title: A new sentinel surveillance system for severe influenza in England shows a shift in age distribution of hospitalised cases in the post-pandemic period.
abstract: BACKGROUND
  The World Health Organization and European Centre for Disease Prevention and Control have highlighted the importance of establishing systems to monitor severe influenza. Following the H1N1 (2009) influenza pandemic, a sentinel network of 23 Trusts, the UK Severe Influenza Surveillance System (USISS), was established to monitor hospitalisations due to confirmed seasonal influenza in England. This article presents the results of the first season of operation of USISS in 2010/11.
  
  
  RESULTS
  A case was defined as a person hospitalised with confirmed influenza of any type. Weekly aggregate numbers of hospitalised influenza cases, broken down by flu type and level of care, were submitted by participating Trusts. Cases in 2010/11 were compared to cases during the 2009 pandemic in hospitals with available surveillance data for both time periods (n = 19). An unexpected resurgence in seasonal A/H1N1 (2009) influenza activity in England was observed in December 2010 with reports of severe disease. Reported cases over the period of 4 October 2010 to 13 February 2011 were mostly due to influenza A/H1N1 (2009). One thousand and seventy-one cases of influenza A/H1N1 (2009) occurred over this period compared to 409 at the same Trusts over the 2009/10 pandemic period (1 April 2009 to 6 January 2010). Median age of influenza A/H1N1 (2009) cases in 2010/11 was 35 years, compared with 20 years during the pandemic (p = <0.0001).
  
  
  CONCLUSIONS
  The Health Protection Agency successfully established a sentinel surveillance system for severe influenza in 2010/11, detecting a rise in influenza cases mirroring other surveillance indicators. The data indicate an upward shift in the age-distribution of influenza A/H1N1 (2009) during the 2010/11 influenza season as compared to the 2009/10 pandemic. Systems to enable the ongoing surveillance of severe influenza will be a key component in understanding and responding to the evolving epidemiology of influenza in the post-pandemic era.
authors.affiliation: Health Protection Agency, London, United Kingdom.
authors.forename: Shelly
authors.initials: S
authors.lastname: Bolotin
authors.forename: Richard
authors.initials: R
authors.lastname: Pebody
authors.forename: Peter J
authors.initials: PJ
authors.lastname: White
authors.forename: James
authors.initials: J
authors.lastname: McMenamin
authors.forename: Luke
authors.initials: L
authors.lastname: Perera
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Nguyen-Van-Tam
authors.forename: Thomas
authors.initials: T
authors.lastname: Barlow
authors.forename: John M
authors.initials: JM
authors.lastname: Watson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000502:physiology; D007251:Influenza, Human / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D058873:Pandemics / Q000706:statistics & numerical data*; D010865:Pilot Projects; D018571:Sentinel Surveillance; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult