Surveillance of seasonal respiratory illnesses

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Updated: 5 April 2024

Please note that the final update of this report will be Friday 5 April 2024.

On this page

• Introduction
• Summary
• GP in-hours, Acute Respiratory Infections Surveillance
• GP out-of-hours
• Emergency Department
• Mortality
• Seasonal Influenza Vaccination Statistics
• COVID-19 Vaccination Statistics
• United Kingdom Update
• Global Update
• Variants of Concern
• Data disclaimer
• Glossary of terms
• References 

Introduction

The purpose of this report is to provide an overview of surveillance information concerning respiratory viruses on the Isle of Man.  The report is currently being developed and additional information will appear within it as soon as it is available.

While reporting requirements have evolved post pandemic, the World Health Organisation emphasises the importance of ongoing monitoring to assess the impact to services and mortality from the burden of COVID-19 and other respiratory illnesses such as influenza and RSV.

During the winter months, respiratory illnesses have variable effects and can strain the health and social care services as well as lead to significant absences from work and school.  Data collected by this integrated respiratory surveillance system will help inform control measures by monitoring the spread and intensity of respiratory viruses and vaccination progress.

Summary

• GP in-hours surveillance shows levels of acute respiratory infections continued to decreased in week 13.

• Emergency Department attendances for respiratory illnesses decreased in week 13, driven, in main, by decreased attendances from all age-groups except 65+.

• Mortality from respiratory deaths and all-causes remains stable and within expected levels.

• Currently, for the 2023/24 season, influenza vaccine coverage for all ages is 41.56% of those eligible.

• Currently, for the Autumn Booster Programme, COVID-19 vaccine coverage for all ages is 69.05% of those eligible.

GP in-hours, Acute Respiratory Infections Surveillance

GP in-hours (GPIH) surveillance monitors the number of GP visits during regular hours.  Data for surveillance is obtained from the EMIS Primary Care system by using a selection of READ codes.  The codes selected form part of a pilot project and will remain under continuous development during the next few months.

Figure 1 – Weekly number of GP in-hours appointments for selected respiratory EMIS codes, all-ages.

GP consultations for respiratory infections decreased in week 13, compared to week 12, remaining at seasonal levels.

The weekly acute respiratory infection (ARI) consultation rate, through GP practices, decreased from 298.56 per 100,000 population in week 12 to 275.96 per 100,000 in week 13.  This remains within baseline activity levels (less than 445.45 per 100,000), and is shown in Figure 2.

Figure 2: Acute respiratory infection (ARI) consultation rates, all ages, Isle of Man.

Figure 3 – RCGP influenza-like illness (ILI) consultation rates, all ages, England.¹

The weekly ILI consultation rate through the RCGP surveillance decreased to 3.4 per 100,000 registered population in participating GP practices in week 13 compared to 4.9 per 100,000 in the previous week. This is within baseline activity levels (less than 10.25 per 100,000).

GP out-of-hours

GP out-of-hours (GPOH) surveillance monitors the total number of telephone triage calls during the opening hours of the Manx Emergency Doctor Service (MEDS).  Data for surveillance is obtained from the EMIS Electronic Patient Record System for all codes.

Please note that, due to changes in operating procedures of the MEDS service, reporting of this data has been suspended for the remainder of the reporting period.  Further information on the changes to the MEDS service can be found here.

Emergency Department

The Nobles Hospital Emergency Department (ED) surveillance monitors the number of daily visits to the ED for respiratory illnesses.  This data is gathered from the Medway hospital patient administration system using a selection of SNOMED codes.  The code selection for this data will be continuously monitored, and updates to this will be reflected in the report.

Figure 4: Weekly ED attendances for respiratory illnesses, 2019 – 2023.

Figure 5: Weekly ED attendances for respiratory illnesses, by age-group, 2023.

The number of ED attendances for respiratory illnesses decreased in week 13, compared to week 12.  Driven, in main, by decreased attendances from all age-groups except 65+.

Figure 6: Weekly ED attendance crude rate per 100,000 population, all ages, Isle of Man.

Figure 6 shows that the rate of ED attendances for respiratory illnesses decreased from 53.53 per 100,000 in week 12, to 44.01 per 100,000 in week 13.  This remains within baseline intensity activity levels (< 71.63 per 100,000).

Manx Care Testing

The Manx Care Infection Prevention & Control (IPC) team monitors the number of cases of a number of respiratory illnesses, from several sources.  Here, data shown is collected and collated by the IPC team weekly to inform surveillance of confirmed respiratory illnesses.  Figure 7 shows the number of cases for specified respiratory illnesses, recorded by week, in the various Manx Care settings.

Figure 7: Weekly number of positive tests from IPC sources*, by virus type.  IPC – Infection Prevention and Control.  Note:  IPC sources include Noble’s Hospital, Ramsey & District Cottage Hospital, Mannanan Court, and Community sources.  COVID-19 data is sourced from Noble's Hospital and Ramsey & District Cottage Hospital only.  Test results are from Lateral Flow Device (LFD) and PCR testing.

Figure 7 shows that, in week 13, all positive tests identified through the IPC pathways were Influenza A cases (n = 2), and RSV cases (n = 1).  This decreased Influenza activity over recent weeks reflects activity seen in England.¹

Mortality

A mortality dataset can be presented based on the underlying/ultimate cause of death codes from the International Statistical Classification of Diseases and Related Health Problems (ICD-10) or a condition appearing on a death certificate.  The ICD-10 approach considers all factors affecting the death; however, the external coding results in a significant delay in reporting.  A real-time picture of the death rate can be obtained from raw death certificate data that is available weekly however, variation between the two methods will exist.  To understand this further, a death certificate includes four sections: 

Part I:

(a) Disease or condition leading to death,

(b) Other disease or condition, if any, leading to I (a),

(c) Other disease or condition, if any, leading to I (b), and;

Part II: other significant conditions contributing to death but not related to the disease or condition causing it.

Mortality data can be presented by date of death or by date of registration.  The registration process may be delayed, for instance during an inquest.  In this report, the charts are based on the date of death rather than the date of registration.

Figure 8: Annual deaths by ICD-10 underlying cause code, per 1,000 total annual deaths, 2006 – 23.  Note: Data is calculated from year of death.  2006 – 2009 average is calculated as average annual deaths per 1,000 for underlying cause codes J00 – J99, U07.1, U07.2, and U08 – U10.  * - denotes year to-date.

Figure 8 shows that in 2023, to date, the number of deaths per 1,000 total deaths from respiratory cause codes is similar to that of 2020, 2021, and 2022.  The office for National Statistics imports all four sections of the death certificate data twice per year to assign an underlying cause code to the death certificate.  The results from this process are reported in the Public Health Mortality Report.

Figure 9: All-cause weekly deaths compared to baseline, with 2 and 3 standard deviation (SD) upper-thresholds, 2023 – 24.  Note: Baseline is calculated as the 10-year average of the corresponding week (2020 and 2021 have been excluded).

Figure 9 shows that, in week 11, the number of all-cause deaths remained below the 2 and 3 standard deviation thresholds, with expected deviation from the baseline due to the stochastic nature of small numbers seen in weekly deaths on the Isle of Man.

Seasonal Influenza Vaccination Statistics

Seasonal influenza (flu) is a contagious acute respiratory infection caused by influenza virus.  Typically, most people recover from symptoms within a week; however, some people may be more susceptible to developing serious illness or worsening of existing conditions.  The flu vaccination is available to those at a higher risk of complications.

The data presented here is intended to show vaccine programme progress.  During the winter period, the vaccination data will be updated on a monthly basis.

Figure 10: Number of influenza vaccination administered, and percentage of uptake, by vaccination cohort, as of 31 March 2024.

COVID-19 Vaccination Statistics

COVID-19 is a contagious respiratory illness caused by infection with a coronavirus, the symptoms of which can be very similar.  An individual’s likelihood of developing serious illness from COVID-19 depends on a number of factors, such as level of natural or vaccination induced immunity, age, and presence of co-morbidities.

Vaccination induced immunity for COVID-19 decreases over time, known as waning immunity.  The data presented here is intended to show vaccine programme progress, which began on 13 September 2023.  During the winter period, the vaccination data will be updated on a monthly basis.

Figure 11: Number of COVID-19 booster vaccines administered, and percentage of uptake, by vaccination cohort, as of 31 March 2024.

United Kingdom Update

Data provided in this section is from the latest UKHSA National Influenza and COVID-19 surveillance report.¹  The latest report shows that, in week 13, influenza activity decreased across all indicators, and COVID-19 activity decreased across most indicators. Respiratory syncytial virus (RSV) activity fluctuated at low levels across most indicators.

UKHSA Data Dashboard

The UKHSA data dashboard shows public health data across England, and is an iteration of the ‘COVID-19 in the UK’ dashboard.²  Initially, the dashboard presents data on respiratory viruses.  In the future, it will grow to present a wider range of data on public health topics.

The most recent data from the dashboard show mixed COVID-19 activity (in the most recent 7-days), with a decrease in cases (-13.6%), and deaths (-30.6%), but an increase in patients admitted (6.7%).  Weekly Influenza test positivity was 3.6%, with weekly hospital admission rates for influenza (per 100,000 trust catchment population) decreasing by 14.6% in the most recent 7-days.  Regarding wider respiratory viruses, Table 1 shows the latest weekly positivity for each virus.

UKHSA Winter COVID-19 Infection Study

The UKHSA, in partnership with ONS, is running the Winter Coronavirus (COVID-19) Infection Study between November 2023 and March 2024.  The study aims to provide information on the effects of COVID-19 on the lives of individuals, the community, and health services.  The Winter COVID-19 Infection Study will help understanding of potential winter pressures, acting as an early warning system to support the NHS and other services.³

The Winter COVID-19 Infection Survey has now ended, with a final publication on 14 March 2024. Published reports can be accessed through the Office for National Statistics (ONS) webpage and the UKHSA webpage.  Content below is taken from the final publication.

Data from the UKHSA Winter COVID-19 Infection Study shows that, on 6 March 2024, the estimated prevalence of COVID-19 in England and Scotland was 0.7% (95% credible interval [CrI]: 0.5% to 1.0%) compared to 0.8% (95% CrI: 0.7% to 1.1%) on 21 February 2024.  This estimated prevalence on 5 March 2024 corresponds to around 418,000 people infected, or 1 in 143 people.^1,4

Global Update

The latest data from the World Health Organisation (WHO) shows that globally, influenza activity continued to decline in most countries in the Northern Hemisphere, with small increases reported in some countries in North Africa, Central America, and the Caribbean.⁵

Regarding COVID-19, globally, during the 28-day period from 5 February to 3 March 2024, 76 countries reported COVID-19 cases and 46 countries reported COVID-19 deaths.  Note that this does not reflect the actual number of countries where cases or deaths are occurring as a number of countries have stopped or delayed reporting of these data.

From the available data, the number of reported cases and deaths have decreased during the 28-day period, with over 292 000 new cases and over 6200 deaths, a decrease of 44% and 51%, respectively, compared to the previous 28 days.  Trends in the number of reported new cases and deaths should be interpreted with caution due to decreased testing and sequencing, alongside reporting delays in many countries.⁶

Variants of Concern

Variant classification serves as an important communication tool for alerting countries about the emergence of SARS-CoV-2 variants with concerning properties likely to impact their epidemiological situation.

The ECDC utilises three categories of variant classification to communicate increasing levels of concern about a new or emerging SARS-CoV-2 variant, detailed in Figure 12:

• variant under monitoring (VUM); 

• variant of interest (VOI), and; 

• variant of concern (VOC)

Figure 12: ECDC Variants classification criteria, as of 29 June 2023.⁷.

As of 3 March 2024, ECDC has de-escalated BA.2, BA.4, and BA.5 from its list of SARS-CoV-2 variants of concern, as these parental lineages are no longer circulating.  There are currently no SARS-CoV-2 variants meeting the VOC criteria.⁸

The latest ECDC Communicable Disease Threats Report does not contain an update on SARS-CoV-2 variants of concern.  As of 15 March 2024, the variants of interest (VOIs) XBB.1.5-like and XBB.1.5-like+F456L have been re-merged into a single VOI designated XBB.1.5-like in ECDC's variant classifications since the levels of circulation of both VOIs are very low and because this simplifies the view in ERVISS. The variant landscape in the EU/EEA is clearly dominated by BA.2.86. As of 11 March 2024, the median proportion for BA.2.86 in the EU/EEA for week 8 (19 February 2024 to 25 February 2024) is 92.7% (range: 75.0100.0%). Among the five EU/EEA countries reporting at least 20 sequences to GISAID EpiCoV for week 8, the proportions of BA.2.86 lineages were as follows: France (92.7%), Germany (100.0%), Ireland (75.0%), Spain (92.3%) and Sweden (96.0%).⁹

The latest detailed list of variants can be found here: www.ecdc.europa.eu/en/covid-19/variants-concern 

Data disclaimer

While we have used reasonable efforts to ensure the accuracy of the data used within this report, the data is still provisional and may be subject to change and retrospective amendment as new systems become established, data become updated, and current code lists become update due to ongoing review.  The quality of data provided to Public Health by other organisations is the responsibility of the originating organisation.  Individuals may appear in multiple datasets since data is based on presentations rather than individuals.  This report will include additional surveillance information as it becomes available.

For any questions regarding this report, please contact publichealth@gov.im

Glossary of terms

References

1. National flu and COVID-19 surveillance reports: 2023 to 2024 season - GOV.UK. Accessed April 5, 2024. https://www.gov.uk/government/statistics/national-flu-and-covid-19-surveillance-reports-2023-to-2024-season 
   
   
2. UKHSA data dashboard. Accessed April 5, 2024. https://ukhsa-dashboard.data.gov.uk/ 
   
   
3. Winter Coronavirus (COVID-19) Infection Study - Office for National Statistics. Accessed April 5, 2024. https://www.ons.gov.uk/surveys/informationforhouseholdsandindividuals/householdandindividualsurveys/wintercoronaviruscovid19infectionstudy
   
   
4. Winter Coronavirus (COVID-19) Infection Study, England and Scotland - Office for National Statistics. Accessed April 5, 2024. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/wintercoronaviruscovid19infectionstudyenglandandscotland
   
   
5. Global Influenza Programme. Accessed April 5, 2024. https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/influenza-updates/current-influenza-update
   
   
6. COVID-19 Epidemiological Update - 15 March 2024. Accessed April 5, 2024. https://www.who.int/publications/m/item/covid-19-epidemiological-update-15-march-2024
   
   
7. ECDC SARS-CoV-2 variant classification criteria and recommended EU/EEA Member State actions – 29 June 2023. Accessed April 5, 2024. https://www.ecdc.europa.eu/sites/default/files/documents/ECDC%20SARS-CoV-2%20variant%20classification%20criteria%20and%20recommended%20Member%20State%20actions.pdf
   
   
8. SARS-CoV-2 variants of concern as of 15 March 2024. Accessed April 5, 2024. https://www.ecdc.europa.eu/en/covid-19/variants-concern
   
   
9. Communicable disease threats report, 24-30 March 2024, week 13. Accessed April 5, 2024. https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-24-30-march-2024-week-13