CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Influenza Surveillance in Mainland of China...

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION

Influenza Surveillance in Mainland of China

Yuelong Shu

Chinese National Influenza CenterNational Institute for Viral Disease

Control and PreventionChina CDC

2009-8-18, Beijing


Management of Influenza Surveillance Network in

Mainland China

Influenza Surveillance Data

Response to Pandemic H1N1 2009


Classification: Seasonal Influenza: Class C Notifiable Infectious Disease Pandemic A(H1N1) 2009 : Class B Notifiable Infectious Disease H5N1: Class B Notifiable Infectious Disease

Sentinel hospital-based surveillance: ILI surveillance Virological surveillance Influenza or ILI outbreak surveillance: Outbreak report Virological surveillance


To monitor influenza activity in mainland China

To monitor the antigenic and genetic characterization of influenza

virus: for recommendation of representative strain and vaccine strain

To monitor reassortant or mutation of the virus: more severe or/and

transmissible?

Drug resistance surveillance

To monitor the novel influenza virus

4


5

History

Influenza research initiated in 1952 in mainland of China Influenza department of Institute of Virology was established in

1954 Chinese National Influenza Center was established in 1957 Rejoined WHO Global influenza surveillance network (GISN)

in 1981


Structure of National Influenza Surveillance Network(NISN)


63 network laboratories and 197 sentinel hospitals since Oct, 2005


411 network laboratories and 556 sentinel hospitals since June, 2009


Network Laboratories

Samples CollectionSamples Collection

Fill the Original Form For Delivery and ExaminationFill the Original Form For Delivery and Examination

Sentinel Hospitals

CNIC

Samples IdentificationSamples Identification

Print the Delivery and ExaminationForm of Flu Virus StrainPrint the Delivery and ExaminationForm of Flu Virus Strain

Confirmation& FeedbackConfirmation& Feedback

Lab Results EntryLab Results Entry

ILI ReportILI Report

Updated Surveillance Information System for InfluenzaChina Information System for Disease Control and Prevention

Surveillance Information System for Influenza

Information Management System for A (H1N1)


Influenza Surveillance Information System (continued)

ILI report by sentinel hospitals

ILI report by sentinel hospitals

Virological SurveillanceVirological

Surveillance

Influenza Surveillance Information System (3)

No. of consultations

ILI by age groups


Patient’s Information

Patient’s Information

Specimen’sInformationSpecimen’sInformation

LaboratoryInformationLaboratoryInformation



PCR Test for novel A(H1N1) 2009


Accelerating national and international cooperation and communication and continuing participation in the GISN

English Weekly ReportEnglish Weekly Report

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION 15

高燕

要求：体现出数据库的现有功能和将来还要扩展的功能。蓝雨：提供


Identification and confirmation of influenza virus in CNIC


Number of virus isolates sequenced in CNIC


高燕

加上文字，体现意义


Trainings to the NISN

19

Every year CNIC organizes various training courses for the NISN, such as epidemiology workshop, laboratory detection techniuqe training, Biosafety training, GLP training and laboratory hands on training, etc.

More than 2000 epidemiologists and laboratory technicians were trained in the last five years.


Supervision

Supervision have been organized each year since 2000.


National Influenza Surveillance Quality Evaluation System

To strengthen the management of the NISN.

The evaluation system includes the following 4 parts: Virological Surveillance Epidemiological Surveillance Outbreak Surveillance Management of the Network Laboratory

The Quality Evaluation includes about 20 indicators.


Quality Evaluation to the National Influenza Surveillance System

The Quality Evaluation results


International Cooperation & Communication


Surveillance Data


Percentage of ILI Reported by Sentinel Hospitals during 2006 － 2009 in Southern Area


Percentage of ILI Reported by Sentinel Hospitals during 2006 － 2009 in Northern Area


H3dominant

H1 dominant

H3 dominant


Composition of the type/subtype of influenza virus since June1st,2009

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION*≥8 fold lower in HI titer

Seasonal Influenza A(H1N1) NO. PercentWHO recommended Vaccine strain (2008/09North-2009/10 North)

In total 1400 isolates

A/Brisbane/59/2007-like 1263 90.2%

A/Brisbane/59/2007-low* 137 9.8%

WHO recommended Vaccine strain (2007/08North-2008South)

In total 1400isolates

A/Solomon islands/3/2006-like 795 56.8%

A/Solomon islands/3/2006-low* 605 43.2%

China Recommended Epidemic Reference Strain for Network labs (2008 Oct-2009 Sept)


A/Guangdong-baoan/51/2008-like

1259 89.9%

A/Guangdong-baoan/51/2008-low*

141 10.1%



A/Tianjin-jinnan/15/2009-like 753 93.9%

A/Tianjin-jinnan/15/2009-low* 49 6.1%

Antigenic Analysis of Seasonal H1N1 –Tested at CNIC (Jan, 2009-July, 2009)(Chicken Antiserum)


A(H3N2) NO. PercentWHO recommended Vaccine strain (2008South-2009/10 North)


A/Brisbane/10/2007-like 221 55.8%

A/Brisbane/10/2007-low* 175 44.2%

WHO recommended Vaccine strain (2006/07North-2007/08North)


A/Wisconsin/67/2005-like 28 7.1%

A/Wisconsin/67/2005 -low* 368 92.9%



A/Jiangxi-donghu/312/2006-like 60 15.0%

A/Jiangxi-donghu/312/2006-low* 339 85.0%



A/Anhui-baohe/137/2008-like 112 28.1%

A/Anhui-baohe/137/2008-low* 287 71.9%



A/Fujian-tongan/196/2009-like 57 76.0%

A/Fujian-tongan/196/2009-low* 18 24.0%

Antigenic Analysis of H3N2 –Tested at CNIC (Jan, 2009-July, 2009)(Chicken Antiserum)


B(Victoria) NO. Percent

WHO recommended Vaccine strain (2009South- )

In total 56 isolates(with Ferret Antiserum)

BV/Brisbane/60/2008-like 32 57.1%

BV/Brisbane/60/2008-low* 24 42.9%

WHO recommended Vaccine strain (2006South-2007/8 North)

In total 1292 isolates(with Chicken Antiserum)

B/Malaysia/2506/2004-like 68 5.3%

B/Malaysia/2506/2004-low* 1224 94.7%



B/Jiangxi-Xinjian/39/2008-like 52 3.9%

B/Jiangxi-Xinjian/39/2008-low*

1291 96.1%

China Recommended Epidemic Reference Strain for Network labs(2009 Oct-2010 Sept)


B/Jiangxi-xiushui/32/2009-like 529 55.8%

B/Jiangxi-xiushui/32/2009-low*

420 44.2%

Antigenic Analysis of B(Victoria) –Tested at CNIC (Jan, 2009-July, 2009)


B(Yamagata) NO. PercentWHO recommended Vaccine strain (2008South-2009South)


B/Florida/4/2006-like 109 94.8%

B/Florida/4/2006-low* 6 5.2%

China Recommended Epidemic Reference Strain for Network labs (2008Oct-2009Sept)


B/Shanxi-beilin/127/2008-like 30 26.1%

B/Shanxi-beilin/127/2008-low* 85 73.9%



B/Fujian-Xinluo/54/2006-like 77 67.0%

B/Fujian-Xinluo/54/2006-low* 38 33.0%



B/Hubei-wujiagang/158/2009-like 11 100%

B/Hubei-wujiagang/158/2009-low* 0 0

Antigenic Analysis of B(Yamagata)–Tested at CNIC (Jan, 2009-July, 2009)(Chicken Antiserum)


Drug resistance surveillance for seasonal influenza (bioinformatics)

( Collection date from Jan2009 to July 2009)

• 39.0% (30/77) H1N1 viruses and 100% (49/49) H3N2 viruses isolated in mainland China from Jan2009 to July 2009 are resistant to adamantine.

• 61.0% (47/77) H1N1 viruses isolated in mainland China from Jan2009 to July 2009 are resistant to Oseltamivir. No Oseltamivir resistance viruses were found in H3N2(0/83) and B (0/49)viruses.


Response to 2009 H1N1 Pandemic


Support to Chinese Influenza Surveillance Network

Special financial funds for Chinese Influenza Surveillance Network from Central finance

Timely development of diagnostic method

Enhanced Surveillance: Expansion of network laboratories Expansion of sentinel hospitals

A series of trainings and meetings On site or by video/teleconference


Diagnostic method development timeline


Distribution of Diagnostic Kit to NISN and other countries/areas

Country /areasRT PCR

kits

Real-time PCRkits

Singapore 5Papua New Guinea 5

Mongolia 5 5Cuba 30 5

Macau 10 10Vietnam 2

Laos 2Cambodia 2

Brunei 2Indonesia 2Malaysia 2Philipine 2Thailand 2

NISN in China Test for 45,200 specimens

Test for 75,752 specimens


Rapid information exchange


China-ASEAN workshop for Pandemic A(H1N1) 2009


Illness onset date of the cases infected with the novel A(H1N1) influenza virus in Mainland China


Geographic distribution of the cases infected with the novel A(H1N1) influenza virus


Infection sources the cases infected with the novel A(H1N1) influenza virus in Mainland China


Composition of the type/subtype of influenza virus since June1st,2009

Pandemic A(H1N1)

A(Unsubtyped)

B(Unsubtyped)


HA

Isolates from ChinaNovel A(H1N1)Seasonal H1N1

MP

NA NP NS

PA PB1 PB2

Phylogenetic Analysis


Drug Resistance Analysis by bioinformatics

All the A(H1N1) viruses isolated in Mainland China are resistant to adamantine

A/Hunan/SWL3/2009(H1N1) has a histamine to tyrosine mutation at residue 274 of the NA (N2

numbering; residue 275 by N1 numbering), which confers a high level of resistance to Oseltamivir. The case was imported case from US, and took Oseltamivir for prophylactic purpose 1~6 days before the onset of illness. The sequence was reported to Genebank.

The other isolates are sensitive to Oseltamivir.

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Influenza Surveillance in Mainland of China...

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