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Circulating Influenza Viruses |
Two A viruses (H1N1), (H3N2) & some B viruses - blend varied with season |
Almost exclusively the pandemic (H1N1), a few (H3N2) & increasing numbers of B viruses latterly |
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When waves occurred |
In season - mostly starting after Christmas in recent years |
Started out of season with Spring/Summer wave then an early Autumn/Winter wave in Europe |
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Intensity of transmission |
Variable year on year, with local heterogeneity but estimated to be 5 to 15% per annum |
Hard to estimate, local heterogeneity, estimated to be over 15% through serological studies reviewed by WHO and in New Zealand |
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Setting for transmission |
Probably any setting where people come together |
Schools are considered especially important, along with household transmission |
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Experiencing severe disease |
Those in clinical risk groups and older people |
Young children, pregnant women and those in clinical risk groups. About 30% with severe disease were outside risk groups. Many born before mid-1950s were immune, but those not experienced severe disease. Donaldson et al |
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Premature Deaths |
Considered that around 90% were in those aged 65 years or older Thompson et al |
In confirmed reported deaths around 80% were under age 65 years (Reports to ECDC) Increase in all-cause deaths in children detected across eight EU countries by Euromomo system |
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Mortality and Years of Potential Life Lost (YPLL) |
Few confirmed deaths reported each year in official statistics. Have been estimates of up to 40,000 in a bad year using statistical methods |
Substantial numbers of confirmed deaths announced by EU/EFTA Member States (n = 2900) but recognised to be an underestimate. Not estimated in any EU member states but estimated in the US |
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Acute respiratory distress syndrome |
Extremely rare |
Uncommon but has been recorded in many countries, even in young fit adults. WHO Clinical summary |
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Pathological Findings |
Viral pneumonia rare but secondary bacterial infections more common in fatal cases |
Fatal viral pneumonias relatively common with alveolar lining cells, including type I and type II pneumocytes the primary infected cells. In fatalities more than 25% also had bacterial infections. WHO Clinical summary Shieh et al |
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Antiviral resistance |
Common and transmissible oseltamivir resistance in A(H1N1) emerged in season 2007/8 Meijer et al |
Observed most often following antiviral treatment of susceptible individuals. However to date (July 2010) only transmitting very rarely in certain circumstances see WHO. Resistant seasonal A(H1N1) seemingly displaced by the new influenza, at least for now. |