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Annual report Influenza Surveillance in Victoria, 2005 Box. Summary of recommendations arising from the evaluation of influenza surveillance in Victoria 1. Improve coordination between VIDRL and DHS, including weekly sharing of data between institutions and production of a single annual surveillance report. 2. Improve the quality of data for notifi cations of infl uenza held in the DHS database, including: follow-up of cases; ensuring notification of all laboratory-confi rmed cases occurs; collation of strain information by DHS; adherence to serological case defi nitions for infl uenza, and; distinction in analysis and reports between the sources of laboratory-confi rmed infl uenza notifi cations, namely GP sentinel surveillance and hospital laboratories. 3. All GP sentinel surveillance spatial data should be reported according to the geographic boundaries defi ned by DHS. 4. A review of the utility of available data on the impact of infl uenza on morbidity and mortality in Victoria should be conducted. 5. ILI data should be collected from Victorian emergency departments to provide an early warning system for epidemic infl uenza. Work in DHS on electronic syndromic surveillance may provide a simple and timely method of capturing these data. peak in laboratory notifi cations occurred two weeks earlier than it did in the community surveillance systems. This may refl ect a delay in notifi cation of the increase in ILI rates observed at the start of the season. It is not clear why the onset of seasonal activity was seen earlier in locum service, compared with sentinel surveillance, but may represent earlier contact with the medical system by patients who are more acutely ill and who require after-hours care. However the early rise in ILI activity detected by community surveillance reinforces the importance of these systems in detecting increased infl uenza activity in the community. The GP Sentinel Surveillance Scheme also serves an important function in notifi able disease surveillance by making a substantial contribution to the total laboratory confi rmed infl uenza cases (nearly 30%) notifi ed during the infl uenza season. However, given the differing age distributions of these patients, sentinel patients may not be representative of all patients with infl uenza in the community. Similarly, cases identifi ed as part of outbreaks may skew data describing the epidemiology of community-acquired infl uenza. Both infl uenza A sub-types, H3N2 and H1N1, circulated throughout the season. Most infl uenza A viruses were reported as either A/California/7/2004- like (H3) or A/New Caledonia/20/99-like (H1), both of which have been included in the 2006 vaccine. A/Wellington also circulated in smaller numbers throughout the whole season. Both A/New Caledonia and A/Wellington were covered by the 2005 vaccine. Circulating infl uenza B was either B/ Shanghai/3611/2002-like or B/HongKong/330/2001- like. B/Shanghai was covered by the 2005 vaccine. The vaccine for the 2006 season will contain the following: 7 • A/New Caledonia/20/99 (H1N1)-like virus • A/California/7/2004 (H3N2)-like virus • B/Malaysia/2506/2004-like virus The data received from MMLS refl ected that of metropolitan surveillance. Following analysis and confi rmation that MMLS is an appropriate data source for ILI surveillance, MMLS has been adopted as an integral component of infl uenza surveillance in Victoria. 8 MMLS data are collected all year round and will continue to supplement the sentinel surveillance data in 2006, including during the Melbourne Commonwealth Games. In light of the fi ndings from the evaluation, coordination of surveillance activities between DHS and VIDRL has been improved. Acknowledgements The sentinel influenza surveillance program would not be possible without the ongoing support of the participating general practitioners and their practice staff. The Viral Identification Laboratory at VIDRL is responsible for the laboratory diagnosis for surveillance cases. We thank other laboratories for notification of influenza to DHS and the WHO Collaborating Centre for Reference and Research on Influenza for provision of influenza strain identification. Dr Ian Barr of the WHO Collaborating Centre provided advice on the serological match of vaccine and circulating influenza virus strains. Our thanks also go to the Melbourne Medical Locum Services for sharing their data with us. We also acknowledge the private pathology providers who facilitate transport of respiratory specimens from rural and regional general practices. Albert Tiong was responsible for the evaluation of the influenza surveillance system in Victoria. VIDRL 142 CDI Vol 30 No 1 2006
Influenza Surveillance in Victoria, 2005 Annual report receives a contribution for its influenza surveillance program from the Department of Human Services, Victoria. References 1. The Infl uenza Pandemic Planning Committee Communicable Diseases Network Australia and New Zealand. A Framework for an Australian Infl uenza Pandemic Plan. Commonwealth Department of Health and Aged Care, Australia 1999;Version 1. 2. Watts CG, Andrews RM, Druce JD, Kelly HA. Establishing thresholds for infl uenza surveillance in Victoria. Aust N Z J Public Health 2003;27:409–412. 3. Druce J, Tran T, Kelly H, Kaye M, Chibo D, Kostecki R, et al. Laboratory diagnosis and surveillance of human respiratory viruses by PCR in Victoria, Australia, 2002–2003. J Med Virol 2005;75:122–129. 4. Centers for Disease Control and Prevention. Updated Guidelines for Evaluating Public Health Surveillance Systems. MMWR Recomm Rep 2001;50 (RR–13);1–35. 5. World Health Organization. World Health Organization infl uenza vaccine recommendation for the Southern Hemisphere for 2005. Available from: http:// www.infl uenzacentre.org/fl unews.htm Accessed on 16 November 2004. 6. Atkin L, Clothier H, Turner J, Sundararajan V, Kelly H. Comparison of Infl uenza and ILI Data Sources, Victoria, Australia. Poster Presentation; Public Health Association Australia Annual Conference; Perth, 2005. 7. World Health Organization. World Health Organisation Infl uenza vaccine recommendations for the Southern Hemisphere for 2006. Available from: http://www. who.int/csr/disease/infl uenza/infl uenzarecommendations2006.pdf Accessed on 14 November 2005. 8. Turner J, Kelly H. A Medical locum service as a site for sentinel infl uenza surveillance. Eurosurveillance 2005;10:96–98. CDI Vol 30 No 1 2006 143
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