Surveillance of influenza-like illness in Israel
Weekly update report for Week 12, ending 22-Mar-14
Summary: Influenza-like morbidity rates are continuing to decrease, as seasonally
expected. In parallel, there is a decrease in the percentage of specimens positive for
influenza from the sentinel network and from hospitalized patients.
Clinically: In the community: The decrease in the crude visit rate due to due to influenzalike illness and due to pneumonia is continuing. In hospitals: Decreases in the percentage
of visits to pediatric and internal medicine emergency rooms due to pneumonia, and in
hospital bed occupancy rates in pediatric and internal medicine departments.
Laboratory: 18 of 36 specimens (50%) collected from the sentinel clinics during the past
week were found to be positive for influenza: 11 specimens (61.1%) were found to be
positive for influenza A: of these, one specimen (9.1%) was positive for influenza A/H1N1
2009 and 10 specimens (90.9%) were positive for influenza subtype A/H3. 7 specimens
(38.9%) were found to be positive for influenza B.
Morbidity

Influenza-like morbidity (Figures 1-3): In the community: The decrease in the crude
rate of visits to "Maccabi Healthcare Services" clinics due to influenza-like illness is
continuing. This is manifest in all age groups and in all Districts. A similar picture arises
from data from "Clalit" Health Services.
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
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‫משרד הבריאות‬
12625 ‫ תה"ש‬,‫ מרכז רפואי שיבא‬,‫מכון גרטנר‬
[email protected]
03-5349881 :‫ פקס‬03-7371500 :‫טל‬
Fig. 1:Weekly visits to community clinics due to
influenza- like illness, by year 2011-2013, compared to
annual average
Cases/10,000
35
2 55 52
2 5 5
1998-2012 average
30
2 52 5
2
5
25
20
15
10
5
0
2
2
2
2
6
12
52
56
Week
Fig. 2: Weekly visits to community clinics due to
influenza- like illness, by age, 2014-2011
Fig. 3: Weekly visits to community clinics due to influenza-like
illness, by district, 2011-2013
Haifa
Jerusalem
North
South
Tel-Aviv
Cases/10,000
Cases/10,000
Central
30
25
20
15
10
5
0
2
2-5
1 6
5 5552 5 2
5 -6
61
30
25
20
15
10
5
0
5 55 52 5 2
2 55
1 6
2 52
5 5552 5 2
1 6
5 5552 5 2
25
Year, month, week
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
25
5 55 52 5 2
2 55
2 52
1 6
5 5552 5 2
2 5
Year, month & week
‫המרכז הלאומי לבקרת מחלות‬
‫משרד הבריאות‬
12625 ‫ תה"ש‬,‫ מרכז רפואי שיבא‬,‫מכון גרטנר‬
[email protected]
03-5349881 :‫ פקס‬03-7371500 :‫טל‬
2 5

Pneumonia morbidity (Figures 4-7): In the community: The decrease in the crude rate
of visits to "Maccabi Healthcare Services" clinics due to pneumonia is continuing. This is
manifest in all age groups. A similar picture arises from data from "Clalit" Health Services.
Fig.4: Weekly visits to community clinics due to
pneumonia, by year, 2011-2013, compared to annual
average
2 55 52
30
2 52 5
2 5 5
1998-2011 average
Cases/10,000
25
20
15
10
5
0
2
2
2
2
6
12
52
56
Week
Fig. 5: Weekly visits to community clinics
due to pneumonia, by age, 2011-2013
5 -6
61
2
20
18
16
14
12
10
8
6
4
2
0
100
90
80
70
60
50
40
30
20
10
0
5 55525 2
2 55
16
2 52
5 5552 5 2
16
2 5
Cases/10,000 (age<2 only)
Cases/10,000
2-5
5 5552 5 2
2 5
year, month & week
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
‫המרכז הלאומי לבקרת מחלות‬
‫משרד הבריאות‬
12625 ‫ תה"ש‬,‫ מרכז רפואי שיבא‬,‫מכון גרטנר‬
[email protected]
03-5349881 :‫ פקס‬03-7371500 :‫טל‬
In hospitals: In the past week, decreases were observed in the percentage of visits to
pediatric and internal medicine emergency rooms due to pneumonia. These percentages
are still below the multi-annual average.
Figure 6: Percentage of visits to adult ERs due to pneumonia out
of total visits, Clalit hospitals, 2014-2011, compared to annual
average
Fig 7: Percentage of visits to pediatric ERs due to
pneumonia out of total visits, Clalit hospitals, 2014-2011,
compared to annual average
2 55 2 52
2 52 5
2 5 5
2 55 2 52
2 6-2 55 ‫ממו ע‬
2 5 2 5
2 6-2 55 ‫ממו ע‬
4
6
Percentage
5
Percentage
2 52 2 5
4
3
2
3
2
1
1
0
0
2 22 2 26 2
2
6
2
6
1 12 2
6
5 52 5 56 5
2 22 2 26 2
6
2
6
1 12 2
6
5 52 5 56 5
week
week

2
Hospitalizations (Figure 8): In the past week, a decrease was observed in the hospital
bed occupancy rate in internal medicine departments (110%, as compared to 114% in the
previous week). The decrease in hospital bed occupancy rates in pediatric departments is
continuing (78%, as compared to 84% in the previous week).
Fig. 8: Weekly average bed occupancy, internal and
pediatric departments, all hospitals, 2013-2010
Pediatric Departments
Internal departments
Percent
150
100
50
2010
2011
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
2012
2013
2014
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12625 ‫ תה"ש‬,‫ מרכז רפואי שיבא‬,‫מכון גרטנר‬
[email protected]
03-5349881 :‫ פקס‬03-7371500 :‫טל‬
Mortality

Figures 9-10: Figure 9 shows the number of deaths throughout Israel as compared to
the multi-annual average (updated for Week 7, ending 15-Feb-14). It arises from this
figure that an increase has recently been observed in the number of deaths, which is
above the multi-annual average. It arises from Figure 10, based on data from the
Epidemiology Division, updated until Week 5, that the percentage of mortality due to
pneumonia increased at the beginning of 2014 to a level in excess of that seasonally
expected, but below the epidemic threshold.
Fig. 9: Total deaths, all causes, 2010-2014,
compared to annual average
Deaths
2007-2012 average
1100
1000
Deaths
900
800
700
600
500
400
Year & week
Fig. 10: Precentage of pneumonia-related deaths of all
deaths, 2010-2012, compared to seasonal prediction
% pneumonia deaths
24
Seasonal prediction
Epidemic threshold
Precent
20
16
12
8
4
0
6 12 6 52 5 2
2 5
2 55
6 2
2
5 2 26 2
2 52
1
5 56 22 2
2 5
Year & week
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
‫המרכז הלאומי לבקרת מחלות‬
‫משרד הבריאות‬
12625 ‫ תה"ש‬,‫ מרכז רפואי שיבא‬,‫מכון גרטנר‬
[email protected]
03-5349881 :‫ פקס‬03-7371500 :‫טל‬
Laboratory
Findings of the Sentinel Clinic Network (Figures 11-12): Results of tests by the Central
Virology Laboratory for the current week are summarized in the following table:
Week 12
Cumulative Data since
(16-Mar-14 – 22-Mar-14)
Week 41
(ending 12-Oct-13)
6
1,618
No. of RSV-positive specimens
1 (2.7%)
202 (12.5%)
No. of influenza-positive specimens
18 (50%)
462 (28.5%)
No. of specimens
No. of influenza-positive specimens by type/ sub-type
Type A influenza
-
A (H1N1)pdm 09
-
A/unsubtyped*
-
A/H3
-
A/H1
Type B influenza
11 (61.1%)
291 (62.9%)
1 (9.1%)
70 (24.1%)
0
0
10 (90.9%)
221 (75.9%)
7 (38.9%)
171 (37.1%)
*Specimens that were found to be positive for type A influenza, but have not yet been
subtyped.
4 specimens found positive for influenza subtype A/H3 that have been characterized thus far
were antigenically identified as A/victoria/361/2011 (H3N2)-like, which corresponds to the strain
included in this season's vaccine.
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
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‫משרד הבריאות‬
12625 ‫ תה"ש‬,‫ מרכז רפואי שיבא‬,‫מכון גרטנר‬
[email protected]
03-5349881 :‫ פקס‬03-7371500 :‫טל‬
Influenza B viruses are divided into two lineages: Yamagata and Victoria. Of 77 specimens positive
for influenza B tested so far by various methods in the laboratory, 72 (93.5%) were antigenically
identified as the vaccine strain, B/Massachusetts/2/2012-like, from the Yamagata lineage. 5
additional specimens (6.5%) were from the Victoria lineage, which is not included in the inactivated
vaccine.
No. of samples
negative
Flu B
A/unsubtyped
A/H3
A(H1N1) pdm09
% positive
120
110
100
90
80
70
60
50
40
30
20
10
0
100
90
80
70
60
50
40
30
20
10
0
5
2
1
6
1
15 12 5
2
1
6
5
2 5
55 52 5
5
51 56
Percentage of positive samples for
influenza
Fig 11: Positive influenza samples out of total samples collected by sentinel
network, 2013/2014
2 5
Year & week
Fig 12: Percentage of positive influenza and RSV samples out of total
samples collected by sentinel network, 2013/2014
% for Influenza
80
% for RSV
70
Percent
60
50
40
30
20
10
0
5 2
1 6
1 15 12 5 2
1 6
2 5
5 55 52 5 5 51 56
2 5
Year & week
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
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Data from hospitalized patients diagnosed at the Central Virology Laboratory
at the Sheba Medical Center, Tel Hashomer (Figure 13)
Fig 13: Percentage of positive samples for respiratory viruses from
patients hospitalized at the Sheba Medical Center, Tel Hashomer
(The Central Virulogy Laboratory)
Percentage
Flu
RSV
hMPV
Adenovirus
Parainfluenza 3
40
35
30
25
20
15
10
5
0
2
6
1
12
2
2 5
6
5
52 5
2 5
Year & week
The decrease in the percentage of specimens positive for influenza is continuing (19%, as
compared to approximately 22% in the previous week).
Immunization against seasonal influenza
By 17-Mar-14, some 1,446,000 people had been immunized against seasonal influenza
(approximately 17.9% of the total population of Israel). Immunization coverage in the elderly
group, of persons aged 65 years and over, has now reached approximately 61.6%. In the
group of babies, toddlers and children aged 6-59 months, immunization coverage has reached
approximately 18.7%.
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
‫המרכז הלאומי לבקרת מחלות‬
‫משרד הבריאות‬
12625 ‫ תה"ש‬,‫ מרכז רפואי שיבא‬,‫מכון גרטנר‬
[email protected]
03-5349881 :‫ פקס‬03-7371500 :‫טל‬
International influenza activity
Europe (EuroFlu): Updated for Week 11, ending 16-Mar-14: Low influenza activity is reported in
European countries. Combined activity of influenza A/H1N1 2009 and influenza subtype A/H3 is
continuing. 2,784 specimens out of 13,561 (20.5%) were found to be positive for influenza. Of
these, 2,602 (93%) were positive for influenza A: 722 (48%) were positive for influenza A/H3 and
783 (52%) were positive for influenza A/H1N1 2009. 182 (7%) of the specimens were found to be
positive for influenza B.
USA (CDC): Updated for Week 11, ending 15-Mar-14: The reduction in influenza activity is
continuing. At a national level, the percentage of clinic visits due to influenza-like illness is below
baseline level. 495 of this week's 5,650 specimens (8.8%) were found to be positive for influenza.
Of these, 341 (68.9%) were found to be positive for influenza A: 146 (42.8%) were positive for
influenza A/H1N1 2009, 46 (13.5%) were positive for influenza A/H3 and 149 (43.7%) were not yet
subtyped. 154 specimens (31.3%) were found to be positive for influenza B.
ICDC-Israel Center for Disease Control
Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
[email protected]
Tel: 03-7371500 Fax: 03-5349881
‫המרכז הלאומי לבקרת מחלות‬
‫משרד הבריאות‬
12625 ‫ תה"ש‬,‫ מרכז רפואי שיבא‬,‫מכון גרטנר‬
[email protected]
03-5349881 :‫ פקס‬03-7371500 :‫טל‬