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Influenza SurveillanceCountry, Territoryand Area Profiles
2017
December 2017
© World Health Organization 2017
All rights reserved. The Regional Office for Europe of the World Health Organization welcomesrequests for permission to reproduce or translate its publications, in part or in full.
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Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 2017i
ContentsData......................................................................................................................................................... iii
Abbreviations ....................................................................................................................................... iii
Source................................................................................................................................................... iii
Notes....................................................................................................................................................... iv
Albania ..................................................................................................................................................... 1
Armenia ................................................................................................................................................... 2
Austria...................................................................................................................................................... 3
Azerbaijan ................................................................................................................................................ 4
Belarus ..................................................................................................................................................... 5
Belgium .................................................................................................................................................... 6
Bosnia and Herzegovina .......................................................................................................................... 7
Bulgaria .................................................................................................................................................... 8
Croatia...................................................................................................................................................... 9
Cyprus .................................................................................................................................................... 10
Czech Republic....................................................................................................................................... 11
Denmark ................................................................................................................................................ 12
Estonia ................................................................................................................................................... 13
Finland ................................................................................................................................................... 14
France .................................................................................................................................................... 15
Georgia................................................................................................................................................... 16
Germany ................................................................................................................................................ 17
Greece.................................................................................................................................................... 18
Hungary.................................................................................................................................................. 19
Iceland.................................................................................................................................................... 20
Ireland.................................................................................................................................................... 21
Israel ...................................................................................................................................................... 22
Italy ........................................................................................................................................................ 23
Kazakhstan............................................................................................................................................. 24
Kyrgyzstan.............................................................................................................................................. 25
Latvia...................................................................................................................................................... 26
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.ii
Lithuania ................................................................................................................................................ 27
Luxembourg ........................................................................................................................................... 28
Malta...................................................................................................................................................... 29
Montenegro........................................................................................................................................... 30
Netherlands ........................................................................................................................................... 31
Norway................................................................................................................................................... 33
Poland .................................................................................................................................................... 35
Portugal.................................................................................................................................................. 36
Republic of Moldova.............................................................................................................................. 37
Romania................................................................................................................................................. 38
Russian Federation ................................................................................................................................ 40
Serbia ..................................................................................................................................................... 41
Slovakia .................................................................................................................................................. 42
Slovenia.................................................................................................................................................. 43
Spain ...................................................................................................................................................... 44
Sweden .................................................................................................................................................. 45
Switzerland ............................................................................................................................................ 46
Tajikistan................................................................................................................................................ 47
The former Yugoslav Republic of Macedonia........................................................................................ 48
Turkey .................................................................................................................................................... 49
Turkmenistan......................................................................................................................................... 50
Ukraine................................................................................................................................................... 52
United Kingdom ..................................................................................................................................... 53
England................................................................................................................................................ 53
Northern Ireland ................................................................................................................................. 54
Scotland............................................................................................................................................... 55
Wales................................................................................................................................................... 55
Uzbekistan ............................................................................................................................................. 57
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 2017iii
Data
Abbreviations
ARI Acute respiratory infection
ECDC European Centre for Disease Prevention and ControlGP General practitioner/general practice
HMO Health maintenance organization (Israel)
ICPC International Classification of Primary CareICU Intensive care unitILI Influenza-like illnessNHS National Health Service (United Kingdom)NIC National Influenza CentrePAHO Pan American Health OrganizationPCR Polymerase chain reactionPHE Public Health EnglandRSV Respiratory syncytial virusSARI Severe acute respiratory infectionWHO World Health Organization
SourceThe data in these profiles were submitted by the country, territory or area during the period July to August 2017 andare presented here unedited.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.iv
NotesI. These profiles include only details of national surveillance systems which provide data to The European Surveillance System (TESSy)
and used in the drafting of the joint European Centre for Disease Prevention and Control (ECDC)–WHO Regional Office for Europeinfluenza bulletin, Flu News Europe (https://flunewseurope.org/).
II. Mid-year population estimates are based on 2015 data, according to the WHO Regional Office for Europe’s European Health for Alldatabase (http://data.euro.who.int/hfadb).
III. Income group is based on the World Bank list of economies (June 2017) (http://data.worldbank.org/about/country-and-lending-groups).
IV. The type of surveillance can be defined as: 1. sentinel; 2. universal; or 3. non-sentinel.(http://www.euro.who.int/__data/assets/pdf_file/0020/90443/E92738.pdf?ua=1)
1. A sentinel surveillance system is formed by one or more designated health care facilities or providers that routinely and consistentlycollect epidemiological information from patients presenting with an illness consistent with a specified case definition.Representative clinical specimens are collected from all or a subset of patients according to a randomized/standardized samplingprotocol. Sentinel surveillance systems provide an efficient way to obtain high‐quality data on relatively common conditions from amanageable number of locations. Each sentinel site should include facilities that together represent the population undersurveillance.
2. A universal surveillance system is formed by all designated health care facilities or providers in a country, territory or area. Thisgenerally includes reporting of all clinician‐defined “ARI” and is part of the national disease surveillance systems of several MemberStates in the WHO European Region. These universal systems provide subnational resolution of clinician‐reported respiratory diseaseactivity.
3. A non-sentinel surveillance system includes other types of surveillance system (e.g. laboratory surveillance), which do not meet thedefinition of the other two types of system. Non-sentinel surveillance generally refers to viruses reported from/detected in patientsfrom non-sentinel surveillance systems. In the WHO European Region, this includes viruses from clinical diagnostic laboratories,outbreaks, or universal ARI surveillance systems that do not have randomized/ standardized sampling strategies.
The most common case definitions can be found in the table below:
ILI
ECDCSudden onset of symptoms and at least one of the following four systemic symptoms: fever or feverishness,malaise, headache, myalgia and at least one of the following three respiratory symptoms: cough, sore throat orshortness of breath.
WHO <2011 Sudden onset of fever >38 C° AND cough OR sore throat in the absence of other diagnosis.WHO 2011 An acute respiratory illness with onset during the last 7 days with, measured temperature ≥ 38°C, AND cough.WHO 2014 An acute respiratory infection with: measured fever of ≥ 38 C° and cough; with onset within the last 10 days.
ARI ECDC, WHO Sudden/acute onset of at least one of the following four respiratory symptoms: cough, sore throat, shortness ofbreath, coryza; and a clinician’s judgement that the illness is due to an infection.
SARI
WHO <2011
Onset of the following symptoms ≤7 days prior to hospital admission: Fever >38°C AND cough OR sore throatAND shortness of breath or difficulty in breathing. For children aged <5 years the IMCI case definition forpneumonia and severe pneumonia is applied.*
WHO 2011An acute respiratory illness with onset during the previous 7 days requiring overnight hospitalization thatincludes: history of fever or measured fever of ≥ 38°C, AND cough, AND shortness of breath or difficultybreathing.
WHO 2014 An acute respiratory infection with: history of fever or measured fever of ≥ 38 C°; and cough; with onset withinthe last 10 days; and requires hospitalization.
*Pneumonia: cough OR difficulty in breathing AND breathing faster than 40 breaths/minute (12 – 59 months); breathing faster than 50breaths/minute (2 – 11 months); Severe pneumonia: cough OR difficulty in breathing AND any of the following general severe signs: unable todrink or breastfeed OR vomits everything OR convulsions OR lethargy or unconsciousness OR chest in drawing or stridor in a calm child.”
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 20171
AlbaniaTotal population: 2 889 173 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal Sentinel Virological surveillancefrom other hospitals inthe country
Populationcovered (%)
6% 100% 62% 38%
Type of healthfacilities/hospitals
Pediatric practice,general practice,polyclinic
General practice,paediatric practices,polyclinic, emergencydepartment
8 regional hospitals, 2university hospitalcentres (paediatrichospital, infectiousdiseases hospital), 1lung hospital
District hospitals
Number of healthfacilities/hospitals
11 hospitals 27 hospitals
Case definitionused
WHO 2014 ECDC, WHO WHO 2014 WHO 2014
Year introduced 2009 1999 2009 2009
Epidemicthreshold
No Yes No No
Sampling strategy Sampling is performedin 2 polyclinics inTirana. The first 5patients (on Tuesdaysand Thursdays) aresampled at eachpolyclinic. Samplingoccurs in bothpaediatric and adultpatients.
Sampling occurs whenthere is an increase incases in differentdistricts or age groupsand in outbreaks.
All SARI cases aresampled at all times(24hrs/7 days a week).
SARI cases
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.2
ArmeniaTotal population: 3 017 712 Income group: lower middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal Sentinel Laboratory-confirmedinfluenza. This includesinfluenza-confirmedARI from universalsurveillance.
Populationcovered (%)
100%
Type of healthfacilities/hospitals
Polyclinic General practice,polyclinic
Intensive care unit,general/internalmedecine, paediatricmedicine, mother careinstitute
Number of healthfacilities/hospitals
6 facilities All medical facilities 9 hospitals
Case definitionused
WHO 2014 ECDC, WHO WHO 2014 Laboratory-confirmedinfluenza
Year introduced 2010 1990 2010 2009
Epidemicthreshold
No Yes No No
Sampling strategy All cases are includedin the samplingstrategy
A small number of ARIcases are sampled andtested for influenza (2per week)
All cases are includedin the samplingstrategy
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 20173
AustriaTotal population: 8 544 586 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Virological samples arecollected fromhospitals andunaffiliated physicians.
Populationcovered (%)
0.5-1%
Type of healthfacilities/hospitals
General practice,paediatric practice
Paediatricians,paediatric clinic,infectious diseasehospital outpatientdepartment andinfectious diseasehospital department.
Number of healthfacilities/hospitals
50 facilities
Case definitionused
ECDC ECDC
Year introduced 2000/2001 1952
Epidemicthreshold
Yes No
Sampling strategy Strategy is to collect 3-5 specimens per weekper sentinel site.
No sampling strategy.Physicians takenasopharyngeal swabsfor diagnosticpurposes.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.4
AzerbaijanTotal population: 9 649 300 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel System in place, butnot reported to TESSy
Sentinel
Populationcovered (%)
20% 2.9%
Type of healthfacilities/hospitals
Paediatric practice,polyclinic
Infectious diseaseward, pulmonary ward
Number of healthfacilities/hospitals
16 facilities 2 hospitals
Case definitionused
WHO <2011 WHO <2011
Year introduced 2009 2009
Epidemicthreshold
Yes No
Sampling strategy Every 3rd patient issampled. All agegroups are sampled.
Every 3rd patient issampled. All agegroups are sampled.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 20175
BelarusTotal population: 9 495 826 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Sentinel Virological surveillancein all hospitals forsevere cases fordiagnostics andtreatment.
Populationcovered (%)
5.2% 50% 30% 100%
Type of healthfacilities/hospitals
Paediatric practice,polyclinic
General practice,paediatric practice,polyclinic, emergencydepartment, infectiousdisease department.
Intensive care unit,general therapeutic,paediatric, obstretricsand gynecology,infectious disease,pulmonaryhospitals/wards.
Intensive care unit,general therapeutic,pediatric, obstretricsand gynecology,infectious disease,pulmonaryhospitals/wards.
Number of healthfacilities/hospitals
13 facilities 189 facilities 11 hospitals
Case definitionused
WHO 2014 ECDC, WHO WHO 2014
Year introduced 2010 2010 2010 2010
Epidemicthreshold
No No No No
Sampling strategy In the epidemic period,10 specimens arecollected per week byage group in each site.In the non-epidemicperiod, 10 specimensare collected per 2weeks by each agegroup in each site.
In the epidemic period,10 specimens arecollected per week byage group in each site.In the non-epidemicperiod, 10 specimenscollected per 2 weeksby each age group ineach site.
In the epidemic period,10 specimens arecollected per week byage group in each site.In the non-epidemicperiod, 10 specimenscollected per 2 weeksby each age group ineach site.
According to thedecision of the doctor.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.6
BelgiumTotal population: 11 265 834 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Sentinel Virological surveillancepossible from allgeneral hospitals in thecountry.
Populationcovered (%)
1.3% 1.3% Unknown
Type of healthfacilities/hospitals
General Practice General Practice General hospitals (allwards)
General hospitals (allwards)
Number of healthfacilities/hospitals
170 facilities 170 facilities 6 hospitals 117 hospitals
Case definitionused
National National National
Description ofnational casedefinition
Sudden onset of feverwith respiratorysysmptoms ANDgeneral symptoms.
Acute respiratoryinfection of the upper,medium or lowerrespiratory tract(including commoncold, rhinitis,(rhino)pharyngitis,angina, sinusitis, otitis,laryngitis, (laryngo)-tracheitis, bronchitis,bronchiolitis and(bronco)pneumonia)without influenzasyndrome.
Slightly adapted fromthe case definitionproposed in WHOguidance: an acuterespiratory illness withonset within the last 7days of history of fever,or measured fever of ≥38°C, and cough ordyspnoea (shortness ofbreath or difficulty tobreath) and requiringhospitalization (24h ormore).
Samples from patientspresenting with severeinfluenza in particularspecific conditions:ARDS (acuterespiratory distresssyndrome), ECMO(extracorporealmembraneoxygenation), death,suspicion of antiviralresistance, returningfrom abroad or in caseof outbeaks.
Year introduced 1985 1985 2011-2012 2011-2012
Epidemicthreshold
Yes No No No
Sampling strategy The first 2 ILI cases in aweek seen by the GP.
All hospitalisedpatients meeting thecase definition aresampled.
Only cases frompatients with severesuspected influenza.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 20177
Bosnia and HerzegovinaTotal population: 3 810 416 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal Universal Universal
Populationcovered (%)
100% 100% 100%
Type of healthfacilities/hospitals
General practice,paediatric practice,polyclinic, emergencydepartment.
General practice,paediatric practice,polyclinic, emergencydepartment.
University clinicalcentres, generalhospitals (ICUs,paediatric wards,infectious diseasewards, respiratorydisease wards).
Number of healthfacilities/hospitals
135 facilties: 52facilities (Republic ofSrpska); 79 facilities(Federation of Bosniaand Herzegovina); 4facilities (Brcko districtof Bosnia andHerzegovina).
135 facilities: 52facilities (Republic ofSrpska); 79 facilities(Federation of Bosniaand Herzegovina); 4facilities (Brcko districtof Bosnia andHerzegovina).
30 hospitals: 10hospitals (Republic ofSrpska); 19 hospitals(Federation of Bosniaand Herzegovina); 1hospital (Brcko Districtof Bosnia andHerzegovina).
Case definitionused
WHO 2011 ECDC, WHO WHO 2011
Year introduced 2009 (Federation ofBosnia andHerzegovina, Republicof Srpska, Brcko Districtof Bosnia andHerzegovina)
2009 (Federation ofBosnia andHerzegovina, Republicof Srpska, Brcko Districtof Bosnia andHerzegovina)
2009 (Federation ofBosnia andHerzegovina, BrckoDistrict of Bosnia andHerzegovina); 2013(Republic of Srpska)with current WHO casedefinition.
Epidemicthreshold
No No No
Sampling strategy FBIH, Brcko District: nosampling strategy,universal surveillancedepending on theavailability andcapacity of thereference laboratory.Republic of Srpska:sampling strategy is 1case every week at thesentinel site.
No samples collected. FBIH: all SARI cases aresampled at all times(24 hrs/7 days a week),depending on theavailability andcapacity of thereference laboratory.Republic of Srpska:sampling strategy is 1case every week at thesentinel site.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.8
BulgariaTotal population: 7 149 787 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Virological surveillancefrom 40 hospitals in thecountry.
Populationcovered (%)
5.38%
Type of healthfacilities/hospitals
General practices General practices,polyclinics, intensivecare/critical care units,infectious diseasehospital and wards,paediatric hospital andwards, pulmonarywards, and generalhospitals.
Number of healthfacilities/hospitals
211 facilities 40 hospitals
Case definitionused
ECDC, WHO ECDC - ILI and ARI casedefinition
Year introduced 2001 1958
Epidemicthreshold
Yes No
Sampling strategy Not available According to thedecision of the doctor.Laboratory-confirmedinfluenza cases arereported.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 20179
CroatiaTotal population: 4 240 317 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal System in place, butnot reported to TESSy
Populationcovered (%)
100%
Type of healthfacilities/hospitals
General practice,paediatric practice,polyclinic, emergencydepartment, hospitals
Number of healthfacilities/hospitals
Not available. 21counties collect datafrom district level
Case definitionused
ECDC
Year introduced 1975
Epidemicthreshold
No
Sampling strategy Patients are sampledbased on the GP's orepidemiologist'sdecision. All age groupsare included. Mostsamples are collectedat the start and duringthe peak of the season.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.10
CyprusTotal population: 853 166 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel No system available Universal
Populationcovered (%)
100% 100% 90%
Type of healthfacilities/hospitals
Paediatric outpatientdepartment of publichospital; adultoutpatient departmentof public hospital;office of primary healthcare paediatrician andadult-care physicianpracticing in privatesector.
Paediatric outpatientdepartment of publichospital; adultoutpatient departmentof public hospital;office of primary healthcare paediatrician andadult-care physicianpracticing in PrivateSector
Nearly all hospitals inthe private and publicsector.
Number of healthfacilities/hospitals
54 facilities 54 facilities 9 facilities
Case definitionused
National National
Description ofnational casedefinition
Sudden appearance offever >39°C for at least2 days AND respiratorysymptoms, malaise,myalgia, headache.
Severe acuterespiratory illnessrequiringhospitalizationincluding ICUadmissions withconfirmed virologicalspecimen for influenza.
Year introduced 2003 2003 2013
Epidemicthreshold
No No
Sampling strategy All cases according tothe national casedefinition visiting theobserver at thereporting centre.
All cases according tothe national casedefinition visiting theobserver physician atthe reporting centre.
Universal
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201711
Czech RepublicTotal population: 10 542 942 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Sentinel Virological surveillancefrom non-sentinelsites.
Populationcovered (%)
~50% ~50%
Type of healthfacilities/hospitals
General practice,paediatric practice.
General practice,paediatric practice.
Number of healthfacilities/hospitals
2,230 generalpractitioners and 1,240paediatricians.1
2,230 generalpractitioners and 1,240paediatricians.1
Case definitionused
ECDC ECDC, WHO ECDC
Year introduced 2004 1956 1956
Epidemicthreshold
Yes Yes No No
Sampling strategy One sample fromgeneral practice andone sample frompaediatric practice perweek from all regionsare collected duringthe influenza season(week 40-20).
One sample fromgeneral practice andone sample frompaediatric practice perweek from all regionsare collected duringthe influenza season(week 40-20).
Upon request from thenon-sentinel site.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
1 Details of number of health facilities were not available.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.12
DenmarkTotal population: 5 678 348 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Data on nationalinfluenza PCR tests areobtained weekly from anational microbiologydatabase. Clinicalmicrobiologicaldepartments athospitals send selectedpositive influenzasamples to the NIC forfurthercharacterization forvirological surveillance.
Populationcovered (%)
4% 100%
Type of healthfacilities/hospitals
General practice All
Number of healthfacilities/hospitals
140 facilities All national hospitals,out-patients clinics andGPs.
Case definitionused
National
Description ofnational casedefinition
Sudden onset of fever,muscle pain andrespiratory tractsymptoms.
Year introduced 1994 2010
Epidemicthreshold
Yes No
Sampling strategy GPs are asked to swabthe first 5 ILI patientsthey see. 5 Sample kitsare sent to 1/3 of allGPs at three differentpoints in time duringthe season: before thestart of the season, andjust before and justafter the peak.
There are nationalguidelines for when toswab patients in andoutside hospitalsduring and outside theinfluenza season.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201713
EstoniaTotal population: 1 312 558 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal System in place, butnot reported to TESSy
Virological surveillancefrom 3 hospitals in thecountry
Populationcovered (%)
13.6% 100%
Type of healthfacilities/hospitals
General practice,polyclinic, familydoctor
General practice,paediatric practice,polyclinic, familydoctor
ICU of central andregional hospitals
2 regional hospitalsand 1 central hospital
Number of healthfacilities/hospitals
16 facilities (80 medicaldoctors)
470 facilities (925medical doctors)
9 hospitals 3 hospitals
Case definitionused
ECDC ECDC, WHO Not available
Year introduced 2006 1954 2011 2000
Epidemicthreshold
Yes Yes No No
Sampling strategy Each sentinel sitecollects up to 10specimens per weekfrom cases that meetthe ECDC casedefinition. All agegroups are included.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.14
FinlandTotal population: 5 503 457 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Universal Universal
Populationcovered (%)
About 50% About 50% Not known. All ICUs inFinland are included;specimens arecollected on sentinelbasis.
100%
Type of healthfacilities/hospitals
General practice General practice Intensive care unit All hospitals andoutpatient clinics
Number of healthfacilities/hospitals
About 150 health carecentres report ILI-visits,11 of them also collectvirological specimens.10 health care centresof garrisons collectvirological specimens.
About 150 health carecentres report ARI-visits, 11 of them alsocollect virologicalspecimens. 10 healthcare centres ofgarrisons collectvirological specimens.
11 intensive care units
Case definitionused
ECDC ECDC, WHO ARI treated in intensivecare unit
No case definition used
Year introduced 2013 2013 2014 1995
Epidemicthreshold
No No No No
Sampling strategy Up to 5 specimens arecollected per week.
Up to 5 specimens arecollected per week.
Defined on clinicalbasis. All ICUs areasked to send 5-10clinical samples frompatients with clinicallysuspected influenzainfection that requireintensive care.
Defined on clinicalbasis.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201715
FranceTotal population: 64 395 344 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel No system available No system available Universal Virological surveillancefrom 44 hospitals.
Populationcovered (%)
0.7% ~100%
Type of healthfacilities/hospitals
General practice Intensive care unit General hospitals
Number of healthfacilities/hospitals
363 (including 96paediatricians)1
44 hospitals
Case definitionused
National Laboratory-confirmedinfluenza and casesdiagnosed as influenzaby the clinician.
No case definition used
Description ofnational casedefinition
Sudden onset of fever>39°C with respiratorysymptoms and myalgia.
Year introduced 1984 2009 1994
Epidemicthreshold
No No No
Sampling strategy First ILI case of theweek.
Virtually all. No sampling strategy.All samples taken fromin-patients fordiagnosis of influenza.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
1 Details of number of health facilities were not available.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.16
GeorgiaTotal population: 3 727 000 Income group: lower middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Virological testing isperformed for unusualcases of SARI.
Populationcovered (%)
1.7%
Type of healthfacilities/hospitals
General practice,paediatric practice,polyclinic.
Children's hospital inTbilisi and Kutaisisentinel sites. Wardsincluded are: intensivecare unit, internalmedecine, paediatric,maternity, infectiousdisease, respiratorydisease,therapeutic/chronicdisease.
Hospitals in Batumi,Akhaltsikhe and Zugdid(virological surveillanceonly).
Number of healthfacilities/hospitals
1 facility 5 hospitals
Case definitionused
WHO 2014 WHO 2014 PAHO/WHO 2014,unusual SARI
Year introduced 2007 2007 2015
Epidemicthreshold
No No No
Sampling strategy Every 3rd ILI patient onTuesday and Thursday
Every SARI patient onTuesday and Thursday
Every unusual case ofSARI
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201717
GermanyTotal population: 80 688 544 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Virological samplessent to the NIC fromnon-sentinel sources
Populationcovered (%)
>1%
Type of healthfacilities/hospitals
General practice,paediatric practice
Number of healthfacilities/hospitals
650 facilities
Case definitionused
National
Description ofnational casedefinition
Patients withpharyngitis, bronchitisor pneumonia (with orwithout fever)
Year introduced 1992 1998
Epidemicthreshold
No No
Sampling strategy Specimens collectedfrom the first ILIpatients (using theECDC case definition)per week in differentage groups.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.18
GreeceTotal population: 10 954 617 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel No system available Universal Universal Virological surveilance
Populationcovered (%)
~1.5%
Type of healthfacilities/hospitals
Primary health carecenters, NationalOrganisation for theProvision of HealthcareServices (EOPYY)clinics, privatepractitioners.
Number of healthfacilities/hospitals
145 facilities
Case definitionused
ECDC
Year introduced 2004 (revised in 2014)
Epidemicthreshold
No
Sampling strategy Sampling plan for2017-2018: all agegroups, at sentinelphysician’s discretion.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201719
HungaryTotal population: 9 855 023 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Virological surveillance
Populationcovered (%)
>20%
Type of healthfacilities/hospitals
General practice,paediatric practice
Hospitals
Number of healthfacilities/hospitals
~1400 facilities
Case definitionused
ECDC
Year introduced 2005
Epidemicthreshold
Yes No
Sampling strategy Doctors are advised tocollect 2 specimens ofILI patients per weekper site
Diagnostic purposes
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.20
IcelandTotal population: 330 814 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal System in place, butnot reported to TESSy
System in place, butnot reported to TESSy
Universal
Populationcovered (%)
100% 100%
Type of healthfacilities/hospitals
General practice,emergencydepartment, long termcare, selected privatepractitioners.
All health care facilities
Number of healthfacilities/hospitals
94 facilities
Case definitionused
National ECDC
Description ofnational casedefinition
ICD-10 codes J09, J10and J11 with subcodes
Year introduced 2009 2009
Epidemicthreshold
Yes No
Sampling strategy No sampling strategy,sampling is done onclinical suspicion fordiagnostic purposes.
No sampling strategy.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201721
IrelandTotal population: 4 635 400 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal All respiratoryspecimens referred tothe National VirusReference Laboratoryare tested forinfluenza.
Populationcovered (%)
6.2% 100%
Type of healthfacilities/hospitals
General practice All acute hospitals Mainly hospitals andsome GPs (excludingsentinel GPs)
Number of healthfacilities/hospitals
61 facilities 58 acute care publicand private hospitals
Case definitionused
ECDC Laboratory-confirmedinfluenza
Laboratory-confirmedinfluenza
Year introduced 2000 2009 (all ages);2003 (age 0-14)
2000
Epidemicthreshold
Yes No No
Sampling strategy One ILI patient perweek is sampled byeach of the sentinelGPs. For sentinel GPsparticipating in theIMOVE study: up to 5ILI patients per weekaged <65 years and allpatients aged ≥65 yearsshould be tested.
All cases reported All cases reported
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.22
IsraelTotal population: 8 064 036 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Virological surveillancefrom one hospital inthe country.
Populationcovered (%)
25%
Type of healthfacilities/hospitals
General practice,paediatric practice.Community clinics ofthe 2nd largest HMO inthe country.
Tertiary medical centre
Number of healthfacilities/hospitals
26 clinics - this isrelated to laboratorysurveillance only.
1 hospital
Case definitionused
National Hospitalized ARI cases
Description ofnational casedefinition
Acute fever of at least37.8 C accompanied byat least one of thefollowing symptoms:runny nose, sorethroat, cough, myalgia.
Year introduced 2000 2012/2013
Epidemicthreshold
Yes No
Sampling strategy Convenience sampling.Swabs are taken fromsome ILI cases. Swabsare taken on the first orsecond day of illness.
Hospitalized cases withARI.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201723
ItalyTotal population: 60 697 504 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal Universal
Populationcovered (%)
2% 100% 100%
Type of healthfacilities/hospitals
General practice,paediatric practice
Hospitals Hospitals
Number of healthfacilities/hospitals
900 facilities 1407 hospitals
Case definitionused
ECDC National National
Description ofnational casedefinition
Every hospitalizedpatient in ICU and/or inECMO with SARI(according to the WHO2011 case definition)and/or ARDSsymptoms is eligible.Only the positive casesfor any of the influenzaviruses are reported.
Hospitalized patientswith ILI and/or ARDSsymptoms.
Year introduced 1999 2009 2009
Epidemicthreshold
Yes No No
Sampling strategy All age groups areincluded in thesampling.
All cases hospitalized inICU and/or in ECMOwith SARI and ARDSsymptoms.
All cases hospitalizedwith ILI and/or ARDSsymptoms are includedin the sampling.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.24
KazakhstanTotal population: 17 544 126 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal Sentinel
Populationcovered (%)
9.4% 100%
Type of healthfacilities/hospitals
Paediatric polyclinic,adult polyclinic
Paediatric practice,polyclinic, infectiousdisease hospital, publichospitals, pulmonarydepartment
General/internal,paediatric, infectiousdisease ward
Number of healthfacilities/hospitals
30 facilities 25 hospitals
Case definitionused
National WHO 2011
Description ofnational casedefinition
Cases of acuterespiratory viraldiseases accompaniedby fever > 38°C andcough, which areobserved at least oncewithin 7 days from theonset of the disease.
Year introduced 2008 2010
Epidemicthreshold
No Yes No
Sampling strategy Sampling is carried outon a weekly basis frompatients with ILI (age >1 year) and onset ofillness <72 hours), allage groups.
Monthly from at least10 patients with ARVI,influenza, with clearclinical symptomsduring pre-epidemicand epidemic seasonsof ARVI and influenzamorbidity.
Sampling is carried outon SARI patients (age >1 year) and onset ofillness <72 hours, forpersons >18 years notmore than 7 days fromthe onset of thedisease. Samples takenfor max. 1 patient perday from each agegroup.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201725
KyrgyzstanTotal population: 5 957 271 Income group: lower middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal Sentinel Sentinel
Populationcovered (%)
2.8% 100% 1.5% M (26%)
Type of healthfacilities/hospitals
General practice,Polyclinic
General practice,Polyclinic
Intensive care unit,Infectious diseaseward, Pulmonary ward
Number of healthfacilities/hospitals
4 facilities 5 hospitals
Case definitionused
WHO <2011 ECDC, WHO WHO <2011
Year introduced 2009 1950 2008
Epidemicthreshold
No Yes No
Sampling strategy At least 3 patients ineach age group whomeet the standard casedefinition criteria aresampled each week.
Laboratoryexamination ofpatients is not carriedout.
At least 3 patients ineach age group whomeet the standard casedefinition criteria aresampled each week.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.26
LatviaTotal population: 1 970 503 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Virological surveillancemainly from hospitalsand also outpatientfacilities in the country
Populationcovered (%)
5.4% 5.4%
Type of healthfacilities/hospitals
General/paediatricpractice
General/paediatricpractice
Any type of hospitalsand outpatient facilities
Number of healthfacilities/hospitals
70 GPs1 70 GPs1
Case definitionused
ECDC ECDC, WHO ECDC
Year introduced 1995 1995 1995
Epidemicthreshold
Yes Yes No
Sampling strategy Preferably ILI cases aresampled, including allage groups; 50-100specimens per seasonmainly in Riga (capital).
Mainly ILI cases aresampled and very fewARI cases. There is nopredefined standardsampling strategy.
Hospitalised severe ILIcases are sampled atany time (24 hrs/7 daysper week).
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
1 Details of number of health facilities were not available.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201727
LithuaniaTotal population: 2 878 405 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel
Populationcovered (%)
2.5% 2.5%
Type of healthfacilities/hospitals
General practitioner General practitioner
Number of healthfacilities/hospitals
97 medical doctors1 97 medical doctors1
Case definitionused
ECDC No case definition used
Year introduced 2004 2012
Epidemicthreshold
Yes Yes
Sampling strategy All cases are included. On Tuesday accordingto medical doctor'sdecision.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
1 Details of number of health facilities were not available.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.28
LuxembourgTotal population: 567 110 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel The laboratoryprovides routinevirology results tointerested physisicans.
Populationcovered (%)
3% 3%
Type of healthfacilities/hospitals
Private GP practices Private GP practices GPs, pediatricians,pneumologist, neo-natalogist.
Number of healthfacilities/hospitals
15 facilities 15 facilities
Case definitionused
ECDC ECDC, WHO
Description ofnational casedefinition
Respiratory symptomsAND sudden fever>38.0 degrees CelciusAND myalgia
Year introduced 2003 2003
Epidemicthreshold
Yes No No
Sampling strategy All patients aresampled in principle
No systematic samplingfor ARI cases
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201729
MaltaTotal population: 418 670 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Virological data fromhospitalized SARI casesand other patientsadmitted withrespiratory symptomsat the single statehospital from somerespiratory physicians.
Populationcovered (%)Type of healthfacilities/hospitals
General practice forsentinel (public andprivate)
Main state hospital
Number of healthfacilities/hospitals
One large health carecentre and 7 private GPclinics
1 state hospital
Case definitionused
WHO 2014 WHO 2014
Year introduced 2003 2009
Epidemicthreshold
No No
Sampling strategy Patients that accept tohave a specimen taken.
At discretion of thehospital respiratoryphyscian orpaediatrician.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.30
MontenegroTotal population: 625 781 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal Universal
Populationcovered (%)
100% 100%
Type of healthfacilities/hospitals
General practice,paediatric practice,polyclinic
General hospitals,Clinical Centre ofMontenegro
Number of healthfacilities/hospitals
29 health facilities 8 hospitals
Case definitionused
ECDC WHO 2011
Year introduced 2009 2016
Epidemicthreshold
No No
Sampling strategy Limited virologicaldiagnostics performed
All SARI cases aresampled at all times
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201731
NetherlandsTotal population: 16 924 928 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel 1) Peripheral andhospital laboratorysurveillance ofinfluenza. 2) Virologicalsurveillance of RSVfrom 21 laboratories inthe country.
Populationcovered (%)
0.8% 1) ARI syndrome: 7%2) ARI virology: 0.75%
Type of healthfacilities/hospitals
General practice 1) ARI syndrome:General practice.2) ARI virology: Generalpractice; same networkas sentinel ILI.
Virology laboratories
Number of healthfacilities/hospitals
40 facilities 1) 280 facilities2) 40 facilities
1) 21 laboratories2) 24 laboratories
Case definitionused
National National 1) All influenza virus-positive and RSV-positive laboratoryresults.2) Depending onlaboratory, all orsubset of influenzavirus-positive results.
Description ofnational casedefinition
Acute onset AND rectaltemperature >38°CAND at least one of thefollowing symptoms:cough, coryza, sorethroat, frontalheadache, retrosternalpain, myalgia
1) ICPC codes R74, R75,R77, R78, R802) any ARI other thanILI
Based on diagnosticrequests fromphysicians, no specificcase definition.
Year introduced 1970; testing ofspecimens introducedin 1994
1) 20152) 1994
1) 19642) 1948
Epidemicthreshold
Yes No No
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.32
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Sampling strategy All ILI patients ≥65years and first two ILIpatients <65 yearspresenting Monday-Wednesday. If thereare no ILI patientsMonday -Wednesday,then the first two ILI orARI patients presentingThursday -Sunday. Inabsence of ILI cases,samples are collectedfrom ARI cases.
1) No sampling,syndromic surveillanceonly.2) See ILI surveillance.
Based on diagnosticrequests fromphysicians, no nationalsampling strategy.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201733
NorwayTotal population: 5 210 967 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal System in place, butnot reported to TESSy
No system available System in place, butnot reported to TESSy
Universal reporting oflaboratory confirmedinfluenza bylaboratories. Mostdetections or fromhospitalized cases, andsome are from primarycare.
Populationcovered (%)
100% 100%
Type of healthfacilities/hospitals
All general practicesand emergency clinicsin primary health care.
Medical microbiologylaboratoriesperforming influenzavirus diagnostics.
Number of healthfacilities/hospitals
About 5600 medicaldoctors report data. 1
17 laboratories
Case definitionused
National National National National
Description ofnational casedefinition
ICPC-2 diagnosis code"R80 Influenza" wherean ILI case is definedas:Myalgia and coughwithout abnormalfindings upon airwayexamination exceptinflammation of nasalmucosa and throat,plus three or more ofthe following:-sudden onset ofsymptoms (within 12hours)- fever, chills orfeverishness- malaise and fatigue- influenza in thecommunity- ongoing influenzaepidemic- laboratory confirmedinfluenza
Hospitalized ANDlaboratory-confirmedinfluenza
Laboratory confirmedinfluenza
1 Details of number of health facilities were not available.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.34
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Year introduced 2014 (the currentsystem). Prior to thisthere was a sentinelsystem for ILI thatstarted in 1998; beforethat clinical influenzawas notifiable(aggregated).
2017 1980s
Epidemicthreshold
Yes No
Sampling strategy 82 general practicesand primary careemergency wards areparticipating in thevoluntary network ofinfluenza sentinelpractices coordinatedby the NIC. These sendin ILI patient specimensall year round, basedon WHO 2014 casedefinition.
Medical microbiologylaboratories thatperform influenza virusdiagnostics reportweekly all detections,by type and subtype,with testingdenominators by agegroup (0-4, 5-14, 15-24,25-59, >60).These labs also submitinfluenza positivespecimens to NIC, eachup to five samples pertype per week plusspecial cases (severe,unusual circumstances,suspicion ofresistance).
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201735
PolandTotal population: 38 454 576 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Virological surveillancefrom all hospitals andall non-sentinel GPs inthe country.
Populationcovered (%)
19% 100%
Type of healthfacilities/hospitals
General practice General practice andhospitals
Number of healthfacilities/hospitals
625 facilities
Case definitionused
ECDC ECDC
Year introduced 2004 1951
Epidemicthreshold
No No
Sampling strategy It is advised to collectspecimens 7 days aweek (by age andsentinel site). Thesampling procedure isthe same in the wholeseason - all cases andall age groups areincluded.
There is no nationalsampling strategy.Sampling is based onthe doctors' decision.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.36
PortugalTotal population: 10 349 803 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel System in place, butnot reported to TESSy
Laboratory surveillancebased on emergencyunits and hospitals(laboratory network) inthe Portugal mainlandand Atlantic islands.
Populationcovered (%)
2.1% 300 beds Not known
Type of healthfacilities/hospitals
General practice ICU/hospitals Hospitals, EmergencyUnits
Number of healthfacilities/hospitals
125 generalpractitioners1
30 ICU/24 hospitals 111 Emergency Units +19 Hospitals(laboratory network)
Case definitionused
ECDC National ECDC
Description ofnational casedefinition
Hospitalized influenza-confirmed cases
Year introduced 1989 2011-2012 1989: Emergency Units.2009: Hospital(Laboratory Network)
Epidemicthreshold
Yes No No
Sampling strategy Samples are collectedfrom ILI cases, from GPpatient list, all ages,and during the wholeseason.
Once a week(Wednesdays) the ICUsends information oncases admitted to ICUduring the previousweek with laboratoryconfirmation forinfluenza. All cases andall age groups areincluded in thesampling; the samesampling procedure isused during the entireseason.
Laboratory basedsurveillance. All casesare sampled. Casessampled fit the ECDCcase definition and/orthe clinician's decision.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
1 Details of number of health facilities were not available.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201737
Republic of MoldovaTotal population: 4 068 897 Income group: lower middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Sentinel Health facilities notcovered by sentinelsurveillance.
Populationcovered (%)
11% 11% 43% 57%
Type of healthfacilities/hospitals
Polyclinic Polyclinic Intensive care unit,general/internalmedicine, paediatricmedicine, infectiousdisease and respiratorydisease ward,therapeutic/chronicdisease ward.
Intensive care unit,general/internalmedecine, paediatricmedicine, infectiousdisease and respiratorydisease ward,therapeutic/chronicdisease ward,polyclinic.
Number of healthfacilities/hospitals
10 facilities 10 facilities 17 hospitals 492 facilities
Case definitionused
ECDC ECDC, WHO WHO <2011 ILI: ECDC casedefinition. ARI:ECDC/WHO casedefinition. SARI: WHO<2011 case definition.
Year introduced 2004 1995 2009 (changed in 2015) 2009
Epidemicthreshold
No Yes No No
Sampling strategy 12 samples arecollected weekly fromthe first patientpresenting with casedefinition symptoms in10 facilities regardlessof the age group.Sampling is performedbetween week 40 andweek 20; outside thisperiod sampling isperformed in case oftheir existence.
12 samples arecollected weekly fromthe first patientpresenting with casedefinition symptoms in10 facilities regardlessof the age group.Sampling is performedbetween week 40 andweek 20; outside thisperiod sampling isperformed in case oftheir existence.
20 samples arecollected weekly frompatients presentingwith SARI symptoms in17 hospitals. Samplingis performed betweenweek 40 and week 20;outside this period,sampling is performedin case of theirexistence.
Any sample collectedfrom patients withsevere evolution of ILI,ARI and SARI, inoutbreaks, patientsfrom high risk groupregardless of age groupand period of the year.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.38
RomaniaTotal population: 19 511 324 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Sentinel For ILI/ARI: virologicalsurveillance from allnon-sentinel healthcare providers in thecountry.
Populationcovered (%)
2% 2% 20% 98%
Type of healthfacilities/hospitals
General practice General practice Intensive care unit,general/internalmedicine, paediatricmedicine, infectiousdisease ward,respiratory diseaseward.
Hospitals, primaryhealth care practices,specialized medicalpractices,healthcentres, outpatientclinics,emergencyservices providers,home care providers,long term careinstitutions.
Number of healthfacilities/hospitals
192 facilities 192 facilities 20 hospitals around 12000 GPs and10000 other healthfacilities/hospitals
Case definitionused
National ECDC, WHO National Clinical criteria:Fever ≥ 38 °CCoughOnset within the last10 daysIn the absence of otherclinical diagnosis.
Description ofnational casedefinition
ECDC and WHO 2014 An acute respiratoryillness with a history offever or measuredfever of ≥38°C andcough and shortness ofbreath or difficultybreathing, with onsetwithin the past 10days, requiringhospitalizationovernight.
For ILI: WHO 2014
Year introduced 2014 2001 2009 for ILI: 2014
Epidemicthreshold
Yes Yes No No
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201739
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Sampling strategy On Tuesdays fromweek 40 (onset ofinfluenza season)swabs are collectedfrom all casespresented and whomeet the ILI casedefinition. After theonset of the season thealgorithm is establishedby the National Center,according to specificseason parameters.
Depending on theepidemiologicalcontext, ARI cases canbe sampled and testedfor influenza.
From week 46 until theonset of the influenzaseason, the first 3detected SARI cases ineach sentinel hospitalare sampled. Afterthat, only the firstdetected SARI case ineach sentinel hospitalis sampled.
For ILI: there is only asentinel samplingstrategy. Non-sentinel:sampling is done forthe more serious cases,depending on thefunds available forpayment of the tests.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.40
Russian FederationTotal population: 143 456 912 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal Universal Sentinel Virological surveillancefrom a large number ofhospitals andpolyclinics in thecountry.
Populationcovered (%)
35% 35% About 17% of thepopulation in the citieswhere sentinel sitesare located.
About 35% of thepopulation
Type of healthfacilities/hospitals
Polyclinic (GP) Polyclinic (GP) Intensive care units,paediatric medicine,infectious disease andrespiratory diseasewards.
Intensive care units,paediatric medicine,infectious disease andrespiratory diseasewards
Number of healthfacilities/hospitals
59 cities (baselabs) 59 cities (baselabs) 19 hospitals (10laboratories confirmedinfluenza by PCR)
58 laboratories
Case definitionused
No case definition used No case definition used WHO 2011
Year introduced 2005 1971 2010 1971
Epidemicthreshold
Yes Yes No No
Sampling strategy The average number ofsamples taken fromILI/ARI patients is 29per week; all agegroups are included.The WHO 2011 casedefinition is used forARI and ILI sentinelsurveillance.
The average number ofsamples taken fromILI/ARI patients is 29per week; all agegroups are included.The WHO 2011 casedefinition is used forARI and ILI sentinelsurveillance.
All SARI cases aresampled. The averagenumber of SARI casessampled is 26 perweek; all age groupsare included.
20-50 samples aretested for influenza perweek. The numberdepends on theepidemiologicalsituation.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201741
SerbiaTotal population: 7 131 787 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal Sentinel Laboratory-confirmedinfluenza cases fromnon-sentinel primarycare and from non-sentinel hospitals.
Populationcovered (%)
100% 80%
Type of healthfacilities/hospitals
General practice,paediatric practice.
Intensive care unit,general/internalmedicine, paediatricmedecine, infectiousdisease ward,respiratory diseaseward.
Number of healthfacilities/hospitals
158 facilities 11 hospitals
Case definitionused
WHO 2011 WHO 2011
Year introduced 2006 2009
Epidemicthreshold
Yes No
Sampling strategy ILI cases are sampledmostly during the first4 days in the week.
Sentinel SARI cases aresampled mostly duringthe first 4 days in theweek.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.42
SlovakiaTotal population: 5 426 258 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal Universal Universal
Populationcovered (%)
52.6% 52.6% 100%
Type of healthfacilities/hospitals
General practice,paediatric practice
General practice,paediatric practice
Intensive care unit
Number of healthfacilities/hospitals
88 facilities 88 facilities 74 hospitals
Case definitionused
ECDC ECDC, WHO WHO 2014
Year introduced 2002 2002 2009
Epidemicthreshold
Yes Yes No
Sampling strategy Based on the doctor'sdecision. All cases areincluded in thesampling strategy.
Based on the doctor'sdecision. All cases areincluded in thesampling strategy.
All reported SARI casesare laboratory tested.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201743
SloveniaTotal population: 2 063 077 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Virological surveillanceof non-sentinel sites
Populationcovered (%)
4% 4% 100%
Type of healthfacilities/hospitals
General/familypractices, paediatricpractices, schooldoctors
General/familypractices, paediatricpractices, schooldoctors
Hospitals
Number of healthfacilities/hospitals
45 facilities 45 facilities All facilities/hospitals
Case definitionused
ECDC ECDC, WHO No case definitionused. Most samplesare derived fromhospitalized patientswith ARI, but notexclusively.
Year introduced 1999 1999
Epidemicthreshold
No No No
Sampling strategy Samples are collectedfrom ILI patients. Moreintensive sampling isadvised during thebeginning of theseason. The number ofsamples is not limited.
No samples arecollected from ARIpatients
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.44
SpainTotal population: 46 423 064 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Influenza-confirmedcases reported fromvirological diagnosticassays in regionalinfluenza laboratories.
Populationcovered (%)
2.4% 52%
Type of healthfacilities/hospitals
General practice,paediatric practice
All wards in mainlypublic general hospitals
Laboratories mainly inpublic hospitals
Number of healthfacilities/hospitals
776 facilities 91 hospitals
Case definitionused
ECDC Laboratory-confirmedinfluenza in all wards
Influenza-confirmedcases (no casedefinition used)
Year introduced 1996 2009 1996
Epidemicthreshold
Yes No No
Sampling strategy Samples are collectedfrom the first 2patients who attendthe sentinel facilityduring the week.
All patients who meetclinical criteria ofsevere influenza likeillness who requiredhospitalization(pneumonia/septicshock/ ARDS/multipleorgan dysfunctionsyndrome or admittedto intensive care) aresampled.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201745
SwedenTotal population: 9 799 186 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal Virological surveillancefrom all laboratories inthe country
Populationcovered (%)
8% 100% (with 25%underreporting)
100%
Type of healthfacilities/hospitals
General practice, andsome infectiousdisease and paediatricclinics.
Intensive care unit Primarily emergencycare, hospitals,infectious disease andpaediatric clinics, andsome primary carefacilities.
Number of healthfacilities/hospitals
99 facilities 78 intensive care units 28 laboratories
Case definitionused
ECDC Laboratory-confirmedinfluenza
Laboratory-confirmedinfluenza cases.Patients presentingwith ILI - similar toECDC ILI casedefinition.
Year introduced 2006 2013 1993, changed in 2013
Epidemicthreshold
No No No
Sampling strategy Up to 5 specimenscollected per week persite.
No sampling strategy.Samples are collectedbased on decision ofthe clinician.
No sampling strategy.Samples are collectedbased on decision ofthe clinician.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.46
SwitzerlandTotal population: 8 298 663 Income group: high
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Virological surveillancefrom all laboratories inthe country
Populationcovered (%)
1.9-2% 100%
Type of healthfacilities/hospitals
General practice,paediatrician
Laboratories
Number of healthfacilities/hospitals
150-200 facilities <200 laboratories
Case definitionused
WHO <2011 Laboratory-confirmedinfluenza
Year introduced 1987 1988
Epidemicthreshold
Yes No
Sampling strategy About 45% of thesentinel facilties collectspecimens. Theysample all ILI patientswhen the incidence isbelow the epidemicthreshold, and every4th-5th ILI patientswhen the incidence isabove the epidemicthreshold.
Mandatory notificationof influenza detection.Consequently, nostandard samplingstrategy.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201747
TajikistanTotal population: 8 481 855 Income group: lower middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal Universal Sentinel
Populationcovered (%)
100% 100% 10.3%
Type of healthfacilities/hospitals
Health Centers (PHC)and Hospitals
Health Centers (PHC)and Hospitals
Hospital
Number of healthfacilities/hospitals
3085 facilities 3085 facilities 1 hospital
Case definitionused
National National WHO 2014
Description ofnational casedefinition
Cases are identifiedprimarily based onclinical diagnoses,consequently thesystem includes thesurveillance of bothviral and bacterialacute respiratorydiseases.
Cases are identifiedprimarily based onclinical diagnoses,consequently thesystem includes thesurveillance of bothviral and bacterialacute respiratorydiseases.
Year introduced 2016
Epidemicthreshold
No No No
Sampling strategy Not available Not available All patients that meetthe SARI case definition(hospitalized ARI withfever (≥38°C or verbalmentioning ofincreasedtemperature/fever)and cough) who arenewly hospitalizedthrough the admissionunit on Monday andTuesday, and moreoften upon instructionof the MoH RT, need tobe sampled.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.48
The former Yugoslav Republic of MacedoniaTotal population: 2 078 453 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal Sentinel System in place, butnot reported to TESSy
System in place, butnot reported to TESSy
Virological surveillance
Populationcovered (%)
100% 1.7%
Type of healthfacilities/hospitals
General practice,paediatric practice,polyclinic, infectiousdisease clinic, all otherhealth facilities fromprimary care,secondary care andtertiary level of healthcare
General practices
Number of healthfacilities/hospitals
All 14 facilities
Case definitionused
ECDC ECDC, WHO Laboratory-confirmedinfluenza
Year introduced 1966 2014
Epidemicthreshold
Yes No
Sampling strategy For universalsurveillance there is nosampling strategy.
For sentinel ILI/ARIsurveillance, the first ILIcase in the week issampled. As of the2017/2018 season,advice is to collect 2specimens per site perweek. All age groupsare included in thesampling, and all casesare included in thesampling strategy.
Based on clinician'sdecision.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201749
TurkeyTotal population: 78 665 832 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel System in place, butnot reported to TESSy
Virological surveillancefrom non-sentinelfacilities
Populationcovered (%)
1%
Type of healthfacilities/hospitals
Family physiciancentres
Intensive care unit,emergencydepartment, internaldisease department,paediatric diseasedepartment, infectiousdisease department,pulmonary diseasedepartment.
Hospitals
Number of healthfacilities/hospitals
17 provinces/ 180family physicians1
5 provinces/ 9 hospitals
Case definitionused
WHO <2011 WHO 2014 WHO 2014
Description ofnational casedefinition
WHO 2014; age-specific case definitions
Year introduced 2004 2016 2004
Epidemicthreshold
No No No
Sampling strategy At least one sample foreach week randomlychosen until Fridayshowing ILI casedefinition, including allage groups, by 180family doctors.
Samples are collectedfrom all patients thatmeet the SARI casedefinition, all age-groups included, in 9hospitals.
No sampling strategy.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
1 Details of number of health facilities were not available.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.50
TurkmenistanTotal population: 5 373 502 Income group: upper middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type System in place, butnot reported to TESSy
System in place, butnot reported to TESSy
System in place, butnot reported to TESSy
System in place, butnot reported to TESSy
Conventionalsurveillance of ARI andinfluenza
Populationcovered (%)Type of healthfacilities/hospitals
Polyclinic Polyclinics andhospitals
Hospitals Virological referencelaboratory in theCentre for PublicHealth and Nutrition
Number of healthfacilities/hospitals
1 Все 1 Currently, onelaboratory providesconfirmation
Case definitionused
WHO <2011 National WHO 2011
Description ofnational casedefinition
Case definition ofinfluenza-like illness(ILI):acute respiratorydisease with onset inprevious 7 days andwith the followingsymptoms:• measured fever ≥ 38°C;• cough.
Acute upperrespiratory infectionsof multiple andunspecified sites (ICD-10 code J06).
Case definition of thesevere acuterespiratory infection(SARI):acute respiratorydisease with onset inprevious 7 days,requiringhospitalisation, andwith the followingsymptoms:• measured fever orhistory of fever ≥ 38 °C,• cough,• shortness of breathor difficulty inbreathing, not causedby nasal congestion orother types of upperrespiratoryobstruction.
Influenza caseconfirmed by use ofone of laboratory testsrecommended for fludiagnosis in thecountry.
Year introduced 2016 2009 2016 2009
Epidemicthreshold
No No No No Yes
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201751
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Sampling strategy Two throat swabs aretaken from each of thetwo patients referredby the responsiblefamily physician. Thefirst swab is used forthe rapid testing onsite, the second one issent (compliant to coldchain requirements) tothe virologicalreference laboratory inthe Centre for PublicHealth and Nutritionfor PCR testing. Onethroat swab is takenfrom subsequentpatients referred bythe responsible familyphysicians, for on-siterapid testing.
Samples are takenfrom patients admittedfrom 8 a.m. Tuesday till8 a.m. Wednesday,who present threepositive indicators,with onset of thesymptoms ≤7 daysprior to hospitaladmission. The numberof daily samples shouldnot exceed 10.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.52
UkraineTotal population: 44 823 764 Income group: lower middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Sentinel Universal
Populationcovered (%)
1.8% 1.8% 6.5% 100%
Type of healthfacilities/hospitals
General practice,paediatric practice,polyclinic
General practice,paediatric practice,polyclinic
Intensive care unit,paediatric infectiousdisease ward,respiratory diseaseward
General practice,paediatric practice,polyclinic, intensivecare unit, infectiousdisease respiratorydisease ward,maternity units
Number of healthfacilities/hospitals
39 facilities 39 facilities 10 hospitals 16730 facilities
Case definitionused
WHO 2011 WHO 2011 WHO 2011 WHO 2011
Year introduced 2016 2016 2007 1976
Epidemicthreshold
No No No No
Sampling strategy The samples are takenin each sentinelinstitution, on everyMonday during theyear, from each of thefirst 5 patients whomeet the casedefinition. Thesampling proceduredoes not differbetween the beginningand the peak of theseason;- all cases and all agegroups are included inthe sampling strategy.
6 by site during theweek 40-20; 3 by siteduring week 21-39. Allsevere cases should besampled.
The sampling strategyfor non-sentinelsurveillance is definedin order no. 499 of theMinistry of Health ofUkraine.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201753
United KingdomTotal population: 64 715 808 Income group: high
England
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal Influenza data arecollected frompathology systemstransmitted from PHE,NHS, and privatemicrobiologylaboratories acrossEngland.
Populationcovered (%)
1.7% 100% 100%
Type of healthfacilities/hospitals
General practice Intensive care units PHE, NHS and privatemicrobiologylaboratories
Number of healthfacilities/hospitals
190 general practices 150 hospitals >200 laboratories
Case definitionused
National
Description ofnational casedefinition
ILI is clinically definedas an individualpresenting in primarycare with an acuterespiratory illness withphysician-diagnosedfever or complaint offeverishness.
Laboratory-confirmedinfluenza in ICUpatients (Symptoms:Fever (>=38° C) orhistory of fever inprevious 7 days ANDtwo or more of: cough,sore throat, headache,rhinorrhoea, myalgia;D&V, increased resp.rate, poor feeding).
Year introduced 1964 2010
Epidemicthreshold
Yes No No
Sampling strategy At the start of theseason 2-3 ILI cases areswabbed per week. Atthe peak of the seasonmax. 20 patients areswabbed per week.
All cases should besampled
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.54
Northern Ireland
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Universal Universal
Populationcovered (%)
12% 12% 100% 100%
Type of healthfacilities/hospitals
General practice General practice All hospitals All except sentinel GP's(12%)
Number of healthfacilities/hospitals
37 facilities 37 facilities All hospitals All except sentinel GP's(12%)
Case definitionused
National ECDC, WHO Laboratory-confirmedinfluenza
National
Description ofnational casedefinition
A disabling acuterespiratory illnessaccompanied by severefever and myalgia –Read Code H27
Sudden onset andsymptoms includingone or more of thefollowing – cough, sorethroat, shortness ofbreath, coryza and aclinician’s judgementthat the illness is dueto an infection.
A disabling acuterespiratory illnessaccompanied by severefever and myalgia –Read Code H27.
Year introduced 2001 2009 2001
Epidemicthreshold
Yes No No No
Sampling strategy We encourage doctorsto sample all casesmeeting the ILI casedefinition, with aweekly maximum of 5specimens. Weencourage thecollection of samplesfrom all age groupswith particularattention paid tochildren (from 2 years)if possible. Samplingshould not differbetween start and peakseason except innumber.
None Varies by site
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201755
Scotland
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Universal Universal Universal Virological surveillance(universal)
Populationcovered (%)
99% (ILI); 6%(sampling)
99% 100% 100%
Type of healthfacilities/hospitals
GP practices GP practices Hospital, ICU (3rd levelcare)
Mostly hospital/ GPpractices
Number of healthfacilities/hospitals
953 practices; 59 GPs(sampling)
953 practices 23 hospitals 277 hospitals/ 953 GPpractices
Case definitionused
No case definition used No case definition used National Laboratory confirmedInfluenza cases
Description ofnational casedefinition
Based on clinicaldiscretion of GP; forsampling casespresenting to primarycare with ILI symptomsand within 7 days ofdate of onset of thosesymptoms).
Based on clinicaldiscretion of GP.
Laboratory-confirmedinfluenza casesadmitted to thehospital for intensivecare management.
Year introduced 2009 (ILI); 2000(sampling)
2009 (ARI); 2000(sampling)
2010 2009
Epidemicthreshold
Yes No No No
Sampling strategy Up to first 8 patientsper week; 4 swabs inthose aged <15 years; 2in 15-64 and 2 in 65+.
Based on clinicaldiscretion of thedoctor/healthcareprofessional.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Wales
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Universal Universal surveillancefor ILI in all primarycare GPs.
Populationcovered (%)
11.7% 100% 100%
Type of healthfacilities/hospitals
General practice All wards General practice
Influenza surveillance profiles
December 2017 © World Health Organization, 2017. All rights reserved.56
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Number of healthfacilities/hospitals
44 facilities 19 hospitals 450 facilities
Case definitionused
National Laboratory-confirmedinfluenza in all wards
National
Description ofnational casedefinition
GP diagnosed ILI (ECDCILI definition given asguidance)
GP diagnosed ILI (ECDCILI definition given asguidance)
Year introduced 1987 2005 2009
Epidemicthreshold
Yes No
Sampling strategy Sentinel GPs are askedto swab all diagnosedILI cases (around thepeak of an epidemicthis may be limited tothe first 5 patientsdiagnosed in eachpractice per week).
All confirmed cases ofinfluenza in hospitalpatients for whomrespiratory screen testsare requested.
All clinically diagnosedcases of ILI.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.
Influenza surveillance profiles
© World Health Organization, 2017. All rights reserved. December 201757
UzbekistanTotal population: 29 893 488 Income group: lower middle
Systemcharacteristic
Primary care Hospital Non-sentinelInfluenza-like
illness (ILI)Acute respiratory
infection (ARI)Severe acuterespiratory
infection (SARI)
Laboratory-confirmedinfluenza
Surveillance type Sentinel Sentinel Sentinel No system available
Populationcovered (%)
0.01% 0.01%
Type of healthfacilities/hospitals
General practice,polyclinic
General practice,polyclinic
Hospital, maternityhospital
Number of healthfacilities/hospitals
1 facility 1 facility 3 hospitals
Case definitionused
WHO 2014 ECDC, WHO WHO 2014
Year introduced 2016 2016
Epidemicthreshold
No No
Sampling strategy Five doctors, fivesamples, once a week.
All SARI patients whenadmitted.
See Notes for more information on influenza surveillance systems and a description of WHO and ECDC case definitions.