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Comparison of the features of Seasonal Influenza 2000 to 2008/9 and Pandemic Influenza 2009
23 Jul 2010

While there are similarities between all human influenza (e.g. modes of transmission and how transmission risk can be reduced) here ECDC lists ten differences between the old (2000/1 to 2008/9) seasonal influenza and the 2009 pandemic.

Seasonal Influenza 2000/1 to 2008/9

2009 Pandemic Influenza

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

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

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

Setting for transmission

Probably any setting where people come together

Schools are considered especially important, along with household transmission

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

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

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

Acute respiratory distress syndrome

Extremely rare

Uncommon but has been recorded in many countries, even in young fit adults. WHO Clinical summary

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

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.

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