Influenza Surveillance in Mainland of China Yuelong Shu Chinese National Influenza Center National Institute for Viral Disease Control and Prevention China CDC 2009-8-18, Beijing CHINESE CENTER FOR DISEASE.

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Transcript Influenza Surveillance in Mainland of China Yuelong Shu Chinese National Influenza Center National Institute for Viral Disease Control and Prevention China CDC 2009-8-18, Beijing CHINESE CENTER FOR DISEASE. 

Influenza Surveillance in
Mainland of China
Yuelong Shu
Chinese National Influenza Center
National Institute for Viral Disease
Control and Prevention
China CDC
2009-8-18, Beijing
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
 Management of Influenza Surveillance Network in
Mainland China
 Influenza Surveillance Data
 Response to Pandemic H1N1 2009
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Influenza Surveillance in Mainland China




Classification:
Seasonal Influenza: Class C Notifiable Infectious Disease
Pandemic A(H1N1) 2009 : Class B Notifiable Infectious Disease
H5N1: Class B Notifiable Infectious Disease


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


Sentinel hospital-based surveillance:
ILI surveillance
Virological surveillance
Influenza or ILI outbreak surveillance:
Outbreak report
Virological surveillance
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Surveillance Objectives
 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
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
4
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
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Structure of
National Influenza Surveillance Network(NISN)
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
63 network laboratories and 197 sentinel
hospitals since Oct, 2005
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
411 network laboratories and 556 sentinel
hospitals since June, 2009
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Updated Surveillance Information System for Influenza
China Information System for
Disease Control and Prevention
ILI Report
Sentinel Hospitals
Samples Collection
Fill the Original Form
For Delivery and Examination
Lab Results
Entry
Network Laboratories
Surveillance Information
System for Influenza
Samples Identification
Print the Delivery and Examination
Form of Flu Virus Strain
Confirmation
& Feedback
CNIC
Information Management
System for A (H1N1)
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Influenza Surveillance Information System (continued)
ILI report by
sentinel hospitals
Virological
Surveillance
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Influenza Surveillance Information System (3)
ILI
by age groups
No. of
consultations
Influenza Surveillance Information System (4)
Patient’s
Information
Specimen’s
Information
Laboratory
Information
Influenza Surveillance Information System (5)
PCR Test for novel A(H1N1) 2009
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Accelerating national and international cooperation and
communication and continuing participation in the GISN
English Weekly Report
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Virus Information Database for NISN
Virus Database
• Add
• Search
Sequence
Database
• Add
• Search
• Download
Multi-alignment
& BLAST
• Developing
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
15
Identification and confirmation
of influenza virus in CNIC
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Number of virus isolates sequenced in CNIC
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Trainings to the NISN
 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.
19
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Supervision
Supervision have been organized each year since 2000.
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
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.
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Quality Evaluation to the National Influenza
Surveillance System
网
络
实
验
室
（
家
）
70
60
50
40
30
20
10
0
35
省
/
市
（
家
）
25
5
分
4
分
3
分
2
分
20
15
10
5
0
标
本
信
息
5分
4分
3分
2分
1分
0分
接
收
后
鉴
定
时
间
毒
株
复
核
阳
性
率
标
本
分
离
阳
性
率
复
核
一
致
性
细
菌
培
养
情
况
鸡
胚
分
离
情
况
毒
株
滴
度
（
）
天
内
送
检
毒
株
情
况
选
送
评估指标
WHO
送
检
毒
株
量
及
溢
洒
情
况
15
送
检
毒
株
数
HA>8
标
本
分
采
型
集
情
况 间后
送
实
验
室
时
NIC
送
检
标
识
情
况
HI
采
样
数
毒
株
得
分
The Quality Evaluation results
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
(0/1)
结
案
报
告
(0/1)
(0/1)
标
本
采
集
(0-
70
60
50
40
30
20
10
0
实
验
室
检
测
2)
报告及时性 评估指标
(0-5)
报告完整性
网
络
实
验
室
（
家
）
30
5分
4分
3分
2分
1分
0分
个
案
信
息
评估指标
International Cooperation & Communication
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
International Cooperation & Communication
Tabletop
Exercise
Symposium
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Surveillance Data
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Percentage of ILI Reported by Sentinel Hospitals
during 2006－2009 in Southern Area
ILI% Reported by Internal Medicine
ILI% Reported by Pediatric Internal Medicine
10
9
2006 ～2007
2007 ～2008
2008 ～2009
2009…
8
7
5
4
3
2
1
0
14
20
26
32
38
44
50
4
10
16
22
28
34
40
46
52
6
12
18
24
30
36
42
48
2
8
14
20
26
32
38
ILI%
6
Week
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Percentage of ILI Reported by Sentinel Hospitals
during 2006－2009 in Northern Area
ILI% Reported by Internal Medicine
ILI% Reported by Pediatric Internal Medicine
12
2006 ～2007
2007 ～2008
2008 ～2009
2009…
10
ILI%
8
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
6
4
2
14
19
24
29
34
39
44
49
2
7
12
17
22
27
32
37
42
47
52
5
10
15
20
25
30
35
40
45
50
3
8
13
18
23
28
33
38
0
Week
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
H3
dominant
H1
dominant
H3
dominant
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Composition of the type/subtype of influenza virus
since June1st,2009
1.0%
4.7%
9.3%
0.5%
15.1%
H1N1
H3N2
pandemic (H1N1) 2009
A(unsubtyped)
30.4%
B(unsubtyped)
H3 37.5%
Victoria
Yamagata
untyped
Pandemic
A(H1N1)2009
1.5%
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Antigenic Analysis of Seasonal H1N1 –Tested at CNIC (Jan, 2009-July, 2009)
(Chicken Antiserum)
Seasonal Influenza A(H1N1)
NO.
Percent
WHO recommended
Vaccine strain
(2008/09North2009/10 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
(2007/08North2008South)
In total
1400
isolates
A/Solomon islands/3/2006-like
795
56.8%
A/Solomon islands/3/2006-low*
605
43.2%
A/Guangdong-baoan/51/2008like
1259
89.9%
A/Guangdong-baoan/51/2008low*
141
10.1%
China
Recommended
In total
Epidemic Reference
1400
Strain for Network
isolates
labs
(2008 Oct-2009 Sept)
China
753
A/Tianjin-jinnan/15/2009-like
Recommended
In total
Epidemic Reference
802
Strain for Network
49
isolates A/Tianjin-jinnan/15/2009-low*
labs
*≥8 fold lower in HI titer
(2009 Oct-2010
Sept)
CHINESE
CENTER FOR DISEASE CONTROL AND PREVENTION
93.9%
6.1%
Antigenic Analysis of H3N2 –Tested at CNIC (Jan, 2009-July, 2009)
(Chicken Antiserum)
A(H3N2)
NO.
Percent
In total 396
WHO recommended
Vaccine strain
isolates
(2008South-2009/10 North)
A/Brisbane/10/2007-like
221
55.8%
A/Brisbane/10/2007-low*
175
44.2%
WHO recommended
Vaccine strain
(2006/07North2007/08North)
In total 396
isolates
A/Wisconsin/67/2005-like
28
7.1%
A/Wisconsin/67/2005 -low*
368
92.9%
China Recommended
Epidemic Reference
Strain for Network labs
(2007 Oct-2008 Sept)
China Recommended
Epidemic Reference
Strain for Network labs
(2008 Oct-2009 Sept)
In total 399
isolates
A/Jiangxi-donghu/312/2006-like
60
15.0%
A/Jiangxi-donghu/312/2006-low*
339
85.0%
In total 399
isolates
A/Anhui-baohe/137/2008-like
112
28.1%
A/Anhui-baohe/137/2008-low*
287
71.9%
China Recommended
Epidemic Reference
Strain for Network labs
(2009 Oct-2010 Sept)
In total 75
isolates
A/Fujian-tongan/196/2009-like
57
76.0%
A/Fujian-tongan/196/2009-low*
18
*≥8 fold CHINESE
lower in HI titer
CENTER
FOR DISEASE CONTROL AND PREVENTION
24.0%
Antigenic Analysis of B(Victoria) –Tested at CNIC (Jan, 2009-July, 2009)
B(Victoria)
BV/Brisbane/60/2008-like
WHO recommended In total 56
Vaccine strain
isolates(with
(2009South- )
Ferret Antiserum) BV/Brisbane/60/2008-low*
WHO recommended
Vaccine strain
(2006South-2007/8
North)
China
Recommended
Epidemic Reference
Strain for Network
labs
(2008 Oct-2009
Sept)
China
Recommended
Epidemic Reference
Strain for Network
labs
(2009 Oct-2010 Sept)
NO. Percent
32
24
57.1%
42.9%
In total 1292
isolates(with
Chicken
Antiserum)
B/Malaysia/2506/2004-like
68
5.3%
B/Malaysia/2506/2004-low*
1224
94.7%
In total 1343
isolates(with
Chicken
Antiserum)
B/Jiangxi-Xinjian/39/2008-like
52
3.9%
B/Jiangxi-Xinjian/39/2008low*
1291
96.1%
B/Jiangxi-xiushui/32/2009-like
529
55.8%
B/Jiangxi-xiushui/32/2009low*
420
44.2%
In total 949
isolates(with
Chicken
Antiserum)
*≥8 fold lower in HI titer
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Antigenic Analysis of B(Yamagata)–Tested at CNIC (Jan, 2009-July, 2009)
(Chicken Antiserum)
B(Yamagata)
NO.
Percent
WHO recommended In total 115 B/Florida/4/2006-like
Vaccine strain
isolates
(2008SouthB/Florida/4/2006-low*
2009South)
109
94.8%
6
5.2%
China
B/Shanxi-beilin/127/2008-like
Recommended
Epidemic Reference In total 115
Strain for Network
isolates
B/Shanxi-beilin/127/2008-low*
labs
(2008Oct-2009Sept)
30
26.1%
85
73.9%
China
Recommended
Epidemic Reference
Strain for Network
labs
(2007Oct-2008Sept)
China
Recommended
Epidemic Reference
Strain for Network
labs
(2009Oct-2010Sept)
77
67.0%
38
33.0%
B/Hubei-wujiagang/158/2009-like
11
100%
B/Hubei-wujiagang/158/2009low*
0
0
B/Fujian-Xinluo/54/2006-like
In total 115
isolates
B/Fujian-Xinluo/54/2006-low*
In total 11
isolates
*≥8 foldCHINESE
lower in HI CENTER
titer
FOR DISEASE CONTROL AND PREVENTION
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.
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Response to 2009 H1N1 Pandemic
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
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
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Diagnostic method development timeline
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Distribution of Diagnostic Kit
to NISN and other countries/areas
Country /areas
Singapore
Papua New Guinea
Mongolia
Cuba
Macau
Vietnam
Laos
Cambodia
Brunei
Indonesia
Malaysia
Philipine
Thailand
NISN in China
RT PCR
kits
5
5
5
30
10
Real-time PCR
kits
Test for 45,200
specimens
Test for 75,752
specimens
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
5
5
10
2
2
2
2
2
2
2
2
Rapid information exchange
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
China-ASEAN workshop for Pandemic
A(H1N1) 2009
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Illness onset date of the cases infected with the novel
A(H1N1) influenza virus in Mainland China
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Geographic distribution of the cases infected with
the novel A(H1N1) influenza virus
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Infection sources the cases infected with the novel
A(H1N1) influenza virus in Mainland China
Secondary
Cases
10%
Local Cases
15%
Unknown
7%
Imported
Cases
68%
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Composition of the type/subtype of influenza virus
since June1st,2009
Pandemic A(H1N1)
A(Unsubtyped)
B(Unsubtyped)
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
HA
NA
MP
PA
NP
PB1
Phylogenetic Analysis
NS
PB2
Isolates from China
Novel A(H1N1)
Seasonal H1N1
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
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
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION