Bi-weekly Influenza Situation Update

19 July 2023

Virological Surveillance Summary

The total number of specimens and number of positive specimens reported to FluNet by Western Pacific
Region countries and areas between week 1 and week 27 of 2023 are presented in Table 1 below.
Influenza A and B are co-circulating, however, the majority of cases reported to week 27 of 2023 have
been Influenza A (Figure 1). Caution should be taken when interpreting these data as there are reporting
delays.

Table 1: Cumulative data reported to FluNet from Western Pacific Region, week 1 to week 27, 2023
Total number of Total number of
Country (most recent week of report) specimens influenza-positive
processed specimens
Australia (27 of 2023) 114,004 4,288
Cambodia (27 of 2023) 2,376 313
China (27 of 2023) 678,007 119,039
Fiji (24 of 2023) 2,252 463
Japan (26 of 2023) - 2,767
Lao People’s Democratic Republic (27 of 2023) 3,020 277
Malaysia (27 of 2023) 23,354 4,271
Mongolia (25 of 2023) 10,092 1,532
New Caledonia - -
New Zealand (27 of 2023) 1,444 317
Papua New Guinea - -
Philippines (27 of 2023) 2,691 252
Republic of Korea (27 of 2023) 7,803 745
Singapore (27 of 2023) 7,146 1,473
Viet Nam (20 of 2023) 597 235

Figure 1: Number of specimens positive for influenza by subtype, Western Pacific Region,
week 27, 2022 to week 27, 2023 (Source: WHO FLUNET )

Influenza surveillance summary

Influenza surveillance in the WHO Western Pacific Region is based on outpatient and inpatient indicator-
based surveillance (IBS) systems, as well as event-based surveillance. Case definitions, population
groups included and data formats differ among countries. This influenza surveillance summary includes
countries and areas where routine IBS is conducted and information is available.
The WHO surveillance case definition for influenza-like illness (ILI) is an acute respiratory infection with
a measured fever of ≥38oC and cough, with symptom onset within the last 10 days. For SARI, it is an
acute respiratory infection (ARI) with a history of fever or measured fever of ≥38oC and cough, with
symptom onset within 10 days that requires hospitalization. Sentinel site data should be interpreted
with caution since the number of sites reporting may vary between weeks
Countries in the temperate zone of the Northern Hemisphere
In countries within the temperate zone of the Northern Hemisphere, ILI and influenza activity are similar
to the corresponding period from previous years.

Outpatient ILI Surveillance

China (North)
During week 27 of 2023, sentinel hospitals in the northern provinces reported ILI% of 2.9%, lower than
the last week (3.1%), and higher than the same week of 2020-2022 (2.0%, 2.5%, and 1.9%) (Figure 2).

Figure 2: Percentage of visits for ILI at sentinel hospitals in northern China, 2020-2023
(Source: China National Influenza Center)
Mongolia
During week 26 of 2023, the ILI activity in Mongolia decreased to 8 ILI cases per 10,000 population. This
is below the upper tolerance limit (Figure 3).

Figure 3: Proportion of outpatient ILI visits per 10,000 people in Mongolia, 2020-2023
(Source: Mongolia National Influenza Center)

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 Republic of Korea
In week 27 of 2023, the overall weekly influenza-like illness (ILI) rate was 16.3 per 1,000 outpatient
visits, which was similar to the rate recorded in the previous week (16.1) (Figure 4).
ILI (per 1,000 Outpatient Consultations)

Figure 4: Weekly ILI incidence rate per 1,000 outpatient consultations, Republic of Korea, 2018-2023
(Source: Korea Disease Control and Prevention Agency)

Sentinel influenza surveillance

Japan
In week 26 of 2023, the number of cases reported weekly by sentinel hospital sites remained low in
Japan. The number of cases in 2023 is consistently low (Figure 5).

Figure 5: Number of influenza cases reported weekly per reporting sentinel hospital site, Japan 2013-2023
(Source: Japan National Institute of Infectious Diseases)

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Countries/areas in the tropical zone
ILI and influenza activity is similar to the corresponding period from previous years in some of the
countries and areas in the tropical zone.
Hong Kong SAR (China) – ILI and hospital Surveillance
The latest surveillance data showed an increase in the overall seasonal influenza activity. In week 27,
the average consultation rate for influenza-like illness (ILI) among sentinel general outpatient clinics
(GOPC) was 2.6 ILI cases per 1,000 consultations, which was higher than 2.1 recorded in the previous
week (Figure 6). The average consultation rate for ILI among sentinel private medical practitioner (PMP)
clinics was 33.4 ILI cases per 1,000 consultations, which was slightly higher than 32.3 recorded in the
previous week (Figure 7).

Figure 6: ILI consultation rates at sentinel general Figure 7: ILI consultation rates at sentinel private
outpatient clinics, Hong Kong SAR 2020-2023 medical practitioner clinics, Hong Kong SAR 2019-2023
(Source: Hong Kong Centre for Health Protection) (Source: Hong Kong Centre for Health Protection)

China (South) - ILI Surveillance

During week 27, the percentage of outpatient or emergency visits for ILI (ILI%) at national sentinel
hospitals in southern provinces was 4.7%, lower than the last week (5.0%), higher than the same week
of 2020 and 2021 (2.8% and 3.7%) and the lower than the same week of 2022 (5.5%) (Figure 8).

Figure 8: Percentage of visits due to ILI at national sentinel hospitals in Southern China, 2019-2023
(Source: China National Influenza Center)

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Singapore – Acute Respiratory Infection (ARI) Surveillance
In week 27 of 2023, the average daily number of patients seeking treatment in the polyclinics for ARI is
2,211 (over 5.5 working days) (Figure 9). The proportion of patients with influenza-like illness (ILI)
among the polyclinic attendances for ARI is 0.3%. The overall positivity rate for influenza among ILI
samples (n= 846) in the community was 21.5% in the past 4 weeks. Of the 176 specimens tested positive
for influenza in Jun 2023, 103 were positive for Influenza A(H3N2) (58.5%), 60 were positive for
Influenza A(pH1N1) (34.1%), and 12 were positive for Influenza B (6.8%) (Figure 10).

Figure 9: Average daily polyclinic attendances Figure 10: Monthly influenza surveillance for ARI in
for ARI in Singapore, 2022-2023 Singapore, 2018-2023
(Source: Singapore Ministry of Health) (Source: Singapore Ministry of Health)

Lao PDR
During week 27 of 2023, the National Center for Laboratory and Epidemiology received data from all
seven sentinel sites in Lao PDR. The number of influenza-like illness cases presenting at sentinel sites
was 33 cases higher than the previous week. There were 100 samples tested for influenza in week 27,
2023. Influenza A/pdmH1N1 was identified (n=3) (Figure 11).

Figure 11: Weekly number of ILI cases at sentinel sites (2019 to 2023)
(Source: Lao National Center for Laboratory and Epidemiology)

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Cambodia
In week 26 of 2023, the Ministry of Health received data from 7 sentinel sites in Cambodia. During this
period, the number of ILI cases in Cambodia decreased slightly between week 25 (175 cases) and week
26 (165 cases) of 2023. Of the 13 samples collected, 6 (46.2%) samples were positive for influenza
A/H1N1pdm (Figure 12). The proportion of weekly influenza positive samples fluctuated in 2023.

Figure 12: Number of ILI samples from sentinel sites and influenza positivity rate
by the week, of 2020-2023, Cambodia
(Source: Communicable Disease Control Department, Cambodia Ministry of Health)

Countries in the temperate zone of the southern hemisphere

In the temperate zone of the southern hemisphere, influenza activity is reported during the influenza
season, usually starting in May in Australia and New Zealand.

Australia – Laboratory-confirmed influenza

In the year-to-date (1 January to 9 July 2023), there have been 149,989 notifications of laboratory-
confirmed influenza reported to the National Notifiable Diseases Surveillance System in Australia. There
were 32,132 laboratory-confirmed influenza notifications with a diagnosis date this fortnight (Monday
26 June to Sunday 9 July 2023), compared to 30,255 notifications in the previous fortnight. From March
2023 the number of notifications of laboratory-confirmed influenza has gradually increased. The
number of notifications year-to-date is higher than the 5-year average, and higher than observed in the
same period in 2019 (Figure 13).

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Figure 13: Notifications of laboratory-confirmed influenza by month and week from 2016 to 2023 in Australia
(Source: National Notifiable Diseases Surveillance System, Australian Department of Health)

New Zealand – ILI Surveillance

In the week ending on 2 July 2023, the influenza-like illness (ILI) general practitioner consultation rates
increased compared to the previous week (18.35 per 100,000 compared to 17.6 per 100,000) (Figure
14). The national rate is lower than that observed at this time in 2022 and the 2015-2019 period. County
Lakes recorded the highest rate of general practitioner ILI consultations, which is above the national
rate and higher than usual for this time of year. Rates in Manukau and MidCentral also remain above
the national rate. Influenza B and A(H1N1) are the viruses most commonly detected in community
surveillance in recent weeks.

Figure 14: Weekly rates of general practice ILI consultations per 100,000 people in New Zealand in 2015-2023
(Source: New Zealand Institute of Environmental Science and Research)

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Pacific Island Countries and Areas (PICs) - ILI Surveillance
There have been no updates since the previous report. In week 25 of 2023, 18 out of 21 PICs reported
ILI surveillance data. 16 out of 18 PICs reported updated data. No reports are available for American
Samoa, Guam, and Nauru, and no updates from Federated States of Micronesia and Tuvalu. The
following countries reported increased influenza-like illness activity in week 25 compared to the
previous week: Republic of the Marshall Islands, Fiji and Vanuatu. (Figure 15).

Cook Islands ILI Trend 2019 -2023 Fiji ILI Trend 2019 -2023 (WK 25)
(WK 25) 1600
70
1400
60
1200
50
1000
40
800
30
600
20
400
10
200

0
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

ILI 2023 ILI 2019 ILI 2020 ILI 2023 ILI 2019 ILI 2020

ILI 2021 ILI 2022 ILI 2021 ILI 2022 Baseline

French Polynesia ILI trend 2019 - 2023 FSM ILI trend 2019 - 2023 (WK 20)
1200
(WK 25)
700 1000

600
800
500
Cases
Cases

600
400

300 400

200
200
100
0
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Epi week Epi week
ILI 2023 ILI 2020
ILI 2023 ILI 2020 ILI 2021
ILI 2021 ILI 2019
ILI 2022 ILI 2019 ILI 2022

Kiribati ILI trend 2019-2023 (WK 24) Marshall Islands ILI trend 2019-2023
3500 (WK 25)
250
3000

2500 200
Cases
Cases

2000
150
1500
100
1000

500 50

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 0
Epi week 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
Epi week
ILI 2023 ILI 2020 ILI 2021 ILI 2023 ILI 2020 ILI 2021
ILI 2019 ILI 2022 ILI 2019 ILI 2022

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 CNMI ILI Trend 2019 -2023 (WK 25) New Caledonia ILI Trend 2019 -2023
140
700
(WK 25)
120
600
100
500
80
Cases

Cases
60 400

40 300

20
200
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 100

EPi week
0
ILI 2023 ILI 2020 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

ILI 2021 ILI 2022 ILI 2019 Epi week

ILI 2022 ILI 2023 ILI 2020 ILI 2021

Palau ILI Trend 2019 - 2023 (WK 25) Niue ILI Trend 2019 - 2023 (WK25)
200
25
180

160
20
140

120 Cases 15
Cases

100

80 10

60
5
40

20
0
0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 Epi week
Epi week
ILI 2023 ILI 2020
ILI 2023 ILI 2020 ILI 2021 ILI 2021 ILI 2019
ILI 2019 ILI 2022 ILI 2022

Pitcairn Islands ILI Trend 2019 - 2023 Samoa ILI Trend 2019 -2023 (WK 25)
(WK 25) 4000
5
3500

3000
4
Cases

2500
Cases

3 2000

1500
2
1000

1 500

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epi week
Epi week ILI 2023 ILI 2019 ILI 2020
ILI 2019 ILI 2020 ILI 2021 ILI 2022 ILI 2023 ILI 2021 ILI 2022

Solomon Islands ILI Trend 2019 -2023 Tokelau ILI Trend 2019 -2023 (WK 24)
(WK 25) 40
3500
35
3000
30
2500
25
Cases

2000
Cases

20
1500 15

1000 10

500 5

0
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
Epi week Epi week
ILI 2023 ILI 2019 ILI 2023 ILI 2019
ILI 2020 ILI 2021 ILI 2020 ILI 2021

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 Tonga ILI trend 2019 -2023 (WK 25) Tuvalu ILI trend 2019 -2023 (WK 21)
800 120

700
100
600
80
500
Cases

400 60

300
40
200

100 20

0
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Epi week
ILI 2023 ILI 2019 ILI 2023 ILI 2019
ILI 2020 ILI 2021
ILI 2020 ILI 2021 ILI 2022

Vanuatu ILI Trend 2019 - 2023 (WK25) Wallis & Futuna ILI trend 2019 to 2023
2000 (WK25)
1800 800

1600 700

1400 600
Cases
1200 500
Cases

1000 400

800 300
600 200
400 100
200 0
0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 Epi week
Epi week
ILI 2023 ILI 2019 ILI 2020
ILI 2023 ILI 2020
ILI 2021 ILI 2019 ILI 2021 ILI 2022
*Caution should be taken in interpreting these data as there may be changes in the number of sentinel sites reporting to the
Pacific Syndromic Surveillance System.
** FSM: Federated States of Micronesia, CMNI: Commonwealth of Northern Mariana Islands

Figure 15: Reported cases of influenza-like illness in Pacific Island Countries, 2019-2023
(Source: Pacific Syndromic Surveillance System Weekly Bulletin)

Global influenza situation updates

Virological update

Global update

Others:
• New recommended composition of influenza virus vaccines for use in the 2023 southern
hemisphere influenza season Link
• Recommended composition of influenza virus vaccines for use in the 2023-2024 northern
hemisphere influenza season Link
• WHO Consultation on the Composition of Influenza Virus Vaccines for Use in the 2023 Southern
Hemisphere Influenza Season 19-22 September 2022 Link
• WHO issues updated influenza vaccines position paper Link

WHO's YouTube Channel: film exploring a number of key aspects of the constant evolution of influenza
viruses and associated impacts on public health. Arabic, Chinese, English, French, Russian, Spanish

Influenza Situation Update| 10