Covid-19 Coronavirus

Surveillance of seasonal respiratory illnesses

Weekly surveillance report

Updated on Thursday 1 December 2022

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Introduction

The purpose of this report is to provide an overview of surveillance information concerning respiratory viruses on the Isle of Man.

The European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO), and the European surveillance networks for COVID-19 and influenza state the need to develop and sustain resilient population-based surveillance systems for respiratory illnesses; with a continued focus on influenza, COVID-19 and RSV.

Influenza virus types A and B are both common causes of acute respiratory illnesses. Each year, seasonal influenza occurs all over the world. Occurring mainly in winter, influenza is an infectious respiratory disease with symptoms ranging from those similar to a common cold, through to very severe disease.

Respiratory syncytial virus (RSV) is a common respiratory virus that for most people causes mild, cold-like symptoms. For a small number of people RSV can be serious, especially for some infants and older adults. RSV is the most common cause of bronchiolitis in infants.

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people will experience mild to moderate symptoms. Older people and those with certain underlying medical conditions are at a high risk of developing serious illness. 

During the winter months, respiratory illnesses have variable effects and can strain the health and social care services as well as lead to significant absences from work and school. Data collected by this integrated respiratory surveillance system will help inform control measures by monitoring the spread and intensity of respiratory viruses and vaccination progress.

Background and future developments

In August 2022, Public Health Isle of Man discontinued the existing weekly COVID-19 surveillance report in order to focus on the need for wider winter surveillance. The intention is to gather data from a variety of sources to provide a more comprehensive system, allow an early warning for the healthcare system to protect against health and social care pressures, and to have an adaptive system to monitor potential future threats from other viruses which may cause a risk to public health.

Following the pandemic, social mixing and contact have returned to similar levels to pre-pandemic, and therefore seasonal influenza virus and other respiratory viruses will co-circulate alongside COVID-19 this winter. The World Health Organization, European Centre for Disease Prevention and Control (ECDC), and other global bodies emphases the importance of expanding respiratory reporting to enhance the winter planning process.

Global respiratory surveillance focuses on the six domains of community, primary care, secondary care, vaccination, mortality and global monitoring surveillance. Public Health are currently working across government to expand local surveillance in each of these domains.

Over the coming weeks the report will evolve to include additional surveillance from each domain along with a new platform to allow automated chart updates.

Summary
  • GP in-hours surveillance and ED respiratory attendance remains within seasonally expected levels

  • The Autumn Covid-19 booster programme commenced on 5 September 2022. In October, the programme opened to all eligible groups

  • Guidance on staying well this winter

  • Global surveillance indicators suggest increasing levels of influenza activity, with increases seen in multiple indicators including hospitalisations over recent weeks. Admissions being highest in the under 5 and over 75 age groups.

GP In Hours, Acute Respiratory Infections Surveillance

GP in Hours (GPIH) surveillance monitors the number of GP visits during regular hours. Data for surveillance is obtained from the EMIS Primary Care system by using a selection of READ codes. The codes selected form part of a pilot project and will remain under continuous development during the next few months.

Figure 1 – Weekly all age GP in-hours appointments

Figure 1 – Weekly all age Acute Respiratory Infections, GP in-hours appointments (Provisional data).

The number of GP consultations in week 47 increased by 18% on the previous week, matching the volume seen in week 47 of 2021.

As reported by the UK Health Security Agency (UKHSA), the number of consultations with GPs for influenza-like illness in England is stable and below seasonal expectations.

Figure 2 – GP in-hours influenza-like illness 2021-22

Figure 2 – GP in-hours influenza-like illness in England 2021/22.

GP Out of Hours, Acute Respiratory Infections Surveillance

Data was due from the Out of Hours service in Manx Care by 17 November 2022.

Emergency Department attendances

The emergency department (ED) surveillance monitors daily visits to the ED for respiratory illness. The data for surveillance is gathered from the Medway hospital patient administration system using a selection of SNOMED codes. The code selection forms part of a pilot project and will remain under continuous development during the next few months.

Figure 3 – ED attendance for respiratory illness 2022

Figure 3 – ED attendance for respiratory illness 2022.

Figure 4 – 2022 ED attendance for respiratory illness by age groups

Figure 4 – 2022 ED attendance for respiratory illness by age groups.

ED attendances for respiratory illness at week 47 are stable and remain within baseline. In comparison, UK HSA tracks emergency department attendance in England for COVID-19, influenza-like illness, and acute respiratory illness; they report stable ED attendances for COVID-19-like illness while acute respiratory infections and influenza-like-illness increased. Influenza admissions were highest in those under 5 years, followed by 75 to 84 year olds and those aged 85 years and over. Influenza ICU admissions increased and is now in the medium intensity threshold. Read the full report for Emergency Department Syndromic Surveillance System Bulletin (England) 2022 Week 47.

Figure 5 – ED attendances for acute respiratory infection in England 2021/22

Figure 5 – ED attendances for acute respiratory infection in England 2021/22.

Figure 6 – ED attendances for influenza-like illness in England 2021/22

Figure 6 – ED attendances for influenza-like illness in England 2021/22.

Seasonal influenza vaccine statistics

Seasonal influenza (Flu) is a contagious acute respiratory infection caused by influenza viruses. Typically most people recover from the symptoms within a week; however, some people may be more susceptible to developing serious illness or worsening of existing conditions. The flu vaccination is available to those at higher risk of complications.

This dashboard is intended for sharing vaccine programme progress. During the winter, the dashboard will update monthly. As of yet, the dashboard does not include results from the school flu vaccination program.

Figure 7 – Monthly influenza vaccines administered within the health service

Figure 7 – Monthly influenza vaccines administered within the health service at October 2022.

The uptake of influenza vaccine in England for the 2022/2023 influenza season is comparable to the uptake in the previous 2021/2022 season for those 65 and over, for those in clinical risk groups, and for pregnant women. However, it is lower for those ages two and three years.

Figure 8 - Cumulative weekly influenza vaccine uptake in 2 and 3 year olds in England

Figure 8 - Cumulative weekly influenza vaccine uptake in 2 and 3 year olds, in England.

Compared to England, the Isle of Man currently has lower influenza vaccine rates for those who are over 65 years of age and two and three-year-olds. The under 50 and vulnerable is category is not comparable due to different groupings.

AgeIsle of Man (End October 2022)England (Week 42)
65 year olds and over 43.7% 59%
50 to 64 year olds who are not in a clinical risk group 18.5% 15.2%
2 year olds 9.8% 16%
3 year olds 9.8% 17.1%

Figure 9 (table 1) - Isle of Man and England vaccine rates at October 2022.

COVID-19 vaccine statistics

COVID-19 and influenza (flu) are both contagious respiratory illnesses, but different viruses transmit them. COVID-19 is caused by infection with a coronavirus. Flu is caused by infection with an influenza virus. Both viruses can cause similar symptoms.

The likelihood of serious illness from COVID-19 depends on the level of natural or vaccination induced immunity, age and the presence of certain underlying conditions. Older age is the strongest contributing factor.

Immunity derived from vaccination declines over time. The objective for the Autumn 2022 booster programme is to enhance immunity in those at higher risk from COVID-19 and hereby optimise protection against severe COVID-19, specifically hospitalisation and death, over winter 2022 to 2023.

Priority groups for COVID-19 vaccines opened in September 2022. From 17 October, those aged 50 and over and those who meet the eligibility criteria can book their vaccinations via Online Services

During the winter months, a monthly update will be provided on the following dashboard regarding the vaccination program progress. The report below covers booster doses administered from 1 September 2022.

Figure 10 – COVID-19 Autumn booster vaccines administered in October-22

Figure 10 - COVID-19 Autumn booster vaccines administered to 22 November 2022.

COVID-19 Autumn booster vaccine uptake in England was 60.1% at week 46 of 2022 for all people aged over fifty. Using Isle of Man census data for those over fifty, the local rate is 57%.

Global update

UK Health Security Agency (UKHSA)

UK Health Security Agency (UKHSA) produce a weekly national influenza and covid-19 surveillance report. This report summarises the information from the surveillance systems used to monitor coronavirus (COVID-19), influenza, and other seasonal respiratory viruses in England. The surveillance covers laboratory, community, primary care, secondary care, mortality, microbiological, vaccination, and international updates.

In the week 47 report (up to week 46 data) UKHSA key messages from England focus on COVID-19 activity decreasing in most indicators; Influenza-like-illness consultations increased whilst remained below baseline for primary care surveillance however increased above baseline threshold for hospitalisations. Influenza admissions were highest in those under 5 years, followed by 75 to 84 year olds and those aged 85 years and over. Influenza ICU admissions increased and is now in the medium intensity threshold.

Figure 11 – Weekly hospital admission rate by age group for new influenza reported through SARI Watch for England

Figure 11 – Weekly hospital admission rate by age group for new influenza reported through SARI Watch for England.

Here is a summary of the UKHSA's week 46 activities and international updates.

European Centre for Disease Prevention and Control (ECDC)

European Centre for Disease Prevention and Control (ECDC) release a weekly communicable disease threats report. The latest ECDC bulletin covers a variety of public health topics, including COVID-19 and seasonal influenza. Key points are included below:

COVID-19

At the end of week 46, 2022 (week ending 20 November), decreasing trends in EU/EEA-level COVID-19 case rates were observed, including in people aged 65 years and older, and in death rates. Hospital and ICU indicators are decreasing across the region compared to the previous week. Uptake of the second booster dose continues to be relatively low in target groups. It remains important to continue monitoring the epidemiological situation, especially given the increase in the BQ.1 variant of interest.

The European COVID-19 Forecast Hub provide predictions for week 47 and week 48. Compared to the previous week they forecast increasing trend in cases, and a stable trend in deaths for EU/EEA by the end of week 48. To note, changing global testing criteria and reporting procedures make forecasting cases increasingly more difficult.

Weekly update on SARS-CoV-2 variants:

Since the last update on 10 November 2022 and as of 24 November 2022, no changes have been made to ECDC variant classifications for variants of concern (VOC), variants of interest (VOI), variants under monitoring, and deescalated variants.

Influenza

In week 47 (14-20 November 2022), the percentage of all sentinel primary care specimens from patients presenting with influenza-like illness (ILI) or acute respiratory illness (ARI) symptoms that tested positive for an influenza virus was 12%, which is above the epidemic threshold set at 10%. This is the second consecutive week above the epidemic threshold, indicating the start of the influenza epidemic at the European Regional level. This is an earlier start to the influenza epidemic than in the four previous seasons.

Overall, influenza A(H3) viruses have dominated across most surveillance systems.

Australia

Flu season has spiked earlier and more intensely in the southern hemisphere than normal. The flu season usually occurs between July and September, but their outbreak hit between May and June. The highest case numbers and hospital admissions were among young people.

Figure 12 - Notifications of laboratory-confirmed influenza, Australia, 1 January 2017 to 09 October 2022, by month and week of diagnosis

Figure 12 - Notifications of laboratory-confirmed influenza, Australia, 1 January 2017 to 09 October 2022, by month and week of diagnosis (extracted from Australian Influenza Surveillance Report No. 14, 2022, 09 October 2022).

The Australian Influenza Surveillance Report and Activity Updates are compiled from a number of data sources, which are used to monitor influenza activity and severity in the community. These data sources include laboratory-confirmed notifications to NNDSS; influenza associated hospitalisations; sentinel influenza-like illness (ILI) reporting from general practitioners; ILI-related community level surveys; and sentinel laboratory testing results.

Data from the report published 2 September 2022 showed that the weekly number of notifications of laboratory-confirmed influenza in 2022 decreased to below the weekly 5-year average since mid-July. This is after Australia saw a sharp rise in notifications of laboratory-confirmed influenza earlier in the year, which showed a steep but short curve, compared to the previous 5 years, and the 5-year average.

The full Autralian influenza surveillance report can be viewed via health.gov.au.

Data disclaimer

While we have used reasonable efforts to ensure the accuracy of the data used within this report, the data is still provisional and may be subject to change and historical amendment as new systems become established.

The quality of data provided to Public Health by other organisations is the responsibility of the originating organisation.

Individuals may appear in multiple datasets since data is based on presentations rather than individuals.

This report will include additional surveillance information as it becomes available.

For any questions regarding this report, please contact publichealth@gov.im

Glossary of terms 

READ Codes - Diagnosis codes used by GP's.

SNOMED codes – Diagnosis codes used by the Hospital and Emergency Department.

References used

ECDC (July 2022) Operational considerations for respiratory virus surveillance in Europe

World Health Organisation, Influenza

World Health Organisation, Coronavirus disease (COVID-19)

UK Health Security Agency (September 2021) Respiratory syncytial virus (RSV) symptoms, transmission, prevention, treatment

UKHSA (November 2022) Weekly national Influenza and COVID-19 surveillance report

ECDC (November 2022) Communicable disease threat report

NHS Digital (October 2022) Read Codes

WHO (November 2022) COVID-19 weekly epidemiological update

NHS Digital (June 2022) SNOMED CT

ONS (November 2022) Coronavirus (COVID-19) latest insights: comparisons

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