Weekly update report for Week 9, ending 29/2/2020 · 2020-06-11 · Weekly update report for Week 9...

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The National Center for Disease Control Ministry of Health Gaetner Institute, Shiba Medical Center, Tel Hashomer 52621 [email protected] Tel: 03-7371500, Fax: 03-5349881

ICDC-Israel Center for Disease Control Ministry of Health Gertner Institute, Chaim Sheba Medical Center [email protected] Tel: 03-7371500 Fax: 03-5349881

Surveillance of influenza-like illness in Israel

Weekly update report for Week 9, ending 29/2/2020

Summary: The decrease in raspiratory illness continues. At the same time, there is continued decrease in the

percentage of influenza-positive isolates in the sentinel clinic network and among hospitalized patients.

Clinical: The decline in referral rates to the clinics due to influenza-like illness continues. In hospitals: The

percentage of visits to the internal medicine as well as the pediatric emergency departments due to

pneumonia is low; and currently under the multi annual average; the decrease in the percentage of visits of

0-2 year olds to the pediatric emergency room for bronchiolitis continues.

Laboratory: 10 of 24 samples (41%) collected from the Sentinel clinics were found positive for influenza: 9

samples tested positive for B type influenza and one sample tested positive for sub - type A/N1H1 09

influenza.

Morbidity

Influenza-like illness (Figure 1-3): In the community: Continued decrease in raw rate of referrals to Maccabi

Health Services clinics due to influenza-like illness, which is reflected in all age groups and across all of the

country’s regions. The crude rate has dropped below the epidemic threshold over the past week. A similar

situation is shown by the data of Clalit Health Services.




* The baseline level and the influenza activity intensities were calculated using an algorithm that was developed

in the framework of the European influenza surveillance project (EuroFlu), based on past data accumulated at

the ICDC regarding visits to "Maccabi Healthcare Services" clinics due to influenza-like illness.

Pneumonia Morbidity (Figures 4-5): In the Community: In the past week, no significant change in the rate of

referrals to clinics was due to pneumonia were observed at the Maccabi Health Services clinics. There is a

decrease in referral rate of adults aged 65 and over. Clalit Health Services’ data shows similar situation.

0

5

10

15

20

25

30

Ca

se

s/1

0,0

00

Week

Fig. 1: Weekly rate of visits due to influenza like illness, 2017-2020, compared to multi-annual average

2010-2019 average

Epidemic threshold medium intensity high intensity

very high

0

5

10

15

20

25

30

Ca

se

s/1

0,0

00

Year, month and week

Fig. 3:Weekly rate of visits due to influenza-like illness, by district of residence, 2017-2020

Central Haifa Jerusalem

North South Tel-Aviv

0

5

10

15

20

25

30

35

Ca

se

s/1

0,0

00


Fig.2: Weekly rate of visits due to influenza-like illness, by age and year, 2017-2020

- -




0

5

10

15

20

Cas

es/1

0,00

0

week

Fig. 4: Weekly rate of visits due to pneumonia, , 2017-2020, compared to multi-annual average

average 2010-2019

0102030405060708090100

0

5

10

15

20

25

Ca

se

s/1

0,0

00

(a

ge

<2

on

ly)

Case

s/1

0,0

00


Fig. 5:Weekly rate of visits due to pneumonia, by

age and year, 2017-2020

- -




In hospitals (based on the Ministry of Health's data base managed by the Information Division) pneumonia

(Figures 6-7): In the past week the percentage of visits to the internal medicine and pediatrics emergency room

due to pneumonia has been low and is below the multi annual average.

0

1

2

3

4

5

6

Pe

rce

nta

ge

Week

Fig. 7: Percentage of visits to pediatric ERs due to pneumonia , Clalit hospitals 2017-2020, compared

to multi-annual average

Average 2011-2019

0

1

2

3

4

5

Pe

rce

nta

ge

Week

Fig. 6: Percentage of visits to internal medicine ERs due to pneumonia ,Clalit

hospitals, 2016-2019, compared to multi-

annual average

Average 2011-2019




Bronchiolitis (Figure 8): The decrease in the percentage of visits of 0-2 year olds to pediatric emergency room

due to bronchiolitis, is continued, as expected in the season.

Hospitalizations (Figure 9): In the past week, there was no significant change in bed occupancy in the

internal medicine wards (about 104%) and the pediatric wards (102%).

0.00

2.00

4.00

6.00

8.00

10.00

12.00

Pe

rce

nta

ge

Year and week

Fig. 8: Percentage of visits of ages 0-2 year old infants to pediatric ERs in Clalit hospitals due to bronchiolitis, 2017-2020

Percentage Average 2011-2019

50

60

70

80

90

100

110

120

130

2017 2018 2019 2020 2021

Per

cen

t

Fig. 9: Weekly average bed occupancy rate, internal and pediatric departments, all hospitals 2017-2020

Pediatric Departments Internal departments




Mortality

Figure 10-11: Figure 10 shows the overall national mortality rate, as compared to the multi-annual

average (updated for Week 2, ending 11/1/20). The figure suggests that recently, the total number of

deaths is currently declining and is similar to the multi-annual average. Figure 11, which is based on data

from the Epidemiology Division updated until Week 7 (ending 15/2/20), suggests that the percentage of

mortality due to pneumonia is within the seasonally expected range.

6

7

8

9

10

11

12

13

14

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Cas

es/1

0,00

0

week and year

Fig. 10: Overall national mortality rate, 2016-2020,

compared to multi-annual average

Weekly mortality rate Average 2010-2017

0

4

8

12

16

20

24

Per

cent

age

Year & week

Fig. 11:Deaths from pneumonia as a percentage of all deaths , 2017-2020, compared to multi-annual seasonal

prediction

Percentage of deaths from pneumonia Seasonal prediction Epidemic threshold




Laboratory

Sentinel Community Clinic Network Findings: Findings of the Sentinel Community Clinic Network (Figures

12+13): Results of tests by the Central Virology Laboratory for the current week are summarized in the

following table:

Number of Samples Week 9

(23/2/20-29/2/20)

Accumulated Data from

Week 40 (29/9/19-5/10/19)

Number of samples 24 1,993

Number of RSV positive

samples

0 197 (9.8)

Number of samples positive

for Influenza*

10 (41.6) 1,036 (51.9)

Number of samples positive for Influenza by type/ sub type

type of Influenza Week 9

(23/2/20-29/2/20)

Accumulated Data from

Week 40 (29/9/19-5/10/19)

type A influenza 1 (10) 669 (64.5)

– A (H1N1)pdm 09 1 (100) 651 (97.3)

– A/unsubtyped** 0 0

– A/H3 0 18 (2.7)

– A/H1 0 0

Type B influenza 9 (90) 367 (35.5)

*In the past week one sample was found positive for Type B influenza + A/H1N1 09.

**Samples found positive for influenza A, but cannot be classified into a sub-type.




0

10

20

30

40

50

60

70

80

90

100

0

20

40

60

80

100

120

140

160

180

200

220

No.

of

sam

ple

s

Year & week

Fig. 12: Specimens positive for influenza out of total specimens collected by sentinel network, 2019/2020

negative Flu B A/unsubtyped

A/H3 A(H1N1) pdm09 % positive for Influenza

0102030405060708090

Pe

rce

nta

ge

week & year

Fig. 13: Percentage of specimens positive for influenza and RSV in the sentinel network,2017-2020

Positive for influenza Positive for RSV




Data from inpatients meeting the Severe Acute Respiratory Infection (SARI) case definition in

the influenza monitoring network in hospitalized patients* (Figure 14)

The SARI case definition was determined by the World Health Organization. As part of this monitoring,

samples are taken from inpatients exhibiting a temperature of C380 and above (or reported fever) and

cough within 10 days of onset.

As of week 8 (ending on 22/2/20), 3 samples were found positive for type A influenza and 3 samples

were found positive for Type B influenza among SARI patients. It appears that influenza activity in SARI

patients is low.

*On the network are selected departments from 2 medical centers (Shiba and Rambam).

0

20

40

60

80

100

No

. o

f sa

mp

ale

s

Year, week

Fig.14: Number of specimens positive for Influenza in the SARI network*, 2019-2020

Flu A Flu B Negative Unknown




Data from inpatients diagnosed in the Central Virus Laboratory at Sheba Medical Center, Tel

Hashomer (Figure 15)

During the past week, 18 (about 6%) samples were found positive for influenza out of the 288 samples collected

from inpatients: 5 samples were positive for A/H1N1 09, one sample tested positive for A/H3N2, and 12 samples

tested positive for Type B influenza. About 6% of the samples were found positive for RSV.

0

5

10

15

20

25

30

35

40

Pe

rce

nta

ge

Year & week

Fig 15: Percentage of specimens positive for respiratory viruses from patients hospitalized at the Sheba Medical Center, Tel Hashomer (The

Central Virology Laboratory), 2019-2020

Flu RSV hMPV Adenovirus Parainfluenza 3




Vaccination against seasonal influenza in the HMOs

Up to March 1, 2020, about 2,210,000 people have vaccinated against seasonal influenza (about 25% of Israel's

population, compared to about 20% in the same period of last year). Immune coverage in the elderly group

aged 65 and over reaches about 60% (compared to 58% in the same period of last year). Immune coverage of

infants and children 6-59 months of age reached approximately 24% (compared to 16% in the same period of

last year).

International Influenza Activity

Europe (fluNewsEurope): As of week 8 (ending 17/2/20), a decrease in influenza activity was reported. The

Sentinel Clinic Network reported about 37% of the samples as positive for A/H3 influenza, about 25% of the

samples as positive for A/H1 influenza, and about 34% of the samples as positive for type B influenza.

USA (CDC): As of week 8 (ending 22/2/20), a decrease in influenza activity was reported. The percentage of visits

to clinics due to influenza-like illness is still above the baseline. Out of 1,783 samples, 1,153 samples (about 64%)

tested positive for influenza. Of these, 835 (approximately 72%) tested positive for type A influenza: 697 (about

95%) tested positive for influenza A/H1N1 2009, 38 samples (5%) tested positive for influenza A/H3 and 100

samples (12%) were not yet classified. 318 (about 27%) additional samples were found to be positive for type B

influenza.

England: As of week 9 (ending 27/2/20), there is continued decrease in influenza activity. In Addition, ILI

morbidity rates are now lower than the baseline. Virologically speaking - out of 137 samples, 20 samples were

found positive for A/H3 influenza, 49 samples tested positive for type A influenza that had not yet been broken

into sub-types, and 33 samples tesed positive for A/H1N1 09 influenza. 35 additional samples were found to be

positive for type B influenza.

Canada: As of week 8 (ending 22/2/20), high influenza activity was reported. There is a mixed activity of A/H3

influenza, A/H1N1 09 and type B influenza. This week, A/H1N1 2009 influenza is the most dominant strain in

Canada.




Canada: As of week 8 (ending 22/2/20), low influenza activity was reported. As of this week, influenza A/H1 is

the most prominent strain in Hong Kong. In addition, it was reported that out of 5,575 samples, 18 (0.23%) were

found positive for influenza: 12 samples (67%) were tested positive for A/H1 influenza, 4 (22%) of the samples

were tested positive for A/H3 influenza, 2 (11%) of the samples tested positive for type B influenza.

Weekly update report for Week 9, ending 29/2/2020 · 2020-06-11 · Weekly update report for Week 9...

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