Introduction to Group Work 2

1. Introduction to Group Work 2 Summary of Seasonal Influenza in the WPR Group C

2. Group Work 2

3. Overall Comments • Not clear what aims of project is from Introduction. • May not answer all of these in this paper, but at least the aims are clear (and could be improved upon in a subsequent report). = Baseline for future reports • Introduction - clarify aims of this study: • assist public health policies for vaccine usage (i.e. timing of when to vaccinate) • lack of awareness of burden of disease in region • Informing public health sector • harmonization of virological and epidemiological data from the Region • comparisons of seasonality in tropical/temperate countries to both Nth/Sth hemispheres

4. Results Section • Methods - Data Collection: • Methodology (does the surveillance system used by individual countries need to be mentioned) • How were viruses typed/subtyped (? all countries by PCR as a minimum?) • Some clinical specimens and some on isolates? = limitation as wont all be done the same way (sensitivity issues)

5. Results Section Results: Suggested modification of Table 1 – want to capture the numbers of samples from different countries. Table 3 – page 6 (as is) Clarity on submission of data (H1 pdmvs H1 – sometimes its recorded as seasonal H1 but actually pandemic – worth checking seasonal H1N1 in 2010/2011) = limitation of data? (e.g 31 samples in table 1).

6. Results Section Figure 1 One suggestion was to remove this figure and to replace with a figure showing numbers of influenza positive samples from tropical (panel 1), Nth hemisphere (panel 2) and Southern Hemisphere (Panel 3). Suggestions as to whether ILI and virological data can be linked somehow to gain insight as to whether ILI is a good or bad indicator of flu activity? Side by side or superimposed? Scale of displacement of seasonal H1 by H1N1 pdm Shows the enhanced levels of detection during pandemic **Standardization of data = figure 1 in its current form shows numbers of positive specimens – would this be better as a percentage? Much more sampling in 2009**

7. Limitation of Data • Aggregated tropical data are likely to mask variation in seasonality in particular tropical countries • Contributions from different countries not reported. Total sample number from each country • Difficulties in presentation of Northern/Southern virological data – is information from tropical countries lost? Re-graph Figure to show Tropical/Nth/Sth regions. • Surveillance systems vary country to country as to how well they sample the whole population • Tropical classifications is too hard – propose further classification (e.g. subtropical) • When investigating influenza seasonality it is important to remember that there was a pandemic right in the middle.

8. Discussion • Relate Discussion to Intro (How well has the study addressed aims and objectives? Can we provide any further info?) • What developments are needed for next time to allow us to answer these questions? • Conclusions: • Influenza virus is prevalent throughout WPR • Virological data essential as other indicators are not as specific (at least in some parts of the world). May be particularly relevant to tropical climates. • Virological data is needed to inform public health policy. • Pandemic will have increased awareness and testing – this may be relevant when comparing 2008 and 2010 data (2009 pandemic displaced seasonal and now become seasonal)