Meeting report

7th Joint WHO Regional Office for Europe and European Centre for Disease Prevention and Control

Annual European Influenza and COVID-19 Surveillance Meeting

October 7-8, 2021 Online meeting

Keywords

Influenza

COVID-19

RSV

Surveillance

Pandemic

Epidemiology

Virology

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This publication contains the report of the 7th Joint WHO Regional Office for Europe and European Centre for Disease Prevention and Control Annual European Influenza and COVID-19 Surveillance Meeting held online on 7 and 8 October 2021 and does not necessarily represent the decisions or policies of WHO.

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Table of contents

Abbreviations ................................................................................................................. iiiAcknowledgements ........................................................................................................ ivExecutive summary ......................................................................................................... vSession topics and discussion points ................................................................................. 1

Session 1: Opening remarks and welcome ....................................................................... 1Session 2: Pandemic related challenges and solutions from the 2020/2021 influenza season and plans for the upcoming season ................................................................................ 3Session 3: Future look for influenza surveillance and virology ............................................ 5Session 4: COVID-19 surveillance and response in the European Region ............................ 6Session 5: COVID-19 surveillance and virology – what is needed next? .............................. 9Evaluation results ........................................................................................................ 11Appendix .............................................................................................................. 15A. Scope and purpose .................................................................................................. 15B. Programme ............................................................................................................. 17C. List of participants ................................................................................................... 21

iii

Abbreviations COVID-19 Coronavirus Disease of 2019

ECDC European Centre for Disease Prevention and Control EEA European Economic Area EU European Union euroMOMO European Monitoring of Excess Mortality for Public Health Action GISAID Global Initiative of Sharing All Influenza Data ICU Intensive care units ILI Influenza-like illness MEM Moving Epidemic Method MS Member State PHSM Public Health and Social Measures PISA Pandemic Influenza Severity Assessment POCT Point of Care Testing RSV Respiratory syncytial virus SARI Severe Acute Respiratory Infection SSI Statens Serum Institute TESSy The European Surveillance System UK United Kingdom of Great Britain and Northern Ireland UKHSA UK Health Security Agency VE Vaccine effectiveness WGS Whole Genome Sequencing WHO World Health Organization

iv

Acknowledgements The WHO Regional Office for Europe (WHO/Europe) and ECDC would like to thank all the chairs, presenters, and participants for their contributions as well as all staff from WHO/Europe and ECDC involved in the organization of the meeting.

v

Executive summary From 7 to 8 October 2021, the 7th Joint WHO Regional Office for Europe and the European Centre for Disease Prevention and Control (ECDC) European Influenza and COVID-19 Surveillance Meeting was held online.

This was the first annual meeting to be held online and to reflect on the COVID-19 pandemic.

The meeting involved 47 countries and areas of the WHO European Region and participants from both the influenza and COVID-19 networks.

The first day of the meeting focussed on influenza surveillance, participants reflected on influenza surveillance in the 2020-21 season, the first complete season since the COVID-19 pandemic was declared and during which public health and social measures (PHSM) were widespread and impacted on influenza circulation and functioning of surveillance systems at both country/area and regional levels. Little to no influenza circulation was noted during the seasonal period in most countries and areas however increases in influenza and RSV detections were noted from week 36 2021 onwards. Discussions focussed on the challenges the COVID-19 pandemic brought to the surveillance of influenza surveillance such as changes to surveillance systems and case definitions.

The second day of the meeting focussed on COVID-19 surveillance at both country/area and regional level. Presentations on the COVID-19 pandemic summarised the monitoring of excess mortality as well as the monitoring of COVID-19 variants and the sero-epidemiology of COVID-19. Participants discussed the many opportunities the COVID-19 pandemic has brought, inrelation to the use and access to new data sources and technologies to improve real timesurveillance and how such new sources may be implemented for influenza surveillance andcontinued for COVID-19 surveillance.

The closing remarks of the meeting highlighted emphasised the continuous need to review pandemic preparedness plans as well as the following points for consideration for future planning:

• the importance of the integration and adaptability of respiratory disease surveillancesystems to capture both influenza and COVID-19 surveillance without overwhelming thehealth system

• the review of the new data sources and technologies the COVID-19 pandemic has allowedwhich may be implemented to influenza surveillance

• the use of genomic surveillance for both COVID-19 and influenza in particular sequencingcoverage

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Session topics and discussion points The following sections provide a short background and outline of the main discussion points that were raised during the different sessions of the Meeting (the full programme of the meeting is available in Appendix B).

Presentations from all sessions which consent to sharing was granted, can be accessed and downloaded in a portable document format (pdf) from an online platform*.

Session 1: Opening remarks and welcome

Chair(s) and affiliation Richard Pebody, WHO Regional Office for Europe

Ole Heuer, European Centre for Disease Prevention and Control

Overview of presentations

Presentation title Presenter and affiliation Introduction to the WHO/Europe & ECDC Joint Annual European Influenza and COVID-19 Meeting 2021

Dr Dorit Nitzan, Regional Emergency Director, WHO Regional Office for Europe

Prof. Karl Ekdahl, Head of Unit Disease Programmes, European Centre for Disease Prevention and Control

Keynote: Influenza surveillance in the era of COVID-19: what is needed?

Cheryl Cohen, National Institute for Communicable Diseases, South Africa

Summary

The meeting was opened by Dr. Richard Pebody, Team Lead, High Threat Pathogens, WHO Regional Office for Europe (WHO/Europe) and Dr. Ole Heuer, Head of Section One Health Related Diseases, European Center for Disease Prevention and Control (ECDC), who welcomed all participants from 47 countries and areas of the WHO European Region and EU/EEA countries to the very first online and joint meeting for influenza and COVID-19.

* https://euro.sharefile.com/share/view/s4527746b0e83405dbc565c72ba328052/fo37e092-314c-4204-ae89-abf9516cdd90

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The introductory presentations by Dr. Dorit Nitzan, Regional Emergency Director at WHO/Europe and Dr. Karl Ekdahl, Head of Unit Disease Programme at ECDC highlighted appreciative words on the hard work which has been done over the biggest pandemic since 1918by all stakeholders and organizations. The COVID-19 pandemic has allowed for the role of public health to be seen, appreciated, and understood by the public and politicians across the world. The importance of the collaboration of networks to record, share and save the works which have been experienced over this pandemic was emphasized, as such lessons learned will be pivotal for future pandemic planning and preparation as well as to understand the commonalities between influenza and COVID-19 and learning from past influenza experiences. The idea of both the influenza and COVID-19 networks becoming one in the future for respiratory diseases was also highlighted.

The keynote presentation by Cheryl Cohen reflected on how the COVID-19 pandemic has shown that developments can happen rapidly e.g. the development and production of vaccines, the use and access to bigger, automated data feeds and therefore such developments should be used as opportunities for improving influenza surveillance. The expansion of genomic surveillance was also highlighted from only being able to sequence random samples in the pre-pandemic era to sequencing all COVID-19 samples during the pandemic in most countries.

Discussion points

• Participants discussed and highlighted some of the most immediate steps which can be implemented for influenza surveillance based on experiences from the COVID-19 pandemic, to be as follows:

o the development and implementation of multi-pathogen surveillance systems to reduce resource burden;

o the implementation and use of broader surveillance case definitions to capture multiple pathogens as it was noted that the ILI case definition was inadequate for COVID-19;

o the implementation of increased genomics surveillance capacity for influenza. The COVID-19 pandemic has shown that increasing genomic surveillance capacity has been possible and important therefore the continuity of this should also be considered for influenza genomics surveillance;

o access to new data sources. The COVID-19 pandemic has opened avenues for accessing new and real time data sources, although this was greatly driven by political and public interest as well as the recognition of the utility and relevance of these new sources to meet public health needs.

• Participants also noted the use of sentinel surveillance platforms to monitor vaccine effectiveness and performance to be important, bearing in mind the challenges such as lack of timeliness and sample size issues.

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Session 2: Pandemic related challenges and solutions from the 2020/2021 influenza season and plans for the upcoming season

Chair(s) and affiliation Jim McMenamin, Public Health Scotland, United Kingdom

Overview of presentations

Presentation title Presenter & affiliation Overview of SARI surveillance in Spain during the 2020-21 season

Amparo Larrauri, Instituto de Salud Carlos III, Spain

Adapting SARI surveillance – Albania Silvia Bino, Institute of Public Health, Albania

Challenge of developing thresholds (PISA) Lisa Donnegan, Health Protection Surveillance Centre, Ireland

Potential impact of false positive tests Ramona Trebbien, Staten Serum Institut, Denmark

Possible early flu circulation 2021/22 season Daria Danilenko, Smorodintsev Research institute, Russian Federation

Characteristics of the 2020/21 influenza season in the European Region and developments for 2021/22

Piers Mook, WHO Regional Office for Europe, Denmark & and Cornelia Adlhoch, ECDC, Sweden

Influenza Vaccine Composition 2021-2022: A review of the results and updates

John McCauley, WHO Collaborating Centre for Reference and Research on Influenza, The Francis Crick Institute, United Kingdom of Great Britain and Northern Ireland

Summary

This session highlighted the key challenges from the 2020/21 influenza season to be, the changes in case definitions, changes in health seeking behaviour, changes to national testing strategies, increased use of point of care testing (POCT), the maintenance of testing and parallel SARI surveillance systems for both influenza and SARS-CoV-2 and resource prioritisations due to the COVID-19 pandemic. The main solutions highlighted throughout this session included the consolidation, development, and integration of surveillance systems to include influenza, SARS-CoV-2, and other respiratory viruses, which some countries have already implemented/started to develop.

The 2020/21 influenza season at the Regional level was at baseline levels as expected due to but not limited to the physical distancing measures in place for the COVID-19 pandemic, there

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were only 47 detections of influenza from sentinel sources and 945 from non-sentinel sources, representing an overall reduction of over 90% in comparison to the previous season respectively, across the whole season. Country/area level presentations looking forward to the 2021-22 season noted the early circulation of influenza A(H3) and B during the summer period of 2021 in some countries/areas as well as an increased overall testing volume for influenza viruses.

Discussion points

• Presentations on SARI surveillance triggered discussions on multiplex testing, the use of case-based data collection systems, the integration of SARI and genomic surveillance and patient data protection. Some countries highlighted that multiplex testing is only currently used in approximately 50% of laboratories but efforts are being taken to change to using such testing universally. Discussions also highlighted that the previously used case-based data collection system for lab-confirmed hospitalised influenza cases in Spain had been completely suspended due to the COVID-19 pandemic.

• Participants reflected on the development of thresholds and the use of the standard EuroMOMO thresholds to allow for comparability of excess mortality activity between countries/areas. It was also noted that Ireland did not experience excess mortality more than 15 z-scores which was the limit for their new threshold ‘Super-extraordinary’ threshold.

• Participants highlighted that all tests irrespective of being a POCT, even with a high specificity will have a poor positive predictive value when prevalence in the population is low. Suggestions on the ideal solution to overcome this included, the need to retest a sample or all false positive tests bearing in mind the resource constraints when quantities of tests are large. It was also noted that it would be good to review the use of POCT in different settings in more detail – this recommendation stemmed from a discussion on the potential of wrong diagnoses linked with the increased use of POCT in hospital settings. Participants also briefly touched on the importance of caveating false positive test in surveillance data in national reports.

• Participants also discussed the importance of the availability of good quality samples to inform surveillance, as well as the observation in the increasing trend in influenza activity from week 36/2021 as we move into the winter period with the easing of pandemic measures.

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Session 3: Future look for influenza surveillance and virology

Chair(s) and affiliation Mia Brytting, Folhalsomyndigheten, Sweden

Overview of presentations

Presentation title Presenter and affiliation

Molecular virus surveillance, genome sequencing and phenotyping

Ron Fouchier, Erasmus MC, the Netherlands

What does this mean from a control and prevention perspective?

Jim McMenamin, Public Health Scotland, UK

Summary

This session presented discussions on the future developments for influenza including prevention and control measures, through two plenary presentations, each covering a laboratory and epidemiology perspective respectively.

The plenary presentation reflecting the laboratory perspective highlighted that the COVID-19 pandemic has accelerated bioinformatics tremendously in the ability to largely upscale genome sequencing techniques to detect COVID-19 variants, which in turn has supported work to understand how COVID-19 variants can affect vaccine effectiveness. It was highlighted that it is also still important to focus on phenotyping and ensure forward-looking horizon scanning to detect changes leading to variant emergences and antigenic evolution.

The epidemiological perspective plenary presentation on the future of influenza surveillance highlighted the opportunities and developments which the COVID-19 pandemic has brought, including how to leverage more acceptable patient self-swabbing and how to maximise the utility of big data to influenza surveillance. The COVID-19 pandemic has raised expectations on timeliness and delivery of data therefore considerations on how this will be reflected for other respiratory diseases surveillance and the reactions from the public and government bodies should be considered.

Discussion points

• Discussions highlighted the following considerations for the future of influenza surveillance and virology based on the experiences of the COVID-19 pandemic: the increased understanding of the need for preparedness, awareness and investment in public health at the political level, increased global capacity for PCT processing sequencing and speed of delivery of results as well as data transfer for collaborative working.

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Session 4: COVID-19 surveillance and response in the European Region

Chair(s) and affiliation Silvia Bino, Institute of Public Health, Albania

Overview of presentations

Presentation title Presenter and affiliation

Keynote: Public health surveillance response to COVID-19 – lessons learnt and how to meet them as we prepare for the next pandemic

John Brownstein, Harvard Medical School, USA

Country/Regional experiences: what has been the experience and lessons learnt? Rapid assessment of COVID variants - what have we learnt? Country perspective Regional perspective

Meera Chand, UK Health Security Agency, UK Erik Alm, ECDC, Sweden

SARS-CoV-2 sero-epidemiology – what have we learnt? Country perspective Regional perspective

Olav Hungnes, Folkehelseinstituttet, Norway Aisling Vaughan, WHO Europe

Excess mortality monitoring in Europe - lessons learnt

Lasse Vestergaard and Jens Nielsen, Statens Serum Institute, Denmark

Adaption of surveillance indicators – what has been learnt? A country perspective

Anna-Maisa, Sante Publique France, France

SARS-CoV-2 virological characterization – what has been learnt? Country perspective Regional perspective

Raquel Guiomar, Instituto Nacional de Saude, Portugal Marco Marklewitz, WHO Regional Office for Europe, Denmark

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Future surveillance plans for COVID? What is planned for 2021/22? A country perspective

Mia Brytting, Folhalsomyndigheten, Sweden Nune Bakuntz, National Center of Disease Control and Prevention, Armenia

Summary

This session highlighted that the European Region has had strong disease surveillance systems in place and with the COVID-19 pandemic, there has been a holistic approach by the countries and areas to further strengthen disease surveillance and pandemic response in the Region.

The keynote presentation demonstrated the use of data from digital and social media platforms to deliver real time surveillance and forecasting during the COVID-19 pandemic, using digital artificial intelligence (AI) and language processing interfaces to inform for real-time public health surveillance such as trend monitoring in the community and carrying out targeted population assessments.

Regional and country specific presentations highlighted the use of new techniques and approaches in identifying the trend and characteristics of new and existing pathogens which can be integrated with the current surveillance strategies, including variant assays, seroprevalence studies/surveys, mortality trend monitoring, adaptation of the surveillance indicators.

Discussion points

• Discussions on the use of social media and digital platforms for real-time surveillance highlighted this to be challenging and resource-intensive to conduct at the beginning of the COVID-19 pandemic. The importance of appropriate validation processes when using such platforms was stressed, for example, validation by experts at the source and validating against traditional surveillance systems/sources. The use of electronic devices such as mobile phone applications to reach out to the public for effective communication and health advice was also noted as such an approach can easily be tailored and transformed according to a country’s specific needs as well as globally.

• Discussions on the rapid assessment and sequencing of COVID-19 variants, although varied across different countries and areas, highlighted the importance of combining genomic surveillance and epidemiological data to inform rapid variant assessments and simulate the impact of future variants. Although the COVID-19 pandemic has allowed for the expansion and increase in sequencing coverage which has informed policy changes, for example the discovery of the Delta variant in the UK informed public health action and vaccine policy changes, careful thought should be given for future planning around the need for increased sequencing coverage and training and the speed of assessment of genomes. WHO and ECDC are supporting countries and areas in developing and strengthening genomic surveillance capacity and viral characterization. Future planning should also include the cross functional collaboration, data sharing within the global/regional genomics surveillance

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framework, access to biological samples for routine surveillance, availability of resources and expertise, and strong support from the policymakers.

• Discussions on mortality trend monitoring highlighted that the EuroMOMO model provided an early signal for increasing mortality trends in the European Regions and was one of the first sources to pick up all-cause excesses in mortality trends during the COVID-19 pandemic, covering 27 countries and a population of approximately 420 million people in the European Region.

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Session 5: COVID-19 surveillance and virology – what is needed next?

Chair(s) and affiliation Bruno Lina, National Influenza Centre, France

Overview of presentations

Presentation title Presenter & affiliation

SARS-CoV2: what are the forthcoming epidemiological and virological surveillance challenges and how do we solve them?

Marion Koopmans, Erasmus MC, the Netherlands Kare Molbak, Statens Serum Institut, Denmark

Panel discussion: Regional strategy All

Summary

This session focussed on reflecting upon what has been done so far on surveillance and virology during the COVID-19 pandemic and discussing the challenges and potential solutions required.

The main virological surveillance challenges were highlighted to be, dealing with the ever-changing genetics of the virus, the inequality in sequencing coverage globally and within Europe and the assessments of escape variants and transmissibility and severity in animals.

Key solutions were presented as:

• consideration of surveillance for long term trends and antigenic evolution, more in-depth surveillance for treatment escapes and potential reservoirs, through redefined role of centralized public health laboratories, enhanced surveillance/monitoring of hospitalized and/or immunocompromised cases

• more risk targeted animal surveillance should also be conducted and a focus on the assessment of phylogenetic groups.

• redefining virological surveillance objectives including consideration of how much sequencing is needed to measure trends as well as ensuring phenotypical assessments.

• monitoring and assessment of clusters of mutations and using different and robust models to assess/measure the rate of growth, transmissibility, virulence, and immune escape

• keeping track of all the information that is being formed e.g. what additional information studies on variants from around the world are showing, would be potential solutions.

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It was noted that the following drivers will need careful consideration over the next few years: the behaviour of the population, seasonal effects and interaction between different respiratory pathogens, vaccine uptake and effectiveness and international developments.

Discussion points

• Integration of genetic surveillance with existing surveillance strategies has proved to be one of the most useful approaches during the COVID-19 pandemic and has informed public health strategies around the world. However, the continuation of such an integration into routine surveillance strategies will require careful resource planning. There was discussion around having a hybrid model with the integration of genetic sequencing in a targeted manner to increase the capacity of the surveillance system. In addition, integration of zoonotic surveillance, sewage testing with routine surveillance could be beneficial too.

• Developing a surveillance strategy that is cost-efficient and effective is also very important. New diagnostic tools are available which can be used in the future to monitor disease surveillance in an accurate and efficient manner. However, careful consideration should be given to collecting the routine surveillance data in a simple and timely manner.

• The investments to increase the capacity of the health system over the COVID-19 pandemic at the country/area and regional level should be continued in the future. Involvement of different stakeholders, including technology and social companies might well be beneficial for future preparedness.

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Evaluation results

After the meeting, participants were invited to fill in an online evaluation form. The form was provided in English and Russian languages and responses were anonymous.

Of the 156 participants that received the link, 37 responded (response rate: 23.7%); 28 participants filled in the English and 9 the Russian form, respectively. For the analyses, we combined results from both languages.

The results of the evaluation will be considered when organizing the next meeting.

The following sub-sections summarise the evaluation results.

1. Meeting focus and objectives

Table 1. Overview of results rating the overall usefulness of the meeting. Answer options ranged from ‘1=Poor’ to ‘5=Excellent’. Overall how useful was this meeting for: Median Geometric

mean a) Influenza surveillance 4 4.1 b) COVID-19 surveillance 4 4.1

Table 2. Overview of results rating the coverage of the main objectives of the meeting. Answer options ranged from ‘1=Poor’ to ‘5=Excellent’. The main objectives of this meeting are listed below. To which extent were they covered?

Median Geometric mean

a) review the achievements and challenges countries faced in establishing and adapting epidemiological and virological surveillance systems for SARS-CoV-2 in the European Region and plan for the next phase of the pandemic

4 4.0

b) review how countries strengthened surveillance and response capacities for seasonal and avian influenza in the European Region with a focus on the 2020/21 season and look forward to the 2021/22 season, particularly in the light of the COVID-19 pandemic

4 3.9

c) share evidence on how epidemiological and virological surveillance data on COVID-19, influenza and other respiratory infections can be used to design policies and programmes for prevention and control

4 4.0

d) present new developments with respect to the joint ECDC-WHO/Europe Flu News Europe and COVID-19 bulletins

4 3.9

e) provide an overview of the global situation regarding SARS-CoV-2 and influenza as well as global surveillance developments

4 4.2

f) maintain and strengthen collaboration and information sharing among network members

4 3.8

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2. Sessions

Table 3. Ranking of the three most useful sessions based on 37 responses

Rank Session n % 1 Session 3: Future look for influenza surveillance and

virology 27 73.0

2 Session 2: Pandemic related challenges and solutions from the 2020/2021 influenza season and plans for the upcoming season

26 70.3

3 Session 5: COVID-19 surveillance and virology – what is needed next?

25 67.6

4 Session 4: COVID-19 surveillance and response in the European Region

24 64.9

5 Session 1: Opening remarks and welcome 0 0.0

1. Topics not covered

Table 4. Overview of topics not covered in this meeting

Nr Topic 1 1.Studies on co-infections of influenza and SARS-CoV-2. 2. With little or no influenza

circulating in Europe since the start of the pandemic, a discussion on the impact lower immunity levels may have (e.g. possibility of a severe influenza season) would have been interesting.

2 available assitance to countries 3 Vaccine effectiveness; surveillance of other respiratory viruses and a comprehensive

surveillance of influenza, SARS-CoV-2, RSV and other respiratory viruses. 4 networking 5 No questions 6 All questions were raised and discussed at the meeting.

The issue of seasonal influenza and COVID-19 requires more attention. 7 I believe all issues were raised and discussed. 8 Scientific data on the incidence rate in Africa. 9 Just about every issue was covered. 10 Nothing. 11 Discussion regarding reporting of the data and user-friendly, useful outputs. Flu News

Europe is much less practical as it was two seasons ago. 12 Future look for influenza surveillance and virology 13 For me all topics were properly selected. 14 Covid-19 vaccine perspective 15 how to deal with understaffed departments

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3. Meeting quality, organization, and satisfaction

Table 5. Overview of results rating overall quality and organisation of the meeting.

Answer options ranged from ‘1=Poor’ to ‘5=Excellent’.

How would you rate the overall: Median Geometric mean

a) quality of the meeting 4 4.2 b) administrative organization of the meeting? 4 4.0 c) virtual connection and facilities? 4 4.1

Of the 37 participants who answered this question, 3 rated it as ‘too short’, 33 as ‘just right’ and one as ‘too long’.

4. Other feedback

Table 6. Overview of other feedback received by participants. (The table displays original responses.)

Nr Topic 1 Thanks to all the organisers, the meeting was very well organised and content was

excellent. My only negative is that there were too many ECDC and WHO meetings/workshops planned for the same 2 week period. This is very difficult for MS then to attend all meetings. The timing of all of the meetings should have been planned better. Also for meetings that span lunchtime, there should be a sufficient break for eating lunch.

2 Presential meetings for the next season will be crucial for an efective interaction between member states focal points.

3 1) ..... I enjoyed the meeting, but I felt there was not enough interaction and too many talks without breaks. Zoom (and many other programs) offers so many possibilities to make virtual meetings more interactive, e.g. creating breakout rooms for certain discussion topics where smaller numbers of participates can interact with each other. It was a pity that some speakers left the meeting right after their talk, so it was not possible to ask them questions with the chat function. For future meetings I would greatly appreciate if WHO/ECDC would increase their efforts to make explore these available options for virtual networking. Thank you. 2) . Many talks / countries focussed too much on their achievements and very little was said about the challenges let alone mistakes and lessons learnt from them. These WHO/ECDC meetings should be a place where also negative experiences and errors are reported and discussed openly, so we can profit from mutual learning and exchange… of course this difficult (political?), but I didn’t feel there was enough openness and trust among the participants and not enough encouragement from the WHO/ECDC side. I do not have a suggestion how to tackle this very challenging issue, but I just wanted to share this feeling.

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4 Thank you for organizing this event. 5 Thank you very much for the meeting. 6 No comments. 7 Thank you! 8 "Such meetings should be held on a regular basis until the epidemiological situation

with COVID-19 has normalized. Electronic copies of presentations should be sent to meeting participants.”

9 A big thank you to all our colleagues from WHO/Europe and ECDC for the chance to analyse and discuss the main areas of, and practical issues in, the epidemiological and virological surveillance of influenza and COVID-19.

10 Just right length for the virtual meeting. More focus on influenza would be appreciated. Very top to bottom lead meeting, no real discussion. Of course the interaction would be better, if meeting would be in person. Thank you for good work anyway.

11 Very interesting and informing presentations. 12 It was a bit hard to concentrate on the presentations if not applicable to my work.

Perhaps breakout groups would have been useful. 13 was more difficult to stablish contacts between members, but it was equal informative

in less time (as no time was spent on travelling), which is an important issue nowadays.

14 Thank you for the two day meeting - it was interesting and useful. 15 The meeting was useful and I hope the presentations will be available. 16 Physical meeting is needed! No more virtual meetings, please.

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Appendix

A. Scope and purpose

WHO Regional Office for Europe and European Centre for Disease Prevention and Control Joint Annual European COVID-19 and Influenza

Surveillance Online Meeting

7-8 October, 2021

Scope and purpose

Scope The WHO Regional Office for Europe (WHO/Europe) and the European Centre for Disease Prevention and Control (ECDC) coordinate surveillance activities related to the prevention and control of influenza in the WHO European Region. Since 2011, the two institutions have jointly organized annual meetings focused on the epidemiological and virological aspects of influenza surveillance, seasonal influenza vaccination and the global situation regarding outbreaks of avian influenza and other emerging respiratory pathogens1. The emergence of SARS-CoV-2 has presented many new challenges to Member States and there is much to learn from country/area experiences since January 2020. This meeting which will be the seventh joint ECDC and Regional Office annual meeting for the 53 Member States of the WHO European Region will be devoted to both influenza and COVID-19. Purpose The aim of the meeting is to discuss technical and operational issues related to both COVID-19 and influenza surveillance, risk assessment and response. Topics for this meeting will be derived from work that has taken place over the past 18 months in the light of what was prioritized during previous Annual Meetings. Objectives The main objectives of the meeting are to: • Review the achievements and challenges countries/areas faced in establishing and adapting epidemiological and virological surveillance systems for influenza and SARS-CoV-2 in the European Region; • Review how countries/areas strengthened surveillance and response capacities for seasonal influenza in the European Region with a focus on the 2020/21 season and look forward to the 2021/22 season, particularly in the light of the COVID-19 pandemic;

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• Share evidence on how epidemiological and virological surveillance data on COVID-19, influenza and other respiratory infections can be used to plan for the next phase of the pandemic; • Present new developments with respect to the joint ECDC-WHO/Europe Flu News Europe and COVID-19 bulletins; • Provide an overview of the global situation regarding SARS-CoV-2 and influenza as well as global surveillance developments; • Maintain and strengthen collaboration and information sharing among network members. Working methods and translation Plenary sessions and group work. The meeting language will be English with simultaneous interpretation into Russian. Target audience National influenza and COVID-19 focal points for epidemiological and virological surveillance designated by national health authorities, reference laboratory representatives and involved international institutions.

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B. Programme

7th Joint WHO Regional Office for Europe & European Centre for Disease Prevention and

Control Annual European Influenza and COVID-19 Surveillance Meeting 2021

Provisional Draft Programme

Objectives

The objectives of the annual meeting are to: - review the achievements and challenges countries faced in establishing and adapting epidemiological and virological surveillance systems for SARS-CoV-2 in the European egion and plan for the next phase of the pandemic - review how countries strengthened surveillance and response capacities for seasonal and avian influenza in the European Region with a focus on the 2020/21 season and look forward to the 2021/22 season, particularly in the light of the COVID-19 pandemic - share evidence on how epidemiological and virological surveillance data on COVID-19, influenza and other respiratory infections can be used to design policies and programmes for prevention and control Thu, 7 October: INFLUENZA

12:00-12:45 Session 1: Opening remarks and welcome

Chairs: Richard Pebody (WHO) and Ole Heuer (ECDC)

12:00-12.15 Introduction to the WHO/Europe & ECDC Joint Annual European Influenza and COVID-19 Meeting 2021

Dr Dorit Nitzan, Regional Emergency Director, WHO Europe Prof. Karl Ekdahl, Head of Unit Disease Programmes, ECDC

12:15-12:45 Keynote: Influenza surveillance in the era of COVID-19: what is needed?

Cheryl Cohen, National Institute for Communicable Diseases, South Africa

12:45-13:00 Coffee break 13:00-15:00 Session 2: Pandemic related

challenges and solutions from the 2020/2021 influenza season and plans for the upcoming season

Chair: Jim McMenamin, Public Health Scotland, UK Minders – Piers Mook, Cornelia Adlhoch

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13:00-14:15

Country experiences

Overview of SARI surveillance in Spain during the 20-21 season

Amparo Larrauri, Instituto de Salud Carlos III, Spain

Adapting SARI surveillance – Albania

Silvia Bino, Institute of Public Health, Albania

Challenge of developing thresholds (PISA)

Lisa Donnegan, Health Protection Surveillance Centre, Ireland

Potential impact of false positive tests

Ramona Trebbien, Staten Serum Institut, Denmark

Possible early flu circulation 2021/22 season

Daria Danilenko, Smorodintsev Research institute, Russian Federation

14:15-14:30 Characteristics of the 2020/21 influenza season in the European Region and developments for 2021/22

Piers Mook, WHO Europe, Denmark Cornelia Adlhoch, ECDC, Sweden

14:30-15:00 Influenza Vaccine Composition 2021-2022: A review of the results and updates

John McCauley, WHO Collaborating Centre for Reference and Research on Influenza, The Francis Crick Institute, United Kingdom of Great Britain and Northern Ireland

15:00-15:15 Tea break

15:15-16:00 Session 3: Future look for influenza surveillance and virology

Chair: Mia Brytting, Folhalsomyndigheten, Sweden Minder – Pasi Penttinen

15:15 – 15:55 Two plenary presentations (one lab and one epi) on what will be the future developments in influenza and other respiratory viruses and what this might mean for future prevention and control measures. Molecular virus surveillance, genome sequencing and phenotyping - Ron Fouchier, Erasmus MC, Netherlands What does this mean from a control and prevention perspective? - Jim McMenamin, Public Health Scotland, Scotland

15:55 – 16:00 Wrap up and closure of the day Richard Pebody, WHO Regional Office for Europe Ole Heuer, European Centre for Disease Prevention and Control

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16:00 -

Friday, 8 October, COVID-19 12:00-12:05 Words of welcome for Day 2 Richard Pebody, WHO Regional Office for

Europe Ole Heuer, European Centre for Disease Prevention and Control

12:05-14:15

Session 4: COVID-19 surveillance and response in the European Region

Chair: Silvia Bino, Institute of Public Health, Albania Minders: Richard Pebody, Gianfranco Spiteri

12:05-12:30

Keynote: Public health surveillance response to COVID-19 – lessons learnt and how to meet them as we prepare for the next pandemic

John Brownstein, Harvard Medical School, USA

12:30 – 14:15 Country/Regional experiences: what has been the experience and lessons learnt?

Rapid assessment of COVID variants - what have we learnt? Country perspective Regional perspective

Meera Chand, UKHSA, UK, Erik Alm, ECDC, Sweden

SARS-CoV-2 sero-epidemiology – what have we learnt? Country perspective Regional perspective

Olav Hunges, Folkehelseinstituttet, Norway Aisling Vaughan, WHO Europe, Denmark

Excess mortality monitoring in Europe - lessons learnt

Lasse Vestergaard and Jens Neilsen, SSI, Denmark,

Adaption of surveillance indicators – what has been learnt? A country perspective

Anna Maisa, Sante Publique France, France

SARS-CoV-2 virological characterization – what has been learnt? Country perspective

Raquel Guiomar, Instituto Nacional de Saude, Portugal

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Regional perspective

Marco Marklewitz, WHO Europe, Denmark

Future surveillance plans for COVID? What is planned for 2021/22? A country perspective

Mia Brytting, Folhalsomyndigheten, Sweden Nune Bakuntz National Center of Disease Control and Prevention, Armenia

14:15-14:30

Coffee break

14:30-16:00

Session 5: COVID-19 surveillance and virology – what is needed next?

Chair: Bruno Lina, National Influenza Centre, France Minder: Angeliki Melidou

14:30 – 15:15 SARS-CoV2: what are the forthcoming epidemiological and virological surveillance challenges and how do we solve them?

Marion Koopmans, Erasmus MC, Netherlands Kare Molbak, Statens Serum Institut, Denmark

15:15 – 15:45

Panel discussion: What does this mean for the Regional strategy? Panel members - All

15:45 – 16:00

Closure of the meeting WHO Regional Office for Europe European Centre for Disease Prevention and Control

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Country/Area/Organization Family Name First Name

Albania Bino Silvia

Vasili Adela

Simaku Artan

Andorra Garcia Fernández Jennifer

Carrasco Garcia Mireia

Armenia Abovyan Romela

Sargsyan Shushan

Hatchatryan Evgeniya

Nune Dolyan

Bakunts Nune

Austria Redlberger Monika

Azerbaijan Mursalova Nazifa

Aliyeva Firuza

Mursalova Nazifa

Oleg Salimov

Belarus Karaban Inna

Shmeleva Natalia

Shmieleva Veronika

Belgium Cuypers Lize

Vermeulen Melissa

Barbezange Cyril

Bossuyt Nathalie

Bosnia and Herzegovina Bastinac Diana

Kojic Dusan

Konjevic Andrea

Acimovic Jela

Dakovic Devic Jelena

Rodic Nina

Musa Sanjin

C. List of participants/observers

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Bulgaria Bogdanov Nikolay

Country/Area/Organization Family Name First Name

Croatia Lovrić Makarić Zvjezdana

Tabain Irena

Petrović Goranka

Ferenčak Ivana

Cyprus Pieridou Despo

Czechia Kynčl Jan

Liptáková Monika

Denmark Dam Lasse

Trebbien Ramona

Nielsen Jens

Molback Kare

Skafte Vestergaard Lasse

Trebbien Ramona

Estonia Lilje Liisa

Finland Ikonen Niina

Nohynek Hanna

Savolainen-Kopra Carita

Lindh Erika

France van der Werf Sylvie

Maisa Anna

Lina Bruno

Georgia Machablishvili Ana

Khmaladze Ekaterine

Chakhunashvili Giorgi

Karseladze Irakli

Germany Haas Walter

Wolff Thorsten

Hungary Zsófia Bognár

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Molnár Zsuzsanna

Country/Area/Organization Family Name First Name

Iceland Erna Baldvinsdottir Gudrun

Armannsdottir Brynja

Aspelund Gudrun

Ireland Dunford Linda

Domegan Lisa

O Donnell Joan

Neary Martha

Robinson Eve

Donnegan Lisa

Italy Stefanelli Paola

Puzelli Simona

Riccardo Flavia

Kazakhstan Sultanova Meirim

Smagul Manar

Smagulova Meiramgul

Nusupbaeva Gaukhar

Userbaev Aidar

Kuatbayeva Ainagul

Lithuania Liausediene Rasa

Gargasiene Greta

Razmuk Jelena

Luxembourg Vergison Anne

Bejko Dritan

Malta Melillo Tanya

Montenegro Rakocevic Bozidarka

Zekovic Zeljka

Netherlands van Gageldonk-Lafeber Rianne

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Hooiveld Mariette

Fouchier Ron

Eggink Dirk

Fouchier Ron

Koopmans Marion

North Macedonia Preshova Ardian

Norway Bragstad Karoline

Nygård Karin

Hungnes Olav

Hessevik Poulsen Trine

Hungnes Olav

Poland Sadkowska-Todys Małgorzata

Pancer Katarzyna

Paradowska-Stankiewicz

Iwona

Portugal Pinto Leite Pedro

Guiomar Raquel

Rodrigues Ana Paula

Guiomar Raquel

Republic of Moldova Druc Alina

Gheorghita Stefan

Capmari Dumitru

Furtuna Nicolae

Romania Popovici Odette

Lazar Mihaela

Russian Federation Melnikova Albina

Ploskireva Antonina

Gavrilova Elena

Kolosova Natalya

Danilenko Daria

Serbia Dmitrijevic Dragana

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Slovakia Tichá Elena

Slovenia Fafangel Mario

Prosenc Katarina

Steyer Andrej

Socan Maja

Country/Area/Organization Family Name First Name

South Africa Cohen Cheryl

Spain Larrauri Amparo

Delgado-Sanz Concha

Pozo Francisco

Casas Inmaculada

Larrauri Amparo

Sweden Brytting Mia

Carnahan Anna Sara

Rehn Moa

Alm Erik

Tajikistan Jafarov Navruz

Firdavs Ahrorov

Tamanno Safarova

Nigina Zakirova

Turkey Pehlivanturk Gulen

Avci Emine

Gulay Korukluoglu Fatma

Basak Altas Ayse

Turkmenistan Ovliyakulova Gurbangul

Mamaeva Jeren

Ukraine Matskov Oleksandr

Koshalko Oksana

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Demchyshyna Iryna

Matchyshyn Serhi

United Kingdom Lopez Bernal Jamie

Watson Conall

Ellis Joanna

Zambon Maria

Chand Meera

McCauley John

McMenamin Jim

USA Brownstein John

Uzbekistan Ikramov Rustam

Kudasheva Lyudmila

Djemileva Sultan

Valieva Nuria

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Kosovo1 Jakupi Xhevat

Country/Area/Organization Family Name First Name

European Centre for Disease Prevention and Control

Melidou Angeliki

Dugarte Ramos Monique

Heuer Ole

Grothier Lilly

Spiteri Gianfranco

Kraus Annette

Penttinen Pasi

Adlhoch Cornelia

Ekdahl Karl

WHO Regional Office for Europe Pebody Richard

Nitzan Dorit

Mook Piers

Marklewitz Marco

Vaughan Aishling

Sinnathamby Mary Anissa

Mesle Margaux

Vanhaverbeke Maarten

WHO Headquarters Zhang Wenqing

Hammond Aspen

Vandemaele Kaat

Country/Area/Organization Family Name First Name

WHO Country Office Albania Ardian Xinxo

WHO Country Office Azerbaijan Javahir Suleymanova

WHO Country Office Belarus Grankov Viatcheslav

WHO Country Office Bosnia and Herzegovina

Palo Mirza

WHO Country Office Bosnia and Herzegovina

Rebac Boris

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1 All references to Kosovo in this document should be understood to be in the context of the United

Nations Security Council resolution 1244 (1999).

WHO Country Office Georgia Tamila Zardiashvili

WHO Country Office Georgia McKnight Jason

WHO Country Office Kazakhstan Bibigul Aubakirova

WHO Country Office Kyrgyzstan Akbar Esengulov

WHO Country Office Kyrgyzstan Kaliya Kasymbekova

WHO Country Office North Macedonia Arta Kuli

WHO Country Office Republic of Moldova

Stela Gheorghita

WHO Country Office Serbia Miljan Rancic

WHO Country Office Serbia Ibrahim Rawi

WHO Country Office Tajikistan Abdulakhad Safarov

WHO Country Office Tajikistan Yusupova Shoira

WHO Country Office Turkmenistan Ayjeren Myratdurdyyeva

WHO Country Office Ukraine Liudmyla Slobodianyk

WHO Country Office Uzbekistan Anna Pashalishvili

WHO Country Office Uzbekistan Yusupov Bekhruz WHO Office in Pristina Isme Humolli

Contacts European Centre for Disease Prevention and Control (ECDC)

World Health Organization, Regional Office for Europe

Tel. +46 858 60 10 00 Fax +46 858 60 10 01 www.ecdc.europa.eu

Tel. +45 45 33 70 00 Fax +45 45 33 70 01 www.euro.who.int