Report No. 44A print friendly version of this report is available as a PDF (319 KB)
Week ending 5 November 2010
The Department of Health and Ageing acknowledges the providers of the many sources of data used in this report and greatly appreciates their contribution.
Key IndicatorsInfluenza activity and severity in the community is monitored using the following indicators and surveillance systems:
|Is the situation changing?||Indicated by trends in:
|How severe is the disease, and is severity changing?||Indicated by trends in:
|Is the virus changing?||Indicated by trends in:
- Levels of influenza-like illness (ILI) in the community remained low through all surveillance systems this reporting period. Sporadic, regional or widespread activity was reported within jurisdictions. The number of laboratory confirmed notifications continued to decline.
- There were 162 laboratory confirmed notifications of influenza during this reporting period, including 67 pandemic (H1N1) 2009 cases. Queensland and South Australia continued to report the highest number of notifications.
- Results from sentinel laboratory surveillance systems for this reporting period show that 13% of the respiratory tests conducted over this period were positive for influenza, although this is slightly higher that the previous reporting period (11%), it is similar to previous weeks. During this period a third of the positive influenza specimens were influenza type B with the majority from WA and the remainder from the NT.
- In 2010, a total of 1,419 specimens have been positive for influenza (of 15,704 specimens tested by sentinel laboratories), of which 64% were pandemic (H1N1) 2009, 25% were influenza B, 9% were A/H3N2 and 2% were influenza A untyped. The majority of influenza B positive specimens have been from WA.
- As at 5 November 2010, there have been 11,317 confirmed cases of influenza reported to the National Notifiable Diseases Surveillance System (NNDSS) in 2010. A total of 44,403 confirmed cases of pandemic (H1N1) 2009 have occurred in Australia since May 2009, including 6,767 in 2010.
- ANZICS reported no ICU admissions for influenza this reporting period.
- The WHO has advised that the world is no longer in phase 6 of influenza pandemic alert and has moved into the post pandemic period.
- This will be the final Australian Influenza Surveillance Report for 2010, unless unusual activity becomes apparent over the summer months.
1. Influenza activity in Australia
Geographic spread of influenza and ILI – Jurisdictional SurveillanceIn the fortnight ending 29 October 2010, influenza and ILI activity as reported by state and territory Health Departments was ‘sporadic’ in Qld and Tas, ‘regional’ in WA and SA, and ‘widespread’ in VIC (Figure 1). The ACT, NSW and NT did not report this fortnight. Definitions of these activity levels are provided in the Data Considerations section of this report.
Figure 1. Map of influenza and ILI activity, by state and territory, during fortnight ending 29 October 2010
Sentinel General Practice SurveillanceIn the week ending 31 October 2010, the national ILI consultation rate to sentinel GPs was approximately 10 cases per 1,000 consultations (Figure 2), which is a slight increase to the previous week. The overall consultation rates for 2010 are similar to those reported in 2008.
Figure 2. Weekly rate of ILI reported from GP ILI surveillance systems from 1 January 2007 to 31 October 2010*
* Delays in the reporting of data may cause data to change retrospectively.
Of the ASPREN ILI specimens collected in the week ending 5 November 2010, four specimens were positive for influenza (Table 1). Please note the results of ASPREN ILI laboratory respiratory viral tests do not currently include WA.
Table 1. ASPREN ILI consultations laboratory respiratory viral tests that were positive for influenza for the week ending 5 November 2010.
|ASPREN – national|
|Total specimens tested||25|
|Positive Influenza A||2|
|Pandemic (H1N1) 2009||1|
|Influenza A untyped||1|
|Positive Influenza B||1|
|Positive – type unknown||1|
WA Emergency DepartmentsRespiratory viral presentations reported in WA EDs decreased this reporting period to below baseline levels. There has been an overall upward trend since the beginning of 2010 up until early October (Figure 3). In the week ending 31 October 2010 there were 362 respiratory viral presentations, including 27 admissions.
Figure 3. Number of respiratory viral presentations to WA EDs from 1 January 2007 to 31 October 2010 by week
Source: WA ‘Virus Watch’ Report
NSW Emergency DepartmentsIn the week ending 22 October 2010, ILI presentations to NSW EDs decreased to 1.1 per 1,000 presentations (Figure 4). ILI presentations were mainly for mild illness and there were two admissions to hospital. In October 2010, there were 287 presentations with ILI, a rate of 1.9 per 1,000 presentations, similar to September, and a total of 22 admissions to hospital. The number of ILI presentations in 2010 is similar to 2008 but well below levels observed in 2007 and 2009.
Figure 4: ILI presentations to NSW EDs from 2007-2010, by week
Source: NSW Health ‘Influenza Weekly Epidemiology Report
FlutrackingFlutracking is a national online system for collecting data on ILI in the community. The final Flutracking report for 2010 was produced for the week ending 17 October. In that week, ILI activity levels decreased and returned to baseline levels across Australia (Figure 5).
Figure 5. Rate of ILI symptoms among Flutracking participants by week, from week ending 30 May 2010 to week ending 17 October 2010
Source: Flutracking Interim Weekly Report
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National Health Call Centre NetworkThe number of calls to the National Health Call Centre Network (NHCCN) in this reporting period continued to be lower than previous reporting periods and the percentage of total calls remained low and stable (Figure 6).
Call numbers cannot be compared between early 2009 and early 2010, as not all call centres were online in early 2009. The difference in the number of operating call centres accounts for the apparent increase in recorded ILI calls (and baseline levels) between the two years.
Figure 6. Number of calls to the NHCCN related to ILI and percentage of total calls, Australia, 1 January 2009 to 5 November 2010
Note: national data does not include QLD and VIC
Source: NHCCN data
AbsenteeismDue to system changes, absenteeism data has not been updated since July 2010. Absenteeism data will not be included in this report until provision of the data resumes.
Laboratory confirmed influenza
Sentinel Laboratory SurveillanceResults from sentinel laboratory surveillance systems for this reporting period show that 13% (49/371) of the respiratory tests conducted over this period were positive for influenza, although this is slightly higher than the previous reporting period (11%), it is similar to previous weeks (Figure 7).
Figure 7. Total number of specimens tested by sentinel laboratories, and proportion positive, 1 January 2010 to 5 November 2010, by week
SOURCE: Sentinel laboratory data from WA NIC, VIC NIC & TAS Labs
Sentinel laboratories reported 49 specimens positive for influenza during this reporting period, of which 21 were pandemic (H1N1) 2009, 26 were influenza B and two were A/H3N2, (Table 2). The proportion of type B influenza in WA and the NT remains high.
Table 2. Laboratory respiratory tests that tested positive for influenza, week ending 5 November 2010
(reported by WA NIC)
|Total specimens tested||253||n/a||74||44|
|Positive Influenza A||5||14||3||1|
|Pandemic (H1N1) 2009||4||14||3||0|
|Influenza A untyped||0||0||0||0|
|Positive Influenza B||18||8||0||0|
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Figure 8. Percentage of specimens tested by sentinel laboratories influenza positive, 1 January 2010 to 5 November 2010, by subtype
SOURCE: Sentinel laboratory data from ASPREN, WA NIC, VIC NIC & TAS Labs
Laboratory Confirmed Cases Notified to Health DepartmentsDuring this reporting period there were 162 influenza notifications reported to the NNDSS (65 in QLD, 63 in SA, 16 in WA, 9 in NSW, 7 in the NT and 2 in Tas). They included 67 cases of pandemic (H1N1) 2009, 60 of influenza A (untyped), 21 of influenza B, 3 of A/H3N2 and 11 of influenza untyped (Figure 9).
There have been 11,317 confirmed cases of influenza of all types diagnosed during 2010 up to
5 November (Figure 9). Of these, 6,767 (60%) have been sub-typed as pandemic (H1N1) 2009 influenza, 3,247 (29%) as influenza A (untyped), 274 (2%) as A/H3N2 and 20 (<1%) as type A&B. A further 776 (7%) have been characterised as influenza type B and 233 (2%) were untyped.
Figure 9. Laboratory confirmed cases of influenza in Australia, 1 January 2005 to 5 November 2010
Source: NetEpi (2009; NSW 2010) and NNDSS (2010)
Note: The scale in this figure has been limited to 1600 notifications per week to allow for comparison
between 2010 and previous years. In 2009, notifications peaked at approximately 8,300 in Week 30.
As at 5 November 2010, the number of laboratory confirmed cases of influenza was 3,855 in SA, 2,378 in QLD, 1,815 in VIC, 1,426 in WA and 1,331 in NSW. There were a further 333 cases in the NT, 93 cases in TAS and 86 cases in the ACT (Figure 10). Nationally and across all jurisdictions, notifications of laboratory confirmed influenza have continued to decline. For a breakdown of trends by state and territory, see Figure 11.
Figure 10. Laboratory confirmed cases of influenza in Australia, 1 January to 5 November 2010, by state, by week.
Figure 11. State breakdowns of laboratory confirmed cases on influenza, 1 January to 5 November 2010, by week
In 2010, influenza notifications have trended downwards with increasing age. This distribution is reasonably similar to 2008, except in the 70 and over age group in 2009, where the rate was considerably higher (Figure 12). In 2009 the distribution of influenza notifications tended to occur in persons aged less than 55 years, with substantially higher rates observed in persons aged less than 30 years, compared to older age groups.
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Figure 12. Laboratory confirmed cases of influenza (pandemic (H1N1) 2009 and seasonal) in Australia, 1 January 2008 to 5 November 2010, by age group
Source: NNDSS and NetEpi (NSW).
2. Influenza severity to 5 November 20101
Pandemic (H1N1) 2009While pandemic (H1N1) 2009 is generally considered a mild disease at the community level, it has had serious consequences for some people. Figures of hospitalisations, ICU admissions and deaths are currently used as indicators of the severity of the disease in Australia (Table 3).
Pandemic (H1N1) data for 2009 are being finalised through cleaning and validation processes. It is possible that these processes will result in some changes in the data presented here. Validated data will be progressively reported as these steps are completed.
Since the first case of pandemic (H1N1) 2009 in Australia in May 2009, there have been a total of 44,403 confirmed cases of pandemic (H1N1) 2009 in Australia as at 5 November 2010. Of these, 37,636 cases were reported in 2009 and 6,767 cases were reported in 2010. A total of 213 pandemic influenza-associated deaths have been reported, 22 of which occurred in 2010.
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1 Note that while the analysis of severity is on-going, updates are presented as required when there are significant changes detected. With the current low levels of pandemic (H1N1) 2009 influenza activity in Australia it is anticipated that the indicators of pandemic associated severity will not vary significantly.
Table 3. Summary of severity indicators of pandemic (H1N1) in Australia, 2009 and 2010 (up to 5 November 2010)
(H1N1) 2009 cases
|Hospitalised cases||ICU cases||Deaths|
|Confirmed (H1N1) 2010 cases||Deaths|
|Total number||37,636||13% (4,992/37,636) confirmed cases)||14% |
|Crude rate per 100,000 population||172.1||22.8||3.1||0.9||30.9||n/a|
|Median age (years)||21||31||44||53||24||51|
|Females||51% (19,139/37,636)||51% (2,528/4,992)||53% |
|Vulnerable groups (Indigenous persons, pregnant women & individuals with at least 1 co-morbidity)||n/a||58% (2,892/4,992)||74% |
|11% (3,877/34,750)||20% |
(287/1,056 hospitalised females aged
(47/289) hospitalised pregnant women)
|Cases with at least 1 co-morbidity||n/a||46% (2,303/4,992)||67%|
#Data are extracted from a number of sources depending on the availability of information. Figures used in the analysis have been provided in parentheses. Data are not always complete for each summarised figure.
a Data for 2009 from NetEpi, data for 2010 from NNDSS and NetEpi (NSW).
b The number of deaths is likely to be under-reported and representative of hospital related death notifications only.
n/a - No data collected or available.
€ The denominator for this row is the number of confirmed deaths for which sex is known. In 2010, one case had sex unknown.
* ncludes women in the post-partum period.
€ The denominator for this row is the number of confirmed cases for which Indigenous status is known. In 2010, 3,541 cases had Indigenous status unknown.
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Influenza Complications Alert Network (FluCAN)The Influenza Complications Alert Network (FluCAN) continued to report a decrease in the number of influenza associated hospitalisations in the week ending 29 October 2010 from sentinel hospitals. During this reporting period there was one pandemic (H1N1) 2009 and two influenza A (H3N2) associated hospitalisations reported. For the period of 1 March to 29 October 2010, FluCAN has reported a total of 296 influenza associated hospitalisations (Figure 13). Of these, 231 were associated with pandemic (H1N1) 2009, including 62 with ICU admission.
Figure 13. Number of influenza hospitalisations, sentinel hospitals, Australia, 1 March to 29 October 2010
Source: Influenza Complications Alert Network (FluCAN). Data from 15 sentinel hospitals from all jurisdictions.
Table 4. FluCAN sentinel hospitalisation severity indicator summary 1 March to 29 October 2010
Pandemic (H1N1) 2009
|All hospitalised||ICU cases||Deaths||All hospitalised||ICU cases||Deaths||All hospitalised||ICU cases||Deaths|
|ICU proportion of all hospitalised||26%||20%||25%|
|Median age (years)||35||39||36||42||46||n/a||36||35||36|
|Total of vulnerable groups (Indigenous, pregnant & individuals with at least 1 co-morbidity)||74%||82%||100%||72%||100%||0%||74%||85%||100%|
|% of all admission|
|% of women of child bearing age (15-49years)||14%||26%||0%||10%||20%||0%||13%||24%||0%|
|Cases with at least 1 co-morbidity||70%||82%||100%||68%||92%||0%||74%||85%||100%|
Australian Paediatric Surveillance Unit (APSU)The Australian Paediatric Surveillance Unit (APSU) conducts a survey of the admissions of children aged 15 years and under to Intensive Care Units (ICUs) due to influenza complications. Details of admissions are reported on a weekly basis.
For the week ending 25 October 2010, there were three cases of severe influenza complications in children reported to the APSU. Since 1 July 2010, 35 hospitalisations have been reported, 16 of which were associated with pandemic (H1N1) 2009. Five of those cases were admitted to ICU. Nine cases were associated with Influenza A (not subtyped), and two were associated with influenza B. Five of the cases associated with pandemic (H1N1) 2009 had an underlying chronic condition.
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Intensive care admissionsThe Australian and New Zealand Intensive Care Society (ANZICS) has reported a total of 247 ICU admissions for influenza in 2010, none of which occurred during this reporting period. Of these, 178 were associated with pandemic (H1N1) 2009, 20 with influenza A (not subtyped), three with seasonal A/H3N2, 41 with seasonal H1N1 (these may be pandemic cases, yet to be confirmed), and five cases of influenza untyped (Figure 14).
Of the 178 pandemic (H1N1) 2009 ICU admissions in 2010, the median age at admission was 42 years (range 2-80) and 97 admissions had known co-morbidities.
Figure 14. Number of ICU admissions for influenza in Australia, 1 January to 5 November 2010
Source: Australian and New Zealand Intensive Care Society (ANZICS) data base
Deaths associated with influenza and pneumonia
Nationally reported pandemic (H1N1) 2009 deathsIn 2010, 22 pandemic influenza related deaths have been notified to the NNDSS. The deaths occurred in late May, July, August, September and October with a median age of 52 years. Sixteen of the deaths were reported as having underlying risk factors.
NSWDeath registration data show that for the week ending 22 October 2010, there were 120 pneumonia or influenza associated deaths per 1,000 deaths in NSW, which is below the seasonal threshold for this period of 141 per 1,000 deaths (Figure 15).
NSW death registration data cross-matched with laboratory cases of influenza show 29 people with laboratory confirmed influenza have died up to 29 October 2010. All cases had an underlying illness and 27 (93%) were aged 50 years and over. 1
Figure 15. Rate of deaths classified as influenza and pneumonia from the NSW Registered Death Certificates, 2005 to 29 October 2010
Source: NSW ‘Influenza Monthly Epidemiology Report’
Typing and antigenic characterisation - WHO Collaborating Centre for Reference & Research on Influenza (WHO CC) in MelbourneFrom 1 January to 7 November 2010, there were 1,277 Australian influenza isolates subtyped by the WHO CC with the majority of isolates typed as pandemic (H1N1) 2009 (Table 5).
Table 5. Typing of influenza isolates from the WHO Collaborating Centre, from 1 January 2010 to 7 November 2010
|Pandemic (H1N1) 2009||16||57||158||295||217||1||255||105||1104|
SOURCE: WHO CC
Please note: There may be up to a month delay on reporting of samples.
Isolates tested by the WHO CC are not necessarily a random sample of all those in the community, hence proportions of pandemic (H1N1) 2009 to seasonal are not representative of the proportions circulating.
Antigenic characterisation of 881 pandemic (H1N1) 2009 isolates has shown 781 to be the A/California/7/2009-like strain and 8 a low reactor version of this strain. Antigenic characterisation of 42 type A/H3N2 isolates has shown 34 to be the A/Perth/16/2009-like and 8 to be the A/Perth/16/2009-like low reactor versions of the strain. One isolate was antigenically characterised as a low-reactor version of B/Florida/4/2006-like, 47 were characterised as B/Brisbane/60/2008-like and two a low reactor version of this strain.
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Antiviral ResistanceThe WHO Collaborating Centre in Melbourne has reported that from 1 January 2010 to
7 November 2010, no isolates (out of 925 tested) have shown resistance to oseltamivir or zanamivir by enzyme inhibition assay (EIA) and two pandemic (H1N1) 2009 isolates (out of 41 tested) have shown the H275Y mutation known to confer resistance to oseltamivir.
2011 Southern Hemisphere VaccineThe WHO has recommended that the composition of vaccines for use in the 2011 influenza season (southern hemisphere winter) contain the following:
— an A/California/7/2009 (H1N1)-like virus;
— an A/Perth/16/2009 (H3N2)-like virus;
— a B/Brisbane/60/2008-like virus2
The 2011 composition is the same as the current 2010 Southern Hemisphere influenza vaccine.
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4. International Influenza SurveillanceThe WHO has advised that the world is no longer in phase 6 of influenza pandemic alert, and has moved into the post pandemic period.3 As at 1 August 2010 there had been over 18,449 deaths associated with pandemic (H1N1) 2009 influenza worldwide since April 2009.4
The WHO has reported that overall influenza activity remained low, except in parts of the tropics including Southeast Asia. Influenza A/H3N2 continued to be the predominant influenza virus worldwide, although many countries have seen a co-circulation of seasonal influenza B and pandemic (H1N1) 2009. Most of the influenza A/H3N2 viruses detected are A/Perth/16/2009-like, which is the strain included in the seasonal vaccine for the Northern and Southern Hemispheres.4
5. Data considerationsThe information in this report is reliant on the surveillance sources available to the Department of Health and Ageing. As access to sources increase and improve, this report will be refined and additional information will be included.
This report aims to increase awareness of pandemic (H1N1) 2009 and seasonal influenza in Australia by providing an analysis of the various surveillance data sources throughout Australia. While every care has been taken in preparing this report, the Commonwealth does not accept liability for any injury or loss or damage arising from the use of, or reliance upon, the content of the report. Delays in the reporting of data may cause data to change retrospectively. For further details about information contained in this report please contact the Influenza Team through firstname.lastname@example.org.
On 17 June 2009 Australia commenced the transition to a new response phase called PROTECT, in which laboratory testing is directed towards people with moderate or severe illness; those more vulnerable to severe illness; and those in institutional settings. This means that the number of confirmed cases does not reflect how many people in the community have acquired pandemic (H1N1) 2009 infection.
Geographic spread of influenza and ILI – Jurisdictional SurveillanceJurisdictions report activity levels (in line with the definitions below) on a fortnightly basis, based on laboratory-confirmed notifications, various syndromic surveillance systems, outbreak reporting and rumour surveillance.
|No activity||No influenza or ILI activity|
|Syndromic only||an increase in syndromic surveillance systems with no laboratory confirmed cases|
|Sporadic||small numbers of laboratory-confirmed influenza cases or a single laboratory-confirmed influenza outbreak during the reporting period, but no increase in cases in syndromic surveillance systems|
|Local||outbreaks of influenza or increases in cases in syndromic surveillance systems and recent laboratory-confirmed influenza in a single region of the state|
|Regional||outbreaks of influenza or increases in cases in syndromic surveillance systems and a recent laboratory confirmed influenza in at least two but less than half the regions of the state|
|Widespread||outbreaks of influenza or increases in cases in syndromic surveillance systems and recent laboratory-confirmed influenza in at least half the regions of the state.|
Sentinel General Practice SurveillanceThe Australian Sentinel Practices Research Network (ASPREN) has Sentinel GPs who report ILI presentation rates in NSW, NT, SA, ACT, VIC, QLD, TAS and WA. As jurisdictions joined ASPREN at different times and the number of GPs reporting has changed over time, the representativeness of ASPREN data in 2010 may be different from that of previous years. ASPREN data and VIDRL influenza surveillance data are sent to the Surveillance Branch on a weekly basis. Further information on Sentinel GPs’ Influenza Surveillance and ASPREN activities are available at www.dmac.adelaide.edu.au/aspren.
Sentinel ED dataWA - ED surveillance data are extracted from the ‘Virus Watch’ Report. This report is provided weekly. The Western Australia Influenza Surveillance Program collects data from eight Perth EDs.
NSW - ED surveillance data are extracted from the ‘Weekly Influenza Report, NSW’. The New South Wales Influenza Surveillance Program collects data from 56 EDs across New South Wales.
FluTrackingFluTracking is a project of the University of Newcastle, the Hunter New England Area Health Service and the Hunter Medical Research Institute. FluTracking is an online health surveillance system to detect epidemics of influenza. It involves participants from around Australia completing a simple online weekly survey, which collects data on the rate of ILI symptoms in communities. Data have been provided weekly and have been presented in this report to show the pattern of self reported ILI in the community over the 2009 season.
Further information on FluTracking is available at www.flutracking.net/index.html.
National Health Call Centre NetworkA national organisation provides call centre data for calls relating to ILI or influenza. Data are provided daily and are collated weekly and have been presented in this report to show the pattern of calls to this Call Centre over the 2009 and 2010 season. Data is available for all jurisdictions other than QLD and VIC.
AbsenteeismA national organisation provides data on the number of employees who have been on sick leave for a continuous period of more than three days. These data are not influenza or ILI specific and absenteeism may be a result of other illnesses.
Sentinel Laboratory Surveillance dataLaboratory testing data are provided weekly directly from PathWest (WA), VIDRL (VIC), ICPMR (NSW), sentinel Tasmanian laboratories, and ASPREN (national).
National Notifiable Diseases Surveillance System (NNDSS)Laboratory confirmed influenza (all types) is notifiable in all jurisdictions in Australia. Confirmed cases of influenza are notified through NNDSS by all jurisdictions except NSW. NSW data are sourced from NetEpi.
NetEpiIn 2009, NetEpi, a web-based outbreak case reporting system for pandemic (H1N1) 2009, was used as the primary source of enhanced data on confirmed cases, hospitalisations and ICU admissions in all jurisdictions. In 2010, only data for NSW are sourced from NetEpi.
Analyses of Australian cases are based on the diagnosis date, which is the earliest of the onset date, specimen date or notification date.
Data AnalysisAnalysis of confirmed influenza cases is conducted on combined NetEpi and NNDSS data. Analysis of morbidity (hospitalisations and ICU admissions) and mortality data in 2009 has been conducted on combined NetEpi and QLD hospitalisation data.
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FluCANThe Influenza Complications Network (FluCAN) collects detailed clinical information on all hospitalised cases of influenza and pneumonia from a sample of 15 sentinel hospitals across Australia. The data for this reporting period are sourced only from 14 hospitals.
APSUThe Australian Paediatric Surveillance Unit collects clinical information on hospitalised cases of children aged 15 years and under with complications due to influenza infection. Approximately 1300 (80% of total) Paediatric clinicians registered with the Paediatrics and Child Health Division of the Royal College of Physicians, respond to APSU report cards. These report cards seek information regarding hospitalisations relating to 12 diseases or conditions, including influenza.
Australian and New Zealand Intensive Care Society data (ANZICS data)The Australian and New Zealand Intensive Care Society provide data from a `near real time` registry of patients admitted to Australian ICUs. This documents the key factors influencing mortality, as well as the need for hospitalisation and mechanical ventilation. Information collected includes person characteristics and information on relevant co-morbidities, nature of the clinical syndrome associated with pandemic (H1N1) 2009, major therapeutic interventions from which organ failure outcomes can be imputed, vaccination status and vital status at time of ICU discharge and hospital discharge.
WHO Collaborating Centre for Reference & Research on Influenza (WHO CC)Data are provided weekly to the Surveillance Branch from the WHO CC.
Deaths associated with influenza and pneumoniaNationally reported pandemic (H1N1) 2009 deaths are notified by jurisdictions to the Commonwealth Department of Health and Ageing as they occur.
NSW influenza and pneumonia deaths data are collected from the NSW Registry of Births, Deaths and Marriages. Figure 14 is extracted from the ‘Weekly Influenza Report, NSW’
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1 NSW Influenza Monthly Epidemiology Report, October 2010. Available from http://www.health.nsw.gov.au/resources/publichealth/infectious/reports/influenza/2010/pdf/october_monthly_report.pdf Accessed 11 November 2010.
2 World Health Organisation Global Alert and Response: Influenza. Recommended composition of influenza virus vaccines for use in the 2011 southern hemisphere influenza season. Available from http://www.who.int/csr/disease/influenza/recommendations2011south/en/index.html Accessed 1 October 2010.
3 World Health Organisation virtual press conference, 10 August 2010. Available from http://www.who.int/en/ Accessed 11 August 2010.
4 WHO Influenza update – 8 October 2010. Available from http://www.who.int/csr/don/en/ Accessed 22 October 2010.