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Saatja: "ECDC respiratory viruses" <[email protected]> Teema: Slides from the Pre-season European Region Respiratory Surveillance Network webinar Kuupäev: 2025-09-23 10:54 Tähelepanu! Tegemist on väljastpoolt asutust saabunud kirjaga. Tundmatu saatja korral palume linke ja faile mitte avada. To: National Focal Points for Viral Respiratory Diseases, Operational Contact Points Epidemiology, Microbiology and TESSy/EPC for COVID-19, Influenza and SARI CC: National Coordinators, Observer National Focal Points for Viral Respiratory Diseases in the Western Balkans and Türkiye, Contact Points for Epidemiology, Microbiology and TESSy/EPC for COVID-19, Influenza and SARI in the Western Balkans and Türkiye Dear colleagues, We are happy to share with you the slides presented during the Pre-season European Region Respiratory Surveillance Network webinar on 18 September 2025 at 10:30-12:30 CEST. With best wishes, The ECDC and WHO Europe and Respiratory Viruses Teams European Centre for Disease Prevention and Control (ECDC) Gustav III:s boulevard 40, 169 73 Solna, Sweden Phone +46 (0)8 58 60 10 00 www.ecdc.europa.eu Follow ECDC on: Confidentiality Notice If you are not the intended recipient of this message, you are hereby kindly requested, to, consecutively, refrain from disclosing its content to any third party, delete it and inform its sender of the erroneous transmittal. Classified as ECDC NORMAL Choose language - Выберите язык English Pусский Click Mute Original Щелкните на Mute Audio to hear only Original Audio, чтобы English. слышать только русскую речь. Start of season Respiratory Virus Surveillance Network Webinar 18 September 2025  Agenda Item Presenter 1. Welcome and opening remarks Marc-Alain Widdowson, WHO/Europe and Edoardo Colzani, ECDC 2. Southern Hemisphere Respiratory season Patrick Reading, WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia 3. Review of 2025 summer period Chair: Edoardo Colzani Overview: Nick Bundle, ECDC Malta: Maria-Louise Borg, Health Promotion and Disease Prevention, Department for Health Regulation Scotland: Ross McQueenie, Vaccine Effectiveness and Respiratory Inequalities, Public Health Scotland Spain: Susana Monge, National Centre of Epidemiology, Institute of Health Carlos III (ISCIII) 4. EpiPulse Cases – reporting PISA to RESPIQUAL Chair: Edoardo Colzani PISA: Piers Mook, WHO/Europe Timeline and Metadata: Luisa Hallmaier-Wacker, ECDC Demo: Claudiu Stancut, ECDC 5. Closing remarks Edoardo Colzani, ECDC 3 Upcoming schedule – 2025/2026 season Webinar Topic Timing Start-of-season September 2025 (today) Mid-season webinar January- February 2025 Late/End-of-season April-May 2025 Additional webinars on specific topics (e.g. EPC TBD metadata) ERVISS Publication week for 2025/2026 season Publication W52 (Dec 26) No ERVISS W01 (Jan 2) Publication moved to Monday 5 Jan 2026 W14 (Apr 3) No ERVISS W18 (May 1) Publication moved to Monday 4 May 2026 W20 (May 15) No ERVISS 4 Southern Hemisphere Respiratory season – Australian perspective Update on the influenza season in the Southern Hemisphere in 2025 Prof. Patrick Reading Director, WHO Collaborating Centre for Reference and Research on Influenza At the Peter Doherty Institute for Infection and Immunity [email protected]  SARS-CoV-2 in Australia • VIDRL at Doherty Institute is a reference laboratory in the WHO Coronavirus Network •COVID-19 vaccines are free to all people under the National COVID-19 Vaccine Program • Less adults have received COVID-19 vaccines in the last 12 months (11.1% compared to 13.9% in prior 12months), with decreased vaccine coverage across all age groups National Notifiable Diseases Surveillance System (NNDSS)  SARS-CoV-2 – variants circulating in Australia? SARS-CoV-2 Omicron sub-lineages by sample collection date, Jan 1 – September 7 • NB.1.8.1 is dominant sub-lineage in Australia in last month, >55% of all sequences Source: AusTrakka, NNDSS  What about RSV in Australia? • WHO CC Melbourne is a WHO reference laboratory for RSV • In Australia, the maternal RSV vaccine (Abrysvo®) is free under the National Immunisation Program (recommended for women at 28–36 weeks) • Recommended for other groups Source: NNDSS  Influenza notifications in Australia As at 10/09/2025 NNDSS  Receipt and analysis of influenza samples at WHO CC, Melbourne Receipt of samples by WHO CCs for detailed analysis Sample receipt WHO CC Melbourne (genetic, antigenic, epidemiological) Feb 1 – Sept 16, 2025 Country No of Samples Received Australia 7585 Bhutan 37 Brunei 60 Cambodia 45 Cook Islands 2 Fiji 21 Nepal 36 New Caledonia 73 New Zealand 144 Papua New Guinea 42 Singapore 74 Solomon Islands 6 South Africa 26 Sri Lanka 54 Thailand 21 Vanuatu 2 Total 8,228 US CDC (Atlanta) Crick (London) VIDRL (Melbourne) NIID (Tokyo) CNIC (Beijing) What viruses have been circulating in Australia in 2025? • So far this year, most viruses are A/H1N1pdm or influenza B viruses • In depth characterisation at WHO CCRRI indicates that the majority of recently circulating viruses are reasonably well matched to the current influenza vaccine • The A/H3N2 component of the seasonal influenza vaccine was updated for the Southern Hemisphere vaccine (SH) at the last WHO Recommendation Meeting for the SH vaccine  What about other countries in Asia or the Southern hemisphere? Cambodia Bhutan Brazil South Africa  A quick look at recent A/H1N1pdm viruses Vaccine strain •A/Victoria/4897/2022-like virus, clade 5a.2a.1, subclade D.  A quick look at recent A/H3N2 viruses Vaccine strain •A/Croatia/10136RV/2023-like virus, clade 2a.3a.1, subclade J.2.  A quick look at B/Victoria viruses Vaccine strain •B/Austria/1359417/2021-like virus, clade V1A.3a.2, subclade C  Summary • In Australia, we have moved from winter to spring and levels of influenza, SARS-CoV-2 and RSV are starting to decline. • The Australian influenza season saw predominantly A/H1N1pdm and lower levels of B/Victoria viruses. A/H3N2 was detected at low levels throughout the season. • In general, A/H1N1pdm circulation was high in the Southern Hemisphere, noting that A/H3N2 predominated in South Africa in the winter months. • Data from our WHO CC indicate that recently circulating viruses are generally well covered by current components of influenza vaccines for the Southern Hemisphere. • The WHO Consultation on the Composition of Influenza Vaccines for the Southern Hemisphere in 2026 will be held in Japan next week. Review of 2025 summer period Reflections from European level surveillance during summer 2025 Nick Bundle, ECDC  Reflections from European level summer surveillance 2025 1. How best to assess the situation during periods of low respiratory activity? 2. What has been the impact of COVID-19 in secondary care over the summer? 3. Seasonality and thinking ahead 20 1. How best to assess the situation during periods of low respiratory activity? H 1. How best to assess the situation during periods of low respiratory activity? • Rising primary care test positivity was hard to interpret while ARI/ILI was baseline in all countries • Most country level data initially very noisy and based on v low counts of detections • Single large country driving up the pooled line above the 75th centile of country values H 1. How best to assess the situation during periods of low respiratory activity? • Non-sentinel lab-based surveillance data was extremely useful in early summer period • Smoother trends that were detected much earlier than ILI/ARI virological data • Still unclear why the syndromic systems hadn’t detected anything • What would be the impact on severe disease? 23 2. What has been the impact of COVID-19 in secondary care over the summer? 24  2. What has been the impact of COVID-19 in secondary care over the summer? SARI virological surveillance • Used proxy SARI rates internally as part of our weekly assessment H 2. What has been the impact of COVID-19 in secondary care over the summer? • Proxy rates were lower than last summer • Hospital lab-based data also suggested lower in many countries • But....what will come next? 26  3. Seasonality and thinking ahead • Timing of 2025 summer COVID-19 has • In 2024 the impact in SARI continued long into the closely matched that of summer 2024 winter 27  3. Seasonality and thinking ahead • RSV - another summer without early activity. • Influenza - limited summer detections overall More evidence of return to normal seasonality? with some exceptions Eurosurveillance | An interseasonal outbreak of influenza A(H1N1)pdm09 related to a music festival, Denmark, August 2025 28 COVID-19 in Scotland 2024-25 Ross McQueenie – Acting lead healthcare scientist in vaccine effectiveness and respiratory inequalities 18 September 2025 Wastewater Surveillance  Wastewater-based surveillance National running average trends in wastewater RNA up to 28th August 2025. For this graph, a Situation up to 28th August 2025: wastewater RNA average using the last 7 days of data is computed at every sampling date. Prevalence estimates and 95% confidence intervals from the ONS Coronavirus Infection Survey is overlaid, with a • During the one-week period of 22 August 2025 scale chosen to approximately match post-July 2022 trends in WW viral RNA level. to 28 August 2025 levels ranged between 34 and 49 Mgc/p/d, while in the previous week (15 August 2025 to 21 August 2025) levels were 49 to 52 Mgc/p/d. • COVID-19 RNA wastewater levels increased gradually over summer 2025, though remained at lower levels than in the previous summer. • RNA levels in wastewater continue to circulate at reduced levels. This remains consistent with other PHS indicators, including hospital admissions. Quality control (QC) samples (with a known quantity of virus) are PCR-tested alongside surveillance samples to assess changes in RNA recovery efficiency. When comparing estimates of RNA levels across surrounding sampling dates, this can indicate "batch" effects, whereby unusually high RNA recovery rates most likely explain the observed rise. See Public Health Scotland COVID-19 Statistical Report for further details: https://publichealthscotland.scot/our-areas-of-work/covid-19/covid-19-data-and-intelligence/covid-19-weekly-report-for-scotland/. Laboratory Surveillance  COVID-19 PCR/LFD cases • Among PCR tests, PCR positivity (7-day Daily number of PCR testing and proportion PCR positive average) increased in the most recent week (from 9.89% to 10.69%, 414/3873). • Summer 2025 COVID-19 incidence showed a small peak around week 25 – consistent with PCR test positivity around the same time. Incidence was lower than in previous seasons. COVID-19 incidence rate (per 100,000 population), seasons 2022/2023 to 2024/2025 Note: As of 4th June 2024, asymptomatic testing of those being discharged from hospital into the residential care setting has ceased. Secondary Care Surveillance  COVID-19 Hospital Admissions and Inpatients • The number of hospital admissions (RAPID) have decreased, and inpatient numbers have increased (7-day average of 144 inpatients on the 24th August compared with 177 inpatients on the 31st August). • Admission rates have increased in the under 18, 40-49, 50-54, 55-59, 60-64 and 75-79 age groups and decreased or remained consistent in all other age groups. • COVID-19 hospital admissions for all age ranges remained low over summer 2025 but, as in other indicators, appear to be increasing in recent weeks. Data Sources: Hospital Admissions – RAPID, Hospital Inpatients – PHS COVID-19 admission definition: PCR confirmed episode of COVID-19 infection that is community acquired (up to 14 days before or within 2 days of admission). This includes emergency admissions (except for patient injury codes) and medical and paediatric specialities only. Inpatients were counted for 28 days after testing positive prior to 08 May 2023 and then up to 10 days after testing positive following 08 May 2023 (shown as red line in the admissions and inpatients chart)  COVID-19 ICU inpatients • Numbers of ICU inpatients with a PCR- confirmed SARS-CoV-2 infection have decreased overall since autumn 2021. • There has been an increase (from 59 to 64) in the total number of ICU inpatients with a PCR-confirmed SARS-CoV-2 infection in the most recent week (w/c 18th August and w/c 25th August). • The total number of ICU inpatients clinically diagnosed with COVID-19 between w/c 11th August and w/c 18th August remained consistent (19 to 19) and increased (19 to 20) between w/c 18th August and w/c 25th August. • No noticeable increase in ICU inpatients over summer 2025. Data Sources: SICSAG ICU report Since 21st Oct 2020, a COVID-19 related ICU admission is identified as follows: A patient who has tested positive for COVID at any time in the 21 days prior to admission to ICU, or who has tested positive from the date of admission up to and including the date of ICU discharge. Mortality  NRS COVID-19 deaths • There were 7 deaths where COVID-19 was listed on the death certificate in the last week (deaths registered between the 18th August and 24th August), this is 3 more than the previous week. • Deaths have increased in the 75-84 and 85+ age groups and remained consistent in all other age groups in the most recent week. • Most COVID-19 related deaths continue to occur in hospital. There were no care home deaths in the most recent week. • COVID-19 mortality remained at low levels for all age groups over summer 2025. Source: https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/weekly-and-monthly-data-on-births-and-deaths/deaths-involving- coronavirus-covid-19-in-scotland Note: Updated NRS death data are published on Thursday morning. Vaccine Effectiveness COVID-19 Vaccine Effectiveness against Covid 19 hospitalisation among adults aged 65 years and above in Scotland, 2024-2025 Winter Season • The 2024–2025 autumn/winter COVID-19 Vaccine effectiveness (VE) against COVID-19 hospitalisation vaccine offered moderate protection among those aged 65 years and above, with 95% Confidence Intervals against hospitalisation in adults aged 65 and over, with some evidence of waning of protection since time of vaccination after 180 days. • Over the winter period adjusted VE Waning of vaccine effectiveness against COVID-19 hospitalisation against COVID-19 hospitalisation was in those aged 65 and above with 95% confidence intervals 42% (95%: 32- 50%) for those aged 65 and above. • Vaccine effectiveness peaked at 15 to 59 days after vaccination at 44% (95%: 31- 55%), before decreasing to 30% (95%: 11- 45%), after more than 180 days.  Vaccine effectiveness of the maternal RSV vaccine against severe disease in infants in Scotland • Maternal RSV vaccine effectiveness was 82.9% (95% CI: 75.9-87.8%) against RSV-associated lower respiratory tract infection (LRTI) hospitalisation for infants ≤90 when mothers were vaccinated at least Maternal RSV Vaccine Effectiveness (%) against RSV-related LRTI 14 days before their birth. hospitalisation in infants aged ≤90 days • 228 (95%CI: 197-252) fewer RSV-related LRTI hospitalisations in infants aged ≤90 days between August 2024 and March 2025. • Vaccine effectiveness high among preterm infants (<37 weeks: 89.2%, 95%CI: 52.2-97.6) who are most vulnerable to severe disease. • Women who were vaccinated and gave birth within 14 days were not able to offer protection to their infants against hospitalisation (29.6%, 95%CI: -19.6–58.6). Conclusions • ECOSS surveillance of COVID-19 shows low incidence in the year to date, with no large peaks observed unlike previous seasons. However, infections are likely to increase towards the end of the year, and case positivity is rising. • Hospital, inpatient and ICU admissions remain at low levels for all age groups. For ICU, levels remained low both when analysing positivity or reason for admission • COVID-19 related mortality remains low. Most deaths are ed in hospitals, and no deaths were ed in care homes •The COVID-19 vaccine offers effective protection against COVID-19 related hospitalisation in those aged over 65 years old. Protection peaked between 15 and 59 days, and remained up to 180 days. • We have also been able to show, for the first time, that the RSV maternal vaccine is highly effective in preventing RSV related hospitalisation in those aged up to 3 months, and in premature babies. There was no protection against hospitalisation observed in those who gave birth within 14 days of receiving the RSV vaccine.  Use of pathogen-specific proxy indicators in SiVIRA surveillance (Spain) Susana Monge National Centre of Epidemiology Institute of Health Carlos III (ISCIII) [email protected] SiVIRA design in a nutshell Syndromic surveillance Systematic surveillance • All ARI/SARI cases • Oportunistic but representative sampling of all • Based on extraction of diagnotic syndromic cases: codes (ICPC, ICD) ✓ First 2-5 attending PC each week ✓ Admitted to hospital on pre-defined weekdays • Triple PCR • Virological characterisation if positive • Additional information (clinical, vaccination) Weeky ARI/SARI incidence rate Proportion positivity of ARI/SARI cases to: ✓ influenza ✓ SARS-CoV-2 ✓ RSV  Estimating proxy indicators proxy pathogen,week = ARI/SARI rate week x positivity pathogen, week • Need to account for region, age and sex: Example of the PC network in one region ✓The size of the sentinel network varies by region ✓Neither the syndromic nor the systematic samples necessarily have the same age distribution as the population ✓Incidence rates are generally higher for females in PC and for SARS-CoV-2 at hospitals for males  Estimating proxy indicators weekly Strata region age- sex ARI/ Catchment Total Weighting Weighted Positivity pathogen- (i) group SARI population population factor ARI/SARI (%) to specific cases cases pathogen ARI/SARI cases 1 1 <1 F a1 b1 B1 w1 = B1/b1 aw,1 = a1*w1 p1 ap,1 = aw,1 *p1 2 1 <1 M a2 b2 B2 w2 = B2/b2 aw,2 = a2*w2 p2 ap,2 = aw,2 *p2 3 1 1-4 F a3 b3 B3 w3 = B3/b3 aw,3 = a3*w3 p3 ap,3 = aw,3 *p3 4 1 1-4 M a4 b4 B4 w4 = B4/b4 aw,4 = a4*w4 p4 ap,4 = aw,4 *p4 5 1 5-9 F a5 b5 B5 w5 = B5/b5 aw,5 = a5*w5 p5 ap,5 = aw,5 *p5 … … … … … … … … … σ𝒊=𝑰 𝒊=𝟏 𝒂𝒑 𝒊 Weekly pathogen-specific-proxy = , σ𝒊=𝑰 𝒊=𝟏 𝑩𝒊 Advantages of pathogen-specific proxy indicators • Syndromic surveillance is unspecific • Positivity depends on what else is circulating (very low incidence of a single pathogen may result in 100% positivity) • High comparabilty across the three pathogens, flexibility to include others • Only way for pathogens with unspecific clinical presentation (i.e. RSV in the elderly) Use of proxys for ARI cases routine surveillance • COVID-19 summer wave in Primary Care SARS-CoV-2 positivity proxy incidence SARS-CoV-2 Use of proxys for SARI cases routine surveillance • COVID-19 summer wave at hospitals SARS-CoV-2 positivity SARS-CoV-2 proxy hospitalisation  Use of proxys to estimate burden of disease Primary care Hospitals  Use of proxys to estimate intensity and severity* Primary care * Not used for this objective in Spain, explotatory results prepared for this presentation Challenges of pathogen-specific proxy indicators • Unstability of positivity when using multiple strata → wider age-groups, statistical models • The systematic sample is not truly representative of all syndromic cases ✓ Quality of coding in non-trained physicians ✓ Physicians preferably select for systematic testing ILI cases among all ARIs ✓ At hospitals, acute onset in the last 10 days is checked for systematically selected cases but not for syndromic cases • Influenza-ARI estimated with proxys is 2-3 times higher that incidence of ILI  ILI vs. influenza-ARI-proxy ILI codes-based influenza-ARI-proxy Conclusions on pathogen-specific proxys • Combined assessment of syndromic rates and positivity • Relies on the asumption that testing is systematic • Unstability in the positivity can result in unstable proxys • Coherent assessment of the three viruses in PC and hospitals • They may overestimate incidence compared to other indicators (ILI incidence) - different things are being measured • Complicates communication: different indicators Acknowledgements SiVIRA and RELECOV collaborators in the National Centre of Microbiology, National Centre of Epidemiology and Spanish Autonomous Communities Thank you for your attention! Susana Monge National Centre of Epidemiology Institute of Health Carlos III (ISCIII) [email protected], [email protected] Influenza trends in Malta 2022-W40 to 2025-W37 Presented by: Dr. Maria-Louise Borg Infectious Disease Control and Prevention Unit Health Promotion and Disease Prevention Directorate Ministry for Health and Active Ageing Malta 18 September 2025 What are the possible driving factors? • Most densely populated country in the EU • Population of 574,250 (30% are foreign) • Over 10,600 new residents in 2024. 76% of them coming from outside EU • Increase of 38% in population since 2011 and of 14% in the last 5 years • Largest age group in 20-39 years and males • EU. Mass gatherings International festivals, concerts and religious festas starting from June till September Travel (inbound and outbound) • MT received 3,563,618 tourists in 2024, almost half a million more than the year before. • Very dynamic population with increased travel by residents outside of Europe coupled with high influx of TCNs Outbreaks in Institutions • Outbreaks especially in healthcare facilities and in Homes of the Elderly • Lack of staff / HCWs • High staff turn over compromising infection control training • Challenges in isolation and containment due to lack of space • LTCFs at full capacity Other challenges • Small MS – limited expertise and resources • Tests carried out by centralised Molecular diagnostics lab at the Pathology Dept of the main general hospital - primarily a clinical lab and not PH • Lack of capacity (HR and space) to be able to store samples and perform WGS • Strained healthcare system due to population increase PH measures • Vaccination campaigns held annually to encourage population, especially vulnerable to take up Flu/COVID vaccination. Kick off campaigns from October. • Campaigns focused on respiratory illness prevention. These campaigns emphasize the importance of staying home when unwell, sneezing into a tissue, and frequent hand washing. • Circular to doctors to alert and keep informed. Case Definitions: Influenza Case Hospitalisation Patient who tested positive for influenza by RT-PCR. Hospital ward admission of patients who tested Result is valid for 30 days unless different influenza positive for influenza within 14 days prior to admission type/subtype is detected. or during hospitalisation period. Readmissions are reported and included. ICU admission Death If patient was admitted to ICU ward during hospital Patient who died within 14 days after testing positive admission in where patient tested positive for for influenza influenza 14 days prior to admission or during OR hospitalisation period prior or while being admitted to died as an outcome of hospital admission (where ICU. patient tested positive for influenza 14 days prior to admission or during hospitalisation period). Cause of death is not reported quickly enough for timely use. Data include both SARI and non-SARI cases in Malta.  Thank you Acknowledgements IDCU Team: Tanya Melillo; Ausra Dziugyte Pathology Department: Chris Barbara; Graziella Zahra EpiPulse Cases – reporting PISA to RESPIQUAL  WHO Pandemic Influenza Severity Assessment (PISA) • Assess severity of current influenza relative to previous years by using historical data to set thresholds that then allow for the qualitative categorization of such activity. • Updated WHO PISA guidance published in May 2024  Option to report syndromic and/or influenza-specific assessments (except seriousness of disease)  7 PISA indicators (4 influenza specific, 3 syndromic)  Expanded parameter lists for PISA indicators  French and Spanish versions published. Russian to follow shortly. • PISA data collected in EpiPulse Cases from the 2025/26 season via RESPIQUAL subject • Replacing collection of first version PISA indicators in TESSy https://www.who.int/teams/global- influenza-programme/surveillance- and-monitoring/pandemic-influenza- • Uploaded weekly to WHO/HQ by WHO/EURO and used in real time by both teams severity-assessment • Global WHO dashboard for visualizing data (available via the PISA landing page once launched) 45  WHO Pandemic Influenza Severity Assessment (PISA) PISA update indicators Description (full description of parameters and Frequency of methods in the guidance) submission Transmissibility - influenza Measure of how many people get sick with influenza or Weekly respiratory viruses and reflects the ease of movement of Transmissibility - syndromic respiratory viruses between individuals and communities Morbidity & mortality - influenza Measure of the level of serious disease and death in the population due to influenza or acute respiratory disease Morbidity & mortality - syndromic Impact on healthcare capacity - influenza Describes of how the epidemic or pandemic is affecting health care system capacity Impact on healthcare capacity - syndromic Seriousness of disease of influenza Describes the extent to which individuals become ill when Twice per season infected with an influenza virus only (peak & end weeks) • All PISA indicators have supporting confidence and comment fields available for providing certainty and context to submissions (also displayed on public facing global dashboard) • Threshold approaches used to define 5 categories for 6 of 7 indicators (seriousness of disease has no baseline category):  No activity or below epidemic threshold<Low<Moderate<High<Extraordinary 46  WHO Pandemic Influenza Severity Assessment (PISA) • Mapping of additional TESSy data planned to populate gaps in PISA reporting for transmissibility indicators  Opt-out on request ([email protected]) • Transmissibility – influenza  Influenza intensity qualitative indicator to populate indicator where no data submitted for a season by a country  definition of intensity aligns with parameters for transmissibility - influenza • Transmissibility – syndromic Intensity levels of ILI or ARI data (preferential order) used to populate indicator where no data submitted for a season by a country • WHO/EURO can provide support in implementing PISA guidance and threshold setting (MEM, WHO method or other preferred approach) 47  EpiPulse Cases Timeline Year recordtypes/subject codes Approximate date RESPIQUAL data Late September (launch) 2025 INFLZOO (zoonotic influenza subject codes)* Training September and October RESPI (RESPIAGGR, RESPISURV, RESPISEVERE) Approx. June (launch) 2026 SARI (SARISURV, SARISURVDENOM, INFLSARIAGGR) Training May and June INFLCLIN, INFLANTIVIR 48 EpiPulse Cases Timeline - RESPIQUAL Date Activity 18 September Start-of-season webinar which includes a demo of EpiPulse Cases 19 September TESSy reporting of PISA variables is deactivated in INFLCLIN 23 September New subject code are launched in EpiPulse Cases. Data can now be reported. 30 September Network workshop EpiPulse Cases reporting for PISA data – live demo and Q&A 49  Access and permissions The nominated users that currently have access to reporting routine respiratory virus data to TESSy will have access for EpiPulse Cases reporting Changing user access: User Access EU/EEA countries National Coordinator should nominate the user in ECDC Stakeholder Relationship Management system (SRM) Non-EU enlargement countries Check ECDC cooperation framework with your country for with a cooperation frameworks in information on how to initiate nomination process place Other non-EU/EEA countries Please contact WHO Regional Office which then sends a request by email to ECDC Country Cooperation 50  Reporting protocol The latest reporting protocol can be downloaded from EpiPulse Cases platform. On the support page, there will be a section for 'Respiratory viruses' with the reporting protocol and other tools (e.g. webinar ings). 1 EVD example The reporting protocol will also be available on the ECDC website (LINK). Metadata – access the latest version The latest metadata can be downloaded from EpiPulse Cases platform. 1 2 We encourage all users to always download the most up-to-date metadata and reporting protocol to ensure you are looking at the most recent version. 52  Metadata - RESPIQUAL Standard EPC variables Variable name Description Coded Values Health Topic The code of the health topic that is being reported RESPI = Respiratory viruses Reporting Country The country reporting the DELETE = Delete a previously reported . Status Will be selected based on your entry when uploading data NEW/UPDATE = Update a previously reported (default) SubjectCode is a reporting model for a disease/health topic RESPIQUAL = Respiratory virus - qualitative Subject Code indicators Unique identifier for each – selected and generated by the National Id country reporting the . --> Further detail in subsequent slides The data source (surveillance system) that the originates from. The DataSource value must be a special reference value from Data Source EpiPulse Cases metadata. 54  Metadata - RESPIQUAL Epidemiological variables Variable name Description Coded Values The reference week (yyyy-Www) for the reported qualitative Date used for statistics indicator. Pathogen or syndrome that applies. INFL = Influenza Pathogen or syndrome SYND = Syndromic Surveillance type Type of surveillance system. PISA = PISA IMPACT = Impact on healthcare capacity Please select the qualitative indicator that you would like to MORB = Morbidity and mortality Qualitative indicator report. The reporting protocol includes considerations for each SERIOUS = Seriousness of disease qualitative indicator. TRANS = Transmissibility 1 = No activity or below epidemic threshold Please select the value corresponding to the selected 2 = Low Qualitative value combination of pathogen/sydrome, surveillance type and 3 = Moderate qualititive indicator. 4 = High 5 = Extraordinary Level of confidence for the qualitative value reported for the H = High Confidence selected combination of pathogen/sydrome, surveillance type L = Low and qualititive indicator. M = Medium Information should be included on any factors which may have Comment influenced the assessment. 55  Metadata - Example Health Reporting DateUsed Pathogen Surveillance Qualitative Qualitative Confid Status SubjectCode NationalId DataSource Topic Country ForStatistics Syndrome Type Indicator Value ence INFL2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 INFL PISA TRANS 2 M W07PISATRANS SYND2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 SYND PISA TRANS 3 M W07PISATRANS INFL2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 INFL PISA MORB 1 L W07PISAMORB SYND2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 SYND PISA MORB 1 L W07PISAMORB INFL2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 INFL PISA IMPACT 1 H W07PISAIMPACT SYND2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 SYND PISA IMPACT 1 L W07PISAIMPACT 56  Metadata - Example Health Reporting DateUsed Pathogen Surveillance Qualitative Qualitative Confid Status SubjectCode NationalId DataSource Topic Country ForStatistics Syndrome Type Indicator Value ence INFL2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 INFL PISA TRANS 2 M W07PISATRANS SYND2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 SYND PISA TRANS 3 M W07PISATRANS INFL2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 INFL PISA MORB 1 L W07PISAMORB SYND2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 SYND PISA MORB 1 L W07PISAMORB INFL2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 INFL PISA IMPACT 1 H W07PISAIMPACT SYND2025- RESPI CY NEW/UPDATE RESPIQUAL CY-RESPIQUAL 2025-W37 SYND PISA IMPACT 1 L W07PISAIMPACT Make sure the NationalID is unique to each row reporting. In this example, PathogenSyndrome, DateUsedForStatistics, SurveillanceType and QualitativeIndicator are combined to make create the NationalId. 57 Training session for EpiPulse Cases - RESPIQUAL European Centre for Disease Prevention and Control Training session for EpiPulse Cases - RESPIQUAL Agenda EpiPulse Cases DEM O  Access and general navigation  Reporting options  Data preparation  Upload and technical validation  EpiPulse Cases Data validation report  Approval or Rejection of submitted data  Post go-live support description and where to contact us  Q&A EpiPulse Cases Training 2  EpiPulse Cases live demo Where to find Reporting Upload and EPC Data General Approval or Options Prepare data tech validation EpiPulse Cases Navigation Rejection validation report Where to find EpiPulse Cases EpiPulse Cases Training 3  EpiPulse Cases login and access External users need to use this window to add their credentials Login Users can use the following url https://epipulse.ecdc.europa.eu/epipulsecases/app/ and get redirected to the login page EpiPulse Cases Training 4 EpiPulse Cases and TESSy Access is still available in both EpiPulse Cases and TESSy applications and recordtypes NOT yet migrated in EpiPulse Cases will still be reported in TESSy. The latest version of TESSy metadata contains the list with all diseases and subject codes (record types) to be reported there. As metadata format is different between EpiPulse Cases and TESSy, if you report TESSy data to EpiPulse Cases (or the other way around), the validation will fail. EpiPulse Cases Training 5 EpiPulse Cases and TESSy The platforms have a different look and feel! EpiPulse Cases Training 6  EpiPulse Cases live demo Where to find Reporting Upload and EPC Data General Approval or Options Prepare data tech validation EpiPulse Cases Navigation Rejection validation report General navigation EpiPulse Cases Training 7  EpiPulse Cases main page EpiPulse Cases Training 8  EpiPulse Cases live demo Where to find Reporting Upload EPC Data Approval Help General Prepare Options and tech validation or EpiPulse Cases documentation Navigation data validation report Rejection Reporting options EpiPulse Cases Training 9  EpiPulse Cases reporting options EpiPulse Cases Training 10 Manually create a record wizard EpiPulse Cases Training 11 Manually create a record wizard Preview and Submit EpiPulse Cases Training 12  Steps for reporting to EpiPulse Cases Status workflow for an approved submission Report data • prepare data according to metadataset Prepare • csv or other file, or manual entry Get the status Tech validation successful • upload data in EpiPulse Cases • validate data against metadata rules • review errors and warnings Upload and Start Data validation • correct any errors/re-submit validate process • start EpiPulse Cases data validation and generate the EpiPulse Cases data validation report • review inconsistencies (metadata + cross-field) Get the status Data • check the completeness section validation report ready Analyse • check the overview section and review Review the data validation report and Approve • If validation OK, approve • If validation not OK, reject, correct data, upload+check again Finalise Get the status Data change approved EpiPulse Cases Training 13  EpiPulse Cases live demo Where to find Reporting Upload and EPC Data General Approval or Options Prepare data tech validation EpiPulse Cases Navigation Rejection validation report Prepare data EpiPulse Cases Training 14 EpiPulse Cases Upload and Analyse Prepare Finalise validate and review Prepare – Creating and editing a CSV • Assure the content of the file (variables and reference data) is the same with the latest metadata version available in the Help menu • Make sure your file is CSV, XML or ZIP of CSV and XML • Check that your file size is up to 4GB • If you manually edit the CSV file pay attention to date formatting when saving. Windows and Mac regional settings might affect date formatting when editing and saving CSVs with Excel (check the EpiPulse Cases guide to find the best alternatives on how to edit CSVs.) EpiPulse Cases Training 15  EpiPulse Cases live demo Where to find Reporting Upload EPC Data Approval Help General Prepare Options and tech validation or EpiPulse Cases documentation Navigation data validation report Rejection Upload and Tech validation (error management) EpiPulse Cases Training 17 EpiPulse Cases Upload and Analyse Prepare Finalise validate and review Upload and validate • Make sure you add your start and end reporting dates • If the status of your submission after upload is Tech validation failed, click on the status, open the timeline pop-up and check the errors and warnings identified. Make sure you correct all the errors and address all the warnings • If the status of your submission after upload is Tech validation successful you can start the EpiPulse Cases data validation process and view the EpiPulse Cases data validation report EpiPulse Cases Training 18  EpiPulse cases – Tech validation traps Tech validation failed status suggests that errors were identified in the submitted CSV file. To solve the errors the tech validation messages must be verified to understand the type and the location of the errors inside the file Most frequently error types: • Wrong date format or wrong date order: • Missing permissions to submit data: EpiPulse Cases Training 19 EpiPulse Cases – steps to follow to solve Tech validation errors 1. Click on the status value (Tech validation failed) and the Details tab will open 2. In the Details tab you will see a status timeline, click on the ‘View errors’ button in the Tech validation failed box 3. Carefully read the error messages and solutions or download the Error csv file 4. Correct the errors in the original data 5. Upload the corrected CSV file with corrected data EpiPulse Cases Training 20  EpiPulse Cases live demo Where to find Reporting Upload EPC Data Approval Help General Prepare Options and tech validation or EpiPulse Cases documentation Navigation data validation report Rejection EpiPulse Cases Data validation report (data quality management) EpiPulse Cases Training 21 EpiPulse Cases Upload and Analyse Prepare Finalise validate and review Review the analysis results and finalise with the approval or rejection of your submission • Before finalising the submission, make sure you review all sections of the EpiPulse Cases data validation report and identify any unwanted data quality issues • The last step in the entire submission process is the Approval or Rejection of the submitted data. This can be done only by users with the Approve role active • The confirmation of approval will save the submitted data and will make it available for future analysis • The confirmation of rejection will remove the submitted data and will permit users to address potential issues identified during data validation and repeat the submission EpiPulse Cases Training 22 EpiPulse Cases data validation report EpiPulse Cases Training 23  EpiPulse Cases live demo Where to find Reporting Upload and EPC Data General Approval or Options Prepare data tech validation EpiPulse Cases Navigation Rejection validation report Approval or Rejection EpiPulse Cases Training 24 EpiPulse Cases data validation report approval EpiPulse Cases Training 25  Live demo of EpiPulse Cases EpiPulse Cases Training 26  Support EpiPulse Cases Training 27 EpiPulse Cases - user guides and support Materials available in the EpiPulse platform help menu, under EpiPulse Cases: • Application guides • Application video tutorials • Relevant documentation for each disease group (metadata, submission templates, reporting protocols etc.) Dedicated support offered via the EpiPuls eCa s es @ecdc.europa .eu mailbox • A dedicated team will monitor the EpiPulse Cases mailbox and will respond to all questions or concerns sent via e-mail Active monitoring of all submissions • A dedicated team will monitor the submissions made by each country and will flag and follow-up any unexpected behavior Continuous improvement • EpiPulse Cases application development will continue, and any unexpected behavior will be analysed and fixed in next versions or hotfixes EpiPulse Cases Training 28  EpiPulse Cases Help section EpiPulse Cases Training 29  Questions and answers EpiPulse Cases Training 30