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- Distribution of influenza virus types by age using case-based global surveillance data from twenty-nine countries, 1999-2014Publication . Caini, Saverio; Spreeuwenberg, Peter; Kusznierz, Gabriela F.; Rudi, Juan Manuel; Owen, Rhonda; Pennington, Kate; Wangchuk, Sonam; Gyeltshen, Sonam; Ferreira de Almeida, Walquiria Aparecida; Pessanha Henriques, Cláudio Maierovitch; Njouom, Richard; Vernet, Marie-Astrid; Fasce, Rodrigo A.; Andrade, Winston; Yu, Hongjie; Feng, Luzhao; Yang, Juan; Peng, Zhibin; Lara, Jenny; Bruno, Alfredo; de Mora, Doménica; de Lozano, Celina; Zambon, Maria; Pebody, Richard; Castillo, Leticia; Clara, Alexey W.; Matute, Maria Luisa; Kosasih, Herman; Nurhayati, null; Puzelli, Simona; Rizzo, Caterina; Kadjo, Herve A; Daouda, Coulibaly; Kiyanbekova, Lyazzat; Ospanova, Akerke; Mott, Joshua A.; Emukule, Gideon O.; Heraud, Jean-Michel; Razanajatovo, Norosoa Harline; Barakat, Amal; El Falaki, Fatima; Huang, Sue Q.; Lopez, Liza; Balmaseda, Angel; Moreno, Brechla; Rodrigues, Ana Paula; Guiomar, Raquel; Ang, Li Wei; Lee, Vernon Jian Ming; Venter, Marietjie; Cohen, Cheryl; Badur, Selim; Ciblak, Meral A.; Mironenko, Alla; Holubka, Olha; Bresee, Joseph; Brammer, Lynnette; Hoang, Phuong Vu Mai; Le, Mai Thi Quynh; Fleming, Douglas; Séblain, Clotilde El-Guerche; Schellevis, François; Paget, John; Global Influenza B Study groupBackground: Influenza disease burden varies by age and this has important public health implications. We compared the proportional distribution of different influenza virus types within age strata using surveillance data from twenty-nine countries during 1999-2014 (N=358,796 influenza cases). Methods: For each virus, we calculated a Relative Illness Ratio (defined as the ratio of the percentage of cases in an age group to the percentage of the country population in the same age group) for young children (0-4 years), older children (5-17 years), young adults (18-39 years), older adults (40-64 years), and the elderly (65+ years). We used random-effects meta-analysis models to obtain summary relative illness ratios (sRIRs), and conducted meta-regression and sub-group analyses to explore causes of between-estimates heterogeneity. Results: The influenza virus with highest sRIR was A(H1N1) for young children, B for older children, A(H1N1)pdm2009 for adults, and (A(H3N2) for the elderly. As expected, considering the diverse nature of the national surveillance datasets included in our analysis, between-estimates heterogeneity was high (I2>90%) for most sRIRs. The variations of countries’ geographic, demographic and economic characteristics and the proportion of outpatients among reported influenza cases explained only part of the heterogeneity, suggesting that multiple factors were at play. Conclusions: These results highlight the importance of presenting burden of disease estimates by age group and virus (sub)type.
- Estimated number of lives directly saved by COVID-19 vaccination programmes in the WHO European Region from December, 2020, to March, 2023: a retrospective surveillance studyPublication . Meslé, Margaux M.I.; Brown, Jeremy; Mook, Piers; Katz, Mark A.; Hagan, José; Pastore, Roberta; Benka, Bernhard; Redlberger-Fritz, Monika; Bossuyt, Nathalie; Stouten, Veerle; Vernemmen, Catharina; Constantinou, Elisabet; Maly, Marek; Kynčl, Jan; Sanca, Ondrej; Krause, Tyra Grove; Vestergaard, Lasse Skafte; Leino, Tuija; Poukka, Eero; Gkolfinopoulou, Kassiani; Mellou, Kassiani; Tsintziloni, Maria; Molnár, Zsuzsanna; Aspelund, Gudrun; Thordardottir, Marianna; Domegan, Lisa; Kelly, Eva; O'Donell, Joan; Urdiales, Alberto-Mateo; Riccardo, Flavia; Sacco, Chiara; Bumšteinas, Viktoras; Liausediene, Rasa; Mossong, Joël; Vergison, Anne; Borg, Maria-Louise; Melillo, Tanya; Kocinski, Dragan; Pollozhani, Enkela; Meijerink, Hinta; Costa, Diana; Gomes, João Paulo; Leite, Pedro Pinto; Druc, Alina; Gutu, Veaceslav; Mita, Valentin; Lazar, Mihaela; Popescu, Rodica; Popovici, Odette; Musilová, Monika; Mrzel, Maja; Socan, Maja; Učakar, Veronika; Limia, Aurora; Mazagatos, Clara; Olmedo, Carmen; Dabrera, Gavin; Kall, Meaghan; Sinnathamby, Mary; McGowan, Graham; McMenamin, Jim; Morrison, Kirsty; Nitzan, Dorit; Widdowson, Marc-Alain; Smallwood, Catherine; Pebody, Richard; WHO European Respiratory Surveillance NetworkBackground: By March, 2023, 54 countries, areas, and territories (hereafter CAT) in the WHO European Region had reported more than 2·2 million COVID-19-related deaths to the WHO Regional Office for Europe. Here, we estimated how many lives were directly saved by vaccinating adults in the WHO European Region from December, 2020, to March, 2023. Methods: In this retrospective surveillance study, we estimated the number of lives directly saved by age group, vaccine dose, and circulating variant-of-concern (VOC) period, regionally and nationally, using weekly data on COVID-19 mortality and infection, COVID-19 vaccination uptake, and SARS-CoV-2 virus characterisations by lineage downloaded from The European Surveillance System on June 11, 2023, as well as vaccine effectiveness data from the literature. We included data for six age groups (25-49 years, 50-59 years, ≥60 years, 60-69 years, 70-79 years, and ≥80 years). To be included in the analysis, CAT needed to have reported both COVID-19 vaccination and mortality data for at least one of the four older age groups. Only CAT that reported weekly data for both COVID-19 vaccination and mortality by age group for 90% of study weeks or more in the full study period were included. We calculated the percentage reduction in the number of expected and reported deaths. Findings: Between December, 2020, and March, 2023, in 34 of 54 CAT included in the analysis, COVID-19 vaccines reduced deaths by 59% overall (CAT range 17-82%), representing approximately 1·6 million lives saved (range 1·5-1·7 million) in those aged 25 years or older: 96% of lives saved were aged 60 years or older and 52% were aged 80 years or older; first boosters saved 51% of lives, and 60% were saved during the Omicron period. Interpretation: Over nearly 2·5 years, most lives saved by COVID-19 vaccination were in older adults by first booster dose and during the Omicron period, reinforcing the importance of up-to-date vaccination among the most at-risk individuals. Further modelling work should evaluate indirect effects of vaccination and public health and social measures.
- Excess all-cause mortality during the COVID-19 pandemic in Europe – preliminary pooled estimates from the EuroMOMO network, March to April 2020Publication . Vestergaard, Lasse S.; Nielsen, Jens; Richter, Lukas; Schmid, Daniela; Bustos, Natalia; Braeye, Toon; Denissov, Gleb; Veideman, Tatjana; Luomala, Oskari; Möttönen, Teemu; Fouillet, Anne; Caserio-Schönemann, Céline; an der Heiden, Matthias; Uphoff, Helmut; Lytras, Theodore; Gkolfinopoulou, Kassiani; Paldy, Anna; Domegan, Lisa; O'Donnell, Joan; de’ Donato, Francesca; Noccioli, Fiammetta; Hoffmann, Patrick; Velez, Telma; England, Kathleen; van Asten, Liselotte; White, Richard A.; Tønnessen, Ragnhild; Silva, Susana Pereira; Rodrigues, Ana Paula; Larrauri, Amparo; Delgado-Sanz, Concepción; Farah, Ahmed; Galanis, Ilias; Junker, Christoph; Perisa, Damir; Sinnathamby, Mary; Andrews, Nick; O'Doherty, Mark; Marquess, Diogo F.P.; Kennedy, Sharon; Olsen, Sonja J.; Pebody, Richard; Krause, Tyra G.; Mølbak, KåreA remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March–April 2020. Excess mortality particularly affected ≥ 65 year olds (91% of all excess deaths), but also 45–64 (8%) and 15–44 year olds (1%). No excess mortality was observed in 0–14 year olds.
- Health and economic impact of seasonal influenza mass vaccination strategies in European settings: A mathematical modelling and cost-effectiveness analysisPublication . Sandmann, Frank; van Leeuwen, Edwin; Bernard-Stoecklin, Sibylle; Casado, Itziar; Castilla, Jesús; Domegan, Lisa; Gherasim, Alin; Hooiveld, Mariëtte; Kislaya, Irina; Larrauri, Amparo; Levy-Bruhl, Daniel; Machado, Ausenda; Marques, Diogo; Martínez-Baz, Iván; Mazagatos, Clara; McMenamin, Jim; Meijer, Adam; Murray, Josephine; Nunes, Baltazar; O'Donnell, Joan; Reynolds, Arlene; Thorrington, Dominic; Pebody, Richard; Baguelin, MarcIntroduction: Despite seasonal influenza vaccination programmes in most countries targeting individuals aged ≥ 65 (or ≥ 55) years and high risk-groups, significant disease burden remains. We explored the impact and cost-effectiveness of 27 vaccination programmes targeting the elderly and/or children in eight European settings (n = 205.8 million). Methods: We used an age-structured dynamic-transmission model to infer age- and (sub-)type-specific seasonal influenza virus infections calibrated to England, France, Ireland, Navarra, The Netherlands, Portugal, Scotland, and Spain between 2010/11 and 2017/18. The base-case vaccination scenario consisted of non-adjuvanted, non-high dose trivalent vaccines (TV) and no universal paediatric vaccination. We explored i) moving the elderly to "improved" (i.e., adjuvanted or high-dose) trivalent vaccines (iTV) or non-adjuvanted non-high-dose quadrivalent vaccines (QV); ii) adopting mass paediatric vaccination with TV or QV; and iii) combining the elderly and paediatric strategies. We estimated setting-specific costs and quality-adjusted life years (QALYs) gained from the healthcare perspective, and discounted QALYs at 3.0%. Results: In the elderly, the estimated numbers of infection per 100,000 population are reduced by a median of 261.5 (range across settings: 154.4, 475.7) when moving the elderly to iTV and by 150.8 (77.6, 262.3) when moving them to QV. Through indirect protection, adopting mass paediatric programmes with 25% uptake achieves similar reductions in the elderly of 233.6 using TV (range: 58.9, 425.6) or 266.5 using QV (65.7, 477.9), with substantial health gains from averted infections across ages. At €35,000/QALY gained, moving the elderly to iTV plus adopting mass paediatric QV programmes provides the highest mean net benefits and probabilities of being cost-effective in all settings and paediatric coverage levels. Conclusion: Given the direct and indirect protection, and depending on the vaccine prices, model results support a combination of having moved the elderly to an improved vaccine and adopting universal paediatric vaccination programmes across the European settings.
- Interim 2017/18 influenza seasonal vaccine effectiveness: combined results from five European studiesPublication . Rondy, Marc; Kissling, Esther; Emborg, Hanne-Dorthe; Gherasim, Alin; Pebody, Richard; Trebbien, Ramona; Pozo, Francisco; Larrauri, Amparo; McMenamin, Jim; Valenciano, Marta; I-Move/I-Move GroupBetween September 2017 and February 2018, influenza A(H1N1)pdm09, A(H3N2) and B viruses (mainly B/Yamagata, not included in 2017/18 trivalent vaccines) co-circulated in Europe. Interim results from five European studies indicate that, in all age groups, 2017/18 influenza vaccine effectiveness was 25 to 52% against any influenza, 55 to 68% against influenza A(H1N1)pdm09, -42 to 7% against influenza A(H3N2) and 36 to 54% against influenza B. 2017/18 influenza vaccine should be promoted where influenza still circulates.
- Interim 2018/19 influenza vaccine effectiveness: six European studies, October 2018 to January 2019Publication . Kissling, Esther; Rose, Angela; Emborg, Hanne-Dorthe; Gherasim, Alin; Pebody, Richard; Pozo, Francisco; Trebbien, Ramona; Mazagatos, Clara; Whitaker, Heather; Valenciano, Marta; European IVE groupSeasonal influenza vaccine is recommended in all European Union (EU) countries for older people and others at increased risk of severe influenza and its complications, including those with chronic diseases. In the United Kingdom (UK), incremental introduction of a universal childhood influenza vaccination programme began in 2013/14. The World Health Organization (WHO) recommendations for trivalent influenza vaccine strains for the 2018/19 northern hemisphere influenza season included an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/Singapore/INFIMH-16–0019/2016 (H3N2)-like virus and a B/Colorado/06/2017-like virus from the B/Victoria lineage. The early 2018/19 influenza season in Europe was characterised by both influenza A virus subtypes circulating widely. There was co-circulation in some countries, with others reporting dominance of either A(H1N1)pdm09 or A(H3N2) viruses. The season started late in most countries compared with previous seasons, with few influenza B viruses detected in the WHO European Region. Since the 2008/09 season, the UK, Denmark, Spain, and several other EU countries conducting multicentre studies, have participated in I-MOVE (Influenza – Monitoring Vaccine Effectiveness in Europe), a network measuring influenza vaccine effectiveness each season. Interim results from six established influenza VE studies across Europe for the 2018/19 season indicate that VE against laboratory-confirmed influenza A ranged between 32% and 43% among all ages in primary care and hospital settings and was 59% in the target groups for vaccination.
- New perspectives on respiratory syncytial virus surveillance at the national level: lessons from the COVID-19 pandemicPublication . Teirlinck, Anne C.; Johannesen, Caroline K.; Broberg, Eeva K.; Penttinen, Pasi; Campbell, Harry; Nair, Harish; Reeves, Rachel M.; Bøås, Håkon; Brytting, Mia; Cai, Wei; Carnahan, AnnaSara; Casalegno, Jean-Sebastien; Danis, Kostas; De Gascun, Cillian; Ellis, Joanna; Emborg, Hanne-Dorthe; Gijon, Manuel; Guiomar, Raquel; Hirve, Siddhivinayak S.; Jiřincová, Helena; Nohynek, Hanna; Oliva, Jesus Angel; Osei-Yeboah, Richard; Paget, John; Pakarna, Gatis; Pebody, Richard; Presser, Lance; Rapp, Marie; Reiche, Janine; Rodrigues, Ana Paula; Seppälä, Elina; Socan, Maja; Szymanski, Karol; Trebbien, Ramona; Večeřová, Jaromíra; van der Werf, Sylvie; Zambon, Maria; Meijer, Adam; Fischer, Thea K.Learning from the COVID-19 pandemic and considering the effects of this pandemic, we provide recommendations that can guide towards sustainable RSV surveillance with the potential to be integrated into the broader perspective of respiratory surveillance.
- Participatory Syndromic Surveillance of Influenza in EuropePublication . Guerrisi, Caroline; Turbelin, Clément; Blanchon, Thierry; Hanslik, Thomas; Bonmarin, Isabelle; Levy-Bruhl, Daniel; Perrotta, Daniela; Paolotti, Daniela; Smallenburg, Ronald; Koppeschaar, Carl; Franco, Ana O.; Mexia, Ricardo; Edmunds, W. John; Sile, Bersabeh; Pebody, Richard; van Straten, Edward; Meloni, Sandro; Moreno, Yamir; Duggan, Jim; Kjelsø, Charlotte; Colizza, VittoriaThe growth of digital communication technologies for public health is offering an unconventional means to engage the general public in monitoring community health. Here we present Influenzanet, a participatory system for the syndromic surveillance of influenza-like illness (ILI) in Europe. Through standardized online surveys, the system collects detailed profile information and self-reported symptoms volunteered by participants resident in the Influenzanet countries. Established in 2009, it now includes 10 countries representing more than half of the 28 member states of the European Union population. The experience of 7 influenza seasons illustrates how Influenzanet has become an adjunct to existing ILI surveillance networks, offering coherence across countries, inclusion of nonmedically attended ILI, flexibility in case definition, and facilitating individual-level epidemiological analyses generally not possible in standard systems. Having the sensitivity to timely detect substantial changes in population health, Influenzanet has the potential to become a viable instrument for a wide variety of applications in public health preparedness and control.
- The epidemiological signature of influenza B virus and its B/Victoria and B/Yamagata lineages in the 21st centuryPublication . Caini, Saverio; Kusznierz, Gabriela; Garate, Verònica Vera; Wangchuk, Sonam; Thapa, Binay; de Paula Júnior, Francisco José; Ferreira de Almeida, Walquiria Aparecida; Njouom, Richard; Fasce, Rodrigo A.; Bustos, Patricia; Feng, Luzhao; Peng, Zhibin; Araya, Jenny Lara; Bruno, Alfredo; de Mora, Doménica; Barahona de Gámez, Mónica Jeannette; Pebody, Richard; Zambon, Maria; Higueros, Rocio; Rivera, Rudevelinda; Kosasih, Herman; Castrucci, Maria Rita; Bella, Antonino; Kadjo, Hervé A.; Daouda, Coulibaly; Makusheva, Ainash; Bessonova, Olga; Chaves, Sandra S.; Emukule, Gideon O.; Heraud, Jean-Michel; Razanajatovo, Norosoa H.; Barakat, Amal; El Falaki, Fatima; Meijer, Adam; Donker, Gé A.; Huang, Q. Sue; Wood, Tim; Balmaseda, Angel; Palekar, Rakhee; Arévalo, Brechla Moreno; Rodrigues, Ana Paula; Guiomar, Raquel; Lee, Vernon Jian Ming; Ang, Li Wei; Cohen, Cheryl; Treurnicht, Florette; Mironenko, Alla; Holubka, Olha; Bresee, Joseph; Brammer, Lynnette; Le, Mai T.Q.; Hoang, Phuong V.M.; El Guerche-Séblain, Clotilde; Paget, John; Global Influenza B Study teamWe describe the epidemiological characteristics, pattern of circulation, and geographical distribution of influenza B viruses and its lineages using data from the Global Influenza B Study. We included over 1.8 million influenza cases occurred in thirty-one countries during 2000-2018. We calculated the proportion of cases caused by influenza B and its lineages; determined the timing of influenza A and B epidemics; compared the age distribution of B/Victoria and B/Yamagata cases; and evaluated the frequency of lineage-level mismatch for the trivalent vaccine. The median proportion of influenza cases caused by influenza B virus was 23.4%, with a tendency (borderline statistical significance, p = 0.060) to be higher in tropical vs. temperate countries. Influenza B was the dominant virus type in about one every seven seasons. In temperate countries, influenza B epidemics occurred on average three weeks later than influenza A epidemics; no consistent pattern emerged in the tropics. The two B lineages caused a comparable proportion of influenza B cases globally, however the B/Yamagata was more frequent in temperate countries, and the B/Victoria in the tropics (p = 0.048). B/Yamagata patients were significantly older than B/Victoria patients in almost all countries. A lineage-level vaccine mismatch was observed in over 40% of seasons in temperate countries and in 30% of seasons in the tropics. The type B virus caused a substantial proportion of influenza infections globally in the 21st century, and its two virus lineages differed in terms of age and geographical distribution of patients. These findings will help inform health policy decisions aiming to reduce disease burden associated with seasonal influenza.
- Unsupervised extraction of epidemic syndromes from participatory influenza surveillance self-reported symptomsPublication . Kalimeri, Kyriaki; Delfino, Matteo; Cattuto, Ciro; Perrotta, Daniela; Colizza, Vittoria; Guerrisi, Caroline; Turbelin, Clement; Duggan, Jim; Edmunds, John; Obi, Chinelo; Pebody, Richard; Franco, Ana O.; Moreno, Yamir; Meloni, Sandro; Koppeschaar, Carl; Kjelsø, Charlotte; Mexia, Ricardo; Paolotti, DanielaAbstract: Seasonal influenza surveillance is usually carried out by sentinel general practitioners (GPs) who compile weekly reports based on the number of influenza-like illness (ILI) clinical cases observed among visited patients. This traditional practice for surveillance generally presents several issues, such as a delay of one week or more in releasing reports, population biases in the health-seeking behaviour, and the lack of a common definition of ILI case. On the other hand, the availability of novel data streams has recently led to the emergence of non-traditional approaches for disease surveillance that can alleviate these issues. In Europe, a participatory web-based surveillance system called Influenzanet represents a powerful tool for monitoring seasonal influenza epidemics thanks to aid of self-selected volunteers from the general population who monitor and report their health status through Internet-based surveys, thus allowing a real-time estimate of the level of influenza circulating in the population. In this work, we propose an unsupervised probabilistic framework that combines time series analysis of self-reported symptoms collected by the Influenzanet platforms and performs an algorithmic detection of groups of symptoms, called syndromes. The aim of this study is to show that participatory web-based surveillance systems are capable of detecting the temporal trends of influenza-like illness even without relying on a specific case definition. The methodology was applied to data collected by Influenzanet platforms over the course of six influenza seasons, from 2011-2012 to 2016-2017, with an average of 34,000 participants per season. Results show that our framework is capable of selecting temporal trends of syndromes that closely follow the ILI incidence rates reported by the traditional surveillance systems in the various countries (Pearson correlations ranging from 0.69 for Italy to 0.88 for the Netherlands, with the sole exception of Ireland with a correlation of 0.38). The proposed framework was able to forecast quite accurately the ILI trend of the forthcoming influenza season (2016-2017) based only on the available information of the previous years (2011-2016). Furthermore, to broaden the scope of our approach, we applied it both in a forecasting fashion to predict the ILI trend of the 2016-2017 influenza season (Pearson correlations ranging from 0.60 for Ireland and UK, and 0.85 for the Netherlands) and also to detect gastrointestinal syndrome in France (Pearson correlation of 0.66). The final result is a near-real-time flexible surveillance framework not constrained by any specific case definition and capable of capturing the heterogeneity in symptoms circulation during influenza epidemics in the various European countries.