Influenza surveillance in Australia NZ other Southern Hemisphere

Influenza surveillance in Australia, NZ & other Southern Hemisphere countries Ian Barr WHO Collaborating Centre for Reference & Research on Influenza, Melbourne (Now finally re-located at VIDRL) www. influenzacentre. org The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health and Ageing.

Useful publications on influenza Australian Influenza report www. health. gov. au NZ Influenza update www. surv. esr. cri. nz

Influenza like illness in 2009 in Australia 2009 Source: ASPREN Victoria Source: VIDRL

Laboratory confirmed influenza in Australia (NNDSS figures) Australian cases 2009 cases by state

Pandemic H 1 N 1 is the dominant strain circulating – Sentinel surveillance in Victoria Data source VIDRL Sentinel median age 21 y vs all Aus. 16 y

Australian NNDSS lab confirmed influenza by age group; 2009 vs 2007 2009 2007

Australian data on Pandemic (HN 1) 2009 as at 15 August 2009 Hospitalised l l 29, 833 Confirmed cases 3562 people hospitalized 451 people currently in ICU Total 108 deaths Pregnancy 3% of hospitalised 8/47 to ICU (17%)

Time in hospital with H 1 N 1 pdm (Queensland by age; up to 31. 7. 09)

Age of Australian fatal cases with Pandemic H 1 N 1 2009 infections Most deaths have had underlying medical conditions; cancer, diabetes, morbid obesity

Australian seasonal deaths due to influenza & pneumonia appear to be normal (to July 09)

How are alternative influenza monitoring systems performing in the pandemic? Google Flu Trends (as at 14. 8. 09)

And in NZ…. . ILI l l 3051 Confirmed cases H 1 N 1 pdm 914 people hospitalized 225 cases pneumonic, 35 ARDS Total 10 deaths Data: ESR, up to 9 Augus

Pandemic H 1 N 1 2009 is the predominant strain in NZ this year Sentinel surveillance Data: ESR, up to 9 August

Samples received from the region & tested at the WHO CC Melbourne in 2009

CDC (USA) analysis of SH H 1 N 1 activity

Summary of virus analysis from samples received and tested at Melb. CC l l Pandemic H 1 N 1 2009 – All very similar to the A/California/7/2009 reference strain l Seasonal H 1 N 1 – All very similar to current vaccine strain A/Brisbane/59/2009 l H 3 N 2 viruses – Most recent viruses from Australia, Singapore, Philippines are low reactors to A/Brisbane/10/2009 & more A/Perth/16/2009 -like l B viruses have been very few, mostly B Victoria-like 2009 vaccine strains – H 1 – A/Brisbane/59/2007 -like – H 3 – A/Brisbane/10/2007 -like (A/Uruguay/716/2007) – B/Florida/4/2006 -like (B/Yamagata lineage–also B/Brisbane/3/2007)

Phylogenetic analysis of H 1 N 1 2009 viruses l Common swine ancestor l Homogeneous so far, few differences (nt or aa) in H 1 N 1 2009 viruses l Distinct from previous swine & human swine viruses l Distinct from seasonal H 1 N 1 viruses l Reference and vaccine virus is A/California/7/2009 H 1 Haemagglutinin gene Victoria/2025/09 Port. Moresby/2001/09 Darwin/2001/09 Victoria/2001/09 Darwin/2004/09 Darwin/2001/09 St. Australia/2001/09 Darwin/2008/09 Brisbane/17/09 Victoria/2029/09 Brisbane/2011/09 Victoria/2024/09 Sth. Australia/2002/09 dec Canberra/2006/09 Brisbane/2008/09 Shanghai/1/09 Ohio/7/09 New. York/18/09 e Canada-AB/RV 1532/09 Victoria/2004/09 Philippines/2003/09 Philippines/2009/09 Victoria/2004/09 c Auckland/1/09 Mexico/4482/09 e Auckland/4/09 Auckland/3/09 Auckland/2/09 Perth/29/09 c Korea/01/09 Philippines/2001/09 c England/195/09 Palau/1/09 Mexixo/4176/09 Osaka/1/09 Texas/05/09 New. Jersey/02/09 Christchurch/2/09 Philippines/2006/09 California/07/09 California/04/09 Wisconsin/10/98 sw/Ohio/891/01 H 1 N 2 sw/Indiana/9 K 035/99 H 1 N 2 Philippines/344/04 H 1 N 2 sw/Iowa/31483/88 New. Jersey/8/76 Thailand/271/05 Brisbane/1/09 Townsville/1/09 Brisbane/13/09 Brisbane/59/07 Perth/1/09 Darwin/8/08 Brisbane/12/09 Sydney/601/09 Sth. Australia/28/08 Guam/1/07 Malaysia/213/08 Solomon. Islands/3/06 New. Caledonia/20/99 Swine H 1 N 1 2009 Vaccine Swine H 1 N 1/H 1 N 2 1976 -2005 Seasonal H 1 N 1 1999 -2009

Few antigenic differences in H 1 N 1 2009 (by HI or virus neutralization assays) Virus Ferret sera Brisb Cal 7 Auck A/Brisb/59/2007 H 1 seasonal 640 <80 <20 A/Cal/7/2009 H 1 N 1 pandemic <20 640 320 A/Auck/1/2009 H 1 N 1 pandemic <20 1280 320 A/Perth/36/2009 <20 2560 640 A/Brisbane/51/2009 <20 2560 640 A/Canberra/2023/2009 <20 1280 320 A/Darwin/2003/2009 <20 640 320 A/Tasmania/2002/2009 <20 1280 640 A/Victoria/2022/2009 <20 640 320 All H 1 N 1 2009 viruses similar to the vaccine strain A/California/7/2009

vaccine strain e: egg isolate HI reference antigen February 2009 March 2009 April 2009 May 2009 June 2009 Victoria/505/09 Sydney/31/08 6/09 Sydney/25/09 6/09 Sydney/45/09 6/09 Guam/2/09 5/09 Guam/1/09 5/09 Chuuk/3/09 6/09 Johannesburg/883/09 6/09 Cape. Town/783/09 5/09 Perth/26/09 5/09 Port. Moresby/9/09 6/09 Pt. Moresby/2/09 6/09 Malaysia/542/09 3/09 Philippines/40/09 4/09 Malaysia/788/09 5/09 PHILIPPINES/16/09 3/09 Philippines/5/09 3/09 Malaysia/614/09 Perth/15/09 4/09 I 214 S PERTH/16/09 e 4/09 Perth/14/09 Brisbane/52/09 5/09 Singapore/34/09 6/09 I 260 M Singapore/39/09 Victoria/209/09 e 6/09 3/09 Darwin/7/09 6/09 R 261 Q Singapore/22/09 3/09 Johannesburg/1006/09 Western. Sepik/109/09 6/09 Victoria/206/09 Malaysia/720/09 5/09 Brisbane/14/09 2/09 Victoria/231/08 10/08 Sth. Australia/59/08 10/08 Victoria/542/08 12/08 Singapore/619/08 11/08 Sydney/301/09 2/09 Philippines/3688/08 11/08 Taiwan/724/09 Perth/13/09 Singapore/32/09 3/09 Durban/863/09 6/09 Johannesburg/753/09 6/09 Perth/109/08 res 9/08 Sydney/29/08 8/08 Singapore/631/08 12/08 Sri. Lanka/21/08 5/08 Darwin/1/08 res 8/08 Auckland/121/08 8/08 Sydney/31/08 7/08 Waikato/6/08 5/08 res Tasmania/4/08 res 6/08 Victoria/530/08 10/08 New. York/09/08 cdc 4/08 Philippines/3803/08 11/08 Victoria/500/08 Sydney/602/09 Sydney/603/09 2/09 Montana/02/08 cdc 12/08 Townsville/2/09 Darwin/7/08 10/08 Victoria/502/09 res 1/09 SURATTHANI/72/09 Macau/1343/08 7/04 Tasmania/201/08 9/08 Virginia/4/07 e 1/08 BRISBANE/24/08 e 6/08 Thailand/519/08 5/08 Perth/201/08 e 7/08 Thailand/508/08 5/08 K 173 Q Cambodia/3/08 res Thailand/561/08 6/08 Singapore/215/08 Singapore/21/08 Philippines/1713/08 4/08 Taiwan/471/08 niid 4/08 Victoria/500/09 1/09 Wisconsin/3/07 e cdc 1/07 URUGUAY/716/07 e cdc Malaysia/0032/0 res 9 1/09 Thailand/563/08 res 6/08 G 50 E Singapore/241/08 6/08 Malaysia/306/08 K 140 I BRISBANE/10/07 e 2/07 PERTH/27/07 BRISBANE/9/06 e 6/06 sen Nepal/921/06 e 7/06 sen S 193 F Thailand/31/07 sen D 225 N Brisbane/4/07 e 1/07 res WISCONSIN/67/05 e res California/7/04 9/04 sen NEWYORK/55/04 11/04 V 213 A E 62 K K 158 N N 189 K A/Perth/16/2009 -like N 144 K T 212 A H 3 HA genes A/Uruguay/617/2007 A/Brisbane/10/2007

Summary l Australia, NZ and other Sth Hemisphere countries dominated by Pandemic H 1 N 1 l Outbreaks have been short/sharp but cases still persist in most countries l Children & young adults most infected l Disease has been relatively mild but has affected some groups disproportionally eg. Pregnant women, aboriginals, obese patients l Pandemic H 1 N 1 viruses very similar to A/California/7/2009 reference/vaccine virus l Emergence of a H 3 N 2 variant – A/Perth/16/2009 -like l WHO Sth Hem. Formulation meeting in Melbourne 18 -23 Sept. 2009, followed by 5 th AIS 24 -25 Sept.

Melbourne WHO Influenza Centre Staff and collaborators Other collaborators Heath Kelly Paul Selleck Deb Middleton Sue Lowther Lori Brown Steve Rockman Peter Schoofs Phil Franchina Malik Peiris Wilina Lim Other CC’s Other Labs WPRO VIDRL AAHL UM CSL CSL HKU HK PKL NIC’s NHMRC Do. HA