Influenza surveillance in Western Turkey in the era of quadrivalent vaccines: A 2003–2016 retrospective analysis

Figures & data

Figure 1. Numbers of specimens tested each season (excluding the pandemic year [2009–2010]) and percentages positive for influenza.

Figure 2. Pathogen distribution, by season and overall (excluding the pandemic year [2009–2010]). *A/H1N1 (2003–2009) or A/H1N1/pdm09 (2010–2016). IBV, influenza B virus.

Figure 3. IBV circulation by lineage in Turkey during 2005–2016 (excluding the pandemic year [2009–2010]), by season and overall; and the proportions of IBV specimens tested that matched and mismatched the vaccine IBV lineage. IBV, influenza B virus; V, Victoria; Y, Yamagata.

Figure 4. Percentages of all positive specimens (IAV and IBV) estimated* to mismatch the vaccine due to IBV lineage mismatch during 2005–2016 (excluding the pandemic season [2009–2010]). *Based on a subset of IBV samples in which lineage was determined. IAV, influenza A; IBV, influenza B virus.

Figure 5. Timing of the influenza activity periods in Turkey (excluding the pandemic year [2009–2010]). Please note that in years with a week 53, these cases were included in week 52. Please also note the varying y-axis scales by season. *A/H1N1 (2003–2009) or A/H1N1/pdm09 (2010–2016). IBV, influenza B virus.

Figure S1. Changes in the start of influenza activity in Turkey (excluding the pandemic year [2009–2010]). The dotted line is an Excel “linear trendline”.

Figure S2. Comparison of the estimated* pathogen splits in the current study (sentinel surveillance in western Turkey) and Altas et al.1 (sentinel and non-sentinel surveillance in eastern Turkey) during the years common to both studies.

*Based on subsets of influenza B samples in which lineage was determined.

Table S1. Dominant (≥90%) antigenic types of IAV in the vaccine and in circulation in Turkey (2003–2016).

	A/H1N1 (2003–2009) or A/H1N1/pdm09 (2009–2016)		A/H3N2
Season	Vaccine content	Dominant antigenic type in Turkey	Vaccine content	Dominant antigenic type in Turkey
2003–2004	A/New Caledonia/20/99	—	A/Moscow/10/99-like	A/Fujian/411/02-like
2004–2005	A/New Caledonia/20/99-like	A/New Caledonia/20/99	A/Fujian/411/2002-like	A/Netherlands/128/2004
2005–2006	A/New Caledonia/20/99	—	A/California/7/2004-like	A/Hong Kong/443/05
2006–2007	A/New Caledonia/20/99	—	A/Wisconsin/67/2005 or A/Hiroshima/52/2005	A/Wisconsin/67/2005
2007–2008	A/Solomon Islands/3/2006	A/Solomon Islands/3/2006	A/Wisconsin/67/2005 or A/Hiroshima/52/2005	—
2008–2009	A/Brisbane/59/2007	—	A/Brisbane/10/2007	A/Brisbane/10/2007
2009–2010^a	A/California/7/2009	A/California/7/2009	A/Perth/16/2009-like	Not tested
2010–2011	A/California/7/2009	A/California/7/2009	A/Perth/16/2009	Not tested
2011–2012	A/California/7/2009	A/California/7/2009	A/Perth/16/2009	A/Victoria/361/2011-like
2012–2013	A/California/7/2009	A/California/7/2009	A/Victoria/361/2011	A/Texas/50/2012
2013–2014	A/California/7/2009	—	A/Texas/50/2012	A/Victoria/361/2011-like
2014–2015	A/California/7/2009	A/California/7/2009	A/Texas/50/2012	A/Victoria/361/2011
2015–2016	A/California/7/2009	A/California/7/2009	A/Switzerland/9715293/2013	A/Switzerland/9715293/2013

IAV, influenza A virus. Bold text indicates a mismatch of the circulating type with the vaccine type.

^a During the pandemic year (2009–2010), samples were collected from week 21 in 2009 through week 20 in 2010.

Table S2. Antigenic types/lineages of IBV in the vaccine and in circulation in Turkey (2004–2016).

Season	Vaccine content	Antigenic type(s) in Turkey
2004–2005	B/Shanghai/361/2002-like (Yamagata)	Not tested
2005–2006	B/Shanghai/361/2002-like (Yamagata) or B/Jiangsu/10/2003 (Yamagata)	B/Jiangsu/10/2003 (Yamagata) or B/Florida/7/2005 (Yamagata) (60.0%) B/Malaysia/2506/2004 (Victoria) (40.0%)
2006–2007	B/Malaysia/2506/2004-like (Victoria) or B/Ohio/1/2005 (Victoria)	B/Malaysia/2506/2004 (Victoria) (71.4%) B/Florida/4/2006 (Yamagata) (28.6%)
2007–2008	B/Malaysia/2506/2004-like (Victoria)	B/Florida/4/2006 (Yamagata) (90.9%) B/Malaysia/2506/2004 (Victoria) (9.1%)
2008–2009	B/Florida/7/2006-like (Yamagata)	B/Malaysia/2506/2004 (Victoria) (94.4%) B/Florida/4/2006 (Yamagata) (5.6%)
2010–2011	B/Brisbane/60/2008-like (Victoria)	B/Bangladesh/133/07 (Yamagata) (70.8%) B/Brisbane/60/2008-like (Victoria) (29.2%)
2011–2012	B/Brisbane/60/2008-like (Victoria)	B/Brisbane/60/2008 (Victoria) (93.8%) B/Florida/4/2006 (Yamagata) (6.3%)
2012–2013	B/Wisconsin/1/2010-like (Yamagata)	B/Wisconsin/1/2010-like (Yamagata) (88.9%) B/Brisbane/60/2008 (Victoria) (11.1%)
2013–2014	B/Massachusetts/2/2012 (Yamagata)	B/Massachusetts/2/2012 (Yamagata) (92.9%) B/Brisbane/60/2008 (Victoria) (7.1%)
2014–2015	B/Massachusetts/2/2012 (Yamagata)	B/Massachusetts/2/2012 (Yamagata) (90.0%) B/Brisbane/60/2008 (Victoria) (10.0%)
2015–2016	B/Phuket/3073/2013-like virus (Yamagata)	B/Malaysia/2506/2004 (Victoria) (95.0%) B/Massachusetts/2/2012 (Yamagata) (5.0%)

IBV, influenza B virus. Bold text indicates a mismatch between circulating and vaccine lineage.