0) (0) 44(1) (0) 1(0) 1
Cumulative to date
(Week40/2003-
48/2003)
A H1 A H1N1 A H1N2 A H3 AH3N2 Inf B RSV*
North England Comm 66 (1)
Hosp 77 (19)
Central England Comm 52
Hosp 7 (8) 1
South England Comm 112 1
Hosp 135 (35) 1
Wales Comm
Hosp 7
Scotland Comm
Hosp 26 (32)
Northern Ireland Comm 1
Hosp
Region unknown
Sub-total Comm 230 (1) 1
Hosp 253 (94) 2
Cumulative Total 483 (95) 2 2
* RSV detection is by PCR only
Comments
There have been 44 detections of influenza A H3 N un typed viruses and one influenza B detection from any
specimens referred to ERNVL during week 48. Of the isolations typed so far 35 have been confirmed as
A/Fujian/411/2002 (H3N2)-like and three as Panama/2007/99 like. Although Fujian-like strains are drifted from
Panama/2007/99, the H3N2 UK vaccine component, some cross protective immunity is still expected from the current
UK vaccine.
Other NHS and HPA microbiology laboratories
‘Detections’ (isolation or direct immunofluoresence) of influenza and RSV reported to CDSC by NHS and HPA
microbiology laboratories. Data for England and Wales by RCGP region, by week of report**
Detection (isolates and DIF)
Week 48/2003 Influenza A Influenza B RSV*
England and Wales 135 1 67

Cumulative to date
(Week 40/2003 –48/2003)
Northern England 31 1 37
Central England 127 2 97
Southern England 71 0 46
Wales 60 0 9
Cumulative Total 289 3 189
* RSV detection is by direct immunoflouresence (DIF) only
** Only specimens taken in or after week 40/2003 are included in these data.
Comment
One hundred and thirty five Influenza A detections were reported in week 48 (week of specimen beginning week 40)
in NHS and HPA laboratories (11 from the north of England 72 from central England 36 from southern England and
16 from Wales). There was one influenza B infection reported from northern England in week 48. RSV numbers
remain low and lower than this time last year but have started to increase. Levels of Mycoplasma pneumoniae
remain low. 77 influenza A positive detections have been reported in the CDSC virological surveillance scheme since
week 40 and the number of positive detections have increased in week 46.
Virological data from Northern Ireland
In week 48 three positive influenza A detections were made from the GP surveillance scheme and from hospital
sources. The first RSV cases (2 in young children) of the season were confirmed in week 47
http://www.cdscni.org.uk
Virological data from Scotland
There have been 58 influenza A H3 N untyped positive specimens referred to ERNVL from hospital sources in
Scotland since week 40. Information on enhanced virological testing from influenza sentinel surveillance can be
obtained from the Scottish Centre for Infection and Environmental Health (SCIEH):
http://www.show.scot.nhs.uk/scieh/
The Republic of Ireland.
In the Republic of Ireland the GP consultation rate for influenza-like illness has fallen from 62.9 per 100 000 in week
47 to 58.3 per 100 000 in week 48. Rates remain highest in the 0-4 and 5-14 year old age group. 16 Influenza A
viruses were detected in sentinel surveillance during week 48. Eight influenza specimens this season have been
confirmed as A/Fujian/411/2002 (H3N2).
http://www.ndsc.ie/Publications/WeeklyInfluenzaSurveillanceReport/