_|ECDC, AUSTRALIA, WORLD YOUTH DAY, INFLUENZA OUTBREAK|_

Published by: admin 2009-01-08

(1a) Human seasonal influenza appearing in association with a mass-gathering in Australia � World Youth Day Sydney July 2008

There are confirmed media reports of transmission of influenza and other infectious diseases (gastroenteritis) in association with an international religious youth festival that took place in Sydney, Australia July 15-20th.

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Because many international visitors were involved the Australian national authorities alerted other countries of this incident so that they were aware of the phenomenon.

World Youth Day is an event organised for young people in one country by an international religious organisation.

It takes place in July or August every three years. It attracts large numbers of young people from across the world who live together for about a week and culminates in a large open-air ceremony.

In July 2008 it took place in Sydney, Australia.

It was estimated that this year there would be about a quarter of a million people attending, over a hundred thousand of these would have been from outside Australia including many from European Countries.

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ECDC Comment:
Australia is at the start of its annual winter epidemic of influenza. As yet the background level of influenza is low in Australia and there are no remarkable clinical features reported.(1)

There is little information on the Southern Hemisphere winter epidemics as yet (2) and though the oseltamivir resistant A(H1N1) viruses were seen in Australia in 2007 they were at a low level in the A/H1 viruses, only 3 out of 83 (4%).(3)

There are no data yet on specimens from the 2008 season.

The main risk groups more likely to experience severe disease would be the usual ones; older people and those with chronic diseases.(4)

In this sense there should be less people at risk at a youth festival than in other mass gatherings. Also there are few published reports of transmission of influenza at or associated with such gatherings. However this must have happened here since the media reports indicate that some of those known to have become infected in Sydney came from countries outside Australia.

ECDC would point out that with the constant travel of people across the globe the acquisition of influenza by Europeans travelling to the Southern Hemisphere in the European summer and to the tropics all year round must be a constant phenomenon.

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Hence ECDC recommends that persons in influenza disease risk groups travelling to countries where influenza is known or is likely to be circulating (in the Southern Hemisphere in the Southern Winter from May to September, most of the year in the Tropics) should seek vaccination before travelling.(5) That is people in risk groups who would normally be offered immunised for the winter in Europe.

ECDC would point out that with the constant travel of people across the globe the acquisition of influenza by Europeans travelling to the Southern Hemisphere in the European summer and to the tropics all year round must be a constant phenomenon.

Persons in influenza disease risk groups travelling to countries where influenza is known or is likely to be circulating (in the Southern Hemisphere in the Southern Winter from May to September, most of the year in the Tropics) may wish to consider seeking vaccination before travelling.(5) It is often not appreciated that influenza is one of the commonest vaccine preventable infections travellers are infected with while travelling internationally.(6)(see also Scientific Advance below).

This is also the standard travel guidance from WHO.(7)

WHO makes separate recommendations for vaccine configuration for the Northern and Southern hemispheres each year (8) and this has led to some wondering if one can use the Northern Hemisphere vaccine for people travelling to the Southern Hemisphere or the tropics.

Usually this is not a real issue since the vaccines are often almost identical, as is the case at present. What is more often a practical problem is that neither vaccines are necessarily available out of season; though some specialist travel clinics now stock them all year round.

In the case of there being concern about people travelling back to Europe and developing influenza in aircraft en route there are guidance documents on this and other communicable diseases developed by IATA for airline staff with input from WHO.(9)

Bulletins on the situation in Australia are issued at regular intervals by the Australian Department of Health and Aging and there are also reports on the virology from the WHO Collaborating Centre for Reference and Research on Influenza, one of WHO�s handful of Influenza Collaborating Centres worldwide

1.Australian Influenza Epidemiological Reports: http://www.health.gov.au/internet/main/Publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm (http://www.health.gov.au/internet/main/Publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm)

2. WHO Influenza in the World � Winter Season in Southern Hemisphere Update July 10th 2008 http://www.who.int/csr/disease/influenza/update/en/index.html (http://www.who.int/csr/disease/influenza/update/en/index.html)

3. Influenza A(H1N1) virus resistance to oseltamivir Table 18 July 2008 http://www.who.int/csr/disease/influenza/h1n1_table/en/index.html (http://www.who.int/csr/disease/influenza/h1n1_table/en/index.html)

4. World Health Assembly Resolution Prevention and control of influenza pandemics and annual epidemics WHA 2003. 56:19 http://www.who.int/gb/ebwha/pdf_files/WHA56/ea56r19.pdf (http://www.who.int/gb/ebwha/pdf_files/WHA56/ea56r19.pdf)

5. European Centre for Disease Control and Prevention. Influenza situation in Hong Kong, China. 14 March 2008. Available at: http://ecdc.europa.eu/pdf/ECDC_threat_assessment.pdf (http://ecdc.europa.eu/pdf/ECDC_threat_assessment.pdf)

6. Mutsch M, Tavernini M, Marx A, Gregory V, Lin YP, Hay AJ, Tschopp A, Steffen R. Influenza virus infection in travellers to tropical and subtropical countries. Clin Infect Dis 2005;40:1282-7.

7. WHO International Travel and Health 2007 page 104 http://whqlibdoc.who.int/publications/2007/9789241580397_6_eng.pdf (http://whqlibdoc.who.int/publications/2007/9789241580397_6_eng.pdf)

8. Gerdil C. The annual production cycle for influenza vaccine. Vaccine 2003; 21: 1776-9.

9 IATA Air traffic and communicable diseases (Guidance for airlines) http://www.iata.org/whatwedo/safety_security/safety/health_safety/aviation_communicable_diseases.htm (http://www.iata.org/whatwedo/safety_security/safety/health_safety/aviation_communicable_diseases.htm)
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http://www.ecdc.europa.eu/Health_topics/influenza/news/news_Influenza_080724.html
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