The Department of Defense Laboratory Based

Global Influenza SurveillanceProgram

Linda C. Canas

Brooks City-Base, TX

(210)536-1679

Population Based Surveillance

Naval Health Research Center

San Diego, California

DoD Global Influenza Surveillance

AF Institute forOperational HealthBrooks City-BaseSan Antonio, Texas

Influenza Surveillance Influenza Surveillance

DoD GEIS

Laboratory

Funding & Guidance

Routine & Annual Reports; End of Season business meeting

Supplies and Instructions Program

Guidance& routine reports

Collect and ship Samples

Info entered into AF database

Flu Isolated

Conventional Laboratory Methods

Sentinel Sites

Notification

CDCVaccine

DecisionsSelected Samples

DoD Global Influenza SurveillanceDoD Global Influenza Surveillance ..................................IN ACTIONIN ACTION

Epi Services Branch

2003-2004 Influenza Sentinel Sites

New Sentinel Bases

SENTINEL SITES

RAF Lakenheath, U.K.Ramstein AB, GermanySheppard AFB, TXTravis AFB, CAYokota AB, Japan

DeployedAl-Udeid AB, QatarGanci AB, Kyrgyzstan

Overseas Research Sites Armed Forces Research Institute of Medical Sciences (AFRIMS), THAILAND, NEPAL, MALDIVESNaval Medical Research Institute Detachment (NAMRID)

PERU, ECUADOR, BOLIVIA, ARGENTINA, NICARAGUA Walter Reed Army Institute of Research (WRAIR), UGANDA

Army (1)Tripler AMC, HI

Navy/Coast Guard (6)NAB Little Creek, VANH Yokosuka, JapanNMC San DiegoNH Pearl Harbor, HINH BremertonCGS Ketchikan

Air Force (18)Andersen AFB, GuamAir Force Academy, COAndrews AFB, MDAviano AB, ItalyElmendorf AFB, AKHickam AFB, HIIncirlik AB, TurkeyKadena AB, JapanKunsan AB, R.O.K. Maxwell AFB, ALMcGuire AFB, NJMisawa AB, JapanOsan AB, R.O.K.

N=2946Pos=1310Flu A=941

Asia/Pacific: Isolates

N=319

Pos=128

Flu A = 91

North America: Isolates

N=2178

Pos=1036

Flu A=739

South America: Isolates

N=217Pos=61Flu A=26

Europe: Isolates

N=174Pos=74

FluA=64

Deployed: Qatar and Afghanistan

N=58Pos=21

Flu A=21

Percent Positive Isolates by Type

Percent of Positive Isolates

10 nucleotides

bafb-Korea5844-2003bafb-IL5173-2003

bafb-TX4106-2003bafb-Korea5834-2003IA32003

bafb-CO4521-2003VA162003

bafb-DC4081-2003bafb-VA3909-2003

NH22003CO62003

bafb-CO5217-2003bafb-CA5218-2003

bafb-DC4069-2003bafb-CO4634-2003bafb-DC4058-2003bafb-DC4059-2003bafb-DC4072-2003bafb-DC4086-2003bafb-DC4087-2003bafb-Korea5642-2003bafb-Qatar4001-2003bafb-Qatar5681-2003bafb-TX4105-2003bafb-TX4295-2003bafb-VA4383-2003bafb-VA4863-2003bafb-VA5259-2003

bafb-VA5185-2003bafb-CA4640-2003TX1512003bafb-TX4104-2003

bafb-VA5256-2003WI492003

GA282003MO152003

SC62003FL102003

bafb-TX4102-2003bafb-VA4620-2003

bafb-AL4041-2003LA42003

bafb-AL4623-2003bafb-CA4644-2003

Egypt72212003UT12003

NY762003bafb-Peru5034-2003

bafb-Peru5041-2003bafb-WA4605-2003

bafb-CA4507-2003bafb-DC5225-2003

bafb-AL4553-2003bafb-TX3825-2003

bafb-England3968-2003DC42003

CT22003ChristChurch282003

WA72003bafb-Ger5254-2003

bafb-CA4641-2003bafb-TX4107-2003bafb-NM4245-2003

bafb-WA4331-2003bafb-Qatar4353-2003bafb-Qatar4352-2003bafb-Qatar4350-2003bafb-Qatar4094-2003bafb-NM4601-2003bafb-NM4598-2003bafb-Korea5842-2003bafb-Korea5840-2003bafb-Korea5733-2003bafb-Korea5730-2003bafb-Korea5647-2003bafb-CO4636-2003

bafb-Korea5624-2003bafb-Japan5686-2003WY562003

Memphis322003OK82003VT82003ID62003KS32003

bafb-HI5860-2003bafb-NM4089-2003

bafb-VA5187-2003NM172003

bafb-Guam4692-2003bafb-Guam4693-2003bafb-Guam4694-2003bafb-HI4269-2003

bafb-VA5682-2003bafb-VA5800-2003

bafb-VA5264-2003WV82003bafb-VA3994-2003

bafb-Japan2990-2003Taiwan15292003

Taiwan15302003HK11732003

HK11602003HK11862003

Wuhan2142003Fujian4452003

Shanghai3692003bafb-Guam5685-2003

Guam37152003NE62003bafb-Guam3267-2003

Fujian4112002HK63852003

Korea7702002HK10522003

bafb-Peru3162-2003ES362003bafb-Peru3209-2003

bafb-Peru5028-2003bafb-Ger4403-2003

bafb-MI3904-2003bafb-nu5095-2003

bafb-Peru5037-2003bafb-Peru5038-2003bafb-Peru5035-2003

bafb-Peru3223-2003bafb-Peru3233-2003

bafb-Peru3231-2003bafb-Peru3239-2003

bafb-Peru3186-2003OR12003TX272003

bafb-ND2463-2003Wyoming/3/2003

HK62052003PY1292003

Panama/2007/99

N 126 D

K 140 E

S 227 P

H3 HA

Evolutionary Relationship Among Evolutionary Relationship Among Influenza A H3N2 Hemagglutinin Influenza A H3N2 Hemagglutinin

(HA1)(HA1)(2003(2003--2004 Season)2004 Season)

•90 (globally isolated) H3N2 viruses sequenced to date•100% (90/90) have the Fujian-like 155/156 AA change•22% contain the K140E AA substitution

Phylogeny courtesy of Dr. Mike Shaw Centers for Disease Control

Summary 2003-2004

Overall this has been an exceptional year

Monotype season more so than past 5 years

A/H3N2 in most locationsFew Influenza B and A/H1N1. No H5/H7 at this point.

Molecular AnalysisH3N2 viruses: nearly 100% variant from vaccine strain