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This report is published weekly on the PHE website. For further information on the surveillance schemes mentioned in this report,

please see the PHE website and the related links at the end of this document.

| Summary| Community surveillance |GP consultation rates | Hospitalisations | All-cause mortality | Microbiological surveillance|

| Vaccination | International | Acknowledgements | Related links |

Summary Week 11 (ending 17 March 2019)

Secondary Care

Hospitalisation rate observed was at Medium impact levels, with a rate of 1.52 per 100,000 trust catchment population for

England (19 NHS Trusts), this is a slight decrease from 1.56 per 100,000 in week 10.

ICU/HDU admission rate observed was at Low impact levels, with a rate of 0.09 per 100,000 trust catchment population for

England (136/143 NHS Trusts), this is a decrease from 0.20 per 100,000 in week 10.

There was no new laboratory confirmed influenza admissions reported from the 6 Severe Respiratory Failure centres in the

UK.

Hospitalisation

ICU/HDU

PHE Weekly National Influenza Report

Summary of UK surveillance of influenza and other seasonal respiratory illnesses

21 March 2019 Week 12 report (up to week 11 data)

All-cause mortality

In week 11 2019, no statistically significant excess all-cause mortality by week of death was seen overall and by age group in England. In the

devolved administrations, no statistically significant excess all-cause mortality for all ages was observed in Wales and Northern Ireland in

week 11 and in Scotland in week 09 2019

¾ During week 11, influenza continued to circulate in the community with activity indicators decreasing and Below Baseline.

¾ The impact of flu on healthcare services is at Medium impact for hospitalisations and Low for ICU/HDU influenza admissions.

¾ Influenza A(H1N1)pdm09 and influenza A(H3N2) are co-circulating. The Department of Health & Social Care has issued an alert on the

prescription of antiviral medicines by GPs

Microbiological surveillance

Primary care: Two samples tested positive for influenza (2 influenza A(H1N1)pdm09)with a positivity of 16.7% through the

UK GP sentinel swabbing schemes in week 11 2019.

Secondary care: Influenza percent positivity was 13.4%, Above Baseline threshold level, this is a slight increase from 11.5%

in week 10. There were 250 detections recorded through the DataMart scheme (22 influenza A(H1N1)pdm09, 157 influenza

A(H3), 68 influenza A(not subtyped) and 3 influenza B).

Secondary

Care

Community

Thirty-eight new acute respiratory outbreaks have been reported in the past 7 days. Thirty-four outbreaks were reported from care homes

where 12 tested positive for influenza A(not subtyped), 1 human metapneumovirus (hMPV) and 1 co-infection of influenza A(H1N1)pdm09,

hMPV and influenza A(not subtyped). Two outbreaks were reported from hospitals where 1 tested positive for influenza A(not subtyped). Two

outbreaks were reported from schools where one tested positive for influenza B.

Primary Care

The rate of influenza-like illness (ILI) was Below Baseline threshold levels. The overall weekly ILI GP consultation rate was

6.2 per 100,000 registered population in participating GP practices for England, this is a decrease from 9.1 per 100,000 in

week 10 2019.

In the devolved administrations, ILI rates were Below Baseline threshold levels for Northern Ireland, Scotland and Wales.

GP ILI

Consultations

England

Vaccination

Provisional data from the fourth monthly collection of influenza vaccine uptake in GP patients shows that in 99.6% of GP practices the

proportions of people in England who had received the 2018/19 influenza vaccine in targeted groups by 31 January 2019 were: 46.9% in

under 65 years in a clinical risk group, 45.0% in pregnant women and 71.3% in 65+ year olds. In 99.4% of GP practices reporting for the

childhood collection the provisional proportions vaccinated by 31 January 2019 were: 43.1% in 2 year olds and 45.2% in 3 year olds.

Provisional data from the fifth monthly collection of influenza vaccine uptake by frontline healthcare workers show 70.3% were vaccinated by

28 February 2019, compared to 68.7% vaccinated in the previous season by 28 February 2018.

Provisional data from the fourth monthly collection of influenza vaccine uptake for children of school years reception to year 5 shows 63.9% in

school year reception age, 63.4% in school year 1 age, 61.4% in school year 2 age, 60.2% in school year 3 age, 58.0% in school year 4 age

and 56.2% in school year 5 age were vaccinated by 31 January 2019.

WHO have published their recommendations for the composition of the 2019/20 Northern hemisphere influenza vaccine

International situation

In the temperate zone of the Northern hemisphere, influenza activity continued to be reported with influenza A viruses predominating overall.

In the temperate zones of the Southern hemisphere, influenza activity remained at inter-seasonal levels, with the exception of some parts of

Australia which remained above inter-seasonal levels. Worldwide, seasonal influenza subtype A viruses accounted for the majority of

detections.

2 of 12

Community surveillance | Back to top | Thirty-eight new acute respiratory outbreaks were reported in the past 7 days.

Acute respiratory disease outbreaks

-Thirty-eight new acute respiratory outbreaks have been reported in the past 7 days. Thirty-four outbreaks were reported from care homes where 12 tested positive for influenza A(not subtyped), 1 human metapneumovirus (hMPV) and 1 co-infection of influenza A(H1N1)pdm09, hMPV and influenza A(not subtyped). Two outbreaks were reported from hospitals where 1 tested positive for influenza A(not subtyped). Two outbreaks were reported from schools where one tested positive for influenza B. -Outbreaks should be recorded on HPZone and reported to the local Health Protection Teams and respscidsc@phe.gov.uk

FluSurvey

- Internet-based surveillance of influenza-like illness in the general population is undertaken through FluSurvey. A project run by PHE to monitor ILI activity in the community. - The overall ILI rate (all age groups) for week 11 2019 was 19.4 per 1,000 (45/2,317 people reported at least 1 ILI) (Figure 3) compared to 18.2 per 1,000 in the previous week, with the highest rate seen in the 20-44 year olds (23.7 per 1,000). - If you would like to become a participant of the FluSurvey project please do so by visiting the https://flusurvey.net/en/accounts/register/ website for more information.

Medical Officers of Schools Association (MOSA)

& PHE surveillance scheme - Boarding schools in England within the MOSA network are recruited each season to report various respiratory related illnesses including influenza like illnesses (ILI). For the

2018/19 season, 21 MOSA schools have agreed to participate

in the scheme, including a total of 6,661 boarders. - The overall rate (all boarders) for week 10 was 0.0 per 1,000 boarders compared to 0.6 per 1,000 boarders in week 09. -Since week 40, there have been 16 outbreaks reported from

10 MOSA schools, with a total of 59 ILI cases identified. Of

the 16 outbreaks, 2 outbreaks have tested positive for influenza A (H1N1)pdm09 and 1 outbreak has tested positive for influenza B. - If you are a MOSA school and would like to participate in this scheme, please email mosa@phe.gov.uk for more information. 0 50
100
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4044485248121620

Number

Week of report

Care homeHospitalSchoolOther2017/18 - total no. of outbreaks Figure 1: Number of acute respiratory outbreaks by institution, UK 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0

4044485248121620

Rates per 1,000 boarders

Week number

Figure 2: MOSA ILI rates, England

School holiday periodsILI rate

0 50
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400

44464850522468101214161820

ILI incidence per 1,000

Week < 20 20-44 45+

Overall ILI incidence

rate Figure 3: Overall ILI incidence and by age group, UK

3 of 12

Weekly consultation rates in national sentinel schemes | Back to top |

In week 11, the overall weekly influenza-like illness (ILI) GP consultation rate continued to decrease with

ILI rate below baseline threshold levels in England. In the devolved administrations, ILI rates decreased

compared to week 10 and are below their respective baselines in Scotland, Northern Ireland and Wales.

GP ILI consultations in the UK

GP In Hours Syndromic Surveillance System (England) -The weekly ILI consultation rate through the GP In Hours Syndromic Surveillance system is at 5.3 per 100,000 in week 11

2019 (Figure 5).

- During week 11, NHS 111 cold/flu calls and GPOOH consultations remained at pre-epidemic levels. There were further small decreases noted in ED attendances for ILI. GPIH for ILI also continued to decrease and remain below the pre-epidemic threshold. - Figure 5 represents a map of GP ILI consultation rates in week

11 across England by PHE centres, with influenza-like illness

surveillance MEM thresholds applied. ILI consultation rates presented for each utLA on the map should be interpreted in context of regional and national ILI activity; as MEM thresholds are calculated (based on previous influenza seasons from 2012/13 onwards) separately for each of the nine PHE centres and utLA rates are then compared to Centre-level thresholds only, therefore utLAs with higher background rates than the Centre may appear to have higher ILI activity. -For further information, please see the syndromic surveillance webpage. Figure 5: Map of GP ILI consultation rates in week 11

RCGP (England)

- The weekly ILI consultation rate through the RCGP surveillance was at 6.2 per 100,000 registered population in participating GP practices in week 11 2019, this is a decrease from 9.1 per 100,000 in week 10. This is below the baseline threshold (13.1 per 100,000) (Figure 4*). By age group, the highest rates were seen in 15-44 year olds (7.5 per 100,000) and in 45-64 year olds (7.0 per

100,000).

*The Moving Epidemic Method (MEM) has been adopted by the European Centre for Disease Prevention and Control to calculate thresholds for GP ILI consultations for the start of influenza activity (based on 10 seasons excluding 2009/10) in a standardised approach across Europe. For MEM intensity threshold values, please visit: UK

- In week 11, overall weekly ILI consultation rates across countries of the UK decreased compared to the previous week,

with all countries below their respective baseline threshold levels (Table 1).

- By age group, the highest rates were seen in the 45-64 year olds in Scotland and Northern Ireland (8.2 per 100,000

and 8.1 per 100,000 respectively) and in the 15-44 year olds in Wales (10.4 per 100,000).

*The Moving Epidemic Method (MEM) has been adopted by the European Centre for Disease Prevention and Control to calculate thresholds for

GP ILI consultations for the start of influenza activity (based on 10 seasons excluding 2009/10), in a standardised approach across Europe. For

MEM threshold values for each country, please visit: https://www.gov.uk/guidance/sources-of-uk-flu-data-influenza-surveillance-in-the-

0 10 20 30
40
50
60
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80
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100
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140

404448524812162024283236

ILI rate per 100,000

Week number

Figure 4: RCGP ILI consultation rates, England

Baseline thresholdLow Medium

HighVery high

Table 1: GP ILI consultations in the UK for all ages with MEM thresholds applied*

404142434445464748495051521234567891011

England (RCGP)4.23.94.53.63.65.35.26.46.27.68.19.48.414.819.219.617.519.723.121.115.712.19.16.2 Wales 7.03.64.26.66.36.44.54.76.53.24.59.09.514.720.522.915.720.521.417.217.58.28.77.5 Scotland 7.15.84.03.82.87.64.04.75.64.06.510.16.917.726.718.028.432.732.327.220.810.210.26.3 Northern Ireland3.83.53.83.63.85.06.34.55.66.08.48.99.013.518.914.412.414.516.214.511.19.05.95.6

GP ILI

consultation rates (all ages)

Week number

4 of 12

Number of new admissions and fatal confirmed influenza cases in ICU/HDU (USISS mandatory ICU scheme),

UK (week 11)

- In week 11 2019, there were 47 new admissions to ICU/HDU with confirmed influenza (11 influenza A(H1N1)pdm09, 4

influenza A (H3N2) and 32 influenza A(unknown subtype)) reported through the USISS mandatory ICU scheme in the UK

(136/143). The rate for England (n=45) was 0.09 per 100,000 trust catchment population (Figures 8 and 9) compared to 0.20

per 100,000 in week 10 2019). Five fatal influenza cases in ICU were reported in week 11 2019 in the UK.

- A total of 2,999 new admissions (976 influenza A(H1N1)pdm09, 186 influenza A(H3N2), 1,808 influenza A(unknown

subtype) and 29 influenza B) and 293 confirmed deaths have been reported in the UK since week 40 2018.

*The Moving Epidemic Method (MEM) has been adopted by the European Centre for Disease Prevention and Control to calculate thresholds for ICU/HDU

admission rates for the start of influenza activity (based on 6 seasons) in a standardised approach across Europe. For MEM threshold values, please visit:

Influenza confirmed hospitalisations (provisional) | Back to top |

In week 11 2019, there were 137 hospitalised influenza cases (19 influenza A(H1N1)pdm09, 51 influenza A(H3N2),

66 influenza A(unknown) and one influenza B) reported through the USISS sentinel hospital network across

England (21 NHS Trusts). There were 47 new admissions to ICU/HDU with confirmed influenza (11 influenza

A(H1N1)pdm09, 4 influenza A (H3N2), 32 influenza A(unknown subtype)) reported through the USISS mandatory

ICU/HDU surveillance scheme across the UK (136/143 NHS Trusts in England). USISS sentinel weekly hospitalised confirmed influenza cases, England (week 11)

- In week 11 2019, there were 137 hospitalised laboratory confirmed influenza cases (19 influenza A(H1N1)pdm09, 51

influenza A(H3N2), 66 influenza A(unknown) and one influenza B) reported from 19 NHS Trusts across England through the

USISS sentinel hospital network, with a rate of 1.52 per 100,000 trust catchment population compared to 1.56 per 100,000 in

the previous week (Figures 6 and 7). This is within the medium impact range of 1.22 to <5.08 per 100,000.

- A total of 5,130 hospitalised confirmed influenza admissions (1,830 influenza A(H1N1)pdm09, 632 influenza A(H3N2), 2,632

influenza A(unknown) and 33 influenza B) have been reported in the England since week 40 2018 via the sentinel scheme.

*The Moving Epidemic Method (MEM) has been adopted by the European Centre for Disease Prevention and Control to calculate thresholds for ICU/HDU

admission rates for the start of influenza activity (based on 6 seasons) in a standardised approach across Europe. For MEM threshold values, please visit:

0 150
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<11-45-1415-4445-6465-7475+

Number

Age group (years)

A(H1N1)pdm09A(H3N2)

A unknown subtype B

Figure 9: Cumulative ICU influenza admissions (USISS mandatory) by age group and flu type, UK, since week 40 2018 0 50
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0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0

4044485248121620

Number of admissions

Admission rate per 100,000

Week number

Number of cases

Rate of hospital admission/100,000 (2018/19)

Rate of hospital admission/100,000 (2017/18)

Figure 8: Weekly ICU/HDUinfluenza admission rate per 100,000 trust catchment population, England, since week 40 2018

Baseline

thresholdLow MediumHighVery high 0 150
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<11-45-1415-4445-6465+

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A(H1N1)pdm09A(H3N2)

A unknown subtype B

Figure 7: Cumulative hospitalised influenza admissions (USISS sentinel) by age group and flu type, England, since week 40 2018

Baseline

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