Flu surveillance in Sardinia

In Italy, the epidemiological surveillance of flu-like illnesses (ILIs) and severe cases of influenza is coordinated by the Department of Infectious Diseases (DMI) of the National Health Institute (ISS) with the contribution of general practitioners, paediatricians, hospital doctors and contacts in the ASSL and the Regions. The Microbiology and Virology Unit of the AOU of Sassari, nominated as the regional reference centre for Sardinia's InfluNet virological surveillance network, has issued an update regarding the characteristics of the influenza viruses circulating in the 2018-2019 and 2019-2020 flu seasons. As regards the current season, 3 cases of H1N1pdm09 virus were identified in the first week of 2020.

The Surveillance Systems are configured as a dynamic process of collection, storage, organisation, analysis and interpretation of data and/or specific events. They therefore provide the tools to determine the extent of a phenomenon, evaluating its progress and verifying the impact of any control measures in compliance with what is expressly established by the surveillance protocols of the Monitoring and Reporting Centres of the National Health System.

More in detail, the integrated flu surveillance, coordinated by the Department of Infectious Diseases (DMI) of the National Health Institute (ISS), with the contribution of general practitioners, paediatricians, hospital doctors and contacts at the ASSLs and the Regions, considers as a fundamental working principle the constant monitoring of:

  • Serious cases and deaths: active in Italy from 2009-2010, this reporting system communicates serious and complicated cases of influenza to the Ministry: these cases involve hospitalisation in the Intensive Care Unit (ICU) and/or recourse to extracorporeal membrane oxygenation therapy (ECMO);
  • Mortality: this Surveillance System is managed by the Department of Lazio - Asl Roma 1 on behalf of the Ministry of Health;
  • Influweb: this is a system for detecting the flu syndrome that makes use of a web platform (influweb.it) capable of collecting data from participating citizens throughout Italy. Through this surveillance it is possible to detect cases of flu syndrome even among those who do not contact the National Health Service;
  • InfluNet: this is a sentinel surveillance system based on a network of general practitioners and paediatricians representative of all Italian Regions. It makes use of: InfluEpi: an epidemiological surveillance system for influenza, coordinated by the National Health Institute (ISS), in collaboration with the Inter-University Centre for Flu Research (Ciri) of Genoa and with the support of the Ministry of Health; InfluVir: a virological surveillance system, with the aim of monitoring the circulation of the various types of flu viruses in Italy, the evaluation of the homology between epidemic and vaccine strains and the evaluation of the susceptibility of influenza viruses in circulation to antivirals.

In the Region of Sardinia, the Special Virology laboratory (coordinated by Prof. Caterina Serra) of the Microbiology and Virology Unit of the Sassari AOU (headed by Prof. Salvatore Rubino), has been identified as a regional reference centre for the virological surveillance network InfluNet (whose latest bulletin can be found as an attachment to this article) and since 1999, has confirmed influenza diagnosis and surveillance by working in close synergy with the WHO National Influenza Centre.

In this regard, Prof. Caterina Serra has issued an update regarding the characteristics of the flu viruses circulating in the 2018-2019 flu season (the technical data sheet of which can be consulted in the attached document), and comments on what has occurred so far in the 2019-2020 season: “The clinical samples used to research the influenza virus or its components are tested with molecular methods to identify the type and subtype of the influenza virus in circulation. The data obtained are electronically sent, on a weekly basis, to the National Coordination Centre of the ISS in order to monitor the effectiveness of the vaccination campaign and the appearance of any viral mutations. In fact, for the two-year period 2019-20, in the Microbiology laboratories of the AOU of Sassari the first 3 positive samples for the influenza virus have been identified - out of 26 samples received - in the first week of the new year, in patients hospitalised in the University Hospital of Sassari. All 3 specimens tested positive for type A influenza virus, subtype H1N1pdm09. At the moment, no positive samples have been identified for influenza A virus subtype H3N2, and type B, already reported at national level. At the moment the doctors involved in the project number 20 for the Epidemiological part and only 11 for the virological part."

Professor Paolo Castiglia, Director of the Hygiene and Control of Hospital Infections Unit of the AOU of Sassari, and Head of Vaccinarsinsardegna.org, comments that the estimated incidence is still below the epidemic threshold and explains that the epidemic peak of influenza on our island occurs later than in the rest of Italy; this is due to Sardinia’s geographical characteristics (insularity) and to the temperatures being currently higher than the seasonal average, conditions which, overall, represent the elements capable of influencing the transmissibility of the virus.

A drop in temperatures is a risk - explains Prof. Castiglia - which on the one hand lowers our defences and also induces us to spend our time in confined environments where inter-human contact is more efficient, and on the other it preserves the virus in the environment. Once the virus is eliminated from an infected subject, its infectious power remains high. That's why it is still advisable to get vaccinated. In order to be effective, the vaccine needs a window of about 12 days. Moreover, the simple rules that help prevent flu should be followed carefully."

Here, Vaccinarsinsardegna.org reminds users that, in addition to the highly recommended flu vaccination every year, the following are essential as preventive measures of the flu syndrome:

  1. wash hands carefully with soap and water and sanitation with hydro-alcoholic gel in the event that sinks and running water are not immediately available;
  2. stay away from crowded places as much as possible and limit physical contacts;
  3. avoid, where possible, close contact with sick, or potentially sick people (aim to keep a distance of not less than about one and a half metres);
  4. stay at home in the presence of flu symptoms (fever, sore throat, cough, general malaise and/or the other symptoms described above) from the onset of the symptoms and up to 24 hours after their complete resolution (without the use of antipyretics);
  5. adopt the norms of good hygiene, covering the mouth and nose with a tissue when coughing or sneezing.

Users are invited to visit the "Vaccinations in Sardinia" page on our website where an entire section is dedicated to "Flu vaccination". Here you can consult the circulars and recommendations about the current flu season 2019-2020 together with the data relating to the previous season 2018-2019 and updates and news relevant to the topic.

Lastly, it should be remembered that surveillance of the following Infectious Diseases are constantly active throughout the region: Legionellosis, Acute Flaccid Palsy, Bacterial Meningitis and invasive diseases of Meningococcus, Pneumneumococcus and Haemophilus Influenzae, Measles, Mumps, Rubella and congenital Rubella syndrome, Malaria, West Nile Disease (WND) and Usutu, Chikungunya-Dengue-Zika and other mosquito-borne arboviruses, Tick-borne Viral Encephalitis (TBE) and other arboviruses and Hantavirus, Tuberculosis, Acute Hepatitis, Sexually Transmitted Diseases, Botulism , Creutzfeldt-Jacob Disease and related syndromes, Carbapenemase-producing enterobacterial bacteria, Salmonellosis, Entero-bacterial food poisoning, Hemolytic-uremic syndrome - Verocytotoxin-producing Escherichia Coli disease, Healthcare Acquired Infections (HAI) and Anti-Microbial Resistance (AMR), Flu - severe forms, Listeriosis, Hemorrhagic fevers - Ebola virus, the specifications of which are indicated in the attached regional document.

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