title: The significance of increased influenza notifications during spring and summer of 2010-11 in Australia.
abstract: OBJECTIVE
  During the temperate out-of-season months in Australia in late 2010 and early 2011, an unprecedented high number of influenza notifications were recorded. We aimed to assess the significance of these notifications.
  
  
  METHODS
  For Australia, we used laboratory-confirmed cases notified to the WHO FluNet surveillance tool; the percentage of these that were positive; notifications by state and influenza type and subtype; and surveillance data from Google FluTrends. For the state of Victoria, we used laboratory-confirmed notified cases and influenza-like illness (ILI) proportions. We compared virus characterisation using haemagglutination-inhibition assays and phylogenetic analysis of the haemagglutinin gene for seasonal and out-of-season notifications.
  
  
  RESULTS
  The increase in notifications was most marked in tropical and subtropical Australia, but the number of out-of-season notifications in temperate Victoria was more than five times higher than the average of the previous three seasons. However, ILI proportions in spring-summer were not different to previous years. All out-of-season viruses tested were antigenically and genetically similar to those tested during either the 2010 or 2011 influenza seasons. An increase in the number of laboratories testing for influenza has led to an increase in the number of tests performed and cases notified.
  
  
  CONCLUSIONS
  An increase in influenza infections in spring-summer of 2010-11 in tropical and temperate Australia was not associated with any differences in virus characterisation compared with viruses that circulated in the preceding and following winters. This increase probably reflected a natural variation in out-of-season virus circulation, which was amplified by increased laboratory testing.
authors.affiliation: Victorian Infectious Diseases Reference Laboratory, North MelbourneNational Centre for Epidemiology and Population Health, Australian National University, CanberraCommunicable Disease Epidemiology and Surveillance, Department of Health, VictoriaWorld Health Organization Collaborating Centre for Reference and Research on Influenza, MelbourneMonash University, School of Applied Sciences, Churchill, Vic., Australia.
authors.forename: Heath A
authors.initials: HA
authors.lastname: Kelly
authors.forename: Kristina A
authors.initials: KA
authors.lastname: Grant
authors.forename: Ee Laine
authors.initials: EL
authors.lastname: Tay
authors.forename: Lucinda
authors.initials: L
authors.lastname: Franklin
authors.forename: Aeron C
authors.initials: AC
authors.lastname: Hurt
mesh_terms: D001315:Australia / Q000453:epidemiology; D018563:Disease Notification / Q000706:statistics & numerical data*; D014644:Genetic Variation; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology; D009975:Orthomyxoviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D010802:Phylogeny