As NHS braces for record flu cases, is the strain active in continental Europe too?

When does the flu season start?

In the northern hemisphere it normally runs from mid-November to mid-February, though it can start as early as October and run into May. Health officials call the start of the season when 10% of suspected cases test positive for flu. At the start of November, the figure in England was already at 11% compared with 3% at the same time last year. The season is thought to have started four to five weeks earlier than usual.

What is causing this year’s outbreak?

There are always multiple flu types in circulation. Seasonal flu is caused by influenza A and influenza B viruses. Common subtypes of influenza A are known as H1N1 and H3N2. In the UK, a form H3N2 is dominating the season so far. The virus is a descendant of a strain that this year caused Australia’s worst flu season on record. Since then, the strain acquired seven new mutations, producing what scientists call a drifted strain of H3N2, named subclade K. The mutations are thought to help it spread faster, although it does not seem to cause more severe disease.

What is happening in continental Europe?

It is a similar situation, but with some countries faring worse than others. Overall, the flu season started three to four weeks early on the continent, but in some regions the drifted H3N2 strain has only emerged as the main cause of infections in the past few weeks.

Figures released from Germany’s Robert Koch Institute this week show that the flu season started two to three weeks early in the country and, while both H1N1 and H3N2 forms of flu are in circulation, there has been a “clear increase” in H3N2 in the past three weeks.

In France, cases started a little later. Dr Vincent Enouf, deputy director of the National Respiratory Virus Center of France at the Pasteur Institute in Paris told the Guardian that the flu season started only a week earlier than usual, and that France was detecting as many H1N1 cases as H3N2 subclade K.

France’s national public health agency Sante publique said this week that flu activity was “increasing strongly” in metropolitan France, with cases rising in all age groups. All metropolitan regions are now in the epidemic phase for influenza – except Corsica, where cases remain lower. The number of people with flu seeking treatment at hospital emergency departments and the number of admissions have increased in the past week.

Elsewhere in Europe, in Spain cases are surging, with infection rates already higher than last year’s winter peak and hospitalisations doubling in a week. Romania and Hungary are also experiencing a surge in cases. In Ireland, nearly 3,000 cases were reported in the first week of December, up 49% on the week before, with hospital admissions up 58%.

How effective is the vaccine?

The mutations acquired by the drifted H3N2 flu virus mean that it is not recognised as well by the immune system and is not well matched to the H3N2 virus used in this year’s seasonal flu vaccine. As expected, data from the UK’s Health Security Agency show that the vaccines are less effective at blocking infections caused by the drifted H3N2, but they still provide useful protection against severe disease. The data from the start of England’s flu season show that protection against hospital attendance and admission was within the normal range for flu vaccines, at 70-75% for children and 30-40% for adults.

Despite the vaccine being less effective than hoped, health officials strongly recommend people have the shot to reduce their risk of severe illness. Nearly eight million French people have already had the flu vaccine, Enouf said, 21% more than at this time last year.

Data published by Sante publique this week show that among patients being treated for flu in intensive care units, 58% were aged 65 and older and 90% had at least one other medical condition. Of those whose vaccination status was known, 98% were not vaccinated. In Ireland, 73% of people admitted to intensive care for flu had not had this year’s flu vaccine.