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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 10 (ending 10 March 2019)

Secondary Care

Hospitalisation rate observed was at Medium impact levels, with a rate of 1.55 per 100,000 trust catchment population for

England (21 NHS Trusts), this is a decrease from 2.10 per 100,000 in week 09.

ICU/HDU admission rate observed was at Medium impact levels, with a rate of 0.19 per 100,000 trust catchment population

for England (139/143 NHS Trusts), this is a decrease from 0.24 per 100,000 in week 09.

There was 1 new influenza admissions (1 influenza A(H1N1)pdm09) 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

14 March 2019 Week 11 report (up to week 10 data)

All-cause mortality

In week 10 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 10 and in Scotland in week 08 2019

During week 10 influenza continued to circulate in the community with activity indicators decreasing and Below Baseline.

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

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: 14 samples tested positive for influenza (7 influenza A(H1N1)pdm09 and 7 influenza A(H3))with a positivity of

25.5% through the UK GP sentinel swabbing schemes in week 10 2019.

Secondary care: Influenza percent positivity was 11.5%, Above Baseline threshold level, this is a decrease from 15.8% in

week 09. There were 265 detections recorded through the DataMart scheme (36 influenza A(H1N1)pdm09, 111 influenza

A(H3), 115 influenza A(not subtyped) and 3 influenza B).

Secondary

Care

Community

Forty new acute respiratory outbreaks have been reported in the past 7 days. Twenty-seven outbreaks were reported from care homes where

6 tested positive for influenza A(not subtyped), 1 human metapneumovirus (hMPV) and 1 parainfluenza. Four outbreaks were reported from

hospitals where 2 tested positive for influenza A(not subtyped). Six outbreaks were reported from schools where one tested positive for

influenza A(not subtyped). The remaining 3 outbreaks were reported from the Other settings category where 1 tested positive for Group A

Streptococcus.

Primary Care

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

9.1 per 100,000 registered population in participating GP practices for England, this is a decrease from 12.1 per 100,000 in

week 09 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 fourth monthly collection of influenza vaccine uptake by frontline healthcare workers show 68.6% were vaccinated by

31 January 2019, compared to 67.6% vaccinated in the previous season by 31 January 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 increase with influenza A(H1N1)pdm09 predominating

overall. In the temperate zones of the Southern hemisphere, influenza activity returned to inter-seasonal levels with the exception of some

parts of Australia where influenza activity 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 | Forty new acute respiratory outbreaks were reported in the past 7 days.

Acute respiratory disease outbreaks

- Forty new acute respiratory outbreaks have been reported in the past 7 days. Twenty-seven outbreaks were reported from care homes where 6 tested positive for influenza A(not subtyped), 1 human metapneumovirus (hMPV) and 1 parainfluenza. Four outbreaks were reported from hospitals where 2 tested positive for influenza A(not subtyped). Six outbreaks were reported from schools where one tested positive for influenza A(not subtyped). The remaining 3 outbreaks were reported from the Other settings category where 1 tested positive for Group A Streptococcus. -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 10 2019 was 18.2 per 1,000 (43/2,323 people reported at least 1 ILI) (Figure 3) compared to 23.6 per 1,000 in the previous week, with the highest rate seen in the 20-44 year olds (22.5 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
150
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4044485248121620

Number

Week of report

Care homeHospitalSchoolOther2017/18 - total no. of outbreaks

Figure 1: Number of acuterespiratory 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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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 10, 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 or

remained similar to week 09, below 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 6.9 per 100,000 in week 10

2019 (Figure 5).

- During week 10, there were continued decreases in influenza like illness(ILI) seen in ED attendances. GPOOH and GPIH also so decreases in ILI consultations with both returning to pre-epidemic levels. There were further decreases in NHS 111 cold/flu calls, which have returned to pre-epidemic levels. - Figure 5 represents a map of GP ILI consultation rates in week

10 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 10 Table 1: GP ILI consultations in the UK for all ages with MEM thresholds applied*

RCGP (England)

- The weekly ILI consultation rate through the RCGP surveillance was at 9.1 per 100,000 registered population in participating GP practices in week 10 2019, this is a decrease from 12.1 per 100,000 in week 09. This is below the baseline threshold (13.1 per 100,000) (Figure 4*). By age group, the highest rates were seen in <1 year olds (13.5 per 100,000) and in 45-64 year olds (12.3 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 10, overall weekly ILI consultation rates across countries of the UK either decreased or remained similar 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, Wales and Northern Ireland (14.2 per

100,000, 13.0 per 100,000 and 8.4 per 100,000 respectively).

*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-uk#clinical-

surveillance-through-primary-care 0 10 20 30
40
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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*

4 of 12

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

UK (week 10)

- In week 10 2019, there were 99 new admissions to ICU/HDU with confirmed influenza (24 influenza A(H1N1)pdm09, 7

influenza A(H3N2), 65 influenza A(unknown subtype) and 3 influenza B) reported across the UK (139/143 Trusts in England)

through the USISS mandatory ICU scheme. The rate for England (n=97) was 0.19 per 100,000 trust catchment population

compared to 0.24 per 100,000 in the previous week (Figures 8 and 9), above the baseline threshold of 0.09 per 100,000 within

the medium impact range. Twelve influenza laboratory-confirmed deaths were reported to have occurred in ICU in week 10 in

the UK.

- A total of 2,946 new ICU/HDU admissions (965 influenza A(H1N1)pdm09, 182 influenza A(H3N2), 1,770 influenza A(unknown

subtype) and 29 influenza B) and 287 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 10 2019, there were 147 hospitalised confirmed influenza cases (41 influenza A(H1N1)pdm09, 38 influenza

A(H3N2), 67 in fluenza A(unknown subtype) and 1 influenza B) reported through the USISS sentinel hospital

network across England (21 NHS Trusts). There were 99 new admissions to ICU/HDU with confirmed influenza (24

influenza A(H1N1)pdm09, 7 influenza A(H3N2), 65 influenza A(unknown subtype) and 3 influenza B) reported

through the USISS mandatory ICU/HDU surveillance scheme across the UK (139/143 NHS Trusts in England).

USISS sentinel weekly hospitalised confirmed influenza cases, England (week 10)

- In week10 2019, there were 147 hospitalised laboratory confirmed influenza cases (41 influenza A(H1N1)pdm09, 38 influenza

A(H3N2), 67 influenza A(unknown subtype) and 1 influenza B) reported from 21 NHS Trusts across England through the USISS

sentinel hospital network, with a rate of 1.55 per 100,000 trust catchment population compared to 2.10 per 100,000 in the

previous week (Figures 6 and 7). This is above the baseline impact threshold of 0.89 per 100,000 within the medium impact

range of 1.22 to <5.08 per 100,000.

- A total of 4,991 hospitalised confirmed influenza admissions (1,810 influenza A(H1N1)pdm09, 583 influenza A(H3N2), 2,566

influenza A(unknown subtype) and 32 influenza B) and have been reported in the UK 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
100
150
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400
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 admissionsAdmission 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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1050
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1350
1500
<11-45-1415-4445-6465+

Number

Age group (years)

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

thresholdLow MediumHighVery high 0 100
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0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0

4044485248121620

Number of admissions

Hospitalisation 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 6: Weekly hospitalised influenza case rate per 100,000 trust catchment population, England, since week 40 2018

5 of 12

All-cause mortality data | Back to top |

In week 10 2019, no statistically significant excess all-cause mortality by week of death was observed

overall and by age group in England, through the EuroMOMO algorithm. In the devolved

administrations, no statistically significant excess all-cause mortality for all ages was observed in

Wales and Northern Ireland in week 10 2019 and in Scotland in week 08 2019. Excess all-cause mortality by age group, England, Wales, Scotland and Northern Ireland - In week 10 2019 in England, no statistically significant excess mortality by week of death above the upper 2 z-score threshold was seen overall, by age group and sub-nationally (all ages), after correcting ONS disaggregate data for reporting delay with the standardised EuroMOMO algorithm. This data is provisional due to the time delay in registration; numbers may vary from week to week. - In the devolved administrations, statistically significant excess all- cause mortality for all ages was observed in Wales and Northern Ireland in week 10 2019 and in Scotland in week 08 2019 (Table 2). Figure 10: Weekly observed and expected number of all-age all-cause deaths, with the dominant circulating influenza A subtype, England, 2014 to week 10 2019 *Note: Delays in receiving all registered deaths from April 2018, following changes in IT systems at ONS, may result in some delays in the model to adjust for most recent deaths.

All-cause death registrations, England and Wales

- In week 09 2019, an estimated 11,044 all-cause deaths were registered in England and Wales (source: Office for National

Statistics). This is a decrease compared to the 11,295 estimated death registrations in week 08 2019.

USISS Severe Respiratory Failure Centre confirmed influenza admissions, UK (week 10)

- In week 10, there was 1 new admission for laboratory confirmed influenza (1 influenza A(H1N1)pdm09) among the 6 Severe

Respiratory Failure (SRF) centres in the UK.

- Since week 40 there have been 92 confirmed influenza admissions (76 influenza A(H1N1)pdm09, 4 influenza A(H3N2) and

12 influenza A(unknown subtype)) to ECMO centres

*Note: Delays in receiving all registered deaths from April 2018, following changes in IT systems at ONS, may result in some delays in the model to adjust for most recent deaths. Table 2: Excess mortality by UK country, for all ages*

Country Excess detected in week 10

2019?

Weeks with excess

in 2018/19

England × 6

Wales × NA

Northern Ireland × 6; 9

Country Excess detected in week 08

2019?

Weeks with excess

in 2018/19

Scotland × 52-2

* Excess mortality is calculated as the observed minus the expected number of deaths in weeks above threshold * NA refers to data not available for this week

6 of 12

Microbiological surveillance | Back to top | In week 10 2019, 14 samples tested positive for influenza (7 influenza A(H1N1)pdm09 and 7 influenza A(H3)) with a positivity of 25.5% through the UK GP sentinel schemes. 265 positive detections were recorded through the DataMart scheme (36 influenza A(H1N1)pdm09, 111 influenza A(H3), 115 influenza

A(not subtyped) and 3 influenza B) with a positivity of 11.5%, this is above the baseline threshold of 9.2%.

Respiratory DataMart System (England)

- In week 10 2019, out of the 2,314 respiratory specimens reported through the Respiratory DataMart System, 265 samples were positive for influenza (36 influenza A(H1N1)pdm09, 111 influenza A(H3), 115 influenza A(not subtyped) and 3 influenza B) (Figure 12), with an overall positivity of 11.5% compared to 15.8% the previous week, which is above the MEM baseline threshold for this season of 9.2%. The highest positivity for influenza by age group was seen in the 15-44 year olds at 13.5% in week 10 (Figure 13). RSV positivity remained low. Rhinovirus positivity decreased slightly from

9.5% in week 09 to 8.9% in week 10 2019. Human metapneumovirus (hMPV)

positivity decreased slightly to 3.7% in week 10. Adenovirus and parainfluenza positivities increased slightly from in 3.5% and 4.0% in week 09 to 3.7% and 4.5% in week 10 respectively (Figure 14).

Sentinel swabbing schemes in England (RCGP)

and the Devolved Administrations - In week 10 2019, 14 samples tested positive for influenza (7 influenza A(H1N1)pdm09 and 7 influenza A(H3)) with an overall positivity of 25.5% compared to 26.3% in week 09 2019 through the UK GP sentinel swabbing schemes (Figure 11). Since week 40, a total of 823 samples (640 influenza A(H1N1)pdm09, 156 influenza A(H3), 19 influenza A(unknown subtype) and 8 influenza B) tested positive for influenza through this scheme.

*The Moving Epidemic Method 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 in a standardised approach across Europe. The threshold to indicate a likelihood of influenza community circulation for Datamart % positive

as calculated through the Moving Epidemic Method is 9.2% in 2018/19. Figure 11: Number of influenza positive samples and % positive, UK GP sentinel schemes NB. Positivity (%) omitted when fewer than 10 specimens were tested 0.0 10.0 20.0 30.0
40.0
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404448524812162024283236Number of positive specimens

Proportion positive

Week number (of sample)

Influenza A (n)

Influenza B (n)

2017/18 total influenza (%)

Total influenza (%)

Figure 12: DataMart samples positive for influenza,

England

quotesdbs_dbs20.pdfusesText_26