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Influenza SurveillanceCountry, Territoryand Area Profiles

2017

December 2017

© World Health Organization 2017

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Influenza surveillance profiles

© World Health Organization, 2017. All rights reserved. December 2017i

ContentsData......................................................................................................................................................... iii

Abbreviations ....................................................................................................................................... iii

Source................................................................................................................................................... iii

Notes....................................................................................................................................................... iv

Albania ..................................................................................................................................................... 1

Armenia ................................................................................................................................................... 2

Austria...................................................................................................................................................... 3

Azerbaijan ................................................................................................................................................ 4

Belarus ..................................................................................................................................................... 5

Belgium .................................................................................................................................................... 6

Bosnia and Herzegovina .......................................................................................................................... 7

Bulgaria .................................................................................................................................................... 8

Croatia...................................................................................................................................................... 9

Cyprus .................................................................................................................................................... 10

Czech Republic....................................................................................................................................... 11

Denmark ................................................................................................................................................ 12

Estonia ................................................................................................................................................... 13

Finland ................................................................................................................................................... 14

France .................................................................................................................................................... 15

Georgia................................................................................................................................................... 16

Germany ................................................................................................................................................ 17

Greece.................................................................................................................................................... 18

Hungary.................................................................................................................................................. 19

Iceland.................................................................................................................................................... 20

Ireland.................................................................................................................................................... 21

Israel ...................................................................................................................................................... 22

Italy ........................................................................................................................................................ 23

Kazakhstan............................................................................................................................................. 24

Kyrgyzstan.............................................................................................................................................. 25

Latvia...................................................................................................................................................... 26


December 2017 © World Health Organization, 2017. All rights reserved.ii

Lithuania ................................................................................................................................................ 27

Luxembourg ........................................................................................................................................... 28

Malta...................................................................................................................................................... 29

Montenegro........................................................................................................................................... 30

Netherlands ........................................................................................................................................... 31

Norway................................................................................................................................................... 33

Poland .................................................................................................................................................... 35

Portugal.................................................................................................................................................. 36

Republic of Moldova.............................................................................................................................. 37

Romania................................................................................................................................................. 38

Russian Federation ................................................................................................................................ 40

Serbia ..................................................................................................................................................... 41

Slovakia .................................................................................................................................................. 42

Slovenia.................................................................................................................................................. 43

Spain ...................................................................................................................................................... 44

Sweden .................................................................................................................................................. 45

Switzerland ............................................................................................................................................ 46

Tajikistan................................................................................................................................................ 47

The former Yugoslav Republic of Macedonia........................................................................................ 48

Turkey .................................................................................................................................................... 49

Turkmenistan......................................................................................................................................... 50

Ukraine................................................................................................................................................... 52

United Kingdom ..................................................................................................................................... 53

England................................................................................................................................................ 53

Northern Ireland ................................................................................................................................. 54

Scotland............................................................................................................................................... 55

Wales................................................................................................................................................... 55

Uzbekistan ............................................................................................................................................. 57


© World Health Organization, 2017. All rights reserved. December 2017iii

Data

Abbreviations

ARI Acute respiratory infection

ECDC European Centre for Disease Prevention and ControlGP General practitioner/general practice

HMO Health maintenance organization (Israel)

ICPC International Classification of Primary CareICU Intensive care unitILI Influenza-like illnessNHS National Health Service (United Kingdom)NIC National Influenza CentrePAHO Pan American Health OrganizationPCR Polymerase chain reactionPHE Public Health EnglandRSV Respiratory syncytial virusSARI Severe acute respiratory infectionWHO World Health Organization

SourceThe data in these profiles were submitted by the country, territory or area during the period July to August 2017 andare presented here unedited.


December 2017 © World Health Organization, 2017. All rights reserved.iv

NotesI. These profiles include only details of national surveillance systems which provide data to The European Surveillance System (TESSy)

and used in the drafting of the joint European Centre for Disease Prevention and Control (ECDC)–WHO Regional Office for Europeinfluenza bulletin, Flu News Europe (https://flunewseurope.org/).

II. Mid-year population estimates are based on 2015 data, according to the WHO Regional Office for Europe’s European Health for Alldatabase (http://data.euro.who.int/hfadb).

III. Income group is based on the World Bank list of economies (June 2017) (http://data.worldbank.org/about/country-and-lending-groups).

IV. The type of surveillance can be defined as: 1. sentinel; 2. universal; or 3. non-sentinel.(http://www.euro.who.int/__data/assets/pdf_file/0020/90443/E92738.pdf?ua=1)

1. A sentinel surveillance system is formed by one or more designated health care facilities or providers that routinely and consistentlycollect epidemiological information from patients presenting with an illness consistent with a specified case definition.Representative clinical specimens are collected from all or a subset of patients according to a randomized/standardized samplingprotocol. Sentinel surveillance systems provide an efficient way to obtain high‐quality data on relatively common conditions from amanageable number of locations. Each sentinel site should include facilities that together represent the population undersurveillance.

2. A universal surveillance system is formed by all designated health care facilities or providers in a country, territory or area. Thisgenerally includes reporting of all clinician‐defined “ARI” and is part of the national disease surveillance systems of several MemberStates in the WHO European Region. These universal systems provide subnational resolution of clinician‐reported respiratory diseaseactivity.

3. A non-sentinel surveillance system includes other types of surveillance system (e.g. laboratory surveillance), which do not meet thedefinition of the other two types of system. Non-sentinel surveillance generally refers to viruses reported from/detected in patientsfrom non-sentinel surveillance systems. In the WHO European Region, this includes viruses from clinical diagnostic laboratories,outbreaks, or universal ARI surveillance systems that do not have randomized/ standardized sampling strategies.

The most common case definitions can be found in the table below:

ILI

ECDCSudden onset of symptoms and at least one of the following four systemic symptoms: fever or feverishness,malaise, headache, myalgia and at least one of the following three respiratory symptoms: cough, sore throat orshortness of breath.

WHO <2011 Sudden onset of fever >38 C° AND cough OR sore throat in the absence of other diagnosis.WHO 2011 An acute respiratory illness with onset during the last 7 days with, measured temperature ≥ 38°C, AND cough.WHO 2014 An acute respiratory infection with: measured fever of ≥ 38 C° and cough; with onset within the last 10 days.

ARI ECDC, WHO Sudden/acute onset of at least one of the following four respiratory symptoms: cough, sore throat, shortness ofbreath, coryza; and a clinician’s judgement that the illness is due to an infection.

SARI

WHO <2011

Onset of the following symptoms ≤7 days prior to hospital admission: Fever >38°C AND cough OR sore throatAND shortness of breath or difficulty in breathing. For children aged <5 years the IMCI case definition forpneumonia and severe pneumonia is applied.*

WHO 2011An acute respiratory illness with onset during the previous 7 days requiring overnight hospitalization thatincludes: history of fever or measured fever of ≥ 38°C, AND cough, AND shortness of breath or difficultybreathing.

WHO 2014 An acute respiratory infection with: history of fever or measured fever of ≥ 38 C°; and cough; with onset withinthe last 10 days; and requires hospitalization.

*Pneumonia: cough OR difficulty in breathing AND breathing faster than 40 breaths/minute (12 – 59 months); breathing faster than 50breaths/minute (2 – 11 months); Severe pneumonia: cough OR difficulty in breathing AND any of the following general severe signs: unable todrink or breastfeed OR vomits everything OR convulsions OR lethargy or unconsciousness OR chest in drawing or stridor in a calm child.”

https://flunewseurope.org/

http://data.euro.who.int/hfadb

http://data.worldbank.org/about/country-and-lending-groups

http://data.worldbank.org/about/country-and-lending-groups

http://www.euro.who.int/__data/assets/pdf_file/0020/90443/E92738.pdf?ua=1


© World Health Organization, 2017. All rights reserved. December 20171

AlbaniaTotal population: 2 889 173 Income group: upper middle

Systemcharacteristic

Primary care Hospital Non-sentinelInfluenza-like

illness (ILI)Acute respiratory

infection (ARI)Severe acuterespiratory

infection (SARI)

Laboratory-confirmedinfluenza

Surveillance type Sentinel Universal Sentinel Virological surveillancefrom other hospitals inthe country

Populationcovered (%)

6% 100% 62% 38%

Type of healthfacilities/hospitals

Pediatric practice,general practice,polyclinic

General practice,paediatric practices,polyclinic, emergencydepartment

8 regional hospitals, 2university hospitalcentres (paediatrichospital, infectiousdiseases hospital), 1lung hospital

District hospitals

Number of healthfacilities/hospitals

11 hospitals 27 hospitals

Case definitionused

WHO 2014 ECDC, WHO WHO 2014 WHO 2014

Year introduced 2009 1999 2009 2009

Epidemicthreshold

No Yes No No

Sampling strategy Sampling is performedin 2 polyclinics inTirana. The first 5patients (on Tuesdaysand Thursdays) aresampled at eachpolyclinic. Samplingoccurs in bothpaediatric and adultpatients.

Sampling occurs whenthere is an increase incases in differentdistricts or age groupsand in outbreaks.

All SARI cases aresampled at all times(24hrs/7 days a week).

SARI cases

See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.


December 2017 © World Health Organization, 2017. All rights reserved.2

ArmeniaTotal population: 3 017 712 Income group: lower middle





infection (SARI)


Surveillance type Sentinel Universal Sentinel Laboratory-confirmedinfluenza. This includesinfluenza-confirmedARI from universalsurveillance.


100%


Polyclinic General practice,polyclinic

Intensive care unit,general/internalmedecine, paediatricmedicine, mother careinstitute


6 facilities All medical facilities 9 hospitals

Case definitionused

WHO 2014 ECDC, WHO WHO 2014 Laboratory-confirmedinfluenza


Epidemicthreshold

No Yes No No

Sampling strategy All cases are includedin the samplingstrategy

A small number of ARIcases are sampled andtested for influenza (2per week)

All cases are includedin the samplingstrategy




AustriaTotal population: 8 544 586 Income group: high





infection (SARI)


Surveillance type Sentinel Virological samples arecollected fromhospitals andunaffiliated physicians.


0.5-1%


General practice,paediatric practice

Paediatricians,paediatric clinic,infectious diseasehospital outpatientdepartment andinfectious diseasehospital department.


50 facilities

Case definitionused

ECDC ECDC

Year introduced 2000/2001 1952

Epidemicthreshold

Yes No

Sampling strategy Strategy is to collect 3-5 specimens per weekper sentinel site.

No sampling strategy.Physicians takenasopharyngeal swabsfor diagnosticpurposes.




AzerbaijanTotal population: 9 649 300 Income group: upper middle





infection (SARI)


Surveillance type Sentinel System in place, butnot reported to TESSy

Sentinel


20% 2.9%


Paediatric practice,polyclinic

Infectious diseaseward, pulmonary ward


16 facilities 2 hospitals

Case definitionused

WHO <2011 WHO <2011

Year introduced 2009 2009

Epidemicthreshold

Yes No

Sampling strategy Every 3rd patient issampled. All agegroups are sampled.

Every 3rd patient issampled. All agegroups are sampled.




BelarusTotal population: 9 495 826 Income group: upper middle





infection (SARI)


Surveillance type Sentinel Sentinel Sentinel Virological surveillancein all hospitals forsevere cases fordiagnostics andtreatment.


5.2% 50% 30% 100%


Paediatric practice,polyclinic

General practice,paediatric practice,polyclinic, emergencydepartment, infectiousdisease department.

Intensive care unit,general therapeutic,paediatric, obstretricsand gynecology,infectious disease,pulmonaryhospitals/wards.

Intensive care unit,general therapeutic,pediatric, obstretricsand gynecology,infectious disease,pulmonaryhospitals/wards.


13 facilities 189 facilities 11 hospitals

Case definitionused

WHO 2014 ECDC, WHO WHO 2014


Epidemicthreshold

No No No No

Sampling strategy In the epidemic period,10 specimens arecollected per week byage group in each site.In the non-epidemicperiod, 10 specimensare collected per 2weeks by each agegroup in each site.

In the epidemic period,10 specimens arecollected per week byage group in each site.In the non-epidemicperiod, 10 specimenscollected per 2 weeksby each age group ineach site.

In the epidemic period,10 specimens arecollected per week byage group in each site.In the non-epidemicperiod, 10 specimenscollected per 2 weeksby each age group ineach site.

According to thedecision of the doctor.




BelgiumTotal population: 11 265 834 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel Sentinel Virological surveillancepossible from allgeneral hospitals in thecountry.


1.3% 1.3% Unknown


General Practice General Practice General hospitals (allwards)

General hospitals (allwards)


170 facilities 170 facilities 6 hospitals 117 hospitals

Case definitionused

National National National

Description ofnational casedefinition

Sudden onset of feverwith respiratorysysmptoms ANDgeneral symptoms.

Acute respiratoryinfection of the upper,medium or lowerrespiratory tract(including commoncold, rhinitis,(rhino)pharyngitis,angina, sinusitis, otitis,laryngitis, (laryngo)-tracheitis, bronchitis,bronchiolitis and(bronco)pneumonia)without influenzasyndrome.

Slightly adapted fromthe case definitionproposed in WHOguidance: an acuterespiratory illness withonset within the last 7days of history of fever,or measured fever of ≥38°C, and cough ordyspnoea (shortness ofbreath or difficulty tobreath) and requiringhospitalization (24h ormore).

Samples from patientspresenting with severeinfluenza in particularspecific conditions:ARDS (acuterespiratory distresssyndrome), ECMO(extracorporealmembraneoxygenation), death,suspicion of antiviralresistance, returningfrom abroad or in caseof outbeaks.

Year introduced 1985 1985 2011-2012 2011-2012

Epidemicthreshold

Yes No No No

Sampling strategy The first 2 ILI cases in aweek seen by the GP.

All hospitalisedpatients meeting thecase definition aresampled.

Only cases frompatients with severesuspected influenza.




Bosnia and HerzegovinaTotal population: 3 810 416 Income group: upper middle





infection (SARI)


Surveillance type Universal Universal Universal


100% 100% 100%


General practice,paediatric practice,polyclinic, emergencydepartment.

General practice,paediatric practice,polyclinic, emergencydepartment.

University clinicalcentres, generalhospitals (ICUs,paediatric wards,infectious diseasewards, respiratorydisease wards).


135 facilties: 52facilities (Republic ofSrpska); 79 facilities(Federation of Bosniaand Herzegovina); 4facilities (Brcko districtof Bosnia andHerzegovina).

135 facilities: 52facilities (Republic ofSrpska); 79 facilities(Federation of Bosniaand Herzegovina); 4facilities (Brcko districtof Bosnia andHerzegovina).

30 hospitals: 10hospitals (Republic ofSrpska); 19 hospitals(Federation of Bosniaand Herzegovina); 1hospital (Brcko Districtof Bosnia andHerzegovina).

Case definitionused


Year introduced 2009 (Federation ofBosnia andHerzegovina, Republicof Srpska, Brcko Districtof Bosnia andHerzegovina)

2009 (Federation ofBosnia andHerzegovina, Republicof Srpska, Brcko Districtof Bosnia andHerzegovina)

2009 (Federation ofBosnia andHerzegovina, BrckoDistrict of Bosnia andHerzegovina); 2013(Republic of Srpska)with current WHO casedefinition.

Epidemicthreshold

No No No

Sampling strategy FBIH, Brcko District: nosampling strategy,universal surveillancedepending on theavailability andcapacity of thereference laboratory.Republic of Srpska:sampling strategy is 1case every week at thesentinel site.

No samples collected. FBIH: all SARI cases aresampled at all times(24 hrs/7 days a week),depending on theavailability andcapacity of thereference laboratory.Republic of Srpska:sampling strategy is 1case every week at thesentinel site.




BulgariaTotal population: 7 149 787 Income group: upper middle





infection (SARI)


Surveillance type Sentinel Virological surveillancefrom 40 hospitals in thecountry.


5.38%


General practices General practices,polyclinics, intensivecare/critical care units,infectious diseasehospital and wards,paediatric hospital andwards, pulmonarywards, and generalhospitals.



Case definitionused

ECDC, WHO ECDC - ILI and ARI casedefinition


Epidemicthreshold

Yes No

Sampling strategy Not available According to thedecision of the doctor.Laboratory-confirmedinfluenza cases arereported.




CroatiaTotal population: 4 240 317 Income group: upper middle





infection (SARI)


Surveillance type Universal System in place, butnot reported to TESSy


100%


General practice,paediatric practice,polyclinic, emergencydepartment, hospitals


Not available. 21counties collect datafrom district level

Case definitionused

ECDC

Year introduced 1975

Epidemicthreshold

No

Sampling strategy Patients are sampledbased on the GP's orepidemiologist'sdecision. All age groupsare included. Mostsamples are collectedat the start and duringthe peak of the season.




CyprusTotal population: 853 166 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel No system available Universal


100% 100% 90%


Paediatric outpatientdepartment of publichospital; adultoutpatient departmentof public hospital;office of primary healthcare paediatrician andadult-care physicianpracticing in privatesector.

Paediatric outpatientdepartment of publichospital; adultoutpatient departmentof public hospital;office of primary healthcare paediatrician andadult-care physicianpracticing in PrivateSector

Nearly all hospitals inthe private and publicsector.


54 facilities 54 facilities 9 facilities

Case definitionused

National National


Sudden appearance offever >39°C for at least2 days AND respiratorysymptoms, malaise,myalgia, headache.

Severe acuterespiratory illnessrequiringhospitalizationincluding ICUadmissions withconfirmed virologicalspecimen for influenza.

Year introduced 2003 2003 2013

Epidemicthreshold

No No

Sampling strategy All cases according tothe national casedefinition visiting theobserver at thereporting centre.

All cases according tothe national casedefinition visiting theobserver physician atthe reporting centre.

Universal




Czech RepublicTotal population: 10 542 942 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel Sentinel Virological surveillancefrom non-sentinelsites.


~50% ~50%


General practice,paediatric practice.



2,230 generalpractitioners and 1,240paediatricians.1

2,230 generalpractitioners and 1,240paediatricians.1

Case definitionused

ECDC ECDC, WHO ECDC


Epidemicthreshold

Yes Yes No No

Sampling strategy One sample fromgeneral practice andone sample frompaediatric practice perweek from all regionsare collected duringthe influenza season(week 40-20).

One sample fromgeneral practice andone sample frompaediatric practice perweek from all regionsare collected duringthe influenza season(week 40-20).

Upon request from thenon-sentinel site.


1 Details of number of health facilities were not available.



DenmarkTotal population: 5 678 348 Income group: high





infection (SARI)


Surveillance type Sentinel Data on nationalinfluenza PCR tests areobtained weekly from anational microbiologydatabase. Clinicalmicrobiologicaldepartments athospitals send selectedpositive influenzasamples to the NIC forfurthercharacterization forvirological surveillance.


4% 100%


General practice All


140 facilities All national hospitals,out-patients clinics andGPs.

Case definitionused

National


Sudden onset of fever,muscle pain andrespiratory tractsymptoms.


Epidemicthreshold

Yes No

Sampling strategy GPs are asked to swabthe first 5 ILI patientsthey see. 5 Sample kitsare sent to 1/3 of allGPs at three differentpoints in time duringthe season: before thestart of the season, andjust before and justafter the peak.

There are nationalguidelines for when toswab patients in andoutside hospitalsduring and outside theinfluenza season.




EstoniaTotal population: 1 312 558 Income group: high





infection (SARI)


Surveillance type Sentinel Universal System in place, butnot reported to TESSy

Virological surveillancefrom 3 hospitals in thecountry


13.6% 100%


General practice,polyclinic, familydoctor

General practice,paediatric practice,polyclinic, familydoctor

ICU of central andregional hospitals

2 regional hospitalsand 1 central hospital


16 facilities (80 medicaldoctors)

470 facilities (925medical doctors)

9 hospitals 3 hospitals

Case definitionused

ECDC ECDC, WHO Not available


Epidemicthreshold

Yes Yes No No

Sampling strategy Each sentinel sitecollects up to 10specimens per weekfrom cases that meetthe ECDC casedefinition. All agegroups are included.




FinlandTotal population: 5 503 457 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel Universal Universal


About 50% About 50% Not known. All ICUs inFinland are included;specimens arecollected on sentinelbasis.

100%


General practice General practice Intensive care unit All hospitals andoutpatient clinics


About 150 health carecentres report ILI-visits,11 of them also collectvirological specimens.10 health care centresof garrisons collectvirological specimens.

About 150 health carecentres report ARI-visits, 11 of them alsocollect virologicalspecimens. 10 healthcare centres ofgarrisons collectvirological specimens.

11 intensive care units

Case definitionused

ECDC ECDC, WHO ARI treated in intensivecare unit

No case definition used


Epidemicthreshold

No No No No

Sampling strategy Up to 5 specimens arecollected per week.

Up to 5 specimens arecollected per week.

Defined on clinicalbasis. All ICUs areasked to send 5-10clinical samples frompatients with clinicallysuspected influenzainfection that requireintensive care.

Defined on clinicalbasis.




FranceTotal population: 64 395 344 Income group: high





infection (SARI)


Surveillance type Sentinel No system available No system available Universal Virological surveillancefrom 44 hospitals.


0.7% ~100%


General practice Intensive care unit General hospitals


363 (including 96paediatricians)1

44 hospitals

Case definitionused

National Laboratory-confirmedinfluenza and casesdiagnosed as influenzaby the clinician.

No case definition used


Sudden onset of fever>39°C with respiratorysymptoms and myalgia.


Epidemicthreshold

No No No

Sampling strategy First ILI case of theweek.

Virtually all. No sampling strategy.All samples taken fromin-patients fordiagnosis of influenza.





GeorgiaTotal population: 3 727 000 Income group: lower middle





infection (SARI)


Surveillance type Sentinel Sentinel Virological testing isperformed for unusualcases of SARI.


1.7%


General practice,paediatric practice,polyclinic.

Children's hospital inTbilisi and Kutaisisentinel sites. Wardsincluded are: intensivecare unit, internalmedecine, paediatric,maternity, infectiousdisease, respiratorydisease,therapeutic/chronicdisease.

Hospitals in Batumi,Akhaltsikhe and Zugdid(virological surveillanceonly).


1 facility 5 hospitals

Case definitionused

WHO 2014 WHO 2014 PAHO/WHO 2014,unusual SARI


Epidemicthreshold

No No No

Sampling strategy Every 3rd ILI patient onTuesday and Thursday

Every SARI patient onTuesday and Thursday

Every unusual case ofSARI




GermanyTotal population: 80 688 544 Income group: high





infection (SARI)


Surveillance type Sentinel Virological samplessent to the NIC fromnon-sentinel sources


>1%




650 facilities

Case definitionused

National


Patients withpharyngitis, bronchitisor pneumonia (with orwithout fever)


Epidemicthreshold

No No

Sampling strategy Specimens collectedfrom the first ILIpatients (using theECDC case definition)per week in differentage groups.




GreeceTotal population: 10 954 617 Income group: high





infection (SARI)


Surveillance type Sentinel No system available Universal Universal Virological surveilance


~1.5%


Primary health carecenters, NationalOrganisation for theProvision of HealthcareServices (EOPYY)clinics, privatepractitioners.


145 facilities

Case definitionused

ECDC

Year introduced 2004 (revised in 2014)

Epidemicthreshold

No

Sampling strategy Sampling plan for2017-2018: all agegroups, at sentinelphysician’s discretion.




HungaryTotal population: 9 855 023 Income group: high





infection (SARI)


Surveillance type Sentinel Virological surveillance


>20%



Hospitals


~1400 facilities

Case definitionused

ECDC


Epidemicthreshold

Yes No

Sampling strategy Doctors are advised tocollect 2 specimens ofILI patients per weekper site

Diagnostic purposes




IcelandTotal population: 330 814 Income group: high





infection (SARI)



System in place, butnot reported to TESSy

Universal


100% 100%


General practice,emergencydepartment, long termcare, selected privatepractitioners.

All health care facilities


94 facilities

Case definitionused

National ECDC


ICD-10 codes J09, J10and J11 with subcodes


Epidemicthreshold

Yes No

Sampling strategy No sampling strategy,sampling is done onclinical suspicion fordiagnostic purposes.

No sampling strategy.




IrelandTotal population: 4 635 400 Income group: high





infection (SARI)


Surveillance type Sentinel Universal All respiratoryspecimens referred tothe National VirusReference Laboratoryare tested forinfluenza.


6.2% 100%


General practice All acute hospitals Mainly hospitals andsome GPs (excludingsentinel GPs)


61 facilities 58 acute care publicand private hospitals

Case definitionused

ECDC Laboratory-confirmedinfluenza


Year introduced 2000 2009 (all ages);2003 (age 0-14)

2000

Epidemicthreshold

Yes No No

Sampling strategy One ILI patient perweek is sampled byeach of the sentinelGPs. For sentinel GPsparticipating in theIMOVE study: up to 5ILI patients per weekaged <65 years and allpatients aged ≥65 yearsshould be tested.

All cases reported All cases reported




IsraelTotal population: 8 064 036 Income group: high





infection (SARI)


Surveillance type Sentinel Virological surveillancefrom one hospital inthe country.


25%


General practice,paediatric practice.Community clinics ofthe 2nd largest HMO inthe country.

Tertiary medical centre


26 clinics - this isrelated to laboratorysurveillance only.

1 hospital

Case definitionused

National Hospitalized ARI cases


Acute fever of at least37.8 C accompanied byat least one of thefollowing symptoms:runny nose, sorethroat, cough, myalgia.

Year introduced 2000 2012/2013

Epidemicthreshold

Yes No

Sampling strategy Convenience sampling.Swabs are taken fromsome ILI cases. Swabsare taken on the first orsecond day of illness.

Hospitalized cases withARI.




ItalyTotal population: 60 697 504 Income group: high





infection (SARI)


Surveillance type Sentinel Universal Universal


2% 100% 100%



Hospitals Hospitals



Case definitionused

ECDC National National


Every hospitalizedpatient in ICU and/or inECMO with SARI(according to the WHO2011 case definition)and/or ARDSsymptoms is eligible.Only the positive casesfor any of the influenzaviruses are reported.

Hospitalized patientswith ILI and/or ARDSsymptoms.


Epidemicthreshold

Yes No No

Sampling strategy All age groups areincluded in thesampling.

All cases hospitalized inICU and/or in ECMOwith SARI and ARDSsymptoms.

All cases hospitalizedwith ILI and/or ARDSsymptoms are includedin the sampling.




KazakhstanTotal population: 17 544 126 Income group: upper middle





infection (SARI)


Surveillance type Sentinel Universal Sentinel


9.4% 100%


Paediatric polyclinic,adult polyclinic

Paediatric practice,polyclinic, infectiousdisease hospital, publichospitals, pulmonarydepartment

General/internal,paediatric, infectiousdisease ward



Case definitionused

National WHO 2011


Cases of acuterespiratory viraldiseases accompaniedby fever > 38°C andcough, which areobserved at least oncewithin 7 days from theonset of the disease.


Epidemicthreshold

No Yes No

Sampling strategy Sampling is carried outon a weekly basis frompatients with ILI (age >1 year) and onset ofillness <72 hours), allage groups.

Monthly from at least10 patients with ARVI,influenza, with clearclinical symptomsduring pre-epidemicand epidemic seasonsof ARVI and influenzamorbidity.

Sampling is carried outon SARI patients (age >1 year) and onset ofillness <72 hours, forpersons >18 years notmore than 7 days fromthe onset of thedisease. Samples takenfor max. 1 patient perday from each agegroup.




KyrgyzstanTotal population: 5 957 271 Income group: lower middle





infection (SARI)


Surveillance type Sentinel Universal Sentinel Sentinel


2.8% 100% 1.5% M (26%)


General practice,Polyclinic

General practice,Polyclinic

Intensive care unit,Infectious diseaseward, Pulmonary ward



Case definitionused

WHO <2011 ECDC, WHO WHO <2011


Epidemicthreshold

No Yes No

Sampling strategy At least 3 patients ineach age group whomeet the standard casedefinition criteria aresampled each week.

Laboratoryexamination ofpatients is not carriedout.

At least 3 patients ineach age group whomeet the standard casedefinition criteria aresampled each week.




LatviaTotal population: 1 970 503 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel Virological surveillancemainly from hospitalsand also outpatientfacilities in the country


5.4% 5.4%


General/paediatricpractice

General/paediatricpractice

Any type of hospitalsand outpatient facilities


70 GPs1 70 GPs1

Case definitionused

ECDC ECDC, WHO ECDC


Epidemicthreshold

Yes Yes No

Sampling strategy Preferably ILI cases aresampled, including allage groups; 50-100specimens per seasonmainly in Riga (capital).

Mainly ILI cases aresampled and very fewARI cases. There is nopredefined standardsampling strategy.

Hospitalised severe ILIcases are sampled atany time (24 hrs/7 daysper week).





LithuaniaTotal population: 2 878 405 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel


2.5% 2.5%


General practitioner General practitioner


97 medical doctors1 97 medical doctors1

Case definitionused

ECDC No case definition used


Epidemicthreshold

Yes Yes

Sampling strategy All cases are included. On Tuesday accordingto medical doctor'sdecision.





LuxembourgTotal population: 567 110 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel The laboratoryprovides routinevirology results tointerested physisicans.


3% 3%


Private GP practices Private GP practices GPs, pediatricians,pneumologist, neo-natalogist.


15 facilities 15 facilities

Case definitionused

ECDC ECDC, WHO


Respiratory symptomsAND sudden fever>38.0 degrees CelciusAND myalgia


Epidemicthreshold

Yes No No

Sampling strategy All patients aresampled in principle

No systematic samplingfor ARI cases




MaltaTotal population: 418 670 Income group: high





infection (SARI)


Surveillance type Sentinel Virological data fromhospitalized SARI casesand other patientsadmitted withrespiratory symptomsat the single statehospital from somerespiratory physicians.

Populationcovered (%)Type of healthfacilities/hospitals

General practice forsentinel (public andprivate)

Main state hospital


One large health carecentre and 7 private GPclinics

1 state hospital

Case definitionused

WHO 2014 WHO 2014


Epidemicthreshold

No No

Sampling strategy Patients that accept tohave a specimen taken.

At discretion of thehospital respiratoryphyscian orpaediatrician.




MontenegroTotal population: 625 781 Income group: upper middle





infection (SARI)


Surveillance type Universal Universal


100% 100%


General practice,paediatric practice,polyclinic

General hospitals,Clinical Centre ofMontenegro


29 health facilities 8 hospitals

Case definitionused

ECDC WHO 2011


Epidemicthreshold

No No

Sampling strategy Limited virologicaldiagnostics performed

All SARI cases aresampled at all times




NetherlandsTotal population: 16 924 928 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel 1) Peripheral andhospital laboratorysurveillance ofinfluenza. 2) Virologicalsurveillance of RSVfrom 21 laboratories inthe country.


0.8% 1) ARI syndrome: 7%2) ARI virology: 0.75%


General practice 1) ARI syndrome:General practice.2) ARI virology: Generalpractice; same networkas sentinel ILI.

Virology laboratories


40 facilities 1) 280 facilities2) 40 facilities

1) 21 laboratories2) 24 laboratories

Case definitionused

National National 1) All influenza virus-positive and RSV-positive laboratoryresults.2) Depending onlaboratory, all orsubset of influenzavirus-positive results.


Acute onset AND rectaltemperature >38°CAND at least one of thefollowing symptoms:cough, coryza, sorethroat, frontalheadache, retrosternalpain, myalgia

1) ICPC codes R74, R75,R77, R78, R802) any ARI other thanILI

Based on diagnosticrequests fromphysicians, no specificcase definition.

Year introduced 1970; testing ofspecimens introducedin 1994

1) 20152) 1994

1) 19642) 1948

Epidemicthreshold

Yes No No







infection (SARI)


Sampling strategy All ILI patients ≥65years and first two ILIpatients <65 yearspresenting Monday-Wednesday. If thereare no ILI patientsMonday -Wednesday,then the first two ILI orARI patients presentingThursday -Sunday. Inabsence of ILI cases,samples are collectedfrom ARI cases.

1) No sampling,syndromic surveillanceonly.2) See ILI surveillance.

Based on diagnosticrequests fromphysicians, no nationalsampling strategy.




NorwayTotal population: 5 210 967 Income group: high





infection (SARI)



No system available System in place, butnot reported to TESSy

Universal reporting oflaboratory confirmedinfluenza bylaboratories. Mostdetections or fromhospitalized cases, andsome are from primarycare.


100% 100%


All general practicesand emergency clinicsin primary health care.

Medical microbiologylaboratoriesperforming influenzavirus diagnostics.


About 5600 medicaldoctors report data. 1

17 laboratories

Case definitionused

National National National National


ICPC-2 diagnosis code"R80 Influenza" wherean ILI case is definedas:Myalgia and coughwithout abnormalfindings upon airwayexamination exceptinflammation of nasalmucosa and throat,plus three or more ofthe following:-sudden onset ofsymptoms (within 12hours)- fever, chills orfeverishness- malaise and fatigue- influenza in thecommunity- ongoing influenzaepidemic- laboratory confirmedinfluenza

Hospitalized ANDlaboratory-confirmedinfluenza

Laboratory confirmedinfluenza








infection (SARI)


Year introduced 2014 (the currentsystem). Prior to thisthere was a sentinelsystem for ILI thatstarted in 1998; beforethat clinical influenzawas notifiable(aggregated).

2017 1980s

Epidemicthreshold

Yes No

Sampling strategy 82 general practicesand primary careemergency wards areparticipating in thevoluntary network ofinfluenza sentinelpractices coordinatedby the NIC. These sendin ILI patient specimensall year round, basedon WHO 2014 casedefinition.

Medical microbiologylaboratories thatperform influenza virusdiagnostics reportweekly all detections,by type and subtype,with testingdenominators by agegroup (0-4, 5-14, 15-24,25-59, >60).These labs also submitinfluenza positivespecimens to NIC, eachup to five samples pertype per week plusspecial cases (severe,unusual circumstances,suspicion ofresistance).




PolandTotal population: 38 454 576 Income group: high





infection (SARI)


Surveillance type Sentinel Virological surveillancefrom all hospitals andall non-sentinel GPs inthe country.


19% 100%


General practice General practice andhospitals


625 facilities

Case definitionused

ECDC ECDC


Epidemicthreshold

No No

Sampling strategy It is advised to collectspecimens 7 days aweek (by age andsentinel site). Thesampling procedure isthe same in the wholeseason - all cases andall age groups areincluded.

There is no nationalsampling strategy.Sampling is based onthe doctors' decision.




PortugalTotal population: 10 349 803 Income group: high





infection (SARI)



Laboratory surveillancebased on emergencyunits and hospitals(laboratory network) inthe Portugal mainlandand Atlantic islands.


2.1% 300 beds Not known


General practice ICU/hospitals Hospitals, EmergencyUnits


125 generalpractitioners1

30 ICU/24 hospitals 111 Emergency Units +19 Hospitals(laboratory network)

Case definitionused

ECDC National ECDC


Hospitalized influenza-confirmed cases

Year introduced 1989 2011-2012 1989: Emergency Units.2009: Hospital(Laboratory Network)

Epidemicthreshold

Yes No No

Sampling strategy Samples are collectedfrom ILI cases, from GPpatient list, all ages,and during the wholeseason.

Once a week(Wednesdays) the ICUsends information oncases admitted to ICUduring the previousweek with laboratoryconfirmation forinfluenza. All cases andall age groups areincluded in thesampling; the samesampling procedure isused during the entireseason.

Laboratory basedsurveillance. All casesare sampled. Casessampled fit the ECDCcase definition and/orthe clinician's decision.





Republic of MoldovaTotal population: 4 068 897 Income group: lower middle





infection (SARI)


Surveillance type Sentinel Sentinel Sentinel Health facilities notcovered by sentinelsurveillance.


11% 11% 43% 57%


Polyclinic Polyclinic Intensive care unit,general/internalmedicine, paediatricmedicine, infectiousdisease and respiratorydisease ward,therapeutic/chronicdisease ward.

Intensive care unit,general/internalmedecine, paediatricmedicine, infectiousdisease and respiratorydisease ward,therapeutic/chronicdisease ward,polyclinic.


10 facilities 10 facilities 17 hospitals 492 facilities

Case definitionused

ECDC ECDC, WHO WHO <2011 ILI: ECDC casedefinition. ARI:ECDC/WHO casedefinition. SARI: WHO<2011 case definition.

Year introduced 2004 1995 2009 (changed in 2015) 2009

Epidemicthreshold

No Yes No No

Sampling strategy 12 samples arecollected weekly fromthe first patientpresenting with casedefinition symptoms in10 facilities regardlessof the age group.Sampling is performedbetween week 40 andweek 20; outside thisperiod sampling isperformed in case oftheir existence.

12 samples arecollected weekly fromthe first patientpresenting with casedefinition symptoms in10 facilities regardlessof the age group.Sampling is performedbetween week 40 andweek 20; outside thisperiod sampling isperformed in case oftheir existence.

20 samples arecollected weekly frompatients presentingwith SARI symptoms in17 hospitals. Samplingis performed betweenweek 40 and week 20;outside this period,sampling is performedin case of theirexistence.

Any sample collectedfrom patients withsevere evolution of ILI,ARI and SARI, inoutbreaks, patientsfrom high risk groupregardless of age groupand period of the year.




RomaniaTotal population: 19 511 324 Income group: upper middle





infection (SARI)


Surveillance type Sentinel Sentinel Sentinel For ILI/ARI: virologicalsurveillance from allnon-sentinel healthcare providers in thecountry.


2% 2% 20% 98%


General practice General practice Intensive care unit,general/internalmedicine, paediatricmedicine, infectiousdisease ward,respiratory diseaseward.

Hospitals, primaryhealth care practices,specialized medicalpractices,healthcentres, outpatientclinics,emergencyservices providers,home care providers,long term careinstitutions.


192 facilities 192 facilities 20 hospitals around 12000 GPs and10000 other healthfacilities/hospitals

Case definitionused

National ECDC, WHO National Clinical criteria:Fever ≥ 38 °CCoughOnset within the last10 daysIn the absence of otherclinical diagnosis.


ECDC and WHO 2014 An acute respiratoryillness with a history offever or measuredfever of ≥38°C andcough and shortness ofbreath or difficultybreathing, with onsetwithin the past 10days, requiringhospitalizationovernight.

For ILI: WHO 2014

Year introduced 2014 2001 2009 for ILI: 2014

Epidemicthreshold

Yes Yes No No







infection (SARI)


Sampling strategy On Tuesdays fromweek 40 (onset ofinfluenza season)swabs are collectedfrom all casespresented and whomeet the ILI casedefinition. After theonset of the season thealgorithm is establishedby the National Center,according to specificseason parameters.

Depending on theepidemiologicalcontext, ARI cases canbe sampled and testedfor influenza.

From week 46 until theonset of the influenzaseason, the first 3detected SARI cases ineach sentinel hospitalare sampled. Afterthat, only the firstdetected SARI case ineach sentinel hospitalis sampled.

For ILI: there is only asentinel samplingstrategy. Non-sentinel:sampling is done forthe more serious cases,depending on thefunds available forpayment of the tests.




Russian FederationTotal population: 143 456 912 Income group: upper middle





infection (SARI)


Surveillance type Universal Universal Sentinel Virological surveillancefrom a large number ofhospitals andpolyclinics in thecountry.


35% 35% About 17% of thepopulation in the citieswhere sentinel sitesare located.

About 35% of thepopulation


Polyclinic (GP) Polyclinic (GP) Intensive care units,paediatric medicine,infectious disease andrespiratory diseasewards.

Intensive care units,paediatric medicine,infectious disease andrespiratory diseasewards


59 cities (baselabs) 59 cities (baselabs) 19 hospitals (10laboratories confirmedinfluenza by PCR)

58 laboratories

Case definitionused

No case definition used No case definition used WHO 2011


Epidemicthreshold

Yes Yes No No

Sampling strategy The average number ofsamples taken fromILI/ARI patients is 29per week; all agegroups are included.The WHO 2011 casedefinition is used forARI and ILI sentinelsurveillance.

The average number ofsamples taken fromILI/ARI patients is 29per week; all agegroups are included.The WHO 2011 casedefinition is used forARI and ILI sentinelsurveillance.

All SARI cases aresampled. The averagenumber of SARI casessampled is 26 perweek; all age groupsare included.

20-50 samples aretested for influenza perweek. The numberdepends on theepidemiologicalsituation.




SerbiaTotal population: 7 131 787 Income group: upper middle





infection (SARI)


Surveillance type Universal Sentinel Laboratory-confirmedinfluenza cases fromnon-sentinel primarycare and from non-sentinel hospitals.


100% 80%



Intensive care unit,general/internalmedicine, paediatricmedecine, infectiousdisease ward,respiratory diseaseward.



Case definitionused

WHO 2011 WHO 2011


Epidemicthreshold

Yes No

Sampling strategy ILI cases are sampledmostly during the first4 days in the week.

Sentinel SARI cases aresampled mostly duringthe first 4 days in theweek.




SlovakiaTotal population: 5 426 258 Income group: high





infection (SARI)


Surveillance type Universal Universal Universal


52.6% 52.6% 100%




Intensive care unit


88 facilities 88 facilities 74 hospitals

Case definitionused

ECDC ECDC, WHO WHO 2014


Epidemicthreshold

Yes Yes No

Sampling strategy Based on the doctor'sdecision. All cases areincluded in thesampling strategy.

Based on the doctor'sdecision. All cases areincluded in thesampling strategy.

All reported SARI casesare laboratory tested.




SloveniaTotal population: 2 063 077 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel Virological surveillanceof non-sentinel sites


4% 4% 100%


General/familypractices, paediatricpractices, schooldoctors

General/familypractices, paediatricpractices, schooldoctors

Hospitals


45 facilities 45 facilities All facilities/hospitals

Case definitionused

ECDC ECDC, WHO No case definitionused. Most samplesare derived fromhospitalized patientswith ARI, but notexclusively.


Epidemicthreshold

No No No

Sampling strategy Samples are collectedfrom ILI patients. Moreintensive sampling isadvised during thebeginning of theseason. The number ofsamples is not limited.

No samples arecollected from ARIpatients




SpainTotal population: 46 423 064 Income group: high





infection (SARI)


Surveillance type Sentinel Sentinel Influenza-confirmedcases reported fromvirological diagnosticassays in regionalinfluenza laboratories.


2.4% 52%



All wards in mainlypublic general hospitals

Laboratories mainly inpublic hospitals



Case definitionused

ECDC Laboratory-confirmedinfluenza in all wards

Influenza-confirmedcases (no casedefinition used)


Epidemicthreshold

Yes No No

Sampling strategy Samples are collectedfrom the first 2patients who attendthe sentinel facilityduring the week.

All patients who meetclinical criteria ofsevere influenza likeillness who requiredhospitalization(pneumonia/septicshock/ ARDS/multipleorgan dysfunctionsyndrome or admittedto intensive care) aresampled.




SwedenTotal population: 9 799 186 Income group: high





infection (SARI)


Surveillance type Sentinel Universal Virological surveillancefrom all laboratories inthe country


8% 100% (with 25%underreporting)

100%


General practice, andsome infectiousdisease and paediatricclinics.

Intensive care unit Primarily emergencycare, hospitals,infectious disease andpaediatric clinics, andsome primary carefacilities.


99 facilities 78 intensive care units 28 laboratories

Case definitionused

ECDC Laboratory-confirmedinfluenza

Laboratory-confirmedinfluenza cases.Patients presentingwith ILI - similar toECDC ILI casedefinition.

Year introduced 2006 2013 1993, changed in 2013

Epidemicthreshold

No No No

Sampling strategy Up to 5 specimenscollected per week persite.

No sampling strategy.Samples are collectedbased on decision ofthe clinician.

No sampling strategy.Samples are collectedbased on decision ofthe clinician.




SwitzerlandTotal population: 8 298 663 Income group: high





infection (SARI)


Surveillance type Sentinel Virological surveillancefrom all laboratories inthe country


1.9-2% 100%


General practice,paediatrician

Laboratories


150-200 facilities <200 laboratories

Case definitionused

WHO <2011 Laboratory-confirmedinfluenza


Epidemicthreshold

Yes No

Sampling strategy About 45% of thesentinel facilties collectspecimens. Theysample all ILI patientswhen the incidence isbelow the epidemicthreshold, and every4th-5th ILI patientswhen the incidence isabove the epidemicthreshold.

Mandatory notificationof influenza detection.Consequently, nostandard samplingstrategy.




TajikistanTotal population: 8 481 855 Income group: lower middle





infection (SARI)


Surveillance type Universal Universal Sentinel


100% 100% 10.3%


Health Centers (PHC)and Hospitals

Health Centers (PHC)and Hospitals

Hospital


3085 facilities 3085 facilities 1 hospital

Case definitionused

National National WHO 2014


Cases are identifiedprimarily based onclinical diagnoses,consequently thesystem includes thesurveillance of bothviral and bacterialacute respiratorydiseases.

Cases are identifiedprimarily based onclinical diagnoses,consequently thesystem includes thesurveillance of bothviral and bacterialacute respiratorydiseases.


Epidemicthreshold

No No No

Sampling strategy Not available Not available All patients that meetthe SARI case definition(hospitalized ARI withfever (≥38°C or verbalmentioning ofincreasedtemperature/fever)and cough) who arenewly hospitalizedthrough the admissionunit on Monday andTuesday, and moreoften upon instructionof the MoH RT, need tobe sampled.




The former Yugoslav Republic of MacedoniaTotal population: 2 078 453 Income group: upper middle





infection (SARI)


Surveillance type Universal Sentinel System in place, butnot reported to TESSy


Virological surveillance


100% 1.7%


General practice,paediatric practice,polyclinic, infectiousdisease clinic, all otherhealth facilities fromprimary care,secondary care andtertiary level of healthcare

General practices


All 14 facilities

Case definitionused

ECDC ECDC, WHO Laboratory-confirmedinfluenza


Epidemicthreshold

Yes No

Sampling strategy For universalsurveillance there is nosampling strategy.

For sentinel ILI/ARIsurveillance, the first ILIcase in the week issampled. As of the2017/2018 season,advice is to collect 2specimens per site perweek. All age groupsare included in thesampling, and all casesare included in thesampling strategy.

Based on clinician'sdecision.




TurkeyTotal population: 78 665 832 Income group: upper middle





infection (SARI)



Virological surveillancefrom non-sentinelfacilities


1%


Family physiciancentres

Intensive care unit,emergencydepartment, internaldisease department,paediatric diseasedepartment, infectiousdisease department,pulmonary diseasedepartment.

Hospitals


17 provinces/ 180family physicians1

5 provinces/ 9 hospitals

Case definitionused

WHO <2011 WHO 2014 WHO 2014


WHO 2014; age-specific case definitions


Epidemicthreshold

No No No

Sampling strategy At least one sample foreach week randomlychosen until Fridayshowing ILI casedefinition, including allage groups, by 180family doctors.

Samples are collectedfrom all patients thatmeet the SARI casedefinition, all age-groups included, in 9hospitals.

No sampling strategy.





TurkmenistanTotal population: 5 373 502 Income group: upper middle





infection (SARI)


Surveillance type System in place, butnot reported to TESSy




Conventionalsurveillance of ARI andinfluenza

Populationcovered (%)Type of healthfacilities/hospitals

Polyclinic Polyclinics andhospitals

Hospitals Virological referencelaboratory in theCentre for PublicHealth and Nutrition


1 Все 1 Currently, onelaboratory providesconfirmation

Case definitionused

WHO <2011 National WHO 2011


Case definition ofinfluenza-like illness(ILI):acute respiratorydisease with onset inprevious 7 days andwith the followingsymptoms:• measured fever ≥ 38°C;• cough.

Acute upperrespiratory infectionsof multiple andunspecified sites (ICD-10 code J06).

Case definition of thesevere acuterespiratory infection(SARI):acute respiratorydisease with onset inprevious 7 days,requiringhospitalisation, andwith the followingsymptoms:• measured fever orhistory of fever ≥ 38 °C,• cough,• shortness of breathor difficulty inbreathing, not causedby nasal congestion orother types of upperrespiratoryobstruction.

Influenza caseconfirmed by use ofone of laboratory testsrecommended for fludiagnosis in thecountry.


Epidemicthreshold

No No No No Yes







infection (SARI)


Sampling strategy Two throat swabs aretaken from each of thetwo patients referredby the responsiblefamily physician. Thefirst swab is used forthe rapid testing onsite, the second one issent (compliant to coldchain requirements) tothe virologicalreference laboratory inthe Centre for PublicHealth and Nutritionfor PCR testing. Onethroat swab is takenfrom subsequentpatients referred bythe responsible familyphysicians, for on-siterapid testing.

Samples are takenfrom patients admittedfrom 8 a.m. Tuesday till8 a.m. Wednesday,who present threepositive indicators,with onset of thesymptoms ≤7 daysprior to hospitaladmission. The numberof daily samples shouldnot exceed 10.




UkraineTotal population: 44 823 764 Income group: lower middle





infection (SARI)


Surveillance type Sentinel Sentinel Sentinel Universal


1.8% 1.8% 6.5% 100%




Intensive care unit,paediatric infectiousdisease ward,respiratory diseaseward

General practice,paediatric practice,polyclinic, intensivecare unit, infectiousdisease respiratorydisease ward,maternity units


39 facilities 39 facilities 10 hospitals 16730 facilities

Case definitionused

WHO 2011 WHO 2011 WHO 2011 WHO 2011


Epidemicthreshold

No No No No

Sampling strategy The samples are takenin each sentinelinstitution, on everyMonday during theyear, from each of thefirst 5 patients whomeet the casedefinition. Thesampling proceduredoes not differbetween the beginningand the peak of theseason;- all cases and all agegroups are included inthe sampling strategy.

6 by site during theweek 40-20; 3 by siteduring week 21-39. Allsevere cases should besampled.

The sampling strategyfor non-sentinelsurveillance is definedin order no. 499 of theMinistry of Health ofUkraine.




United KingdomTotal population: 64 715 808 Income group: high

England





infection (SARI)


Surveillance type Sentinel Universal Influenza data arecollected frompathology systemstransmitted from PHE,NHS, and privatemicrobiologylaboratories acrossEngland.


1.7% 100% 100%


General practice Intensive care units PHE, NHS and privatemicrobiologylaboratories


190 general practices 150 hospitals >200 laboratories

Case definitionused

National


ILI is clinically definedas an individualpresenting in primarycare with an acuterespiratory illness withphysician-diagnosedfever or complaint offeverishness.

Laboratory-confirmedinfluenza in ICUpatients (Symptoms:Fever (>=38° C) orhistory of fever inprevious 7 days ANDtwo or more of: cough,sore throat, headache,rhinorrhoea, myalgia;D&V, increased resp.rate, poor feeding).


Epidemicthreshold

Yes No No

Sampling strategy At the start of theseason 2-3 ILI cases areswabbed per week. Atthe peak of the seasonmax. 20 patients areswabbed per week.

All cases should besampled




Northern Ireland





infection (SARI)


Surveillance type Sentinel Sentinel Universal Universal


12% 12% 100% 100%


General practice General practice All hospitals All except sentinel GP's(12%)


37 facilities 37 facilities All hospitals All except sentinel GP's(12%)

Case definitionused

National ECDC, WHO Laboratory-confirmedinfluenza

National


A disabling acuterespiratory illnessaccompanied by severefever and myalgia –Read Code H27

Sudden onset andsymptoms includingone or more of thefollowing – cough, sorethroat, shortness ofbreath, coryza and aclinician’s judgementthat the illness is dueto an infection.

A disabling acuterespiratory illnessaccompanied by severefever and myalgia –Read Code H27.


Epidemicthreshold

Yes No No No

Sampling strategy We encourage doctorsto sample all casesmeeting the ILI casedefinition, with aweekly maximum of 5specimens. Weencourage thecollection of samplesfrom all age groupswith particularattention paid tochildren (from 2 years)if possible. Samplingshould not differbetween start and peakseason except innumber.

None Varies by site




Scotland





infection (SARI)


Surveillance type Universal Universal Universal Virological surveillance(universal)


99% (ILI); 6%(sampling)

99% 100% 100%


GP practices GP practices Hospital, ICU (3rd levelcare)

Mostly hospital/ GPpractices


953 practices; 59 GPs(sampling)

953 practices 23 hospitals 277 hospitals/ 953 GPpractices

Case definitionused

No case definition used No case definition used National Laboratory confirmedInfluenza cases


Based on clinicaldiscretion of GP; forsampling casespresenting to primarycare with ILI symptomsand within 7 days ofdate of onset of thosesymptoms).

Based on clinicaldiscretion of GP.

Laboratory-confirmedinfluenza casesadmitted to thehospital for intensivecare management.

Year introduced 2009 (ILI); 2000(sampling)

2009 (ARI); 2000(sampling)

2010 2009

Epidemicthreshold

Yes No No No

Sampling strategy Up to first 8 patientsper week; 4 swabs inthose aged <15 years; 2in 15-64 and 2 in 65+.

Based on clinicaldiscretion of thedoctor/healthcareprofessional.


Wales





infection (SARI)


Surveillance type Sentinel Universal Universal surveillancefor ILI in all primarycare GPs.


11.7% 100% 100%


General practice All wards General practice







infection (SARI)



44 facilities 19 hospitals 450 facilities

Case definitionused

National Laboratory-confirmedinfluenza in all wards

National


GP diagnosed ILI (ECDCILI definition given asguidance)

GP diagnosed ILI (ECDCILI definition given asguidance)


Epidemicthreshold

Yes No

Sampling strategy Sentinel GPs are askedto swab all diagnosedILI cases (around thepeak of an epidemicthis may be limited tothe first 5 patientsdiagnosed in eachpractice per week).

All confirmed cases ofinfluenza in hospitalpatients for whomrespiratory screen testsare requested.

All clinically diagnosedcases of ILI.




UzbekistanTotal population: 29 893 488 Income group: lower middle





infection (SARI)


Surveillance type Sentinel Sentinel Sentinel No system available


0.01% 0.01%


General practice,polyclinic

General practice,polyclinic

Hospital, maternityhospital


1 facility 1 facility 3 hospitals

Case definitionused



Epidemicthreshold

No No

Sampling strategy Five doctors, fivesamples, once a week.

All SARI patients whenadmitted.


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