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1

Summary

The surveillance data indicates that influenza in community and hospital settings across Northern Ireland has

decreased. Primary Care influenza rates remain well below the baseline Moving Epidemic Method (MEM)

threshold1 for Northern Ireland and have now returned to baseline levels.

Northern Ireland Primary Care Consultation Rates

GP consultation rate for flu and flu-like illness (flu/FLI) during weeks 13 and 14, 2019 was 5.7 and 4.3 per

100,000 population respectively.

OOH GP flu/FLI consultation rate was 2.6 and 2.2 per 100,000 population respectively.

Microbiological Surveillance (Flu and RSV)

During week 13 and 14 there were 504 specimens submitted for virological testing, of which 39 tested

positive for influenza (8% positivity). There were 20 detections of Flu A(H3), nine Flu A(H1N1)pdm09, eight (Flu A (untyped) and two Flu B. There were 13 positive RSV detections in week 13 and 14 (8% positivity).

Secondary Care (Hospital both non-ICU and ICU)

In week 13 and 14 there were nine detections of Flu A(H1N1)pdm09, 17 Flu A(H3), eight Flu A (untyped) and

two Flu B. There were no new cases reported in ICU with laboratory confirmed influenza and no deaths reported.

To date, there have been a total of 67 admissions to ICU with confirmed influenza reported to PHA and seven

deaths reported in ICU patients who had laboratory confirmed influenza.

Respiratory Outbreaks across Northern Ireland

During weeks 13 and 14 there were no respiratory outbreaks reported to PHA.

To date, there have been 12 respiratory outbreaks reported, nine in care homes (five Flu A(untyped), one Flu

B and three RSV) and three in a hospital setting (Flu A(untyped)).

Mortality

The proportion of deaths related to respiratory keywords (bronchiolitis, bronchitis, influenza and pneumonia)

rose in week 14 (25%) compared to week 13 (21%).

Influenza Vaccine Uptake

2018/19 (to Jan 31st) 2017/18 (to Jan 31st)

>65 years 68.7% 70.4% <65 years at risk 50.7% 53.5%

Pregnant women 47.0% 47.9%

2 to 4 year olds 47.2% 49.1%

Primary School 75.7% 76.2%

Trust Frontline 34.8% 32.8%

Trust Frontline (excluding social workers and social care workers) 38.5% -

Influenza Weekly Surveillance Bulletin

Northern Ireland, Weeks 13 and 14 (25th March 7th April 2019) 2

Introduction

Influenza is an acute viral infection of the respiratory tract (nose, mouth, throat, bronchial tubes and lungs). There are three types of flu virus: A, B and C, with A and B responsible for most clinical illness. Influenza activity in Northern Ireland is monitored throughout the year to inform public health action and to prevent spread of the infection. The influenza season typically runs from week 40 to week 20. Week 40 for the 2018/19 season commenced on 1st October 2018. Surveillance systems used to monitor influenza activity include: Northern Ireland GP surveillance representing 98% of Northern Ireland population; Sentinel flu-swabber GP practices representing 11.2% of the NI population, contributing to the measurement of circulating influenza in the community GP Out-of-Hours surveillance system representing the entire population; Virological reports from the Regional Virus Laboratory (RVL); Individual virology reports from local laboratories (as outlined); Influenza outbreak report notification to PHA Duty Room; Critical Care Network for Northern Ireland reports on patients in ICU/HDU with confirmed influenza; Mortality data from Northern Ireland Statistics and Research Agency (NISRA); Excess mortality estimations are calculated using the EuroMOMO (Mortality Monitoring in Europe) model based on raw death data supplied by NISRA NB: Please note the change in the collection of Flu/FLI consultation data since 2017-18. Data is collected from 325 GP practices, representing 98% of the Northern Ireland (NI) population. This represents a change from pre 2017-18 season when data was collected from 37 sentinel GP practices (representing 11.7% of the NI population). As a result, Flu/FLI consultation rates and the MEM threshold from 2017-18 onwards will be generally lower than in previous years. Please take this into account when interpreting the figures. 3

Northern Ireland GP Consultation Data

Figure 1. Northern Ireland GP consultation rates for flu/FLI 2017/18 - 2018/19 Figure 2. Northern Ireland GP age-specific consultation rates for flu/FLI from week 40, 2017 0 20 40
60
80
100
120

Consulttion rate per 100,000 population

Year/Week

2010-112017-182018-19Mem Threshold

Moderate

High Low 0 10 20 30
40
50
60
70
80
90
100

Consultation rate per 100,000 population

2017/18

0-45-1415-4445-6465+

2018/19

4

Comment

The NI GP consultation rate for flu and flu-like illness (flu/FLI) for weeks 13 and 14, 2019 was

5.7 and 4.3 per 100,000 population respectively. Activity remains well below the baseline MEM

threshold for Northern Ireland (<17.1 per 100,000) (Figure 1). The rate is lower in weeks 13 and 14 than the same week in 2017/18 (5.7 compared to 11.7 per 100,000 in week 13 and 4.3 compared to 6.0 in week 14) (Figure 1). The consultation rates decreased from week 13 to week 14 in all age groups with the exception of those aged 5-14 years which increased from 2.2 to 2.7 per 100,000. The consultation rate was highest in those aged 15-44 years in week 13 (7.0 per 100,000) and highest in those aged 45-64 years in week 14 (6.7 per 100,000). Rates were lowest in those aged 0-4 years in week 13 and week 14 (0.9 and 0.0 per 100,000 respectively) (Figure 2). 5

Out-of-Hours (OOH) Centres Call Data

Figure 3. OOH call rate for flu/FLI, 2016/17 2018/19 Figure 4. OOH call rates of flu/FLI by age-group from week 40, 2017 0 5 10 15 20 25
30
35
40
45
50

OOH consulttion rate per 100,000 population

Year/Week

2017-182018-19

0 5 10 15 20 25
30
35
40
45
50

OOH consultation rate per 100,000

population

2017/18

0-45-1415-4445-6465+

2018/19

6

Comment

The OOH flu/FLI consultation rates during weeks 13 and 14, 2019 were 2.6 and 2.2 per

100,000 population respectively (Figure 3). The rate in week 13 was lower than the same

week in 2017/18 (2.6 compared to 6.4 per 100,000). The proportion of calls related to flu/FLI in OOH centres remained stable at 0.5%. The rate in week 14 decreased from week 13 from 2.6 to 2.2 per 100,000. The rate in week 14 was lower than the same week in 2017/18 (2.2 compared to 5.9 per 100,000). The proportion of calls related to flu/FLI in OOH centres decreased slightly in week 14 to 0.4%. Consultation rates decreased between weeks 13 and 14 in those aged 5-14 years (3.7 to 1.6 per 100,000), 15-44 years (4.0 to 2.2 per 100,000) and 65 years and over (2.7 to 1.7 per

100,000), but increased in those aged 0-4 years (0.0 to 5.2 per 100,000) and 45-64 years (0.6

to 2.0 per 100,000) (Figure 4). 7

Virology Data

Figure 5. Northern Ireland GP consultation rates for flu/FLI and number of influenza positive detections 2013/14 2018/19 Figure 6. Northern Ireland GP consultation rates for flu/FLI and number of virology 'fludetections from week 40, 2017 0 50
100
150
200
250
300
350
400
450
0 10 20 30
40
50
60
70
80

Number of laboratory reports

Consultation rate per 100,000 population

Flu A not subtypedFlu AH3Flu A(H1N1) 2009

Flu BN. Ireland ILI consultation rateMEM Epidemic Threshold 0 50
100
150
200
250
300
350
400
450
0 10 20 30
40
50
60
70
80

Number of laboratory reports

Consultation rate per 100,000 population

Flu A not subtypedFlu AH3Flu A(H1N1) 2009

Flu BN. Ireland ILI consultation rateMEM Epidemic Threshold 8 Table 1. Virus activity in Northern Ireland by source, Weeks 13-14, 2018-19

Source Specimen

s tested Flu AH3 Flu

A(H1N1)

2009)
A (Untyped) Flu B RSV Total influenza

Positive

Influenza

Positive

Sentinel 15 2 0 0 0 0 2 13%

Non- sentinel 489 18 9 8 2 13 37 8%

Total 504 20 9 8 2 13 39 8%

Table 2. Cumulative virus activity from all sources by age group, Week 40 - 14, 2018-19

Age Group Flu AH3 Flu A(H1N1)

2009

A (Untyped) Flu B Total

Influenza

RSV

0-4 12 148 26 0 186 357

5-14 17 42 15 0 74 16

15-64 136 529 233 4 902 125

65+ 112 162 115 3 392 179

Unknown 0 0 0 0 0 0

All ages 277 881 389 7 1554 677

Table 3. Cumulative virus activity by age group and source, Week 40 - Week 14, 2018-19

Sentinel Non-sentinel

Age Group

Flu AH3

Flu A(H1N1)

2009

A (Untyped)

Flu B

Total Influenza

RSV

Flu AH3

Flu A(H1N1)

2009

A (Untyped)

Flu B

Total Influenza

RSV

0-4 0 3 0 0 3 0 12 145 26 0 183 357

5-14 1 4 0 0 5 0 16 38 15 0 69 16

15-64 15 44 11 0 70 10 121 485 222 4 832 115

65+ 2 3 2 1 8 1 110 159 113 2 384 178

Unknown 0 0 0 0 0 0 0 0 0 0 0 0

All ages 18 54 13 1 86 11 259 827 376 6 1468 666

Note

All virology data are provisional. The virology figures for previous weeks included in this or future bulletins are

updated with data from laboratory returns received after the production of the last bulletin. The current bulletin

reflects the most up-to-date information available. Sentinel and non-sentinel samples are tested for influenza

and for RSV. Cumulative reports of influenza A(untyped) may vary from week to week as these may be subsequently typed in later reports.

Many Flu A positives this season have not been typed using the normal H1 typing assay but are proving to be

Flu A(H1)2009 on nucleic acid sequencing of selected positive samples. This has been a phenomenon seen

throughout the UK this season and relates to virus mutations that affect the H1 typing assay. A new PHE

typing assay for H1 will be in use from week 6, 2019 and the numbers of Flu A(untyped) should decline in

subsequent reports. 9 Figure 7. Number of samples tested for influenza and proportion positive,

2017/18 and 2018/19, all sources

Comment

Additional virology testing has been undertaken at a local laboratory since week 2, 2018 and at

another since week 2, 2019. This bulletin includes this data along with the data from the

Regional Virology Laboratory. Other local laboratories may begin undertaking influenza testing and this data will be included in later bulletins if applicable. During weeks 13 and 14, 2019 there were 504 specimens submitted for virological testing. There were 39 detections of influenza in total (8% positivity); 20 Flu A(H3), nine Flu A(H1N1)pdm09, eight Flu A(untyped) and two Flu B. Flu A(H3) appears to be the dominant virus circulating now. There were 15 samples submitted through the GP based sentinel scheme across Northern Ireland. There were two detections of influenza in total (13% positivity); both Flu A(H3) (Tables 1, 2 & 3; Figures 5, 6 & 7). 0% 5% 10% 15% 20% 25%
30%
35%
40%
45%
50%
0 100
200
300
400
500
600
700
800
900
1000

Proportion positive

Number of tests

Week

2017-18 No Tested2018-19 No Tested

2017-18 Proportion positive2018-19 Proportion positive

10

Respiratory Syncytial Virus (RSV)

Figure 8. Number of samples tested for RSV and proportion positive,

2017/18 and 2018/19, all sources

Comment

During weeks 13 and 14, 2019 there were thirteen positive detections of RSV (2% positivity). To date there have been a total of 677 detections of RSV of which the majority (53%) were inquotesdbs_dbs20.pdfusesText_26