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Start of season Respiratory Virus Surveillance Network Webinar

18 September 2025

Agenda

3

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

Upcoming schedule – 2025/2026 season

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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 metadata)

TBD

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

Webinar

ERVISS

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?

• NB.1.8.1 is dominant sub-lineage in Australia in last month, >55% of all sequences

Source: AusTrakka, NNDSS

SARS-CoV-2 Omicron sub-lineages by sample collection date, Jan 1 – September 7

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

NNDSS

As at 10/09/2025

Receipt and analysis of influenza samples at WHO CC, Melbourne

Receipt of samples by WHO CCs for detailed analysis (genetic, antigenic, epidemiological)

Sample receipt WHO CC Melbourne Feb 1 – Sept 16, 2025

No of Samples ReceivedCountry

7585Australia 37Bhutan 60Brunei 45Cambodia 2Cook Islands

21Fiji 36Nepal 73New Caledonia

144New Zealand 42Papua New Guinea 74Singapore 6Solomon Islands

26South Africa 54Sri Lanka 21Thailand 2Vanuatu

8,228Total

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

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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

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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?

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2. What has been the impact of COVID-19 in secondary care over the summer?

H

SARI virological surveillance

2. What has been the impact of COVID-19 in secondary care over the summer?

• Used proxy SARI rates internally as part of our weekly assessment

2. What has been the impact of COVID-19 in secondary care over the summer?

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• Proxy rates were lower than last summer

• Hospital lab-based data also suggested lower in many countries

• But....what will come next?

3. Seasonality and thinking ahead

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• Timing of 2025 summer COVID-19 has closely matched that of summer 2024

• In 2024 the impact in SARI continued long into the winter

3. Seasonality and thinking ahead

• RSV - another summer without early activity. More evidence of return to normal seasonality?

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• Influenza - limited summer detections overall with some exceptions

Eurosurveillance | An interseasonal outbreak of influenza A(H1N1)pdm09 related to a music festival, Denmark, August 2025

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 Situation up to 28th August 2025: • During the one-week period of 22 August 2025

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.

National running average trends in wastewater RNA up to 28th August 2025. For this graph, a 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 scale chosen to approximately match post-July 2022 trends in WW viral RNA level.

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 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.

Daily number of PCR testing and proportion PCR positive

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

• 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 Hospital Admissions and Inpatients

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 offered moderate protection 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 against COVID-19 hospitalisation was 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 (VE) against COVID-19 hospitalisation among those aged 65 years and above, with 95% Confidence Intervals

Waning of vaccine effectiveness against COVID-19 hospitalisation in those aged 65 and above with 95% confidence intervals

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 14 days before their birth.

• 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).

Maternal RSV Vaccine Effectiveness (%) against RSV-related LRTI hospitalisation in infants aged ≤90 days

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

• All ARI/SARI cases

• Based on extraction of diagnotic codes (ICPC, ICD)

• Oportunistic but representative sampling of all syndromic cases:

✓ First 2-5 attending PC each week

✓ Admitted to hospital on pre-defined weekdays

• Triple PCR

• Virological characterisation if positive

• Additional information (clinical, vaccination)

Syndromic surveillance Systematic surveillance

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:

✓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

Example of the PC network in one region

Estimating proxy indicators weekly

Strata (i)

region age- group

sex ARI/ SARI cases

Catchment population

Total population

Weighting factor

Weighted ARI/SARI cases

Positivity (%) to pathogen

pathogen- specific 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

… … … … … … … … …

σ= = ,

σ= =

Weekly pathogen-specific-proxy =

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 routine surveillance • COVID-19 summer wave

in Primary Care

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Use of proxys for routine surveillance • COVID-19 summer wave

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Use of proxys to estimate burden of disease

Primary care Hospitals

Use of proxys to estimate intensity and severity*

* Not used for this objective in Spain, explotatory results prepared for this presentation

Primary care

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

Thank you for your attention! Susana Monge

National Centre of Epidemiology

Institute of Health Carlos III (ISCIII)

[email protected], [email protected]

Acknowledgements

SiVIRA and RELECOV collaborators in the National Centre of Microbiology, National Centre of Epidemiology and Spanish Autonomous Communities

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

Patient who tested positive for influenza by RT-PCR. Result is valid for 30 days unless different influenza type/subtype is detected.

Hospitalisation

Hospital ward admission of patients who tested positive for influenza within 14 days prior to admission or during hospitalisation period.

Readmissions are reported and included.

ICU admission

If patient was admitted to ICU ward during hospital admission in where patient tested positive for influenza 14 days prior to admission or during hospitalisation period prior or while being admitted to ICU.

Death

Patient who died within 14 days after testing positive for influenza OR died as an outcome of hospital admission (where 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)

45

• 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

• Uploaded weekly to WHO/HQ by WHO/EURO and used in real time by both teams

• Global WHO dashboard for visualizing data (available via the PISA landing page once launched)

https://www.who.int/teams/global- influenza-programme/surveillance- and-monitoring/pandemic-influenza- severity-assessment

WHO Pandemic Influenza Severity Assessment (PISA)

46

PISA update indicators Description (full description of parameters and methods in the guidance)

Frequency of submission

Transmissibility - influenza Measure of how many people get sick with influenza or respiratory viruses and reflects the ease of movement of respiratory viruses between individuals and communities

Weekly

Transmissibility - syndromic

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 infected with an influenza virus

Twice per season 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

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

Year recordtypes/subject codes Approximate date

2025 RESPIQUAL data INFLZOO (zoonotic influenza subject codes)*

Late September (launch) Training September and October

2026 RESPI (RESPIAGGR, RESPISURV, RESPISEVERE)

SARI (SARISURV, SARISURVDENOM, INFLSARIAGGR) INFLCLIN, INFLANTIVIR

Approx. June (launch) Training May and June

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EpiPulse Cases Timeline

49

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

Access and permissions

50

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 with a cooperation frameworks in place

Check ECDC cooperation framework with your country for information on how to initiate nomination process

Other non-EU/EEA countries Please contact WHO Regional Office which then sends a request by email to ECDC Country Cooperation

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).

The reporting protocol will also be available on the ECDC website (LINK).

Reporting protocol

EVD example

1

The latest metadata can be downloaded from EpiPulse Cases platform.

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.

Metadata – access the latest version

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1

2

Metadata - RESPIQUAL

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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

Status Will be selected based on your entry when uploading data DELETE = Delete a previously reported . NEW/UPDATE = Update a previously reported (default)

Subject Code SubjectCode is a reporting model for a disease/health topic RESPIQUAL = Respiratory virus - qualitative indicators

National Id Unique identifier for each – selected and generated by the country reporting the . --> Further detail in subsequent slides

Data Source

The data source (surveillance system) that the originates from. The DataSource value must be a special reference value from EpiPulse Cases metadata.

Standard EPC variables

Metadata - RESPIQUAL

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Variable name Description Coded Values

Date used for statistics The reference week (yyyy-Www) for the reported qualitative indicator.

Pathogen or syndrome Pathogen or syndrome that applies. INFL = Influenza SYND = Syndromic

Surveillance type Type of surveillance system. PISA = PISA

Qualitative indicator Please select the qualitative indicator that you would like to report. The reporting protocol includes considerations for each qualitative indicator.

IMPACT = Impact on healthcare capacity MORB = Morbidity and mortality SERIOUS = Seriousness of disease TRANS = Transmissibility

Qualitative value Please select the value corresponding to the selected combination of pathogen/sydrome, surveillance type and qualititive indicator.

1 = No activity or below epidemic threshold 2 = Low 3 = Moderate 4 = High 5 = Extraordinary

Confidence Level of confidence for the qualitative value reported for the selected combination of pathogen/sydrome, surveillance type and qualititive indicator.

H = High L = Low M = Medium

Comment Information should be included on any factors which may have influenced the assessment.

Epidemiological variables

Metadata - Example

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Health Topic

Reporting Country Status SubjectCode NationalId DataSource DateUsed

ForStatistics Pathogen Syndrome

Surveillance Type

Qualitative Indicator

Qualitative Value

Confid ence

RESPI CY NEW/UPDATE RESPIQUAL INFL2025- W07PISATRANS CY-RESPIQUAL 2025-W37 INFL PISA TRANS 2 M

RESPI CY NEW/UPDATE RESPIQUAL SYND2025- W07PISATRANS CY-RESPIQUAL 2025-W37 SYND PISA TRANS 3 M

RESPI CY NEW/UPDATE RESPIQUAL INFL2025- W07PISAMORB CY-RESPIQUAL 2025-W37 INFL PISA MORB 1 L

RESPI CY NEW/UPDATE RESPIQUAL SYND2025- W07PISAMORB CY-RESPIQUAL 2025-W37 SYND PISA MORB 1 L

RESPI CY NEW/UPDATE RESPIQUAL INFL2025- W07PISAIMPACT CY-RESPIQUAL 2025-W37 INFL PISA IMPACT 1 H

RESPI CY NEW/UPDATE RESPIQUAL SYND2025- W07PISAIMPACT CY-RESPIQUAL 2025-W37 SYND PISA IMPACT 1 L

Metadata - Example

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Health Topic

Reporting Country Status SubjectCode NationalId DataSource DateUsed

ForStatistics Pathogen Syndrome

Surveillance Type

Qualitative Indicator

Qualitative Value

Confid ence

RESPI CY NEW/UPDATE RESPIQUAL INFL2025- W07PISATRANS CY-RESPIQUAL 2025-W37 INFL PISA TRANS 2 M

RESPI CY NEW/UPDATE RESPIQUAL SYND2025- W07PISATRANS CY-RESPIQUAL 2025-W37 SYND PISA TRANS 3 M

RESPI CY NEW/UPDATE RESPIQUAL INFL2025- W07PISAMORB CY-RESPIQUAL 2025-W37 INFL PISA MORB 1 L

RESPI CY NEW/UPDATE RESPIQUAL SYND2025- W07PISAMORB CY-RESPIQUAL 2025-W37 SYND PISA MORB 1 L

RESPI CY NEW/UPDATE RESPIQUAL INFL2025- W07PISAIMPACT CY-RESPIQUAL 2025-W37 INFL PISA IMPACT 1 H

RESPI CY NEW/UPDATE RESPIQUAL SYND2025- W07PISAIMPACT CY-RESPIQUAL 2025-W37 SYND PISA IMPACT 1 L

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.

Training session for EpiPulse Cases - RESPIQUAL

European Centre for Disease Prevention and Control

EpiPulse Cases DEMO

 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

Agenda

EpiPulse Cases live demo

EpiPulse Cases Training 3

Where to find EpiPulse Cases

General Navigation

Reporting Options Prepare data

Upload and tech

validation

EPC Data validation

report Approval or Rejection

EpiPulse Cases Training 4

EpiPulse Cases login and access

Users can use the following url https://epipulse.ecdc.europa.eu/epipulsecases/app/

and get redirected to the login page

Login

External users need to use this window to add their credentials

EpiPulse Cases and TESSy

EpiPulse Cases Training 5

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.

6

The platforms have a different look and feel!

EpiPulse Cases and TESSy

EpiPulse Cases Training

EpiPulse Cases live demo

EpiPulse Cases Training 7

General navigation

Where to find EpiPulse Cases

General Navigation

Reporting Options Prepare data

Upload and tech

validation

EPC Data validation

report Approval or Rejection

EpiPulse Cases Training 8

EpiPulse Cases main page

EpiPulse Cases live demo

EpiPulse Cases Training 9

Reporting options

Where to find EpiPulse Cases

Help documentation

General Navigation

Reporting Options

Prepare data

Upload and tech

validation

EPC Data validation

report

Approval or

Rejection

EpiPulse Cases Training 10

EpiPulse Cases reporting options

Manually create a record wizard

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EpiPulse Cases Training 12

Manually create a record wizard Preview and Submit

Steps for reporting to EpiPulse Cases

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Prepare • prepare data according to metadataset • csv or other file, or manual entry

Upload and validate

• upload data in EpiPulse Cases • validate data against metadata rules • review errors and warnings • correct any errors/re-submit

Analyse and review

• start EpiPulse Cases data validation and generate the EpiPulse Cases data validation report • review inconsistencies (metadata + cross-field) • check the completeness section • check the overview section

Finalise

• If validation OK, approve • If validation not OK, reject, correct data, upload+check again

Report data

Get the status Tech validation successful

Start Data validation process

Get the status Data validation report ready

Review the data validation report and Approve

Get the status Data change approved

Status workflow for an approved submission

EpiPulse Cases live demo

EpiPulse Cases Training 14

Prepare data

Where to find EpiPulse Cases

General Navigation

Reporting Options Prepare data

Upload and tech

validation

EPC Data validation

report Approval or Rejection

EpiPulse Cases

EpiPulse Cases Training 15

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.)

Prepare Upload and validate

Analyse and review Finalise

EpiPulse Cases live demo

EpiPulse Cases Training 17

Upload and Tech validation (error management)

Where to find EpiPulse Cases

Help documentation

General Navigation

Reporting Options

Prepare data

Upload and tech

validation

EPC Data validation

report

Approval or

Rejection

EpiPulse Cases

EpiPulse Cases Training 18

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

Prepare Upload and validate

Analyse and review Finalise

EpiPulse cases – Tech validation traps

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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 – 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

EpiPulse Cases Training 21

EpiPulse Cases Data validation report

(data quality management)

Where to find EpiPulse Cases

Help documentation

General Navigation

Reporting Options

Prepare data

Upload and tech

validation

EPC Data validation

report

Approval or

Rejection

EpiPulse Cases

EpiPulse Cases Training 22

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

Prepare Upload and validate

Analyse and review Finalise

EpiPulse Cases data validation report

EpiPulse Cases Training 23

EpiPulse Cases live demo

EpiPulse Cases Training 24

Approval or Rejection

Where to find EpiPulse Cases

General Navigation

Reporting Options Prepare data

Upload and tech

validation

EPC Data validation

report Approval or Rejection

EpiPulse Cases data validation report approval

EpiPulse Cases Training 25

EpiPulse Cases Training 26

Live demo of EpiPulse Cases

EpiPulse Cases Training 27

Support

EpiPulse Cases - user guides and support

EpiPulse Cases Training 28

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

Dedicated support offered via the [email protected] mailbox

• A dedicated team will monitor the EpiPulse Cases mailbox and will respond to all questions or concerns sent via e-mail

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.)

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 29

EpiPulse Cases Help section

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Questions and answers

E-kiri.eml

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

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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

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