1887
Research article Open Access
Like 0

Abstract

We aimed to assess the epidemiology and spatiotemporal patterns of influenza in the World Health Organization (WHO) European Region and evaluate the validity of partitioning the Region into five influenza transmission zones (ITZs) as proposed by the WHO. We used the FluNet database and included over 650,000 influenza cases from 2000 to 2015. We analysed the data by country and season (from July to the following June). We calculated the median proportion of cases caused by each virus type in a season, compared the timing of the primary peak between countries and used a range of cluster analysis methods to assess the degree of overlap between the WHO-defined and data-driven ITZs. Influenza A and B caused, respectively, a median of 83% and 17% cases in a season. There was a significant west-to-east and non-significant (p = 0.10) south-to-north gradient in the timing of influenza activity. Typically, influenza peaked in February and March; influenza A earlier than influenza B. Most countries in the WHO European Region would fit into two ITZs: ‘Western Europe’ and ‘Eastern Europe’; countries bordering Asia may be better placed into extra-European ITZs. Our findings have implications for the presentation of surveillance data and prevention and control measures in this large WHO Region.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2017.22.35.30606
2017-08-31
2017-11-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.35.30606
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/22/35/eurosurv-22-35-2.html?itemId=/content/10.2807/1560-7917.ES.2017.22.35.30606&mimeType=html&fmt=ahah

References

  1. van Lier EA, Havelaar AH, Nanda A. The burden of infectious diseases in Europe: a pilot study. Euro Surveill. 2007;12(12):E3-4. PMID: 18076860 
  2. Antonova EN, Rycroft CE, Ambrose CS, Heikkinen T, Principi N. Burden of paediatric influenza in Western Europe: a systematic review. BMC Public Health. 2012;12(1):968.  https://doi.org/10.1186/1471-2458-12-968  PMID: 23146107 
  3. Kovács G, Kaló Z, Jahnz-Rozyk K, Kyncl J, Csohan A, Pistol A, et al. Medical and economic burden of influenza in the elderly population in central and eastern European countries. Hum Vaccin Immunother. 2014;10(2):428-40.  https://doi.org/10.4161/hv.26886  PMID: 24165394 
  4. van Lier A, McDonald SA, Bouwknegt M, Kretzschmar ME, Havelaar AH, Mangen MJ, et al. Disease Burden of 32 Infectious Diseases in the Netherlands, 2007-2011. PLoS One. 2016;11(4):e0153106.  https://doi.org/10.1371/journal.pone.0153106  PMID: 27097024 
  5. Viboud C, Bjørnstad ON, Smith DL, Simonsen L, Miller MA, Grenfell BT. Synchrony, waves, and spatial hierarchies in the spread of influenza. Science. 2006;312(5772):447-51.  https://doi.org/10.1126/science.1125237  PMID: 16574822 
  6. Charaudeau S, Pakdaman K, Boëlle PY. Commuter mobility and the spread of infectious diseases: application to influenza in France. PLoS One. 2014;9(1):e83002.  https://doi.org/10.1371/journal.pone.0083002  PMID: 24416152 
  7. Gautret P, Botelho-Nevers E, Brouqui P, Parola P. The spread of vaccine-preventable diseases by international travellers: a public-health concern. Clin Microbiol Infect. 2012;18(Suppl 5):77-84.  https://doi.org/10.1111/j.1469-0691.2012.03940.x  PMID: 22862565 
  8. Kenah E, Chao DL, Matrajt L, Halloran ME, Longini IM Jr. The global transmission and control of influenza. PLoS One. 2011;6(5):e19515.  https://doi.org/10.1371/journal.pone.0019515  PMID: 21573121 
  9. Fleming DM, van der Velden J, Paget WJ. The evolution of influenza surveillance in Europe and prospects for the next 10 years. Vaccine. 2003;21(16):1749-53.  https://doi.org/10.1016/S0264-410X(03)00066-5  PMID: 12686088 
  10. Arkema A, Paget J, Meijer A, Meerhoff T, Velden K, van der Faassen A. European Influenza Surveillance Scheme: annual report 2006-2007 influenza season. Utrecht: NIVEL, Netherlands Institute for Health Services Research; 2008. Available from: http://www.nivel.nl/sites/default/files/bestanden/Annual-Report-2006-2007-EISS-nivel-logo.pdf
  11. Azziz Baumgartner E, Dao CN, Nasreen S, Bhuiyan MU, Mah-E-Muneer S, Al Mamun A, et al. Seasonality, timing, and climate drivers of influenza activity worldwide. J Infect Dis. 2012;206(6):838-46.  https://doi.org/10.1093/infdis/jis467  PMID: 22829641 
  12. Alonso WJ, Yu C, Viboud C, Richard SA, Schuck-Paim C, Simonsen L, et al. A global map of hemispheric influenza vaccine recommendations based on local patterns of viral circulation. Sci Rep. 2015;5(1):17214.  https://doi.org/10.1038/srep17214  PMID: 26621769 
  13. Paget J, Marquet R, Meijer A, van der Velden K. Influenza activity in Europe during eight seasons (1999-2007): an evaluation of the indicators used to measure activity and an assessment of the timing, length and course of peak activity (spread) across Europe. BMC Infect Dis. 2007;7(1):141.  https://doi.org/10.1186/1471-2334-7-141  PMID: 18047685 
  14. Martirosyan L, Paget WJ, Jorgensen P, Brown CS, Meerhoff TJ, Pereyaslov D, et al. The community impact of the 2009 influenza pandemic in the WHO European region: a comparison with historical seasonal data from 28 countries. BMC Infect Dis. 2012;12(1):36.  https://doi.org/10.1186/1471-2334-12-36  PMID: 22325082 
  15. World Health Organization (WHO). Influenza transmission zones. Geneva: WHO; 2011. Available from: http://www.who.int/csr/disease/swineflu/Influenza_transmission_zones.pdf?ua=1
  16. World Health Organization (WHO). FluNet. Geneva: WHO. [Accessed: 12 October 2015]. Available from: http://www.who.int/influenza/gisrs_laboratory/flunet/en/
  17. Simonsen L, Spreeuwenberg P, Lustig R, Taylor RJ, Fleming DM, Kroneman M, et al. Global mortality estimates for the 2009 Influenza Pandemic from the GLaMOR project: a modeling study. PLoS Med. 2013;10(11):e1001558.  https://doi.org/10.1371/journal.pmed.1001558  PMID: 24302890 
  18. Rogers DJ, Hay SI, Packer MJ. Predicting the distribution of tsetse flies in West Africa using temporal Fourier processed meteorological satellite data. Ann Trop Med Parasitol. 1996;90(3):225-41.  https://doi.org/10.1080/00034983.1996.11813049  PMID: 8758138 
  19. Alonso WJ, McCormick BJ. EPIPOI: a user-friendly analytical tool for the extraction and visualization of temporal parameters from epidemiological time series. BMC Public Health. 2012;12(1):982.  https://doi.org/10.1186/1471-2458-12-982  PMID: 23153033 
  20. Lin JC, Nichol KL. Excess mortality due to pneumonia or influenza during influenza seasons among persons with acquired immunodeficiency syndrome. Arch Intern Med. 2001;161(3):441-6.  https://doi.org/10.1001/archinte.161.3.441  PMID: 11176770 
  21. Paget J, Marquet R, Meijer A, van der Velden K. Influenza activity in Europe during eight seasons (1999-2007): an evaluation of the indicators used to measure activity and an assessment of the timing, length and course of peak activity (spread) across Europe. BMC Infect Dis. 2007;7(1):141.  https://doi.org/10.1186/1471-2334-7-141  PMID: 18047685 
  22. Finkelman BS, Viboud C, Koelle K, Ferrari MJ, Bharti N, Grenfell BT. Global patterns in seasonal activity of influenza A/H3N2, A/H1N1, and B from 1997 to 2005: viral coexistence and latitudinal gradients. PLoS One. 2007;2(12):e1296.  https://doi.org/10.1371/journal.pone.0001296  PMID: 18074020 
  23. Arkema JM, Meijer A, Meerhoff TJ, Van Der Velden J, Paget WJEuropean Influenza Surveillance Scheme (EISS). Epidemiological and virological assessment of influenza activity in Europe, during the 2006-2007 winter. Euro Surveill. 2008;13(34):18958. PMID: 18761888 
  24. Yu H, Alonso WJ, Feng L, Tan Y, Shu Y, Yang W, et al. Characterization of regional influenza seasonality patterns in China and implications for vaccination strategies: spatio-temporal modeling of surveillance data. PLoS Med. 2013;10(11):e1001552.  https://doi.org/10.1371/journal.pmed.1001552  PMID: 24348203 
  25. Caini S, Andrade W, Badur S, Balmaseda A, Barakat A, Bella A, et al. Correction: Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination? PLoS One. 2016;11(5):e0155089.  https://doi.org/10.1371/journal.pone.0155089  PMID: 27135748 
  26. Caini S, Huang QS, Ciblak MA, Kusznierz G, Owen R, Wangchuk S, et al. Epidemiological and virological characteristics of influenza B: results of the Global Influenza B Study. Influenza Other Respi Viruses. 2015;9(Suppl 1):3-12.  https://doi.org/10.1111/irv.12319  PMID: 26256290 
  27. Hirve S, Newman LP, Paget J, Azziz-Baumgartner E, Fitzner J, Bhat N, et al. Influenza seasonality in the tropics and subtropics – When to vaccinate? PLoS One. 2016;11(4):e0153003.  https://doi.org/10.1371/journal.pone.0153003  PMID: 27119988 
  28. World Health Organization (WHO). WHO interim global epidemiological surveillance standards for influenza. Geneva: WHO; 2012. Available from: http://www.who.int/influenza/resources/documents/INFSURVMANUAL.pdf
/content/10.2807/1560-7917.ES.2017.22.35.30606
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error