Global Spatio-temporal Patterns of Influenza in the Post-pandemic Era

We study the global spatio-temporal patterns of influenza dynamics. This is achieved by analysing and modelling weekly laboratory confirmed cases of influenza A and B from 138 countries between January 2006 and May 2014. The data were obtained from FluNet, the surveillance network compiled by the the World Health Organization. We report a pattern of {\it skip-and-resurgence} behavior between the years 2011 and 2013 for influenza H1N1/09, the strain responsible for the 2009 pandemic, in Europe and Eastern Asia. In particular, the expected H1N1/09 epidemic outbreak in 2011 failed to occur (or"skipped") in many countries across the globe, although an outbreak occurred in the following year. We also report a pattern of {\it well-synchronized} 2010 winter wave of H1N1/09 in the Northern Hemisphere countries, and a pattern of replacement of strain H1N1/77 by H1N1/09 between the 2009 and 2012 influenza seasons. Using both a statistical and a mechanistic mathematical model, and through fitting the data of 108 countries (108 countries in a statistical model and 10 large populations with a mechanistic model), we discuss the mechanisms that are likely to generate these events taking into account the role of multi-strain dynamics. A basic understanding of these patterns has important public health implications and scientific significance.