Surveillance and outbreak report Open Access
Like 0


Influenza antigenic and genetic characterisation data are crucial for influenza vaccine composition decision making. Previously, aggregate data were reported to the European Centre for Disease Prevention and Control by European Union/European Economic Area (EU/EEA) countries. A system for collecting case-specific influenza antigenic and genetic characterisation data was established for the 2013/14 influenza season. In a pilot study, 11 EU/EEA countries reported through the new mechanism. We demonstrated feasibility of reporting strain-based antigenic and genetic data and ca 10% of influenza virus-positive specimens were selected for further characterisation. Proportions of characterised virus (sub)types were similar to influenza virus circulation levels. The main genetic clades were represented by A/StPetersburg/27/2011(H1N1)pdm09 and A/Texas/50/2012(H3N2). A(H1N1)pdm09 viruses were more prevalent in age groups (by years) < 1 (65%; p = 0.0111), 20–39 (50%; p = 0.0046) and 40–64 (55%; p = 0.00001) while A(H3N2) viruses were most prevalent in those ≥ 65 years (62%*; p = 0.0012). Hospitalised patients in the age groups 6–19 years (67%; p = 0.0494) and ≥ 65 years (52%; p = 0.0005) were more frequently infected by A/Texas/50/2012 A(H3N2)-like viruses compared with hospitalised cases in other age groups. Strain-based reporting enabled deeper understanding of influenza virus circulation among hospitalised patients and substantially improved the reporting of virus characterisation data. Therefore, strain-based reporting of readily available data is recommended to all reporting countries within the EU/EEA.


Article metrics loading...

Loading full text...

Full text loading...



  1. Kitler ME, Gavinio P, Lavanchy D. Influenza and the work of the World Health Organization. Vaccine. 2002;20(Suppl 2):S5-14.  https://doi.org/10.1016/S0264-410X(02)00121-4  PMID: 12110248 
  2. World Health Organization (WHO). Global epidemiological surveillance standards for influenza. Geneva: WHO; 2013. Available from: http://www.who.int/influenza/resources/documents/WHO_Epidemiological_Influenza_Surveillance_Standards_2014.pdf
  3. European Centre for Disease Prevention and Control (ECDC). European Influenza Surveillance Network (EISN). [Accessed 24 Feb 2016]. Available from: http://ecdc.europa.eu/en/activities/surveillance/EISN/Pages/index.aspx
  4. European Centre for Disease Prevention and Control (ECDC). The European Surveillance System (TESSy) [Accessed 24 Feb 2016]. Available from: http://ecdc.europa.eu/en/activities/surveillance/TESSy/Pages/TESSy.aspx
  5. Ciancio BC, Meerhoff TJ, Kramarz P, Bonmarin I, Borgen K, Boucher CA, et al. Oseltamivir-resistant influenza A(H1N1) viruses detected in Europe during season 2007-8 had epidemiologic and clinical characteristics similar to co-circulating susceptible A(H1N1) viruses. Euro Surveill. 2009;14(46):19412. PMID: 19941797 
  6. Meijer A, Lackenby A, Hungnes O, Lina B, van-der-Werf S, Schweiger B, et al. . Oseltamivir-resistant influenza virus A (H1N1), Europe, 2007-08 season. Emerg Infect Dis. 2009;15(4):552-60.  https://doi.org/10.3201/eid1504.181280  PMID: 19331731 
  7. Beauté J, Broberg E, Plata F, Bonmarin I, O Donnell J, Delgado C, et al. Overrepresentation of influenza A(H1N1)pdm09 virus among severe influenza cases in the 2011/12 season in four European countries. Euro Surveill. 2012;17(9):20105. PMID: 22401564 
  8. Beauté J, Zucs P, Korsun N, Bragstad K, Enouf V, Kossyvakis A, et al. Age-specific differences in influenza virus type and subtype distribution in the 2012/2013 season in 12 European countries. Epidemiol Infect. 2015;143(14):2950-8.  https://doi.org/10.1017/S0950268814003422  PMID: 25648399 
  9. Lee VJ, Yap J, Ong JB, Chan KP, Lin RT, Chan SP, et al. Influenza excess mortality from 1950-2000 in tropical Singapore. PLoS One. 2009;4(12):e8096.  https://doi.org/10.1371/journal.pone.0008096  PMID: 19956611 
  10. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289(2):179-86.  https://doi.org/10.1001/jama.289.2.179  PMID: 12517228 
  11. Mertz D, Kim TH, Johnstone J, Lam PP, Science M, Kuster SP, et al. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ. 2013;347(aug23 1):f5061.  https://doi.org/10.1136/bmj.f5061  PMID: 23974637 
  12. European Commission. Commission Decision of 28 April 2008 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document number C(2008) 1589) (Text with EEA relevance) (2008/426/EC). Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 18.6.2008:L 159/46. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2008:159:0046:0090:EN:PDF
  13. European Centre for Disease Prevention and Control (ECDC). External quality assessment scheme for influenza virus detection and culture for the European Reference Laboratory Network for Human Influenza. Stockholm: ECDC; 2014. Available from: http://ecdc.europa.eu/en/publications/Publications/influenza-virus-detection-isolation-culture-EQA-2013.pdf
  14. World Health Organization (WHO). Selection of clinical specimens for virus isolation and of viruses for shipment from National Influenza Centres to WHO Collaborating Centres. Geneva: WHO; 2010. Available from: http://www.who.int/influenza/gisrs_laboratory/national_influenza_centres/20101206_specimens_selected_for_virus_isolation_and_shipment.pdf?ua=1
  15. World Health Organization (WHO). Meetings of the WHO working group on surveillance of influenza antiviral susceptibility – Geneva, November 2011 and June 2012. Wkly Epidemiol Rec. 2012;87(39):369-74. PMID: 23061103 
  16. Meijer A, Rebelo-de-Andrade H, Correia V, Besselaar T, Drager-Dayal R, Fry A, et al. Global update on the susceptibility of human influenza viruses to neuraminidase inhibitors, 2012-2013. Antiviral Res. 2014;110:31-41.  https://doi.org/10.1016/j.antiviral.2014.07.001  PMID: 25043638 
  17. Nguyen HT, Fry AM, Gubareva LV. Neuraminidase inhibitor resistance in influenza viruses and laboratory testing methods. Antivir Ther. 2012;17(1 Pt B):159-73.  https://doi.org/10.3851/IMP2067  PMID: 22311680 
  18. Bednarska K, Hallmann-Szelińska E, Kondratiuk K, Brydak LB. Evaluation of the Activity of Influenza and Influenza-Like Viruses in the Epidemic Season 2013/2014. Adv Exp Med Biol. 2015;857:1-7.  https://doi.org/10.1007/5584_2015_116  PMID: 25786402 
  19. Kossyvakis A, Pogka V, Melidou A, Moutousi A, Gioula G, Kalliaropoulos A, et al. Challenges in antigenic characterization of circulating influenza A(H3N2) viruses during the 2011-2012 influenza season: an ongoing problem? J Clin Microbiol. 2015;53(5):1493-9.  https://doi.org/10.1128/JCM.03236-14  PMID: 25694524 
  20. European Centre for Disease Prevention and Control (ECDC). Influenza virus characterisation. Summary Europe, November 2014. Stockholm: ECDC; 2014.Available from: http://ecdc.europa.eu/en/publications/Publications/ERLI-Net%20report%20November%202014.pdf
  21. European Centre for Disease Prevention and Control (ECDC). Influenza in Europe – Season 2013-2014. Stockholm: ECDC; 2014. Available from: http://ecdc.europa.eu/en/publications/Publications/Influenza-2013-14-season-report.pdf
  22. Broberg E, Snacken R, Adlhoch C, Beauté J, Galinska M, Pereyaslov D, et al. Start of the 2014/15 influenza season in Europe: drifted influenza A(H3N2) viruses circulate as dominant subtype. Euro Surveill. 2015;20(4):21023.  https://doi.org/10.2807/1560-7917.ES2015.20.4.21023  PMID: 25655052 
  23. Broberg E, Melidou A, Prosenc K, Bragstad K, Hungnes OWHO European Region and the European Influenza Surveillance Network members of the reporting countries. Predominance of influenza A(H1N1)pdm09 virus genetic subclade 6B.1 and influenza B/Victoria lineage viruses at the start of the 2015/16 influenza season in Europe. Euro Surveill. 2016;21(13):30184.  https://doi.org/10.2807/1560-7917.ES.2016.21.13.30184  PMID: 27074657 
  24. Snacken R, Broberg E, Beauté J, Lozano JE, Zucs P, Amato-Gauci AJ. Influenza season 2012-2013 in Europe: moderate intensity, mixed (sub)types. Epidemiol Infect. 2014;142(9):1809-12.  https://doi.org/10.1017/S0950268814001228  PMID: 24814635 
  25. Kissling E, Valenciano M, Buchholz U, Larrauri A, Cohen JM, Nunes B, et al. Influenza vaccine effectiveness estimates in Europe in a season with three influenza type/subtypes circulating: the I-MOVE multicentre case-control study, influenza season 2012/13. Euro Surveill. 2014;19(6):20701.  https://doi.org/10.2807/1560-7917.ES2014.19.6.20701  PMID: 24556348 

Data & Media loading...

Submit comment
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