General Surveillance Research Articles

Haematological abnormalities in new-onset rheumatoid arthritis and risk of common infections: a population-based study.

ObjectivesTo describe the prevalence of haematological abnormalities in individuals with RA at the point of diagnosis in primary care and the associations between haematological abnormalities, vaccinations and subsequent risk of common infections.MethodsWe studied 6591 individuals with newly diagnosed RA between 2004 and 2016 inclusive using the UK Royal College of General Practitioners Research and Surveillance Centre primary care database. The prevalence of haematological abnormalities at diagnosis (anaemia, neutropenia and lymphopenia) was established. Cox proportional hazards models were used to evaluate the association between each haematological abnormality and time to common infections and the influence of vaccination status (influenza and pneumococcal vaccine) on time to common infections in individuals with RA compared with a matched cohort of individuals without RA.ResultsAnaemia was common at RA diagnosis (16.1% of individuals), with neutropenia (0.6%) and lymphopenia (1.4%) less so. Lymphopenia and anaemia were associated with increased infection risk [hazard ratio (HR) 1.18 (95% CI 1.08, 1.29) and HR 1.37 (95% CI 1.08, 1.73), respectively]. There was no evidence of an association between neutropenia and infection risk [HR 0.94 (95% CI 0.60, 1.47)]. Pneumonia was much more common in individuals with early RA compared with controls. Influenza vaccination was associated with reduced risk of influenza-like illness only for individuals with RA [HR 0.58 (95% CI 0.37, 0.90)].ConclusionAt diagnosis, anaemia and lymphopenia, but not neutropenia, increase the risk of common infections in individuals with RA. Our data support the effectiveness of the influenza vaccination in individuals with RA.

Ontology to identify pregnant women in electronic health records: primary care sentinel network database study

ObjectiveTo develop an ontology to identify pregnant women from computerised medical record systems with dissimilar coding systems in a primary care sentinel network.Materials and methodsWe used a three-step approach to...

Saving bones without risking brain-bisphosphonates and risk of stroke: matched case-control study.

There is conflicting evidence on the link between bisphosphonates and stroke with studies variously showing increased, decreased or unchanged risk. We investigated the association between bisphosphonate treatment and the risk of stroke using a large routine clinical dataset. We used a matched nested case-control study design analysing routinely collected electronic data from patients registered at primary care practices in England participating in the Royal College of General Practitioners Research and Surveillance Centre. Cases were patients aged 18years or over, either living or dead, recorded as having had a stroke in the period 1 January 2005 to 31 March 2016. Each case was matched to one control according to age, sex, general practice attended and calendar time. Data were analysed using Stata, version 14.2. and RStudio, version 1.1.463. Conditional logistic regression was used to determine odds ratios for stroke according to bisphosphonate treatment and duration in cases compared with controls. We adjusted for disease risk groups, cardiovascular risk factors, treatments, smoking status, alcohol consumption, ethnicity, bisphosphonate types, fracture and socioeconomic status using IMD (Index of Multiple Deprivation). We included 31,414 cases of stroke with an equal number of matched controls. Overall, 83.2% of cases and controls were aged 65years or older, and there were similar proportions of females (51.5%) and males (48.5%). Bisphosphonate treatment was not associated with stroke after adjusting for the wide range of confounders considered (OR 0.86, 95% CI 0.62-1.19). We found no association between bisphosphonate treatment and risk of stroke, after adjusting for other confounders.

Crowd surveillance: estimating citizen science reporting probabilities for insects of biosecurity concern

Data streams arising from citizen reporting activities continue to grow, yet the information content within these streams remains unclear, and methods for addressing the inherent reporting biases little developed. Here, we quantify the major influence of physical insect features (colour, size, morphology, pattern) on the propensity of citizens to upload photographic sightings to online portals, and hence to contribute to biosecurity surveillance. After correcting for species availability, we show that physical features and pestiness are major predictors of reporting probability. The more distinctive the visual features, the higher the reporting probabilities—potentially providing useful surveillance should the species be an unwanted exotic. Conversely, the reporting probability for many small, nondescript high priority pest species is unlikely to be sufficient to contribute meaningfully to biosecurity surveillance, unless they are causing major harm. The lack of citizen reporting of recent incursions of small, nondescript exotic pests supports the model. By examining the types of insects of concern, industries or environmental managers can assess to what extent they can rely on citizen reporting for their surveillance needs. The citrus industry, for example, probably cannot rely on passive unstructured citizen data streams for surveillance of the Asian citrus psyllid (Diaphorina citri). In contrast, the forestry industry may consider that citizen detection and reporting of species of the large and colourful insects such as pine sawyers (Monochamus spp.) may be sufficient for their needs. Incorporating citizen surveillance into the general surveillance framework is an area for further research.

Assessment of the 2017 post-market environmental monitoring report on the cultivation of genetically modified maize MON810.

Following a request from the European Commission, EFSA assessed the 2017 post‐market environmental monitoring (PMEM) report on the cultivation of Cry1Ab‐expressing maize event MON 810. Like previous years, partial compliance with refuge requirements is reported for Spain. European and Mediterranean corn borer populations collected from North‐eastern Spain during the 2017 maize growing season and tested for Cry1Ab susceptibility show no symptoms of resistance to maize MON 810. No complaints about unexpected field damage caused by corn borers were received through the farmer complaint system. The assessment of farmer questionnaires and relevant scientific publications does not indicate any unanticipated adverse effects on human and animal health or the environment arising from the cultivation of maize MON 810. No information about the use of existing networks involved in environmental monitoring is provided. Overall, EFSA concludes that the evidence reported in the 2017 PMEM report does not invalidate previous EFSA and GMO Panel evaluations on the safety of maize MON 810. As in previous years, EFSA identifies methodological and reporting shortcomings pertaining to resistance monitoring that need revision in future PMEM reports. In particular, the monitoring plan, as implemented in 2017, is not sufficiently sensitive to detect the recommended 3% resistance allele frequency. Consequently, EFSA strongly recommends the consent holder to: (1) achieve full compliance with refuge requirements in areas where maize MON 810 adoption is high (i.e. North‐eastern Spain); (2) increase the sensitivity of the resistance monitoring plan and address previously mentioned methodological, analytical and/or reporting limitations for resistance monitoring and farmer questionnaires; and (3) perform a F2‐screen on European and Mediterranean corn borer populations from North‐eastern Spain. Moreover, relevant stakeholders should implement a methodological framework to enable making best use of existing networks involved in environmental monitoring for the general surveillance of genetically modified plants.

Adverse Events of Interest Vary by Influenza Vaccine Type and Brand: Sentinel Network Study of Eight Seasons (2010-2018)

Background: There are a range of types of influenza vaccines: Inactivated vaccines vary by number of component virus strains, they are trivalent (TIV) or quadrivalent (QIV) and are given by injection. Live attenuated influenza vaccine (LAIV) is given intranasal. Monitoring of adverse events of interests (AEIs) following influenza vaccination is recommended by the European Medicines Agency (EMA) to monitor common and detect infrequent but important adverse events of interest (AEI). Methods: A retrospective cohort study of the computerised medical record data from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network database 2010-2018 (N=848,375). We extracted data about vaccine exposure (n=3,121,334) and AEIs specified by the EMA (1,488,870 consultations by 430,029 unique individuals). We report relative incidence (RI) of AEIs. An RI <1 signified lower AEI rate compared to TIV. Findings: QIV was associated with a RI of AEIs of 1.14 (95%CI, 1.10-1.18, p<0.01), though the number of years exposure was limited. By way of contrast, LAIV had a lower rate 0.60 (95%CI 0.63-0.68, p<0.001). Cellular manufacture was also associated with a lower rate 0.78 (95%CI 0.61-0.99, p=0.04). AEIs varied by season rash and musculoskeletal conditions are particularly pronounced in the 2014/15 season and respiratory conditions in 2016/17. Interpretation: Routine sentinel network data can be used to contrast AEIs between vaccine types and may provide a consistent method of observation of vaccine benefit-risk over time. The contracting RIs may help guide policy and vaccine choice. Funding: JWC Health Education England academic placement. Declaration of Interest: SdeL received funding from GSK to conduct EMA specification enhanced surveillance of AEIs, through the University of Surrey. He has attended Sanofi, and Seqirus advisory boards. Ethical Approval: The study was approved by RCGP, and the Health Research Authority/ Medical Research Council tool suggested this was a service evaluation of usual practice study not requiring further ethical review.

Obstructive sleep apnoea in Type 2 diabetes mellitus: increased risk for overweight as well as obese people included in a national primary care database analysis.

AimsTo determine obstructive sleep apnoea prevalence in people with Type 2 or Type 1 diabetes in a national primary care setting, stratified by BMI category, and to explore the relationship between patient characteristics and obstructive sleep apnoea.MethodsUsing the Royal College of General Practitioners Research and Surveillance Centre database, a cross‐sectional analysis was conducted. Diabetes type was identified using a seven‐step algorithm and was grouped by Type 2 diabetes, Type 1 diabetes and no diabetes. The clinical characteristics of these groups were analysed, BMI‐stratified obstructive sleep apnoea prevalence rates were calculated, and a multilevel logistic regression analysis was completed on the Type 2 diabetes group.ResultsAnalysis of 1 275 461 adult records in the Royal College of General Practitioners Research and Surveillance Centre network showed that obstructive sleep apnoea was prevalent in 0.7%. In people with Type 2 diabetes, obstructive sleep apnoea prevalence increased with each increasing BMI category, from 0.5% in those of normal weight to 9.6% in those in the highest obesity class. By comparison, obstructive sleep apnoea prevalence rates for these BMI categories in Type 1 diabetes were 0.3% and 4.3%, and in those without diabetes 1.2% and 3.9%, respectively. Obstructive sleep apnoea was more prevalent in men than women in both diabetes types. When known risk factors were adjusted for, there were increased odds ratios for obstructive sleep apnoea in people with Type 2 diabetes in the overweight and higher BMI categories.ConclusionsObstructive sleep apnoea was reported in people with both types of diabetes across the range of overweight categories and not simply in the highest obesity class.

Intensification to injectable therapy in type 2 diabetes: mixed methods study (protocol)

BackgroundIn the UK, type 2 diabetes mellitus (T2D) is largely managed in primary care. Delay in the intensification to injectable therapy, a form of clinical inertia, is associated with worse glycaemic control. UK general practice is highly computerised, with care being recorded on computerised medical record systems; this allows for quantitative analysis of clinical care but not of the underpinning decision-making process. The aim of this study is to investigate perceptions of patients and clinicians in primary care on the initiation of injectable therapies in T2D, and the context within which those decisions are made.MethodsThis is a mixed methods study, taking a “realist evaluation” approach. The qualitative components comprise focus groups, interviews, and video recordings of simulated surgeries; the quantitative analysis: an overview of participating practices, elements of the video recording, and an online survey. We will recruit primary care clinicians (general practitioners and nurses) and patients from a representative sample of practices within the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. Participants will be patients with T2D, and primary care clinicians. Focus groups and semi-structured interviews will be recorded, transcribed verbatim and analysed using Framework Analysis. The simulated surgeries will include cases that might be escalated to injectable therapy. The consultation will be reviewed using the Calgary-Cambridge model to assess communication and determination of adherence to national prescribing guidelines. We will conduct multi-channel video recording including screen capture, clinician and patient facial expressions, wide angle view of the consultation, and the computerised medical record screen. This allows annotation and qualitative analysis of the video recordings, and statistical analyses for the quantitative data. We will also conduct an online survey of primary care clinicians’ attitudes to, and perceptions of, initiation of injectable therapies, which will be analysed using summary statistics.DiscussionResults aim to provide a detailed insight into the dynamic two-way decision-making process underpinning use of injectable therapy for T2D. The study will provide insights into clinical practice and enable the development of training, interventions and guidelines that may facilitate, where appropriate, the intensification to injectable therapy.

How Generalizable Are Cardiovascular Outcome Trials of Sodium-Glucose Co-Transporter-2 Inhibitors? A National Database Study: Study Protocol.

IntroductionSodium-glucose co-transporter-2 (SGLT2) inhibitors are oral antihyperglycemic agents for the treatment of people with type 2 diabetes (T2DM). Two recent cardiovascular outcome trials (CVOTs), the EMPA-REG OUTCOME trial and CANVAS Program, have demonstrated that SGLT2 inhibitors have cardiovascular benefit in high-risk cardiovascular patients. The aim of our study will be to identify the prevalence of patients in an English primary care setting with the equivalent cardiovascular risk profile to those included in each of four SGLT2 inhibitor CVOTs: CANVAS, DECLARE, EMPA-REG, and VERTIS CV.MethodsRoutinely collected primary care data from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database will be used. We will perform a cross-sectional analysis to calculate the prevalence of people that have equivalent cardiovascular risk to participants included in each of the four above-mentioned SGLT2 inhibitor CVOTs. The demographic and clinical characteristics of the subgroups will also be compared with participants in each trial. The study cohort will include people with T2DM in the RCGP RSC dataset. Subgroups of people will be identified using Read codes that most closely match the inclusion criteria of each trial. Descriptive statistics will be used to report the characteristics of people at high cardiovascular risk and compared against those of people in each CVOT.Planned OutputsFindings from the study will be submitted for publication in a peer-reviewed journal to report the applicability of each SGLT2 inhibitor trial to real-world clinical practice.FundingAstraZeneca UK Limited.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-019-0620-8) contains supplementary material, which is available to authorized users.

Real-world prevalence of the inclusion criteria for the LEADER trial: Data from a national general practice network.

AimsTo explore the prevalence and describe the clinical characteristics of people with type 2 diabetes with a similar cardiovascular (CV) profile to that of the LEADER trial participants in a primary care setting in England.Materials and methodsIn this cross‐sectional analysis, using the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database, we identified people with type 2 diabetes meeting the LEADER inclusion criteria. We identified people's CV risk factors using computerized medical records. Additionally, we assessed the prescription pattern of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) in this cohort.ResultsOf 1 275 461 adults, we identified 84 394 with type 2 diabetes, of whom 14 000 (16.6%) met the LEADER inclusion criteria for established or high‐risk CV disease (RCGP RSC‐CVD group). The LEADER cohort was younger than the RCGP RSC‐CVD group (64.2 vs 73.2 years), had higher mean glycated haemoglobin (71.6 vs 67.1 mmol/mol) and blood pressure (BP) values (systolic BP: 135.9 vs 132.9 mmHg; diastolic BP: 77.2 vs 72.7 mmHg), and a higher mean body mass index (32.5 vs 30.9 kg/m2). In the RCGP RSC‐CVD group, only 1215 people (8.7%) had ever been prescribed a GLP‐1RA and 760 (5.4%) had ever received liraglutide.ConclusionsIn a cohort of English general practice patients, one in six people with type 2 diabetes met the LEADER inclusion criteria, and less than one in 10 of these received liraglutide, a drug which has demonstrated CV benefits amongst others. There is scope to improve the outlook in people with type 2 diabetes and high CV risk through evidence‐based use of specific GLP‐1RAs.

Non-invasive surveillance of Plasmodium infection by real-time PCR analysis of ethanol preserved faeces from Ugandan school children with intestinal schistosomiasis

BackgroundAs part of ongoing co-surveillance of intestinal schistosomiasis and malaria in Ugandan school children, a non-invasive detection method for amplification of Plasmodium DNA using real-time (rt)PCR analysis of ethanol preserved faeces (EPF) was assessed. For diagnostic tabulations, results were compared to rtPCR analysis of dried blood spots (DBS) and field-based point-of-care (POC) rapid diagnostic tests (RDTs).MethodsA total of 247 school children from 5 primary schools along the shoreline of Lake Albert were examined with matched EPF and DBS obtained. Mean prevalence and prevalence by school was calculated by detection of Plasmodium DNA by rtPCR using a 18S rDNA Taqman® probe. Diagnostic sensitivity, specificity, positive and negative predictive values were tabulated and compared against RDTs.ResultsBy rtPCR of EPF and DBS, 158 (63.9%; 95% CI 57.8–69.7) and 198 (80.1%, 95% CI 74.7–84.6) children were positive for Plasmodium spp. By RDT, 138 (55.8%; 95% CI 49.6–61.9) and 45 (18.2%; 95% CI 13.9–23.5) children were positive for Plasmodium falciparum, and with non-P. falciparum co-infections, respectively. Using RDT results as a convenient field-based reference, the sensitivity of rtPCR of EPF and DBS was 73.1% (95% CI 65.2–79.8) and 94.2% (95% CI 88.9–97.0) while specificity was 47.7% (95% CI 38.5–57.0) and 37.6% (95% CI 29.0–46.9), respectively. With one exception, school prevalence estimated by analysis of EPF was higher than that by RDT. Positive and negative predictive values were compared and discussed.ConclusionsIn this high transmission setting, EPF sampling with rtPCR analysis has satisfactory diagnostic performance in estimation of mean prevalence and prevalence by school upon direct comparison with POC-RDTs. Although analysis of EPF was judged inferior to that of DBS, it permits an alternative non-invasive sampling regime that could be implemented alongside general monitoring and surveillance for other faecal parasites. EPF analysis may also have future value in passive surveillance of low transmission settings.

Construct validity of a service-setting based measure to identify mental health problems in infancy

Accumulating research document the needs of intervention towards mental health problems in early childhood. The general child health surveillance offers opportunities for early detection of mental health vulnerability, conditioned the availability of feasible and validated measures. The Copenhagen Infant Mental Health Questionnaire, CIMHQ, was developed to be feasible for community health nurses and comprehensive regarding the range of mental health problems seen in infancy. Previous testing of the CIMHQ has documented feasibility and face validity. The aim was to investigate the construct validity of the general population measure by using the Rasch measurement models, and to explore the differential functioning of the CIMHQ relative to a number of characteristics of the infants, local independence of items, and possible latent classes of infants. CIMHQ was tested in 2,973 infants from the general population, aged 9–10 months. The infants were assessed by community health nurses at home visits, in the period from March 2011 to December 2013. Rasch measurement models were used to investigate the construct validity of the CIMHQ. Analyses showed an overall construct valid scale of mental health problems, consisting of seven valid subscales of specific problems concerning eating, sleep, emotional reactions, attention, motor activity, communication, and language, respectively. The CIMHQ fitted a graphical loglinear Rasch model without differential item function. Analyses of local homogeneity identified two latent classes of infants. A simple model with almost no local dependency between items is proposed for infants with few problems, whereas a more complicated model characterizes infants with more problems. The measure CIMHQ differentiates between infants from the general population with few and more mental health problems, and between subgroups of problems that potentially can be targets of preventive intervention.

Serological surveillance of influenza in an English sentinel network: pilot study protocol

BackgroundRapidly undertaken age-stratified serology studies can produce valuable data about a new emerging infection including background population immunity and seroincidence during an influenza pandemic. Traditionally seroepidemiology studies have used surplus...

Variation in the diagnosis and control of hypertension is not explained by conventional variables: Cross-sectional database study in English general practice.

BackgroundHypertension is a major cause of preventable disability and death globally and affects more than one in four adults in England. Unwarranted variation is variation in access, quality, outcome or value which is unexplained by differences in the condition or patient characteristics and which reduces quality and efficiency. Distinguishing unwarranted from variation due to clinical, organisational or patient factors can be challenging. We carried out this study to explore inter-practice variation in the diagnosis and management of hypertension in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database, a large, representative surveillance database.Methods and findingWe carried out a cross-sectional study using primary care data extracted from the electronic health records of 1,271,419 adults registered at RCGP RSC general practices on 31st December 2016. Logistic regression was used to indirectly standardise practice-level hypertension prevalence and control against the RCGP RSC population, adjusted for age, gender, ethnicity, deprivation, co-morbidity, NHS region and practice size. Inter-practice variation was demonstrated using funnel plots with 95% and 99.8% control limits. The prevalence of detected hypertension was 18.4% (95% CI 18.4–18.5), n = 234,165. Uncontrolled hypertension was present in 146,553 of 196,052 individuals, 25.2% (25.1–25.4), in whom blood pressure had been recorded in the previous year. Hypertension management varied markedly between practices with a three-fold difference in prevalence, 13.5–38.4%, and a four-fold difference in the proportion of uncontrolled hypertension, 11.8–47.9%. Despite adjustment for sociodemographic and practice characteristics funnel plots demonstrated marked over-dispersion.ConclusionsSubstantial variation in the prevalence of diagnosed hypertension and the management of hypertension was only partially explained by characteristics captured within a routine dataset. The over-dispersion suggests variation is not fully explained by these factors and that context, behaviour and processes of care delivery may contribute to variation. Routine data sources in isolation to not provide sufficient contextual data to diagnose the causes of variation.

Determinants of inter-practice variation in childhood asthma and respiratory infections: cross-sectional study of a national sentinel network

ObjectivesRespiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study...

Web-GIS and livestock trace tools for epidemiological surveillance, control and management

Web-GIS and livestock trace tools for epidemiological surveillance, control and management

A border surveillance system using WSN under various environment characteristics

Surveillance has become a promising application area of wireless sensor networks (WSNs) where detecting and tracking an intruder as it moves through a sensor network is becoming an increasingly important challenge. This motivates us to investigate the impact of some factors such as the area geography and the intruders behaviours. For this, we present in this paper an efficient surveillance system that uses a WSN deployed inside a border area in order to detect an intruder at least N times from its entrance. The proposed surveillance system is examined under various environment characteristics. First, we focus on modeling the area into multi-thick lines architecture. Then, we provide a deployment method to detect the intruder from its entrance in an area without obstacles. Finally, we investigate the effect of the obstacles in the area and we provide a general surveillance system for detection purpose that considers different intruders behaviours.

Seroprevalence Survey of Rubella IgG Antibodies among Pregnant Women Attending Antenatal Clinics in Abakaliki, Ebonyi State, Nigeria

Rubella is a mild, contagious viral infection that is endemic worldwide and poses a serious threat to infants and pregnant women. It causes a spectrum of severe birth defects like congenital rubella syndrome, abortions and still birth if the infection occurs within the first trimester of pregnancy. The Seroprevalence of rubella IgG antibodies was investigated among 187 pregnant women attending Mile Four Hospital (MFH) Abakaliki, Ebonyi State. Blood specimens were collected from the subjects and sera extracted. The sera were screened for rubella virus immunoglobulin G antibody (IgG) using ELISA test Kit (Micro Immune limited, UK). The results obtained were subjected to SPSS system and Chi square test for significant difference at 95% confidence interval. Of the 187 pregnant women tested, 174(93.05 %) were positive for the rubella virus IgG. This study revealed that all the subjects who were 41 years and above tested positive 5(100.00%), whereas those who were 15 years and below 2 subjects had the prevalence rate of 50.00%. Pregnant women in their third, first and second trimesters had prevalence rates of 95.75%, (95.35%) and 86.95% accordingly. Samples tested shows that unmarried women were more infected with anti- rubella IgG of 94.44% recorded, then followed by married women with 93.79% and divorcee had 90.91%. However, widows had the least prevalence rate of 84.62%. Occupationally, women civil servants had prevalence rate of 97.56%. Educationally, pregnant women with tertiary education were more infected, rubella virus amounting to 96.61%. More infection was found among women living in rural areas with 93.59% rate, than their urban counterparts who had 92.66%. Furthermore, primigravida women were more infected (95.16%). The Sero-prevalence of rubella in this study was high and it calls for general surveillance and mass immunization of children and females of child bearing age.

A severe 2017 influenza season dominated by influenza A(H3N2), Victoria, Australia.

Surveillance for influenza-like illness (ILI) and laboratory-confirmed influenza in Victoria, Australia is undertaken jointly by the Victorian Infectious Diseases Reference Laboratory and the Victorian Government Department of Health and Human Services from May to October each year. Surveillance data comprise notifiable laboratory-confirmed influenza and ILI reporting from from two sources – a general practice sentinel surveillance programme and a locum service.The magnitude of the 2017 influenza season was high in Victoria with widespread circulation of influenza type A(H3N2), which peaked in September. A record number of laboratory-confirmed influenza cases were notified, and the proportion of ILI cases to total consultations from both the general practice and locum service were higher than previous years. Notified cases of influenza A were older than influenza B cases with 25% compared to 17% aged more than 65 years, respectively. The proportion of swabs that were positive for influenza peaked at 58%. Antigenic characterization suggested a good match between the circulating and vaccine strains of influenza A(H3N2).Most of the increases observed in notified cases of laboratory-confirmed influenza in recent years in Victoria have been attributed to increases in testing. However, that cases of ILI also increased in Victoria in 2017 is suggestive that 2017 was a relatively severe season. The dominance of influenza type A(H3N2), the extended duration of elevated activity, and a potential phylogenetic mismatch of vaccine to circulating strains are likely to have contributed to the relative severity of the 2017 season.Victoria is Australia’s second most populous state and is the mainland’s southernmost state. It has a temperate climate with an influenza season usually occurring in the cooler months between May and October. The Victorian Infectious Diseases Reference Laboratory (VIDRL), in partnership with the Victorian Government Department of Health and Human Services (DHHS), coordinates influenza-like illness (ILI) and laboratory-confirmed influenza surveillance in Victoria. There are three data sources included in the influenza surveillance system.

PM 3/85 (1) Inspection of places of production – Vitis plants for planting

Specific scopeThis Standard describes the procedure for inspection of places of production of Vitis plants for planting and includes relevant sampling criteria and the main regulated pests. It mainly focuses on the pests which are present in the EPPO region and affect Vitis plants. Additional information on some soil‐borne pests is also reported, as they could be of phytosanitary relevance, including those that are vectors of pests. Evidence gathered from inspections carried out according to this Standard may be used for export, for internal country movements of materials, for general surveillance or to help demonstrate freedom from relevant pests. The Standard does not cover any provision about the adoption of phytosanitary measures.Specific approvalThis Standard was first approved in 2018‐09.