Pasi Penttinen

Specific serology for emerging human coronaviruses by protein microarray

The influenza season 2014/15 started in Europe in week 50 2014 with influenza A(H3N2) viruses predominating. The majority of the A(H3N2) viruses characterised antigenically and/or genetically differ from the northern hemisphere vaccine component which may result in reduced vaccine effectiveness for the season. We therefore anticipate that this season may be more severe than the 2013/14 season. Treating influenza with antivirals in addition to prevention with vaccination will be important.

Taking stock of the first 133 MERS coronavirus cases globally – Is the epidemic changing?

Since June 2012, 133 Middle East respiratory syndrome coronavirus (MERS-CoV) cases have been identified in nine countries. Two time periods in 2013 were compared to identify changes in the epidemiology. The case-fatality risk (CFR) is 45% and is decreasing. Men have a higher CFR (52%) and are over-represented among cases. Thirteen out of 14 known primary cases died. The sex-ratio is more balanced in the latter period. Nosocomial transmission was implied in 26% of the cases.

Comparing introduction to Europe of highly pathogenic avian influenza viruses A(H5N8) in 2014 and A(H5N1) in 2005

Since the beginning of November 2014, nine outbreaks of highly pathogenic avian influenza virus (HPAIV) A(H5N8) in poultry have been detected in four European countries. In this report, similarities and differences between the modes of introduction of HPAIV A(H5N1) and A(H5N8) into Europe are described. Experiences from outbreaks of A(H5N1) in Europe demonstrated that early detection to control HPAIV in poultry has proven pivotal to minimise the risk of zoonotic transmission and prevention of human cases.

Decreased effectiveness of the influenza A(H1N1)pdm09 strain in live attenuated influenza vaccines: an observational bias or a technical challenge?

There are currently two types of approved influenza vaccines: inactivated or recombinant vaccines, and live attenuated vaccines. The live attenuated influenza vaccines (LAIV) constructed on a backbone of an A/Leningrad virus strain into which the seasonal haemagglutinin (HA) and neuraminidase (NA) selected for the vaccine were inserted by reassortment, were used in the former Soviet Union for over 50 years [1]. Since the early 2000s, a different attenuated virus strain based on the A/Ann Arbor strain, has been approved for vaccine manufacturing in the United States (US) and more recently in the European Union/European Economic Area (EU/EEA) [2,3]. The proposed advantages of the LAIV were that they had superior efficacy compared to inactivated vaccines in young children [4], they were programmatically more suited to immunisation of children [5] and improved cost-effectiveness could potentially be achieved with childhood LAIV programmes [5-7]. LAIV have also been shown to be of great use in pandemic response since the production yield (doses per egg) is much greater than for inactivated vaccines, and the time between production and release is shorter. In addition, the nasal route of delivery could facilitate rapid population-wide immunisation during pandemics.

Determinants and Drivers of Infectious Disease Threat Events in Europe

Globalization and environment, the most frequent underlying drivers, should be targeted for interventions to prevent such events.

Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017

Since December 2016, excess all-cause mortality was observed in many European countries, especially among people aged ≥ 65 years. We estimated all-cause and influenza-attributable mortality in 19 European countries/regions. Excess mortality was primarily explained by circulation of influenza virus A(H3N2). Cold weather snaps contributed in some countries. The pattern was similar to the last major influenza A(H3N2) season in 2014/15 in Europe, although starting earlier in line with the early influenza season start.

Observed and projected drivers of emerging infectious diseases in Europe.

Emerging infectious diseases are of international concern because of the potential for, and impact of, pandemics; however, they are difficult to predict. To identify the drivers of disease emergence, we analyzed infectious disease threat events (IDTEs) detected through epidemic intelligence collected at the European Centre for Disease Prevention and Control (ECDC) between 2008 and 2013, and compared the observed results with a 2008 ECDC foresight study of projected drivers of future IDTEs in Europe. Among 10 categories of IDTEs, foodborne and waterborne IDTEs were the most common, vaccine‐preventable IDTEs caused the highest number of cases, and airborne IDTEs caused the most deaths. Observed drivers for each IDTE were sorted into three main groups: globalization and environmental drivers contributed to 61% of all IDTEs, public health system drivers contributed to 21%, and social and demographic drivers to 18%. A multiple logistic regression analysis showed that four of the top five drivers for observed IDTEs were in the globalization and environment group. In the observational study, the globalization and environment group was related to all IDTE categories, but only to five of eight categories in the foresight study. Directly targeting these drivers with public health interventions may diminish the chances of IDTE occurrence from the outset.

Highly pathogenic avian influenza A(H5N8) outbreaks: protection and management of exposed people in Europe, 2014/15 and 2016

Introduction of highly pathogenic avian influenza (HPAI) virus A(H5N8) into Europe prompted animal and human health experts to implement protective measures to prevent transmission to humans. We describe the situation in 2016 and list public health measures and recommendations in place. We summarise critical interfaces identified during the A(H5N1) and A(H5N8) outbreaks in 2014/15. Rapid exchange of information between the animal and human health sectors is critical for a timely, effective and efficient response.

Influenza season 2013/14 has started in Europe with influenza A(H1)pdm09 virus being the most prevalent subtype.

The 2013/14 influenza season has started in Europe. Four countries have reported medium intensity influenza activity, with children under 15 years being the most affected age group. A growing number of countries see increasing rates of influenza-like illness or acute respiratory infection and increasing proportions of specimens positive for influenza A(H1)pdm09 virus. In previous seasons, this subtype was associated with higher reported numbers of severe and fatal cases. Clinicians should offer influenza vaccination to unvaccinated persons belonging to risk groups.

Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries, 2010 to 2016

Respiratory syncytial virus (RSV) is considered the most common pathogen causing severe lower respiratory tract infections among infants and young children. We describe the seasonality and geographical spread of RSV infection in 15 countries of the European Union and European Economic Area. We performed a retrospective descriptive study of weekly laboratory-confirmed RSV detections between weeks 40/2010 and 20/2016, in patients investigated for influenza-like illness, acute respiratory infection or following the clinician’s judgment. Six countries reported 4,230 sentinel RSV laboratory diagnoses from primary care and 14 countries reported 156,188 non-sentinel laboratory diagnoses from primary care or hospitals. The median length of the RSV season based on sentinel and non-sentinel surveillance was 16 (range: 9–24) and 18 (range: 8–24) weeks, respectively. The median peak weeks for sentinel and non-sentinel detections were week 4 (range: 48 to 11) and week 4.5 (range: 49 to 17), respectively. RSV detections peaked later (r = 0.56; p = 0.0360) and seasons lasted longer with increasing latitude (r = 0.57; p = 0.0329). Our data demonstrated regular seasonality with moderate correlation between timing of the epidemic and increasing latitude of the country. This study supports the use of RSV diagnostics within influenza or other surveillance systems to monitor RSV seasonality and geographical spread.