Report of the First Meeting of the Middle East and Eastern Europe Rabies Expert Bureau, Istanbul, Turkey (June 8-9, 2010)

Rabies is a threat in all parts of the world where animal reservoirs persists, including Eastern Europe and the Middle East. Rabies experts from seven Middle East and Eastern European countries (Croatia, Egypt, Georgia, Iran, Serbia, Turkey, and Ukraine) met for two days in Istanbul, Turkey (June 8-9, 2010), to exchange information on the epidemiological situation concerning human and animal rabies in their respective countries and to discuss strategies for rabies elimination and control. They decided to establish a regional network, the Middle East and Eastern Europe Rabies Expert Bureau (MEEREB), a regional network of experts, to increase collaboration in rabies prevention and control at the local, regional, and global levels

Implementation of a sentinel surveillance system for influenza-like illness (ILI) and severe acute respiratory infection (SARI) in the country of Georgia, 2015-2016

Objectives: Due to reports of substandard influenza preparedness, the country of Georgia developed two influenza surveillance systems. This paper describes these surveillance systems in their capacity to detect influenza. Methods: Two surveillance systems for influenza operate in Georgia: an influenza-like illness (ILI) sentinel surveillance system for out-patient cases, based in the capital, Tbilisi, and a severe acute respiratory infection (SARI) sentinel surveillance system for in-patient cases with five sentinel sites â one in Tbilisi, and four in Kutaisi. Patients in these surveillance systems provide samples for laboratory testing, including influenza confirmation. Results: From 2015-2016, 825 cases were surveilled in the ILI surveillance system and 1367 cases were surveilled in the SARI surveillance system, with 222 (26.9%) and 451 (33.0%) positive for influenza, respectively. Influenza positivity varied by age with adults 30-64 years having highest proportion of influenza-positive cases at 42.2%. Conclusions: The sensitivity of the surveillance systems to influenza was relatively high compared to neighboring countries. These findings show the importance of influenza surveillance in the country of Georgia. Keywords: Surveillance, Influenza, Severe acute respiratory illnes

Severe Acute Respiratory Infection (SARI) sentinel surveillance in the country of Georgia, 2015-2017.

BACKGROUND:Severe Acute Respiratory Infection (SARI) causes substantial mortality and morbidity worldwide. The country of Georgia conducts sentinel surveillance to monitor SARI activity and changes in its infectious etiology. This study characterizes the epidemiology of SARI in Georgia over the 2015/16 and 2016/17 influenza seasons, compares clinical presentations by etiology, and estimates influenza vaccine effectiveness using a test-negative design. METHODS:SARI cases were selected through alternate day systematic sampling between September 2015 and March 2017 at five sentinel surveillance inpatient sites. Nasopharyngeal swabs were tested for respiratory viruses and Mycoplasma pneumoniae using a multiplex diagnostic system. We present SARI case frequencies by demographic characteristics, co-morbidities, and clinical presentation, and used logistic regression to estimate influenza A vaccine effectiveness. RESULTS:1,624 patients with SARI were identified. More cases occurred in February (28.7%; 466/1624) than other months. Influenza was the dominant pathogen in December-February, respiratory syncytial virus in March-May, and rhinovirus in June-November. Serious clinical symptoms including breathing difficulties, ICU hospitalization, and artificial ventilation were common among influenza A and human metapneumovirus cases. For influenza A/H3, a protective association between vaccination and disease status was observed when cases with unknown vaccination status were combined with those who were unvaccinated (OR: 0.53, 95% CI: 0.30, 0.97). CONCLUSIONS:Multi-pathogen diagnostic testing through Georgia's sentinel surveillance provides useful information on etiology, seasonality, and demographic associations. Influenza A and B were associated with more severe outcomes, although the majority of the population studied was unvaccinated. Findings from sentinel surveillance can assist in prevention planning

Referral of ILI cases to outpatient clinic vs laboratory-confirmed influenza detections by week, 2014–2017, Georgia.

<p>Vertical bars represent numbers of influenza positive samples among ILI cases each week over three consecutive seasons. The blue line shows weekly referrals of ILI cases to the outpatient clinic per 100 000 population.</p

Overview of three influenza seasons in Georgia, 2014–2017

<div><p>Background</p><p>Influenza epidemiological and virologic data from Georgia are limited. We aimed to present Influenza Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) surveillance data and characterize influenza viruses circulating in the country over three influenza seasons.</p><p>Methods</p><p>We analyzed sentinel site ILI and SARI data for the 2014–2017 seasons in Georgia. Patients’ samples were screened by real-time RT-PCR and influenza viruses isolated were characterized antigenically by haemagglutination inhibition assay and genetically by sequencing of HA and NA genes.</p><p>Results</p><p>32% (397/1248) of ILI and 29% (581/1997) of SARI patients tested were positive for influenza viruses. In 2014–2015 the median week of influenza detection was week 7/2015 with B/Yamagata lineage viruses dominating (79%); in 2015–2016—week 5/2016 was the median with A/H1N1pdm09 viruses prevailing (83%); and in 2016–2017 a bimodal distribution of influenza activity was observed—the first wave was caused by A/H3N2 (55%) with median week 51/2016 and the second by B/Victoria lineage viruses (45%) with median week 9/2017. For ILI, influenza virus detection was highest in children aged 5–14 years while for SARI patients most were aged >15 years and 27 (4.6%) of 581 SARI cases died during the three seasons. Persons aged 30–64 years had the highest risk of fatal outcome, notably those infected with A/H1N1pdm09 (OR 11.41, CI 3.94–33.04, p<0.001). A/H1N1pdm09 viruses analyzed by gene sequencing fell into genetic groups 6B and 6B.1; A/H3N2 viruses belonged to genetic subclades 3C.3b, 3C.3a, 3C.2a and 3C.2a1; B/Yamagata lineage viruses were of clade 3 and B/Victoria lineage viruses fell in clade1A.</p><p>Conclusion</p><p>In Georgia influenza virus activity occurred mainly from December through March in all seasons, with varying peak weeks and predominating viruses. Around one third of ILI/ SARI cases were associated with influenza caused by antigenically and genetically distinct influenza viruses over the course of the three seasons.</p></div

Admission of SARI cases to hospitals vs laboratory-confirmed influenza detections by week, 2014–2017, Georgia.

<p>Vertical bars show numbers of influenza positive specimens among SARI cases each week. The blue line represents percentages of influenza-positive cases among total SARI hospital admissions on a weekly basis.</p

Monthly distribution of respiratory pathogens in a Severe Acute Respiratory Infection surveillance system in the country of Georgia, 2015–2017.

<p>Monthly distribution of respiratory pathogens in a Severe Acute Respiratory Infection surveillance system in the country of Georgia, 2015–2017.</p

Demographic and clinical characteristics of cases within a Severe Acute Respiratory Infection surveillance system in the country of Georgia, 2015–2017.

<p>Demographic and clinical characteristics of cases within a Severe Acute Respiratory Infection surveillance system in the country of Georgia, 2015–2017.</p