Queensland influenza age shift still shifted...

Figure from State of Queensland (Queensland Health) report found here includes data up to 9th August 2015.
Images excised from PDF and pasted together using Adobe
Photoshop CC 2015.0.0
Click on image to enlarge

Also interesting:

• 3.3X more influenza type B viruses than influenza type A viruses in week to 9th August
• a proportion of the influenza viruses were further genotyped
• 44% of that proportion were influenza B viruses of the Victoria lineage which is not the lineage in the trivalent vaccine this year (it is in the quadrivalent vaccine though - see full report for detail) 
• NOTE - the report is not clear on how many genotyped specimens this represents
• As you can see in the figure below - the 'flu season is still very much underway in Brisbane
• Brisbane is also experiencing its own little 'mass gathering' which started last Friday - the Brisbane Exhibition.

Appendix 1 from the State of
Queensland (Queensland Health) report found here, including data
up to 9th August 2015.
Click on image to enlarge

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Queensland influenza sees a shift in age...

Image adapted from Geoscience Australia,

The Australian Government.[3]

The media Down Under have been doing their thing this influenza season...

• Vaccine delay to cause horror flu season, say experts
• Qld sniffles through highest flu count
• CHART: Australia could be in for its worst flu season on record
• Flu cases tracking at record levels

...lots of inflammatory (pun intended) headlines to make us all fear just about everything and everyone. Blah.

Nonetheless, it is flu season down here - and hopefully you gave vaccination a try this year, or you got your annual shot. Top marks if so! If you can safely and pretty painlessly dodge a preventable disease, save yourself some misery, avoid making your kids sick - who will require time off to be looked after, not make Aunty Robyn crook as a dog and not put Grandad's ailing ticker under extra stress...why wouldn't you? 

VDU Figure 1. Figure 2 from the State of
Queensland (Queensland Health) report
found here.[1]Click on image to enlarge

Thanks to the excellent and publicly available wealth of data presented by the epidemiologists of the State of Queensland (Queensland Health), I talked about influenza in Queensland and the distribution of types (i.e. Flu A or B) and subtypes (e.g. H3N2 or H1N1) last year.[2]

In 2014, influenza A viruses were the big bad, but in 2015, as we can see in VDU Figure 1 (orange), influenza B viruses are ruling the mean streets.

VDU Figure 2. Appendix 1 from the State of
Queensland (Queensland Health) report
found here.[1]Click on image to enlarge

From the look of VDU Figure 2, the influenza season remains in full swing (hint-get that vaccination if you haven't already). 

VDU Figure 2 also shows that things are not tracking all that unusually for a Queensland influenza season when you compare this year to curves from the past 5 years. So I'd suggest taking those media headlines with a box of tissues!

However, something stood out to me when looking at the latest report so I went back and cut-and-pasted the age and sex graphs from the past few consecutive weeks to make VDU Figure 3. Sure enough, there was a particular spike in the 5-9 and 10-19 year old age bands (yellow arrows in graph boxed in red). Even allowing for changed y-axis scale in the first 4 graphs (dates are listed in each graph's legend) these 2 bands seem to have risen just in the past reporting week. 

Still, the overall pattern of rising case numbers, a dip in the 20-29 year old age band, then a rise before a consistent drop off is retained. Is this the result of school kids returning from school holidays on the 23rd of July, sharing their viruses, incubating an infection and becoming ill? If so - will we see a rise in parent - age age bands in the report after next's? Let's watch and see!

VDU Figure 3. Figure 4s from previous weeks of State of Queensland (Queensland Health) report found here.[4]
Images excised from PDFs and pasted together using 
Adobe Photoshop CC 2015.0.0
Click on image to enlarge

References....

1. https://www.health.qld.gov.au/ph/documents/cdb/influenza-qld-150802.pdf
2. http://newsmedicalnet.blogspot.com.au/2014/03/influenza-viruses-in-queensland.html
3. http://www-a.ga.gov.au/web_temp/1531782/61756.pdf
4. https://www.health.qld.gov.au/ph/cdb/sru_influenza.asp
5. http://education.qld.gov.au/public_media/calendar/holidays.html

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Influenza in Queensland, Australia: 1-Jan (Week 1) to 8-June (Week 23)

Map of Queensland's Hospital and Health service 

areas. Adapted from

http://www.health.qld.gov.au/maps/hhs_facilities.pdf.

Click on image to enlarge.

Waaaay back on 18-March we looked at how influenza notifications in Queensland (population ~5mill) were above the 5-year-to-date (YTD) average. 

"Woopty Doo" some, perhaps very few, of you said. "That number means nothing until you look back at it later". 

So, let's look back at it now that it's later. 

It was Autumn then and now its Winter which is Flu season and also the season when we get some more public info on a handful of other  respiratory viruses circulating here in Queensland thanks to the collatory (I don't care if a dictionary doesn't recognize it) genius of the crew at the State of Queensland, Queensland Health (SoQ|QH).

So what's happening with flu Down Under? For all the detailed detail, I recommend you check out the Open Access document, Statewide Weekly Influenza Surveillance Report that spans up to Week-23 (that's the week ending 8-June; we're in Week 25 now)

Turns out its still 2x (well,  1.987x but who;/s counting?) above the 5-year-to-date mean. No, this is not a "I told you so" - just that it's interesting to see that on this occasion at least, autumn trends predicted a winter event. Still, its only early winter. We've also had a very warm and dry autumn (see the Bureau of Meteorology for more on Autumn) for those who like to link weather and influenza activity.

I like to look at virus interactions as driving their own seasons. How is that possible I eerily hear you ask (I'm not listening to the "Oh what a load of..." comments by  the way, so sit back down and put up your hand)? Well, they don't do anything themselves of course, but my theory goes like this...

When there are enough of us in the community infected by one virus (say respiratory syncytial virus [RSV]) and our immune-thing-a-me-whats-it is all fired up and producing an inflammatory response to rid us off said pestilence, that responsey thing offers a kind of "Shield's Up" effect. 

For a short while we feel like rubbish but we also don't let other viruses get in as easily because we're in an "antiviral state". Enough of us in that state and we get a kind of short-term herd immunity (a fairy died) - where the number of people fully susceptible to another virus (say, an influenza virus) is too small for it to get a good toehold in us and the population. This pattern among seasonal respiratory viruses is most often observed, in my experience, for viruses with an RNA genome like RSV, rhinoviruses and influenza viruses. 

Thankfully for my hypothesis, the data from SoQ|QH show a nice example of this pattern of viruses interacting with viruses within us, projected to the level of the community. 

A snippet from the State of Queensland, Queensland 

Health Statewide Weekly Influenza Surveillance 

Report  for 1-January-2014 to 8-June-2014.
Edited by Ian M Mackay, VDU.

Click to enlarge. 

Let's have a look at the adjacent figure I've mixed around from reference [1]. Hopefully I haven't broken any copyright laws in hacking pasting as I have.

Part A shows the notifications for influenza viruses in Queensland. Peaks and troughs, As and Bs. Cool

Part B shows some of the respiratory viruses, including RSV which has been having a bonza season this past autumn by the looks of things.

Can you see the pattern?

Part C is a cobbled together composite I made in Photoshop/Illustrator by laying B over A and making B partly transparent. It's a bit rough and has had the axis labels and legend trimmed off for clarity, but it makes the point. What it shows (to me anyway) is that when RSV numbers go up, influenza virus notifications head downwards. 

Is this due to RSV influencing influenza or influenza exerting its muscle on RSV? Can't tell from this sort of analysis. 

The fact that RSV can rise in the presence of influenza virus may speak to its dominance. But take a step back. Remember we're taking about people not cells in a dish. It may be that 2 distinct populations are at play initially; perhaps younger children with RSV versus older children and adults with influenza. Once infected people reach a critical mass, that virus may win out and "push put" the other.What's happening in a single household - kids bringing home one virus, parents another perhaps? That would be intriguing to know with these concepts in mind using molecular methods and longitudinal regular sampling of whole families, regardless of symptoms.

Statistically, when I've looked at this with other data, that negative association, more obvious and frequent between influenza virus and rhinoviruses, does reach significance. You can read one of my group's hospital-based studies in [4] and a collaborative community study in [5]. Rhinovirus seasons usually bracket influenza season. So I offer a different view of how seasonal viruses are seasonal. With the sources of variability I discuss above as well as genetics and differences in everyone's past virus exposures and immune-thing-a-me-whats-it status to each virus, some cross-protective, some not, some having got really sick last year, some not...its not hard to see how those virus seasons can shift around from year to year as well.

Yet another reason to test for viruses, and to include more than just 1 or 2 viruses in that testing; the more you test, the more you can observe and learn.

By the way, interferon-the major player in causing these virus:virus interactions, got its name because it could block a secondary viral infection much like those that I've described above, but on a population level.

Now, try and get some funding to do any research on that. I hate you if you do by the way (yes, I failed miserably).

References...

1. Statewide Weekly Influenza Surveillance Report, 1-January to 8-June 2014.
   http://www.health.qld.gov.au/ph/documents/cdb/influenza-qld-140101-140608.pdf
2. Queensland in autumn 2014: A warm autumn; coastal rainfall but dry inland of the Great Dividing Range
   http://www.bom.gov.au/climate/current/season/qld/summary.shtml
3. Do rhinoviruses reduce the probability of viral co-detection during acute respiratory tract infections.
   http://www.ncbi.nlm.nih.gov/pubmed/19376742
4. Community-wide, contemporaneous circulation of a broad spectrum of human rhinoviruses in healthy Australian preschool-aged children during a 12-month period.
   http://www.ncbi.nlm.nih.gov/pubmed/22829638

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Influenza viruses in Queensland, Australia: 03-Mar-2014:09-2014.

Map of Queensland's Hospital and Health service
areas. Adapted from
http://www.health.qld.gov.au/maps/hhs_facilities.pdf.
Click on image to enlarge.

Sure enough, as promised on the 12-Mar, the new Queensland flu numbers are out (I post a week after the next new numbers come out publicly; its just the deal I have). So this follows on from last Wednesday.

This is the next week's numbers which follow on from my earlier post on the increased number of influenza cases and the media reports of influenza A(H1N1)pdm09 virus  predominance.

The Queensland Health Statewide Communicable Disease Surveillance Report for the week 03-Mar:09-Mar has some extra detail, this week. The extra detail outlines that most (860; 94%) of this year's 918 influenza notifications (2.3X the 5-year year-to-date mean value) to date are located in the following Hospital Health Service (HHS) areas (see the map above):

• Metro South: 192 (21%)
• Metro North: 176 (19%)
• Gold Coast: 110 (12%)
• Cairns and Hinterland: 106 (12%)
• Townsville: 73 (8%)
• Darling Downs: 52 (6%)
• Sunshine Coast: 50 (5%)
• Cape York: 46 (5%)
• West Moreton: 28 (3%)
• Mackay: 27 (3%)

The median age of cases is 41-years and 50% are male. The highest rate of notifications is in the 50-59-year age group at 24.8/100,000.

Percentages represent the proportion of all 80 
notifications for this reporting period.IFAV-Influenza A virus; IFBV-Influenza B virus.
Click on image to enlarge.

This report also has some typing (Flu A or B) and subtyping data (H3N2 or H1N1).

These data are very much appreciated  since this is ahead of the traditional "flu season" reports. 

Many thanks to all associated with the Communicable Diseases Unit, Queensland Health, for adding this detail in. 

The chart above makes it very clear that H1N1 dominates the Qld influenza landscape so far. Specifically...

• 80 notifications with signs and symptoms during the reporting period
• 68 were typed as influenza type A viruses (85%)
• 13/14 were subtyped as H1N1 (pdm09 I presume; 93% of the FluAs that were subtyped)
• 1/14 H3N2
• 12 were typed as influenza type B viruses

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RSV retreated, flu fading, parainfluenza picking up: Queensland respiratory virus numbers up to Week 45, 2013

If you like to keep track of influenza cases in Queensland, Australia, then the Queensland Government's Queensland Health (QH) influenza data website is for you.

It's a great place to drop by and check out the comings and goings of influenza viruses and many of the other traditional respiratory viruses including adenoviruses (AdVs), parainfluenzaviruses (PIVs) 1, 2 and 3, human metapneumovirus (MPV) and respiratory syncytial virus (RSV) - the "Big8". Testing is not routinely conducted for the rhinoviruses (RVs).

The snippet below is from data that are publicly reported on the QH website. These images cover to the week beginning 3rd of November (up to Sunday, Nov 10th, 2013).

The charts highlight that the 2013 flu season is winding down in Australia, also reflected by the WHO global updates. This year flu followed on from what seemed to have been a large RSV season. Unfortunately I couldn't find data for this same time period last year to compare RSV prevalence.

In the wake of influenzavirus season, the parainfluenzaviruses are now on the rise in the lead up to summer. I expect the RVs (and enteroviruses) are also climbing, but in greater numbers.

Click to enlarge. 
A snippet from the Queensland Health Statewide Weekly Influenza Surveillance Report for 01.01.2013-10.11.2013

My thanks to the team at the Communicable Diseases Unit, Queensland Health.

The source of these data  can be read in full..

• http://www.health.qld.gov.au/ph/cdb/sru_influenza.asp
• WHO global influenza update http://www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en/

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All Australian bat species, including 1 of the 50 species of microbats (order Chiroptera [bats], suborder Microchiroptera) common in Australia, are considered susceptible to ABLV.

Chief Biosecurity Queensland officer Dr Thompson noted that a dead bat had been found on the property housing the Australian Bat Lyssavirus (ABLV) infected horse, but were not closely associated with any colonies.

All 6 human contacts of the horse have been given preventative treatment including rabies vaccine and rabies immunoglobulin, both of which cross-protect against serious disease caused by ABLV.

The main advice for humans to mitigate risk of infection is to avoid handling bats and flying foxes without appropriate vaccination. Even then, it would be best to report ill or strangely behaving (ill) bats to the authorities. Bats have been the source of a number of virus discoveries (not preventable by specific vaccines) in recent years including influenza virus (H17N10)and coronaviruses (numerous bat-CoVs and possible the MERS-CoV).

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