Welcome to the HPS influenza update for the 2011/2012 season
In contrast to previous years influenza surveillance is now a year round activity.
Details on the current surveillance, background to the systems and reports from previous influenza seasons can be access below.
HPS National Influenza Report
Welcome to the HPS influenza update for the 2011/2012 season. Updates will be based on an interpretation of data from the Scottish national surveillance system SISRS in addition to other data sources e.g. routine laboratory information, calls to NHS24, swab results from the sentinel swabbing scheme, all cause mortality and respiratory outbreak information from NHS boards.
Summaries from other UK, European and International surveillance systems are also provided as these give additional useful detail and insight on the global influenza picture.
For this season, we will provide detailed influenza update reports on a monthly basis with bulletin style weekly updates in the weeks in between.
Information on influenza activity for the rest of the UK is based on information provided by the GP sentinel networks operating in England Ireland and Wales and available on the Health Protection Agency website.
International updates are based on information provided by the European Centre for Disease Prevention and Control (European Influenza Surveillance Network - EISN) and from the World Health Organisation (FluNet).
Latest HPS National Influenza Report
Technical Annex for Season 2011/12
For Season 2011/12 a technical annex has been produced to explain the method used to calculate GP flu consultations.
Influenza Report produced by HPS Flu Team (email: nss.hpsflu@nhs.net)
Seasonal Influenza Vaccination Programme
Listed below are key documents and resources that have been made available to assist with Seasonal Influenza vaccination programme:
Influenza Vaccination for 2011/12 winter flu season
Seasonal Influenza Patient Group Directions
Antiviral treatment and prophylaxis of influenza
Background on Influenza Surveillance Systems
In response to the pandemic the prior surveillance in place for influenza changed for the period April 2009 to March 2010. The legacy of the pandemic influenza surveillance will result in many of these new surveillance components continuing in future years.
Replacement of Flu Spotter and SERVIS
The Scottish flu spotter scheme which had been running since 1971 and the Scottish Enhanced Respiratory Viral Infection Surveillance (SERVIS) which had been running since 2000 were superceded by other sources of general practice consultation data. Information from both these systems was used to benchmark the new systems that superceded them. The figure 1 below describes an overview of the relationship between the pre-existing monitoring systems and the new and enhanced systems instituted to monitor the pandemic response detailing the outputs produced by the system that was established.
Figure 1: Overview of the relationship between the pre-existing surveillance systems and the new and enhanced systems for influenza
Pandemic Influenza Primary care Reporting (PIPeR)
Data output from the pre-existing primary care surveillance system of influenza-like illness in Scotland (Pandemic Influenza Primary care Reporting or PIPeR) provided daily clinical presentation with influenza-like illness (ILI) or acute respiratory infections (ARI) in season in real time. The data in the 2009/10 season was restricted to 37 (mainly PTI) practices across Scotland. The PIPeR system routinely extracts and transmits data already held in General Practice clinical information systems on influenza (and pneumococcal) vaccine use and clinical presentation with ILI or ARI, as recorded using Read codes. This is compiled at HPS and was shared with the NHS in Scotland. Such data allows trend data on clinical presentation (spanning the period 2003 to 2010) and timely clinical effectiveness data on seasonal (and in 2009/10 pandemic) influenza vaccine effectiveness.
The data also formed part of a suite of surveillance activities currently in place to provide information and reports on the epidemiology of H1N1 influenza at a national and international level and was utilised to inform policy and guidance in addition to monitoring the trends of the pandemic. Some of the results are summarised in the last Weekly Influenza Situation Report of 4 March 2010 that HPS published before changing back to a two-weekly general influenza report.
Scottish Influenza Surveillance Reporting Scheme (SISRS)
The Scottish Influenza Surveillance Reporting Scheme (SISRS) was devised to provide more comprehensive surveillance during the pandemic of influenza. It included aggregated data from almost all GP practices in Scotland thus improving the geographical coverage of surveillance of GP consultations. It gave a more complete picture of changes within individual NHS boards and provided a signal to them if consultations were increasing within their areas. It was rolled out over the period of a few months.
The system was designed to add to the information already in existence through the PIPeR system. At the beginning of August 2009, SG issued a CMO letter to primary care services requesting them to record all consultations related to Influenza A (H1N1v). All practices were supplied with software to allow data to be automatically extracted and sent to HPS. Standardised codes and recording were used across the UK to allow comparability between the different countries. The specification for the software was determined by Scottish Government and supported by the SCIMP team and endorsed by the Scottish General Practitioners Council (SGPC). HPS facilitated this process by liaising with the e-Health and IM&T facilitators within each NHS Board and the software providers.
SISRS allowed presentation of daily data at either an All Scotland or NHS board level.
Other components of HPS flu surveillance
As a range of pathogens can result in patient consultations for ILI or ARI, it is important that in at least a proportion of these cases that the cause of these illness presentations is subjected to laboratory investigation to discern the cause of the illness. During the 2009/10 pandemic the Sentinel Swabbing Scheme was expanded to cover 101 practices rather than the PIPeR practices only, to allow a representative picture to be drawn from all NHS boards. Additional information was available for analysis provided on a daily basis from NHS 24 regarding call reasons as recorded within their system. Such analysis allows data to be presented as call proportions for Cold/Flu with trend analysis undertaken across time. An innovative feature of the surveillance during the pandemic was the daily reporting of cases of H1N1v hospitalised across Scotland. A feature of each winter is the expected increase in all cause mortality as reported by the GRO(S). HPS receive daily data from GRO(S) on the number of deaths reported to them by date of death. This provisional/raw data is at a stage prior to the intensive scrutiny by GRO(S) which results in the later release of Official Statistics from GRO(S). However the analysis of this provisional data for of trend allows early identification of an increase in mortality which may signal a public health threat. HPS also receives information on absenteeism routinely collected from schools, which has been used in reporting during the pandemic.
Historical Influenza Surveillance Systems
Scottish Enhanced
Respiratory Virus Infection Surveillance (SERVIS)
Winter 2000/2001 saw the introduction of SERVIS (Scottish Enhanced
Respiratory Virus Infection Surveillance). SERVIS is an integrated approach
to influenza surveillance which offers a more detailed and accurate
picture of the influenza outbreak during the winter season. The main
component of SERVIS is the provision of clinical data from sentinel
PTI (practice team information) general practices with linked virological
testing in a small sample of consultations from each practice. There
are 59 sentinel computerised PTI practices in Scotland and covering
13 NHS board areas. PTI practices provide not only weekly-recorded
data of influenza like illness (ILI) cases by age and sex, but also
consultations for acute respiratory infection (ARI). In conjunction
with clinical PTI data, combined nasal and throat swabs are obtained
from patients displaying flu-like symptoms for multiplex PCR testing
at Glasgow's Regional Virus Laboratory. PCR testing provides real time
data (results in 48hrs) identifying influenza and other circulating
respiratory viruses. Overall therefore, SERVIS is well placed to provide
ongoing surveillance of influenza and other respiratory viruses in circulation
with timely information on numbers of consultations and circulating
virus types, as well as age groups affected and regional breakdowns.
Flu Spotters
The Scottish flu spotter scheme has been collating reports of flu-like
illness during the winter flu season in Scotland for 30 years. The scheme
currently consists of routine laboratory reporting to HPS of influenza
virus diagnoses, together with estimated consultations for flu-like
illness from 90 practices in 13 NHS board areas covering around 78%
of the Scottish population. The scheme, together with SERVIS, is part
of a group of early warning systems operating throughout Europe which
contribute data from clinical consultations and laboratory tests to
the European Influenza Surveillance Scheme (EISS). The European scheme
seeks to collect data over a minimum period of week 40 and week 20 of
the following year (roughly October to May). This long season allows
for the surveillance of unusually early or late outbreaks, and the measurement
of background levels of activity allows direct comparisons to be made
between countries. The benefits of the scheme include facilitation of
healthcare and disease control planning, as well as furthering our understanding
of the epidemiology of influenza, which is of particular interest with
the ever-present threat of an international flu pandemic arising in
the future.
Previous Influenza Seasons
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contained within our extensive knowledge base.
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