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Background The 2009 H1N1 pandemic highlighted the need to routinely monitor severe influenza, which lead to the establishment of sentinel hospital-based surveillance of severe acute respiratory infections (SARI) in several countries in Europe. The objective of this study is to describe characteristics of SARI patients and to explore risk factors for a severe outcome in influenza-positive SARI patients. Methods Data on hospitalised patients meeting a syndromic SARI case definition between 2009 and 2012 from nine countries in Eastern Europe (Albania, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Romania, Russian Federation and Ukraine) were included in this study. An exploratory analysis was performed to assess the association between risk factors and a severe (ICU, fatal) outcome in influenza-positive SARI patients using a multivariate logistic regression analysis. Results Nine countries reported a total of 13,275 SARI patients. The majority of SARI patients reported in these countries were young children. A total of 12,673 SARI cases (95%) were tested for influenza virus and 3377 (27%) were laboratory confirmed. The majority of tested SARI cases were from Georgia, the Russian Federation and Ukraine and the least were from Kyrgyzstan. The proportion positive varied by country, season and age group, with a tendency to a higher proportion positive in the 15+ yrs age group in six of the countries. ICU admission and fatal outcome were most often recorded for influenza-positive SARI cases aged >15 yrs. An exploratory analysis using pooled data from influenza-positive SARI cases in three countries showed that age > 15 yrs, having lung, heart, kidney or liver disease, and being pregnant were independently associated with a fatal outcome. Conclusions Countries in Eastern Europe have been able to collect data through routine monitoring of severe influenza and results on risk factors for a severe outcome in influenza-positive SARI cases have identified several risk groups. This is especially relevant in the light of an overall low vaccination uptake and antiviral use in Eastern Europe, since information on risk factors will help in targeting and prioritising vulnerable populations.

This paper presents the causative agent of the epidemic of the influenza in our country during the season 2009-2010. It also shows the effectiveness of the molecular diagnosis for Influenza virus by the means of the real-time PCR method in comparative of classical virological ones. Also in this paper we have presented the antigenic characterization of this virus which caused the pandemic during 2009-2010 years. We have collected and processed with several diagnostic methods like imunoflorescent assay, rapid tests, isolation and molecular method 409 samples. These were collected by the means of a Sentinel Surveillance throughout Albania, (tampon nasal- pharyngeal) from people suspected of influenza in different ages. To isolate the virus of influenza we have used two methods: the method of isolation of influenza in the cell line of MDCK and also the isolation of the viral RNA by the means of the molecular method. The identifications of the isolates were carried out through the reactions of the hem agglutination inhibition and we have used also the method of Immunofluorescence and rapid test for the antigen detection of influenza virus. The results of the virus analyses are given in the relevant figures. The positive isolates were sent to the International Center of Influenza in London to be confirmed and also to have a further genetic analysis through molecular methods. From these tests performed during the season 2009-2010, it came out that our country was affected by one strain of influenza type A, AH1N1 variant A/California/2009/11. This strain circulated in the whole world causing the pandemic of 2009 and was a new variant deriving from the fusion of 4 strains of Influenza a process which occurred in pigs. These variants have affected the majority of the countries in Europe and in the world.

The Binax NOW Flu A+B enzyme immunochromatographic assay was compared to Real-Time PCR assay for 542 specimen from nasal-wash or nasopharyngeal swab collected during the pandemic of 2009. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 44.6%, 95.8%, 73.5%, and 86.9%, respectively. The assay sensitivity shows mixed values decreasing significantly in infants and children age, which is linked with the quality and the way sample is collected.

Motivated by the threat of infectious diseases and bioterrorism, syndromic surveillance systems are being developed and implemented around the world. The aim of this study was to describe the early warning surveillance system in Albania for detection of pandemic influenza 2009. Syndromic surveillance is a primary health care-facility-and emergency room-based syndromic surveillance system aiming at detecting outbreaks and undertaking public health actions. Acute Respiratory Infections (ARI) consist of two syndromes: Upper and Lower respiratory infection. Weekly ARI consultation rates in 2009 were compared, with the rates observed in the same period in the previous 10 years (1999-2008) of influenza season: weeks 40-20. Unlike previous years' pattern, the rate of reported ARI increased sharply from 45th week, and peaked nationally at week 47, starting on November 16 and representing 30% increase compared to previous week, 46. Despite the end of the pandemic period, influenza A(H1N1)pdm09 virus continued to circulate and became the most commonly detected virus in Albania and many other countries in the winter season of 2010-2011.