Laboratory surveillance of influenza
Surveillance of influenza virus infection at the European level requires close collaboration between virologists, epidemiologists and sentinel GP networks to generate the data necessary to inform a timely public health response.
Physicians who participate in sentinel networks take nose and/or throat swabs from a subset of patients with influenza-like illness (ILI) or acute respiratory infection (ARI). Some sentinel surveillance systems also collect blood samples (e.g. the Czech Republic, Romania and Slovakia). The specimens are sent to the national reference laboratory and are tested for influenza viruses (if positive, subtypes are determined) and other respiratory viruses. These results are used to validate the clinical reports of ILI and ARI.
The national reference laboratories also report influenza test results from non-sentinel surveillance to EISN. Specimens (nose swabs, throat swabs and blood samples) can come from a wide range of sources: hospitals, non-sentinel physicians, homes for the elderly, clinics, etc.
Characteristics of the virological surveillance systems participating in EISN
Updated November 2013
|
Country |
Location ref. lab |
Primary virus detection |
Virus detection: Culture eggs, type of cells |
Virus detection: Additional tests A |
Typing (A, B) |
Subtyping (H+N) |
Variant analysis |
|---|---|---|---|---|---|---|---|
|
Austria |
Vienna |
RT-PCR |
MDCK |
ELISA |
HI, NAT, ELISA |
HI, NAT |
HI, sequencing |
|
Belgium |
Brussels |
RT-PCR |
MDCK |
NAT, ELISA, other |
NAT |
HI, sequencing |
|
|
Bulgaria |
Sofia |
RT-PCR |
Eggs, MDCK |
IF |
HI, NAT, IF |
HI, NAT |
HI |
|
Croatia |
Zagreb |
RT-PCR |
Eggs, MDCK |
ELISA, IF |
HI, NAT |
HI, NAT |
|
|
Cyprus B |
Nicosia |
RT-PCR |
|
NAT |
NAT |
||
|
Czech Republic |
Prague |
RT-PCR |
Eggs, MDCK |
ELISA other |
HI, NAT, ELISA, IF other |
HI, NI, NAT |
HI |
|
Denmark |
Copenhagen |
RT-PCR |
MDCK |
HI, NAT |
HI, NAT |
HI, sequencing |
|
|
Estonia |
Tallinn |
RT-PCR |
MDCK |
IF |
NAT, IF |
NAT |
|
|
Finland |
Helsinki |
RT-PCR |
MDCK |
other |
HI, NAT other |
HI, NAT |
HI, sequencing |
|
France |
Lyon |
RT-PCR |
Eggs, MDCK, LLC-MK2 |
ELISA, other |
ELISA |
HI, NI, NAT |
HI |
|
France |
Paris |
RT-PCR |
MDCK |
ELISA |
NAT, ELISA |
HI, NI, NAT |
HI, sequencing |
|
Germany |
Berlin |
RT-PCR |
MDCK |
ELISA, IF other |
HI, NAT, ELISA IF |
HI NAT |
HI, sequencing |
|
Greece |
Athens |
RT-PCR |
MDCK-SIAT-1 |
NAT, ELISA |
HI, NAT, ELISA |
HI, NAT |
HI, sequencing |
|
Greece |
Thessaloniki |
RT-PCR |
Eggs, MDCK |
other |
HI, NAT |
HI, NAT |
sequencing |
|
Hungary |
Budapest |
RT-PCR |
Eggs, MDCK p/t-MK |
IF |
HI, NAT |
HI, NAT |
HI |
|
Iceland |
Reykjavik |
RT-PCR |
MDCK |
IF |
NAT, IF |
NAT, (HI) |
(HI) |
|
Ireland |
Dublin |
RT-PCR |
MDCK, other |
IF |
NAT |
NAT |
sequencing |
|
Italy |
Roma |
RT-PCR |
Eggs, MDCK |
IF, other |
HI, NAT, IF, other |
HI, NAT, IF |
HI, sequencing |
|
Latvia |
Riga |
RT-PCR |
MDCK |
IF |
NAT, HI, IF |
HI NAT IF |
HI, sequencing |
|
Lithuania |
Vilnius |
RT-PCR |
Eggs, MDCK |
IF |
NAT, IF |
||
|
Luxembourg |
Luxembourg |
RT-PCR |
MDCK |
other |
HI, NAT, other |
HI, NI, NAT |
HI |
|
Malta C |
Msida |
RT-PCR |
|
NAT |
NAT |
||
|
Norway |
Oslo |
RT-PCR |
MDCK |
other |
HI, NAT, IF |
HI, NAT, IF |
HI, sequencing |
|
Poland |
Warsaw |
RT-PCR |
Eggs, MDCK |
IF |
HI, NAT, IF |
HI, NAT |
HI |
|
Portugal |
Lisbon |
RT-PCR |
MDCK, MDCK-Siat1 |
HI, NAT |
HI, NAT |
HI, sequencing, NI |
|
|
Romania |
Bucharest |
RT-PCR |
Eggs, MDCK |
HI, NAT |
HI, NI, NAT |
HI, sequencing |
|
|
Slovakia |
Bratislava |
RT-PCR |
Eggs, MDCK |
HI |
HI, NAT |
HI |
|
|
Slovenia |
Ljubljana |
RT-PCR |
MDCK, other |
IF |
HI, NAT, IF |
HI, NI, NAT, IF |
HI |
|
Spain |
Barcelona |
RT-PCR |
MDCK, LLC-MK2 |
IF |
NAT, IF |
NAT, IF |
|
|
Spain |
Madrid |
RT-PCR |
Eggs, MDCK, other |
IF |
NAT, IF |
HI, NAT |
HI, sequencing |
|
Spain |
Valladolid |
RT-PCR |
MDCK, other |
IF other |
HI, NAT, IF |
HI, NAT, IF |
HI |
|
Sweden |
Solna |
RT-PCR |
MDCK |
NAT |
HI, NAT |
sequencing |
|
|
The Netherlands |
Bilthoven |
RT-PCR |
p/t-MK, MDCK-NBL2, MDCK-SIAT |
NAT |
NAT |
sequencing, NI fluorescent assay |
|
|
The Netherlands |
Rotterdam |
RT-PCR |
Eggs, MDCK p/t-MK, other |
IF |
HI, NAT, IF |
HI, NAT |
HI, sequencing |
|
United Kingdom |
Belfast |
RT-PCR |
NAT |
NAT |
|||
|
United Kingdom |
Cardiff |
RT-PCR |
RMix Too, MDCK |
/IF |
NAT, IF |
NAT |
|
|
United Kingdom |
Glasgow |
RT-PCR |
MDCK, LLC-MK2, other |
IF |
NAT, IF |
NAT |
sequencing |
|
United Kingdom |
London |
RT-PCR |
MDCK, other |
HI, NAT |
HI, NAT |
HI, sequencing |
Note: The UK is no longer part of the network from 01.01.2021
Key to abbreviations
|
CE |
Embryonated chicken eggs |
|
ELISA |
Enzyme-linked immunosorbent assay |
|
HI |
Haemagglutination inhibition assay |
|
IF |
Immunofluorescence |
|
LLC-MK2 |
Lewis Lung Carcinoma – monkey kidney cells |
|
MDCK |
Madin Darby Canine Kidney |
|
NAT |
Nucleic acid amplification technology |
|
NI |
Neuraminidase inhibition assay |
|
p/t-MK |
Primary/tertiary – monkey kidney |
|
RT-PCR |
Reverse transcriptase polymerase chain reaction |
Notes
A: All laboratories send a subset of virus isolates to the WHO Collaborating Centre for Reference and Research on Influenza (WHO-CC), London for confirmation and comparison with isolates from all over the world.
B: Cyprus is not an NIC and does not perform virus culture.
C: Malta is in the process of implementing virus culture.