A TIME'S MEMORY

7/06/2009

Argentina. Gripe A: desde el miércoles darían antiviral a todo paciente sospechoso

Gripe A: desde el miércoles darían antiviral a todo paciente sospechoso

10:29 El ministro de Salud bonaerense, Claudio Zin, dijo que aún no tienen "medicamentos suficientes", pero que está acordando con la Nación para obtenerlos. A la tarde, el Consejo Federal de Salud se reunirá para coordinar medidas contra la pandemia.

A horas de que el Consejo Federal de Salud se reúna para coordinar criterios contra la Gripe A, el titular de la cartera sanitaria bonaerense, Claudio Zin, aseguró que "entre miércoles y jueves" habrá suficientes medicamentos con la droga oseltamivir para asistir a todos los infectados con la gripe A y no solamente a quienes integren grupos de riesgo.

El funcionario reconoció que hoy la Provincia no cuenta con la cantidad de medicación suficiente para entregar de forma gratuita en los hospitales. "No tengo medicamentos suficientes para repartir en los hospitales de la provincia de Buenos Aires", explicó Zin en diálogo con radio Continental.

Por eso, dijo, hasta ahora la droga "se está distribuyendo y aplicando a gente que llega a una guardia con síntomas de gripe y constituye un factor de riesgo", como son las embrazadas, los pacientes con enfermedades cardiovasculares crónicas o los inmunodeprimidos."

''La etapa siguiente (en cuanto a las políticas sanitarias) es darle el medicamento, darle oseltamivir a cualquier persona con un estado gripal que llega a una guardia y tenga claramente los síntomas de gripe", explicó. Y agregó que "así se hizo en México y Chile", dos países donde la pandemia pudo ser controlada.

En este sentido, remarcó que la provincia de Buenos Aires "está en condiciones de comenzar esa etapa", para lo que todavía "falta que Nación suministre los medicamentos". Según dijo, "entre miércoles y jueves" los medicamentos podrían estar "distribuidos".

De todos modos, el funcionario aseguró que se reunirá "con el Ministro de Economía" para ver si la Provincia puede "comprar partidas aparte" del antiviral.

En este sentido, remarcó que está "abocado a conseguir los medicamentos". Y aclaró que él, como titular de la cartera sanitaria de la Provincia, no compra los medicamentos, sino que "los envía la Nación". Asimismo, Zin se refirió a la reunión que se hará a las 14 en el Ministerio de Salud de la Nación, donde los ministros de Salud de todas las provincias acordarán si se tratará con oseltamivir a todos los pacientes sospechosos de tener Gripe A y no solamente a los casos graves y además si se pasa de una fase de contención a la de mitigación.
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Gripe A: desde el miércoles darían antiviral a todo paciente sospechoso

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Ethnic riots spread in China's west; 156 killed (AP)

AP - Riots and street battles killed at least 156 people in China's western Xinjiang province, state media said Tuesday, and injured 828 others in the deadliest ethnic unrest to hit the region in decades. Officials said the death toll was expected to rise.

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Philippines seeks extra $390 mln for anti-flu drive (AlertNet, edited)

Philippines seeks extra $390 mln for anti-flu drive

06 Jul 2009 10:09:24 GMT
Source: Reuters
MANILA, July 6 (Reuters)

Philippine health officials asked the lower house of Congress for an extra $393 million this year to stockpile on antiviral drug and possible flu vaccines as the new influenza A(H1N1) virus continues to spread rapidly.

The Philippines has one of the highest number of cases of the new flu virus in Southeast Asia with nearly 2,000 victims and one death since the first case was reported on May 21.

"We haven't really seen enough of this virus and see how it evolves," Francisco Duque, health secretary, told lawmakers at a congressional hearing on Monday.

Duque said his department would need about 19 billion pesos to purchase an additional 225,000 Tamiflu capsules and 450,000 flu shots that might be made available later this year.

The Philippines has a stockpile of 1.18 million Tamiflu tablets but might run out of supplies as an average of 100 people are getting infected by the new flu virus every day, he said.

But, some lawmakers said they were surprised by the figures because the requested amount was about 80 percent of the health department's entire budget for 2009.

"It's an overkill," Congressman Eduardo Zialcita, adding 19 billion pesos was too much for one disease. He said dengue was killing more people in the country than the new flu virus.

About 80 percent of people infected by the deadly strain of swine flu virus have recovered, he added, citing a report from the health department.

(Reporting by Manny Mogato; Editing by Raju Gopalakrishnan)
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Reuters AlertNet - Philippines seeks extra $390 mln for anti-flu drive

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EGYPT: Authorities act in face of plague threat (AlertNet, edited)

EGYPT: Authorities act in face of plague threat

06 Jul 2009 14:38:26 GMT
Source: IRIN
DUBAI, 6 July 2009 (IRIN)

The Egyptian authorities have been taking measures over the past couple of weeks to prevent a plague outbreak in neighbouring Libya from reaching Egypt.

One person has died and five more were infected with bubonic and septicaemic plague in the eastern Libyan town of Tubruq, some 150km from the Egyptian border, according to the World Health Organization (WHO).

"An international [WHO] expert went there and assessed the situation. On 21 June, there were five suspected cases, according to his report; one septicaemic plague who died and four bubonic who recovered," Dr John Jabbour, emerging diseases specialist at the WHO office in Cairo, told IRIN on 5 July.

Jabbour said the WHO expert in Libya had made recommendations to the Libyan authorities on how to educate communities about the disease and its modes of transmission and how to improve surveillance systems in infected areas. He said a team of international experts was being assembled to provide a wider assessment of the situation.

"What we can say here is that the situation is under control and being very well monitored by the national authorities and there is active surveillance in the area to discover any suspected case of plague," Jabbour said.

According to London-based newspaper Al-Quds Al-'Arabi, Algeria has reported 50 cases of bubonic plague and two deaths.

The Egyptian government has declared a state of emergency along the Egypt-Libya border and sent two teams of experts to the border town of Sallum, which was already under quarantine for surveillance of the A(H1N1) virus, to set up a field laboratory and isolation facility. Health checks are being conducted on everyone returning from Libya.

"The medical team on the border was supported with more doctors to survey all the cases that come in. No suspected cases have been registered to date and we think the disease was completely controlled on the Libyan side," Abdel Rahman Shahin, spokesman of the Egyptian Ministry of Health, told IRIN on 6 July.

Shahin said that pest control teams had been sent to the border and were spraying all vehicles coming through Sallum, to kill rodent fleas. "Rodent traps were also put in open areas, while special teams trapped a number of rat fleas and tested them to make sure they are free of the disease. The authorities also got rid of the garbage at Sallum crossing and the exit points of Marsa Matrouh city, which is a very important preventive measure because garbage in open areas can facilitate the reproduction of rodents," he said.

According to WHO, infected persons usually start with "flu-like" symptoms after an incubation period of 3-7 days. Patients typically experience the sudden onset of fever, chills, head and body-aches, and weakness, vomiting and nausea.

WHO stresses that rapid diagnosis and treatment is essential to reduce complications. Effective treatment methods enable almost all plague patients to be cured if diagnosed in time.

Clinical plague infection manifests itself in three forms depending on the route of infection: bubonic, septicaemic and pneumonic.

Plague is a bacterial disease caused by Yersinia pestis, which primarily affects wild rodents or rats. It is then spread from rat to rat by fleas. If a human is bitten by an infected flea, he or she would usually develop a bubonic form of plague (a form that enters via the skin), characterized by a swelling of the nearest nymph node to the bite. If diagnosed early, bubonic plague can be successfully treated with antibiotics. It has a case-fatality ratio of 30-60 percent if left untreated.

The septicaemic form of plague occurs when infection spreads directly through the bloodstream without evidence of a "bubo". It may result from flea bites and from direct contact with infective materials through cracks in the skin.

The rare pneumonic form of plague is the most virulent as it can be transmitted from human to human via aerosolized infective droplets without the involvement of fleas or animals.

According to WHO, plague is endemic in many countries in Africa, in the former Soviet Union, the Americas and Asia. In 2003, nine countries reported 2,118 cases and 182 deaths - most in Africa.
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Reuters AlertNet - EGYPT: Authorities act in face of plague threat

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La vacuna contra la nueva gripe no llegará a la UE hasta diciembre · ELPAÍS.com

La vacuna contra la nueva gripe no llegará a la UE hasta diciembre

Los expertos tratan de determinar cuáles son los grupos de riesgo

EFE - Jönköping (Suecia) - 06/07/2009

Las grandes farmacéuticas realizan ensayos de urgencia para tener lista la vacuna contra la nueva gripe en otoño, cuando se prevé que, con el frío, aumente la incidencia del virus H1N1.

Sin embargo, su autorización tendrá que esperar hasta diciembre, según han informado hoy la directora general de la Organización Mundial de la Salud (OMS), Margaret Chan, y los representantes de la Agencia Europea del Medicamento (EMEA) en una reunión informal de los ministros de Sanidad de los Veintisiete.

La OMS y la EMEA argumentan que los estudios de los expertos sobre los grupos de riesgo explican el retraso. "Creo que va a ser posible determinar unos criterios de cuáles son los grupos de riesgo, pero están pidiéndonos un poco más de tiempo porque aún no ha habido los estudios clínicos necesarios para determinar esto", ha señalado la ministra española de Sanidad, Trinidad Jiménez.

Sí ha apuntado que hay una coincidencia común de algunas poblaciones vulnerables ya identificadas: los niños menores de dos años, las personas que tienen algún tipo de patologías -cardiopatías, diabetes o afecciones respiratorias- y las embarazadas. No obstante, ha insistido en que sobre este nuevo virus, que afecta especialmente a los jóvenes, "hay que seguir haciendo estudios".

La titular de Sanidad ha esgrimido que la mayoría de los países han apostado por una estrategia común de vacunación, para que no haya problemas de igualdad entre los Estados miembros. En esta línea, ha informado de que la Comisión Europea ha ofrecido la posibilidad de crear un consorcio de licitación pública para acceder a las vacunas en aquellos países en que aún no se ha producido un preacuerdo con los laboratorios, para cubrir la "laguna de dificultad" que puedan sufrir los Estados "más pequeños".

"El clima general nos permite ser optimistas", ha afirmado la responsable de Sanidad del Gobierno español, que ha encargado una cantidad de dosis de este fármaco suficiente como para inmunizar al 40% de la población española.
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La vacuna contra la nueva gripe no llegará a la UE hasta diciembre · ELPAÍS.com

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UK. Swine flu: two children and man take UK death toll to seven | World news | guardian.co.uk

Swine flu: two children and man take UK death toll to seven

• Man and child from Yorkshire, child from London killed
• All victims had serious underlying health problems

* Sarah Boseley, health editor
* guardian.co.uk, Monday 6 July 2009 17.56 BST

Three more people, two of them children, have died of swine flu, it was announced today, taking the death toll in the UK to seven.

One of the children, a nine year-old from south London, died at the weekend. The family asked for their privacy to be respected and would not allow any information about the child's health problems to be divulged.

The other two were a man and a child from the Kirklees area of West Yorkshire. All three victims had serious underlying health problems, according to local NHS officials.

Three children have now died. The first, Sameerah Ahmad in Birmingham, was six and suffered from a rare life-threatening disease which impaired her immune system and made her vulnerable to infections. Only one victim so far has been elderly – a 73-year-old man in Scotland. The others were a 19-year-old and a 38-year-old woman, who had recently given birth. All five had serious underlying health problems, according to NHS officials.

The virus is more likely to affect younger people than older. The chief medical officer, Sir Liam Donaldson, has said that the flu strain was part animal, part bird and part human and that the human element had been in circulation in the past, with the result that the immune systems of some of the older generation have some protective "memory" of it.

So far, more than 7,500 people have been diagnosed with swine flu in the UK, although the numbers are now rising so rapidly that the Health Protection Agency is no longer providing them on a daily basis. London, the West Midlands and Scotland have been worst hit so far.

The worldwide figures as of yesterday were 94,512 cases and 429 deaths, according to the World Health Organisation. Many more people will have been infected but will not be reported, because they have not seen a doctor.

The increased vulnerability of younger people could mean that they will be prioritised when the vaccine against swine flu becomes available, which should be by the end of August. Although the government has signed a contract for enough doses for the entire population, they will arrive in batches.

Most cases of swine flu have been and continue to be mild, except in those children and adults with existing serious health problems. However, there have been cases of severe illness involving hospitalisation and even death in some apparently previously healthy people in other countries. For that reason, everybody who falls ill and is diagnosed with swine flu in the UK will continue to be given antiviral drugs, the government said last week, rather than allowing the illness to take its course.

As of last week, however, when the government abandoned its containment strategy; people who fall ill are urged not to go to their doctor or to hospital accident and emergency departments. Instead, they are asked to check their symptoms online at www.nhs.uk or call the swine flu information line, on 0800 1 513 513. If they need drugs, a prescription will be issued for a healthy friend to collect.

Last week the health secretary, Andy Burnham, said contingency planners had estimated the number of new cases could hit 100,000 a day by the end of August. The public health strategy is now to treat those affected rather than attempt to stop the spread. Schools, for instance, will only be closed if too many teachers are off sick to keep classes going.
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Swine flu: two children and man take UK death toll to seven | World news | guardian.co.uk

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Influenza A(H1N1)v infection - Update 6 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 6 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]

Main developments in past 24 hours

82 new confirmed cases reported from the EU and EFTA countries, reaching a total of 10,342;
493 new cases reported from non-EU and EFTA countries, reaching a total of 85,482;
Croatia confirmed its first case;
Denmark announces changing its response strategy to “mitigation”.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 6 July, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer:
the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.

Epidemiological update

Out of the 31 EU and EFTA countries, 30 countries are reporting a total of 10,342 confirmed cases, including four deaths. This count includes the 82 latest cases, reported in the past 24 hours (Table1).

Denmark announced that it will change its response strategy from “containment” to “mitigation”. This means that laboratory testing and the use of anti-viral treatment and prophylaxis will be limited to persons considered at higher risk. More information is available from the following link: http://www.sst.dk/Nyhedscenter/Nyheder/2009/Aendret%20strategi.aspx.

Outside of the EU and EFTA countries, a total of 493 new cases have been reported from 5 countries within the last 24 hours, including 6 new fatal cases: five from Argentina and 1 from Australia. A total of 85,406 cases are reported outside of the EU and EFTA countries, including 427 deaths (Table 2).The global number of confirmed cases is 95,824 and 431 deaths.

On 2–3 July 2009, the EU Swedish Presidency organised an expert meeting of the Member States to discuss pandemic influenza preparedness – lessons learned and next steps. The EU Member States, the World Health Organisation, the European Commission and others were gathered to exchange experience and discuss future areas of cooperation regarding preparedness for the coming influenza season.

The presentations of the expert meeting, including lessons learned from affected countries like the UK, Spain and France, as well situation updates by ECDC and WHO, are available using the following link: http://www.se2009.eu/en/meetings_news/2009/7/3/exchange_of_experience_necessary_in_the_eu_s_fight_against_the_influenza_pandemic.

Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 06 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

[Country - Confirmed cases reported in the last 24h* - Cumulative number of confirmed cases - Deaths among confirmed cases**]

Austria ... - 19 - ...
Belgium ... - 54 - ...
Bulgaria 3 - 13 - ...
Cyprus 8 - 117 - ...
Czech Republic ... - 15 - ...
Denmark 1 - 66 - ...
Estonia ... - 13 - ...
Finland 7 - 62 - ...
France ... - 318 - ...
Germany 22 - 527 - ...
Greece 11 - 151 - ...
Hungary 9 - 21 - ...
Iceland ... - 4 - ...
Ireland 6 - 74 - ...
Italy ... - 146 - ...
Latvia ... - 1 - ...
Lithuania ... - 3 - ...
Luxemburg ... - 6 - ...
Malta ... - 16 - ...
Netherlands 7 - 142 - ...
Norway ... - 41 - ...
Poland ... - 25 - ...
Portugal 3 - 45 - ...
Romania ... - 44 - ...
Slovakia 1 - 19 - ...
Slovenia 1 - 14 - ...
Spain ... - 776 - 1
Sweden 3 - 87 - ...
Switzerland ... - 76 - ...
United Kingdom ... - 7447 - 3

Total 82 - 10,342 - 4

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
(*) Cases reported between 5 July 17:00 hours and 6 July 17:00 hours
(**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 06 July 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h* - Cumulative number of confirmed cases - Deaths among confirmed cases**]

OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

Bosnia and Herzegovina ... - 1 - ...
Channel Islands ... - 16 - ...
Croatia 1 - 1 - ...
Former Yugoslav Republic of Macedonia ... - 2 - ...
Island of Man ... - 1 - ...
Monaco ... - 1 - ...
Montenegro ... - 9 - ...
Russian Federation ... - 3 - ...
Serbia ... - 15 - ...
Ukraine ... - 1 - ...

MEDITERRANEAN AND MIDDLE-EAST

Algeria ... - 5 - ...
Bahrain ... - 15 - ...
Egypt ... - 67 - ...
Iran ... - 1 - ...
Iraq ... - 12 - ...
Israel ... - 577 - ...
Jordan ... - 22 - ...
Kuwait ... - 36 - ...
Lebanon ... - 49 - ...
Morocco ... - 17 - ...
Occupied Palestinian Territory ... - 48 - ...
Oman ... - 4 - ...
Qatar ... - 10 - ...
Saudi Arabia ... - 109 - ...
Tunisia ... - 4 - ...
Turkey ... - 40 - ...
United Arab Emirates ... - 8 - ...
Yemen ... - 8 - ...

AFRICA

Cape Verde ... - 3 - ...
Ethiopia ... - 3 - ...
Ivory Coast ... - 2 - ...
Kenya ... - 12 - ...
Mauritius ... - 1 - ...
South Africa ... - 13 - ...
Uganda ... - 1 - ...

NORTH AMERICA

Canada ... - 8883 - 29
Mexico ... - 10262 - 119
***USA ... - 33902 - 170

CENTRAL AMERICA AND CARIBBEAN

Antigua and Barbuda ... - 2 - ...
Aruba ... - 5 - ...
Bahamas ... - 6 - ...
Barbados ... - 12 - ...
Bermuda ... - 2 - ...
British Virgin Islands ... - 2 - ...
Cayman Islands ... - 14 - ...
Costa Rica ... - 277 - 3
Cuba ... - 85 - ...
Dominica ... - 1 - ...
Dominican Republic ... - 108 - 2
El Salvador ... - 277 - ...
Guatemala ... - 286 - 2
Honduras ... - 123 - 1
Jamaica ... - 32 - ...
Martinique ... - 2 - ...
Netherlands Antilles ... - 15 - ...
Nicaragua ... - 321 - ...
Panama ... - 417 - ...
Saint Lucia ... - 1 - ...
Suriname ... - 11 - ...
Trinidad-Tobago ... - 65 - ...

SOUTH AMERICA

Argentina 76 - 2485 - 60
Bolivia ... - 283 - ...
Brazil 129 - 885 - 1
Chile ... - 8160 - 16
Colombia ... - 101 - 2
Ecuador ... - 163 - ...
Paraguay ... - 103 - ...
Peru ... - 916 - ...
Uruguay ... - 196 - 1
Venezuela ... - 204 - ...

NORTH-EAST AND SOUTH ASIA

Bangladesh ... - 12 - ...
China (mainland) ... - 916 - ...
Hong Kong SAR China 20 - 921 - ...
India ... - 104 - ...
Japan 267 - 1784 - ...
Macao SAR China ... - 47 - ...
Nepal ... - 5 - ...
South Korea ... - 210 - ...
Sri Lanka ... - 17 - ...
Taiwan ... - 72 - ...

SOUTH-EAST ASIA

Brunei Darussalam ... - 93 - 1
Cambodia ... - 7 - ...
Indonesia ... - 20 - ...
Laos Peoples Democratic Republic ... - 3 - ...
Malaysia ... - 411 - ...
Myanmar ... - 1 - ...
Philippines ... - 1709 - 1
Singapore ... - 1003 - ...
Thailand ... - 2009 - 5
Vietnam ... - 131 - ...

AUSTRALIA AND PACIFIC

Australia ... - 5298 - 11
Cook Islands ... - 1 - ...
Fiji ... - 10 - ...
French New Caledonia ... - 6 - ...
French Polynesia ... - 2 - ...
New Zealand ... - 961 - 3
Papua New Guinea ... - 1 - ...
Republic of Palau ... - 1 - ...
Samoa ... - 1 - ...
Vanuatu ... - 2 - ...

TOTAL 493 - 85482 -427

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
(*) Cases reported between 5 July 17:00 hours and 6 July 17:00 hours
(**) Deaths are included in the cumulative number of confirmed cases
(***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)
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India. Update on Influenza A (H1N1) as on 6th July, 2009 20:34 IST (PIB Press Release, edited)

Update on Influenza A (H1N1) as on 6th July, 2009 20:34 IST

World Health Organization has reported 94,512 laboratory confirmed cases of influenza A/H1N1 infection from 135 countries as on 6th July 2009. There have been 429 deaths.

Health screening of passengers coming from affected countries is continuing in 22 International airports.

51,217 passengers have been screened on 5.7.2009 of which 38,624 passengers were from affected countries.

224 doctors and 112 paramedics are manning 77 counters at these airports.

A cumulative total of 2,938,321 passengers have been screened.

Nine new cases has been reported today: Delhi (2), Jalandhar (2), Mumbai (2), Cochin (1) Bangalore (1) and Gurgaon (1).

Out of the two cases in Delhi, one is a 7 year old male child who travelled from Bavaria, Germany by Emeritus Flight EK 516 reaching Delhi on 26th June 2009. He reported with symptoms of fever, sore-throat and cough on 4th July 2009 at the identified health facility where he is admitted. His brother who traveled with him was also reported positive earlier.

The second case in Delhi is a 39 year old male who travelled from Kuwait by Kuwait Airways Flight KU 381 reached Delhi on 5th July 2009. As the passenger was having running nose and fever, he was detected at the airport and admitted in the identified health facility.

The two cases in Jalandhar are husband and wife (46 year old male & 39 year old female) who travelled from Bangkok by Thai Airways TG 323 reaching New Delhi on 3rd July 2009. On 3rd July, they reported with symptoms of fever and running nose at the identified health facility where they are presently admitted.

Out of the two cases in Mumbai, one is a 29 year old female who travelled from Canberra, Australia transiting Bangkok by Thai Airways flight TG 339 reaching Mumbai on 4th July 2009. During screening at the airport she was found to be having fever and was admitted in the identified health facility.

The other case is a 52 year old female who travelled from Bangkok by Thai Airways TG 339 reaching Mumbai on 4th July 2009. During the health screening at the airport she was found to be having fever and was admitted in the identified health facility.

The case in Bangalore is a 26 year old male who travelled from Bangkok to Bangalore by Thai Airways TG 325 reaching Bangalore on 4th July 2009. As he was found having symptoms of fever and cough, during screening at the airport and he was admitted in the identified health facility.

In Cochin, a 25 year old male who travelled from London transiting Doha reaching Cochin on 29th June 2009. On 3rd July 2009, he reported with the symptoms of fever and cough at the identified hospital where he is admitted.

In Gurgaon, a 29 year old female travelled from Singapore by Singapore Airlines reaching Delhi on 28th June 2009. On 4th July she reported at the identified health facility with symptoms of fever and cough.

On 28th June, 2009 two positive cases, a 68 year old male from Bangalore who came from USA and 46 year old male at Delhi, also from USA, were reported on each from National Institute of Communicable Diseases, Delhi and National Institute of Virology, Pune which were inadvertently indicated as repeat samples and hence not listed on that day as new positive cases. Both have been admitted and treated at identified health facilities and got discharged. The respective State Governments have taken all necessary action and traced their contacts. These two cases have now been added to the cumulative total of positive cases.

The indigenous positive case [66 year old female] at Delhi, covered in earlier reports, is stable.

939 persons have been tested so far of which 145 are positive for Influenza A H1N1 [Swine].

284 out of the 939 persons have been identified through entry screening, twenty seven through contact tracing and the rest were self reported.

Of the 145 positive cases, 103 have been discharged. Rest of them remains admitted to the identified health facility.

The situation is being monitored.

KP:CP:health
(6,7,2009)
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PIB Press Release

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Hong Kong: HA update on Designated Flu Clinic and admitted human swine influenza patients (7/6/09)

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Hong Kong: Twenty new cases of human swine influenza (7/6/09)

A spokesman for the Department of Health said there had been 20 newly confirmed cases of human swine influenza (Influenza A H1N1) in the 24 hours to 2.30pm today (July 6).

The new cases involve nine males and 11 females, aged between seven months and 52 years.

This brings to 973 the total number of human swine influenza cases in Hong Kong.
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USA. Ohio Department Of Health Confirms First H1N1 Influenza Death

Ohio Department Of Health Confirms First H1N1 Influenza Death

Article Date: 06 Jul 2009 - 1:00 PDT

The Ohio Department of Health (ODH) announced that a Butler County male in his 40s, who was infected with H1N1 influenza, died June 29.

This is the first Ohio death linked to the pandemic strain of influenza. The patient had underlying health problems that may have contributed to his death.

The H1N1 infection was confirmed at the ODH laboratory today. ODH is unable to provide further details about the patient to protect confidentially. Patient contacts are being identified to determine whether public health interventions are necessary.

"Our hearts go out to this man's family and loved ones," said ODH Director Alvin D. Jackson, M.D. "This is a sad, and not entirely unexpected, event as influenza and its complications cause some 3,000 deaths annually in Ohio, ranking it among the top 10 causes of death. We continue to urge Ohioans to take proper precautions and will monitor the situation closely."

There have been 332 H1N1 deaths worldwide, including 127 in the United States, according to the World Health Organization.

Ohioans should take the following actions to help stay healthy:
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitizers are also effective.
Avoid touching your eyes, nose or mouth. Germs spread that way.
Stay home if you get sick to limit contact with others and the spread of disease.

"Common sense is your best defense," Jackson said.

As of Wednesday, ODH was reporting 108 confirmed and six probable H1N1 cases to date; for more information, please visit http://www.odh.ohio.gov or call the toll-free H1N1 information line at 1-866-800-1404 8 a.m. to 5 p.m. Monday through Friday; the line will not be staffed Friday, July 3.

Source
Ohio Department of Health
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Ohio Department Of Health Confirms First H1N1 Influenza Death

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Interim Guidance for Homeless and Emergency Shelters on the Novel Influenza A (H1N1) Virus (US CDC)

This document provides interim guidance specific for homeless and emergency shelters during the outbreak of novel influenza A (H1N1) virus and suggested means to reduce the spread of influenza in these settings and communities. Recommendations may need to be revised as more information becomes available.

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Indonesia. Lampung - Hospital treats bird flu suspect boy

Bandar Lampung – Abdul Muluk Hospital, Bandar Lampung treats bird flu and swine flu suspect patients. The bird flu suspect patient, Nurman (15) was admitted to the isolation unit today (6/7). Pad Dilangga, Vice Director of Abdul Muluk Hospital, said that those patients were placed in separated room. This decision was made because the hospital, [...]

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Singapore. 56 new confirmed cases of Influenza A (H1N1-2009) (Min. of Health, July 6, 2009, edited)

SINGAPORE- MINISTRY OF HEALTH

FOR IMMEDIATE RELEASE

56 new confirmed cases of Influenza A (H1N1-2009)

[Original Document: LINK. EDITED.]

56 new H1N1 cases were confirmed today. Almost all the cases are mild.

Two cases are notable.

2. A 63-year-old man sought emergency treatment at TTSH Emergency Department on 5 July, after three days of flu-like symptoms. He was immediately admitted and isolated for treatment of several complications, including pneumonia and heart disease. Laboratory diagnosis confirmed that he was also infected with H1N1 and he was started on Tamiflu that night. As he has multiple co-morbidities (coronary heart disease, hypertension, hyperlipideamia), he was transferred to ICU this morning. He remains ill, and is being monitored closely.
3. A 40-year-old Indonesian man from the Asian Youth Games (AYG) Indonesian contingent developed flu-like symptoms on 2 July and was treated symptomatically by the Indonesian team’s doctor. He sought medical attention again on 5 July at the AYG Medical Centre and laboratory diagnosis confirmed that he was infected with H1N1. He is in a stable condition. Two close contacts will be issued HQO. They are currently well.

4. We have routine bio-surveillance on samples of patients presented with influenza-like illness (ILI) in our clinics and hospitals. Latest data shows that 13 per cent of samples taken from patients with ILI are Influenza A (H1N1-2009)-positive. This means that 13 in 100 patients with ILI have Influenza A (H1N1-2009). As observed in other countries, this proportion will grow as the virus spreads further in the community, and displaces other influenza strains.

Advisory

5. The current strain remains mild, except for high-risk individuals with underlying medical conditions where complications and even deaths may occur. We advise at-risk individuals to seek prompt medical attention if unwell.
6. The public is advised to check MOH website for more information on PPCs and the latest update on the H1N1 situation.

MINISTRY OF HEALTH
6 July 2009

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WHO | Pandemic (H1N1) 2009 - update 58

Pandemic (H1N1) 2009 - update 58

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the International Health Regulations (2005)6 July 2009 09:00 GMT

The breakdown of the number of laboratory-confirmed cases is given in the following table and map.
Map of the spread of pandemic (H1N1) 2009: number of laboratory confirmed cases and deaths [png 190kb]

[Country, territory and area - Cumulative total / Newly confirmed since the last reporting period: (Cases - Deaths)]
Algeria 5 - 0 / 0 - 0
Antigua and Barbuda 2 - 0 / 0 - 0
Argentina 2485 - 60 / 898 - 34 [CFR 24.14 x 1,000]
Australia 5298 - 10 / 730 - 1 [CFR 1.88]
Austria 19 - 0 / 4 - 0
Bahamas 7 - 0 / 1 - 0
Bahrain 15 - 0 / 0 - 0
Bangladesh 18 - 0 / 6 - 0
Barbados 12 - 0 / 0 - 0
Belgium 54 - 0 / 5 - 0
Bermuda, UKOT 1 - 0 / 0 - 0
Bolivia 416 - 0 / 133 - 0
Bosnia and Hezegovina 1 - 0 / 0 - 0
Brazil 737 - 1 / 0 - 0 [CFR 1.35]
British Virgin Islands, UKOT 2 - 0 / 0 - 0
Brunei Darussalam 124 - 0 / 39 - 0
Bulgaria 10 - 0 / 0 - 0
Cambodia 7 - 0 / 0 - 0
Canada 7983 - 25 / 0 - 0 [CFR 3.13]
Cap Verde 3 - 0 / 0 - 0
Cayman Islands, UKOT 14 - 0 / 0 - 0
Chile 7376 - 14 / 0 - 0 [CFR 1.89]
China 2040 - 0 / 226 - 0
Colombia 118 - 2 / 17 - 0 [CFR 16.94]
Cook Island 1 - 0 / 1 - 0
Costa Rica 277 - 3 / 50 - 1 [CFR 10.8]
Cote d'Ivoire 2 - 0 / 0 - 0
Croatia 1 - 0 / 1 - 0
Cuba 85 - 0 / 12 - 0
Cyprus 109 - 0 / 39 - 0
Czech Republic 15 - 0 / 0 - 0
Denmark 66 - 0 / 3 - 0
Dominica 1 - 0 / 0 - 0
Dominican Republic 108 - 2 / 0 - 0 [CFR 18.51]
Ecuador 204 - 0 / 41 - 0
Egypt 78 - 0 / 11 - 0
El Salvador 319 - 0 / 66 - 0
Estonia 13 - 0 / 0 - 0
Ethiopia 3 - 0 / 0 - 0
Fiji 2 - 0 / 0 - 0
Finland 47 - 0 / 4 - 0
France 310 - 0 / 10 - 0
French Polynesia, FOC 4 - 0 / 2 - 0
Guadaloupe, FOC 2 - 0 / 2 - 0
Martinique, FOC 3 - 0 / 1 - 0
New Caledonia, FOC 12 - 0 / 6 - 0
Saint Martin, FOC 1 - 0 / 1 - 0
Germany 505 - 0 / 35 - 0
Greece 151 - 0 / 42 - 0
Guatemala 286 - 2 / 32 - 0 [CFR 6.99]
Guyana 2 - 0 / 2 - 0
Honduras 123 - 1 / 0 - 0 [CFR 8.13]
Hungary 11 - 0 / 0 - 0
Iceland 4 - 0 / 0 - 0
India 129 - 0 / 25 - 0
Indonesia 20 - 0 / 12 - 0
Iran, Islamic Republic 1 - 0 / 0 - 0
Iraq 12 - 0 / 1 - 0
Ireland 74 - 0 / 23 - 0
Israel 681 - 0 / 104 - 0
Italy 146 - 0 / 16 - 0
Jamaica 32 - 0 / 0 - 0
Japan 1790 - 0 / 344 - 0
Jordan 23 - 0 / 1 - 0
Kenya 15 - 0 / 3 - 0
Korea, Republic of 202 - 0 / 0 - 0
Kuwait 35 - 0 / 0 - 0
Laos 5 - 0 / 2 - 0
Latvia 1 - 0 / 0 - 0
Lebanon 49 - 0 / 2 - 0
Libya 1 - 0 / 1 - 0
Lithuania 3 - 0 / 0 - 0
Luxembourg 6 - 0 / 2 - 0
Macedonia 2 - 0 / 2 - 0
Malaysia 112 - 0 / 0 - 0
Malta 24 - 0 / 22 - 0
Mauritius 1 - 0 / 0 - 0
Mexico 10262 - 119 / 0 - 0 [CFR 11.59]
Montenegro 10 - 0 / 1 - 0
Morocco 17 - 0 / 0 - 0
Myanmar 1 - 0 / 0 - 0
Nepal 5 - 0 / 0 - 0
Netherlands 135 - 0 / 1 -0
Netherlands, Aruba 5 - 0 / 0 - 0
Netherlands Antilles, Curaçao 8 - 0 / 0 - 0
Netherlands Antilles, Sint Maarten 7 - 0 / 0 - 0
New Zealand 1059 - 3 / 147 - 3 [CFR 2.83]
Nicaragua 321 - 0 / 13 - 0
Norway 41 - 0 / 0 - 0
Oman 4 - 0 / 1 - 0
Palau 1 - 0 / 0 - 0
Panama 417 - 0 / 0 - 0
Papua New Guinea 1 - 0 / 0 - 0
Paraguay 106 - 1 / 3 - 1 [CFR 9.43]
Peru 916 - 0 / 378 - 0
Philippines 1709 - 1 / 0 - 0 [CFR 0.58]
Poland 25 - 0 / 6 - 0
Portugal 42 - 0 / 15 - 0
Qatar 23 - 0 / 13 - 0
Romania 41 - 0 / 5 - 0
Russia 3 - 0 / 0 - 0
Saint Lucia 1 - 0 / 0 - 0
Samoa 1 - 0 / 0 - 0
Saudi Arabia 114 - 0 / 25 - 0
Serbia 15 - 0 / 0 - 0
Singapore 1055 - 0 / 177 - 0
Slovakia 18 - 0 / 0 - 0
Slovenia 14 - 0 / 9 - 0
South Africa 18 - 0 / 6 - 0
Spain 776 - 1 / 16 - 0 [CFR 1.28]
Sri Lanka 19 - 0 / 2 - 0
Suriname 11 - 0 / 0 - 0
Sweden 84 - 0 / 10 - 0
Switzerland 76 - 0 / 4 - 0
Syria 1 - 0 / 1 - 0
Thailand 2076 - 7 / 662 - 4 [CFR 3.37]
Trinidad and Tobago 65 - 0 / 12 - 0
Tunisia 5 - 0 / 2 - 0
Turkey 40 - 0 / 0 - 0
Uganda 1 - 0 / 0 - 0
Ukraine 1 - 0 / 0 - 0
United Arab Emirates 8 - 0 / 0 - 0
United Kingdom 7447 - 3 / 0 - 0 [CFR 0.40]
Guernsey, Crown Dependency 5 - 0 / 0 - 0
Isle of Man, Crown Dependency 1 - 0 / 0 - 0
Jersey, Crown Dependency 11 - 0 / 0 - 0
United States of America 33902 - 170 / 0 - 0 [CFR 5.00]
Puerto Rico 18 - 0 / 18 - 0
Virgin Islands 1 - 0 / 1 - 0
Uruguay 195 - 4 / 0 - 3 [CFR 20.51]
Vanuatu 2 - 0 / 0 - 0
Venezuela 206 - 0 / 2 - 0
Viet Nam 181 - 0 / 50 - 0
West Bank and Gaza Strip 60 - 0 / 30 - 0
Yemen 8 - 0 / 1 - 0
Grand Total 94512 - 429 / 4591 - 47 [CFR 4.53]
Chinese Taipei has reported 61 confirmed cases of pandemic (H1N1) 2009 with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above.Cumulative and new figures are subject to revision
Abbreviations
UKOT: United Kingdom Overseas Territory
FOC: French Overseas Collectivity
Netherlands Antilles, Curaçao : 3 confirmed cases: The three confirmed cases are crew members of a cruise ship. They did not leave the boat during their illness nor during the 24 hours preceding the onset of symptoms.
Norway: 7 confirmed cases are crew members and passengers of a cruise ship. They did not leave the boat during their illness nor during the 24 hours preceding the onset of symptoms.
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[RED figures indicate country/area with new fatal cases; GREEN figures indicate country/area with new confirmed cases; CFR=Case-Fatality Rate expressed as Total Deaths/Total Cases*1,000. Added by Moderator IOH.]
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WHO | Pandemic (H1N1) 2009 - update 58

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Argentina. Situación de la Influenza A (H1N1) (Min. Salud, July 5, 2009, edited)

Argentina. Ministerio de Salud

Situación de la Influenza A (H1N1) - Nº 61 - FECHA: 05/07/09

[Original Full Document: LINK. EDITED.]

(...)

2. VIGILANCIA DE LA MORBIMORTALIDAD

Definición de caso sospechoso:

En las áreas con transmisión extensa área metropolitana: (Ciudad de Buenos Aires, Conurbano Bonaerense incluida la ciudad de La Plata):

Toda persona que presente enfermedad respiratoria aguda febril (>38° C) en un espectro que va de enfermedad tipo influenza a neumonía.

En las áreas sin transmisión extensa:

Toda persona que presente enfermedad respiratoria aguda febril (>38ºC) en un espectro que va de enfermedad tipo influenza a neumonía y que: presente síntomas dentro de los 7 días posteriores a la fecha de su salida de zonas afectadas con transmisión humano-humano sostenida (Canadá, Chile, Estados Unidos, México, y Área Metropolitana de Buenos Aires), o presente síntomas en los próximos 7 días a haber tenido contacto estrecho con un caso sospechoso o confirmado de Influenza A H1N1.

A la fecha ANLIS “Carlos G Malbran” confirmó 2.485 casos y se descartaron 2.199. Con 60 fallecidos.

Distribución de casos confirmados en el país por jurisdicción, edad y sexo:

Totales acumulados desde el 26 de abril

Positivas 2.485
Negativas 2.199
Fallecidos 60

Jurisdicción de residencia - Confirmados para A(H1N1): Total - Fallecidos (*)

CAP.FED. (G.C.B.A.) 936 - 6
BUENOS AIRES 779 - 42
Area Metropolitana sin especificar jurisdicción 155 - 1
SANTA FE 112 - 9
T. DEL FUEGO 103 - ...
NEUQUEN 56 - ...
SANTA CRUZ 39 - ...
CORDOBA 31 - ...
ENTRE RIOS 28 - ...
LA PAMPA 28 - ...
CORRIENTES 27 - ...
SAN JUAN 23 - ...
SGO. DEL ESTERO 22 - ...
TUCUMAN 21 - ...
CHACO 21 - ...
RIO NEGRO 21 - ...
MISIONES 20 - 2
CHUBUT 15 - ...
SALTA 15 - ...
FORMOSA 13 - ...
SAN LUIS 10 - ...
MENDOZA 4 - ...
JUJUY 4 - ...
CATAMARCA 1 - ...
LA RIOJA 1 - ...

TOTAL 2.485 - 60

3. ACCIONES DE PREVENCIÓN Y CONTROL

Se continúa con las acciones de prevención y control frente a la confirmación de nuevos casos, como así también con la investigación epidemiológica de los casos notificados en el día de la fecha.
Desde el 16 de junio de 2009, en el área Metropolitana se modificó la situación epidemiológica pasando de fase de contención a la de mitigación. Por lo tanto, desde esa fecha, este Ministerio informa sólo los casos confirmados por laboratorio y no por cuadro clínico, al igual que lo hacen países con transmisión sostenida (EEUU, México, Chile, etc.).
El diagnóstico virológico tiene por objeto la vigilancia epidemiológica y no la decisión terapéutica. De esta manera, no es correcto el cálculo de tasas a partir de los datos informados.

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Espana. Un mujer, ingresada grave por nueva gripe en L'Hospitalet · ELPAÍS.com

Un mujer, ingresada grave por nueva gripe en L'Hospitalet

La Generalitat catalana confirma además 14 nuevos casos de infección en un grupo de estudiantes de medicina que viajó a la República Dominicana

AGENCIAS - Barcelona - 06/07/2009

Una mujer de 52 años está ingresada en estado grave en el hospital de Bellvitge (L'Hospitalet del Llobregat) a causa de la nueva gripe, según han comunicado fuentes del departamento de Salud de la Generalitat a Efe.

Así, ya son dos las personas que han requerido ser hospitalizadas debido a la gravedad de la enfermedad. Además, Salud también ha confirmado 14 nuevos casos de gripe H1N1 en un grupo de estudiantes de medicina que había viajado a Punta Cana, en la República Dominicana. Se encuentran en estado leve.

En declaraciones a Catalunya Ràdio recogidas por Europa Press, la consellera de Salud de la Generalitat, Marina Geli, ha afirmado esta mañana que la mujer ingresada tiene antecedentes de obesidad, apneade sueño y problemas respiratorios. Señaló que la mujer "evoluciona favoralemente" dentro de la gravedad y "parece que ha respondido a la medicación", lo que ha permitido que saliera de la UCI. Este es el segundo caso grave que se da en Catalunya, después del hombre de 32 años que sigue ingresado en el Hospital JoanXXIII de Tarragona, y que permanece "crítico".

También ha confirmado 14 casos leves en un grupo de 114 estudiantes de la Universitat de Barcelona que fueron de viaje de fin de curso a la República Dominicana entre el 19 y el 26 de junio. Geli ha añadido que la mayoría de afectados ya están en sus domicilios y haciendo vida normal.

Estos casos se suman a los seis jóvenes de Alcanar que fueron a Mallorca, infectados con síntomas leves que se conocieron este fin de semana. En total, en Catalunya se han confirmado 45 casos de nueva gripe, ha recordado la consellera.

Los dos casos graves en Cataluña se suman a los otros dos que siguen ingresados en la Comunidad de Madrid. Se trata de un menor de 8 años con síndrome de Angelman hospitalizado en el Hospital Niño Jesús y una mujer de 35 años que evoluciona favorablemente en el Hospital Universitario de Getafe, según informaron fuentes de la Consejería de Sanidad de Madrid la semana pasada.
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Un mujer, ingresada grave por nueva gripe en L'Hospitalet · ELPAÍS.com

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Australia. Dramatic flu surge at New South Wales hospitals - ABC News (Australian Broadcasting Corporation)

Dramatic flu surge at NSW hospitals

(July 6, 2009, edited)

Concern over swine flu is putting increased pressure on New South Wales emergency departments, with western Sydney the state's hardest hit region.

NSW has experienced a 17-fold increase in the number of people presenting at hospitals with symptoms of the flu compared to the same period last year.

Most of the spikes in hospital attendances have correlated with publicity around swine flu cases and deaths.

NSW Health Minister John Della Bosca says an extra 550 hospital beds are being made available to cope with demand, which has surged in the past few weeks.

"Also, we've put in a place nearly 8,000 extra hospital-in-the-home places for people suffering flu-like symptoms," he said.

Children aged between five to 16 are the largest group presenting at emergency departments.

The state's Chief Medical Oficer, Dr Kerry Chant, says Sydney's west has been the hardest hit.

"It got introduced into that group of the population and so it has spread there like any infectious disease," she said.

"It's started to spread in that community. It will then progressively spread to other communities and it will spread progressively across the state."

Two people with swine flu have died in NSW and nine people suffering from the virus are in intensive care in the state.

Seven people with swine flu have died in Victoria, including a three-year-old boy, as well as two people in Western Australia.

There are more than 1,400 confirmed cases of swine flu in New South Wales.
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Dramatic flu surge at NSW hospitals - ABC News (Australian Broadcasting Corporation)

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Australia. First swine flu death recorded in NT - ABC News (Australian Broadcasting Corporation)

First swine flu death recorded in NT

(July 6, 2009, edited)

The Northern Territory has recorded its first swine flu-related death.

The department of health has confirmed a man in his early 50 has died at Royal Darwin Hospital.

It says he had underlying health issues.

"This is the first H1N1-related death to have occurred in the Northern Territory and RDH staff extend their sincerest sympathy to the patient's family and friends for their sad loss," the hospital's general manager, Dr Len Notaras, said.

"Surveillance and the management of H1N1 Influenza are maintained in accordance with national and international standards, and at this time, in consideration of family privacy, no other further details of the case will be made available."

Neither the hospital nor the Centre for Disease Control would reveal where the man was from, except to say he was a Top End resident.

The number of swine flu cases in the Northern Territory currently stands at more than 350.

There are 13 people in hospital, with four in Darwin and nine in Alice Springs.
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First swine flu death recorded in NT - ABC News (Australian Broadcasting Corporation)

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China state media says 140 killed in riots in west (AP)

AP - Violence in the capital of China's volatile Xinjiang region killed 140 people and injured 828, an official said Monday, following rioting by members of a Muslim ethnic group and a police crackdown on their demonstrations.

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7/05/2009

Peru Reports First Two Swine Flu Deaths

Peru Reports First Two Swine Flu Deaths

LIMA (AFP)

Peru on Sunday reported its first two swine flu fatalities, a 38- year-old woman and a four-year-old girl, Health Minister Oscar Ugarte said.

The Andean nation has more than 810 confirmed infections of A(H1N1) and has become the seventh South American country to report deaths linked to the virus.

Ugarte said the woman died Friday after checking into a Lima hospital with pneumonia on June 29, when tests confirmed she had the virus.

"She received standard antiviral treatment but unfortunately she died," Ugarte said.

The young girl, who had Down Syndrome, was admitted to hospital with severe respiratory problems, and died shortly thereafter.

The American continent remains the world region worst affected by swine flu, which first appeared in Mexico in late April.

The virus, declared a global pandemic last month by the World Health Organization, has infected 89,921 people in 125 countries and territories and caused 382 deaths worldwide, according to the WHO's latest figures.
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Peru Reports First Two Swine Flu Deaths

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Thailand reports 231 new A/H1N1 cases, as numbers keep rising in other Asia-Pacific parts (Xinhua, edited)

Thailand reports 231 new A/H1N1 cases, as numbers keep rising in other Asia-Pacific parts

www.chinaview.cn 2009-07-06 00:14:51
HONG KONG, July 5 (Xinhua)

Thailand on Sunday announced 231 more confirmed cases of Influenza A/H1N1, bringing the total number to 2,076, while other countries in the Asia-Pacific region also reported more infected cases.

Of the total new confirmed cases in Thailand, 26 are domestically infected, and 205 are students, said Thai Deputy Minister Manit Nopamornbodi. While 2,036 patients have already recovered, 33 others are still treated in hospitals, and seven people died of the A/H1N1 flu virus infection, he said.

Meanwhile, among those who have remained in the hospitals, three are in critical condition, he aid.

Singapore on the same day confirmed 52 new cases of Influenza A/H1N1, bringing the total number of such cases to 1,055 in the city state. According to a statement issued by Singapore's Ministry of Health on Sunday, of the cumulative number of 1,003 cases investigated so far, 591 were local cases and 412 were imported ones. Singapore reported its first confirmed case of Influenza A/H1N1on May 27.

The Bangladeshi government also confirmed two more A/H1N1 flu cases, bringing the total number to 18. The Institute of Epidemiology Disease Control and Research (IEDCR) under the Health Ministry confirmed two people in Dhaka got the infection through their relatives, who had recently returned from Australia and the United States. Spokesman of the IEDCR Mustaq Hossain said that the two new patients, a young man and a woman aged between 20 to 22, were kept in home confinement under close observation of the IEDCR experts. Meanwhile, among the earlier 16 cases, eight patients had fully recovered and the others were under the supervision of the health officials at their homes, isolated from other family members.

In Chinese mainland, in the past 24 hours until 18:00 (1000 GMT), 38 more people were confirmed infected with Influenza A/H1N1, bring the total number to 1,040. In China's Hong Kong, 26 newly confirmed cases of A/H1N1 influenza were reported in the past 24 hours till 2:30 p.m. (0630GMT) Sunday, bring the total number to 953, while in China's Macao, two more new cases were reported with a total number reaching 56.

Editor: Mu Xuequan
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Thailand reports 231 new A/H1N1 cases, as numbers keep rising in other Asia-Pacific parts_English_Xinhua

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Egypt reports four more cases of A/H1N1 flu (Xinhua, edited)

Egypt reports four more cases of A/H1N1 flu

www.chinaview.cn 2009-07-06 00:15:55
CAIRO, July 5 (Xinhua)

Egypt reported on Sunday four more cases of influenza A/H1N1, bringing the total number of the flu in the populous country to 78, according to the Ministry of Health.

The first case is a Somali student (17) who just came with his father from Britain, the second is a British man (56) who came from London with his family, and the third and fourth are a man (24) and a woman (22) coming from Chile, Health Ministry Spokesman Abdel Rahman Shahine said in a statement.

The spokesman said that the health condition of the new cases is stable after proper treatment, adding that 61 of the country's total 78 cases have recovered.

Egypt reported its first A/H1N1 flu case on June 2, who was a 12-years-old Egyptian-American girl coming from the United States via the Netherlands.

Egypt, the most populous Arab country that was hit hard by the fatal bird flu in 2006, decided in late April to cull all pigs in the country to stem the highly infectious flu A/H1N1.

According to the World Health Organization (WHO), the disease has killed 382 people and the number of the total infected exceeded 89,921 in 125 nations and regions.

Editor: Mu
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Egypt reports four more cases of A/H1N1 flu_English_Xinhua

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Influenza A(H1N1)v infection - Update 5 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 5 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]

Main developments in past 24 hours

10,260 cases reported from the EU and EFTA countries, with 57 new cases reported in the past 24 hours;
1,465 new cases are reported from non-EU and EFTA countries;
FYROM reported its first two confirmed case;
Thirteen new fatal cases are reported from Non EU and EFTA countries.

Austria 3 - 19 - ...
Belgium 2 - 54 - ...
Bulgaria ... - 10 - ...
Cyprus 14 - 109 - ...
Czech Republic ... - 15 - ...
Denmark 2 - 65 - ...
Estonia ... - 13 - ...
Finland 12 - 55 - ...
France ... - 318 - ...
Germany ... - 505 - ...
Greece 6 - 140 - ...
Hungary ... - 12 - ...
Iceland ... - 4 - ...
Ireland 5 - 68 - ...
Italy ... - 146 - ...
Latvia ... - 1 - ...
Lithuania ... - 3 - ...
Luxemburg ... - 6 - ...
Malta 5 - 16 - ...
Netherlands ... - 135 - ...
Norway ... - 41 - ...
Poland ... - 25 - ...
Portugal 4 - 42 - ...
Romania 3 - 44 - ...
Slovakia ... - 18 - ...
Slovenia 1 - 13 - ...
Spain ... - 776 - 1
Sweden ... - 84 - ...
Switzerland ... - 76 - ...
United Kingdom ... - 7447 - 3

Total 57 - 10,260 - 4

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
(*) Cases reported between 3 July 17:00 hours and 4 July 17:00 hours
(**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 05 July 2009, 17:00 hours (CEST) outside of the EU and EFTA countries

[Country - Confirmed cases reported in the last 24h* - Cumulative number of confirmed cases - Deaths among confirmed cases**]

OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

Bosnia and Herzegovina ... - 1 - ...
Channel Islands ... - 16 - ...
Former Yugoslav Republic of Macedonia 2 - 2 - ...
Island of Man ... - 1 - ...
Monaco ... - 1 - ...
Montenegro ... - 9 - ...
Russian Federation ... - 3 - ...
Serbia ... - 15 - ...
Ukraine ... - 1 - ...

MEDITERRANEAN AND MIDDLE-EAST

Algeria ... - 5 - ...
Bahrain ... - 15 - ...
Egypt ... - 67 - ...
Iran ... - 1 - ...
Iraq 1 - 12 - ...
Israel ... - 577 - ...
Jordan ... - 22 - ...
Kuwait 1 - 36 - ...
Lebanon 2 - 49 - ...
Morocco ... - 17 - ...
Occupied Palestinian Territory 18 - 48 - ...
Oman 1 - 4 - ...
Qatar ... - 10 - ...
Saudi Arabia 20 - 109 - ...
Tunisia 1 - 4 - ...
Turkey ... - 40 - ...
United Arab Emirates ... - 8 - ...
Yemen 1 - 8 - ...

AFRICA

Cape Verde ... - 3 - ...
Ethiopia ... - 3 - ...
Ivory Coast ... - 2 - ...
Kenya ... - 12 - ...
Mauritius ... - 1 - ...
South Africa ... - 13 - ...
Uganda ... - 1 - ...

NORTH AMERICA

Canada ... - 8883 - 29
Mexico ... - 10262 - 119
***USA ... - 33902 - 170

CENTRAL AMERICA AND CARIBBEAN

Antigua and Barbuda ... - 2 - ...
Aruba ... - 5 - ...
Bahamas ... - 6 - ...
Barbados ... - 12 - ...
Bermuda ... - 2 - ...
British Virgin Islands ... - 2 - ...
Cayman Islands ... - 14 - ...
Costa Rica ... - 277 - 3
Cuba ... - 85 - ...
Dominica ... - 1 - ...
Dominican Republic ... - 108 - 2
El Salvador ... - 277 - ...
Guatemala 24 - 286 - 2
Honduras ... - 123 - 1
Jamaica ... - 32 - ...
Martinique ... - 2 - ...
Netherlands Antilles ... - 15 - ...
Nicaragua ... - 321 - ...
Panama ... - 417 - ...
Saint Lucia ... - 1 - ...
Suriname ... - 11 - ...
Trinidad-Tobago ... - 65 - ...

SOUTH AMERICA

Argentina 326 - 2409 - 55
Bolivia ... - 283 - ...
Brazil ... - 756 - 1
Chile ... - 8160 - 16
Colombia ... - 101 - 2
Ecuador ... - 163 - ...
Paraguay ... - 103 - ...
Peru 367 - 916 - ...
Uruguay ... - 196 - 1
Venezuela ... - 204 - ...

NORTH-EAST AND SOUTH ASIA

Bangladesh ... - 12 - ...
China (mainland) ... - 916 - ...
Hong Kong SAR China ... - 901 - ...
India ... - 104 - ...
Japan ... - 1517 - ...
Macao SAR China ... - 47 - ...
Nepal ... - 5 - ...
South Korea ... - 210 - ...
Sri Lanka ... - 17 - ...
Taiwan ... - 72 - ...

SOUTH-EAST ASIA

Brunei Darussalam ... - 93 - 1
Cambodia ... - 7 - ...
Indonesia 12 - 20 - ...
Laos Peoples Democratic Republic ... - 3 - ...
Malaysia ... - 411 - ...
Myanmar ... - 1 - ...
Philippines ... - 1709 - 1
Singapore 34 - 1003 - ...
Thailand 595 - 2009 - 5
Vietnam ... - 131 - ...

AUSTRALIA AND PACIFIC

Australia 44 - 5298 - 10
Cook Islands ... - 1 - ...
Fiji ... - 10 - ...
French New Caledonia ... - 6 - ...
French Polynesia ... - 2 - ...
New Zealand 16 - 961 - 3
Papua New Guinea ... - 1 - ...
Republic of Palau ... - 1 - ...
Samoa ... - 1 - ...
Vanuatu ... - 2 - ...

TOTAL 1,465 - 84,989 - 421

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
(*) Cases reported between 3 July 17:00 hours and 4 July 17:00 hours
(**) Deaths are included in the cumulative number of confirmed cases
(***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)
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India. Update on Influenza A [H1N1] as on 5th July, 2009 19:36 IST (PIB Press Release, edited)

Update on Influenza A [H1N1] as on 5th July, 2009 19:36 IST

World Health Organization has reported 89,921 laboratory confirmed cases of influenza A/H1N1 infection from 125 countries as on 3rd July 2009. There have been 382 deaths. There is no further update available.

Health screening of passengers coming from affected countries is continuing in 22 International airports.

52,388 passengers have been screened on 4.7.2009 of which 41,322 passengers were from affected countries.

224 doctors and 112 paramedics are manning 77 counters at these airports.

A cumulative total of 2,887,104 passengers have been screened.

Five new cases has been reported today: Calicut (2), Cochin (1) and Delhi (2)

The two cases in Calicut are 16 and 19 year old daughters of a case who was reported positive earlier and all of them had travelled from Abu Dhabi to Kozhikode by Air India flight IX 348 reaching Kozhikode on 27th June 2009. They reported to the health facility with history of fever and cough on 1st July 2009 and were admitted at the identified health facility.

The case in Cochin is a 35 year old male who travelled from Cayman Island, UK Overseas Territory transiting Doha by Qatar Airlines flight QR 264 reaching Cochin on 29th June 2009. As he was having symptoms of fever, running nose and sore-throat, he was identified at the airport and was admitted in the identified health facility.

Out of the two cases in Delhi one is the 34 year old mother of a positive case reported on 3rd July 2009. They had travelled together from Newark, New Jersey to Delhi by Continental Airlines CO-082 reaching Delhi on 29th June 2009 reporting to the health facility on 3rd July 2009. The other case is a 30 year old passenger who travelled from Botswana transiting Johannesburg and Dubai reaching Delhi on 30th June 2009 by Air Botswana BP 201. On 3rd July 2009, he reported with fever, cough and sore-throat at the identified health facility where he is admitted.

The indigenous positive case [66 year old female] at Delhi, covered in earlier reports, is stable.

905 persons have been tested so far of which 134 are positive for Influenza A H1N1 [Swine].

272 out of the 905 persons have been identified through entry screening, twenty seven through contact tracing and the rest were self reported.

Of the 134 positive cases, 99 have been discharged. Rest of them remains admitted to the identified health facility.

The situation is being monitored.

DS/AD
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PIB Press Release

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52 new H1N1 cases bring total infected in Singapore to 1,055

52 new H1N1 cases bring total infected in Singapore to 1,055

Posted: 05 July 2009 1741 hrs
SINGAPORE:

Singapore has confirmed 52 new cases of H1N1 flu, bringing the total to 1,055 so far.

Investigations are ongoing for these 52 cases.

Of the 69 cases investigated on Sunday, 50 were local cases while 19 were imported ones.

Of the cumulative number of 1,003 cases investigated thus far, 591 were local cases and 412 were imported ones.

The Health Ministry says that the current strain remains mild, except for high-risk individuals with underlying medical conditions where complications and even deaths may occur.

The ministry urges members of the public who feel unwell with flu-like symptoms (fever, cough, sore throat, runny nose) to promptly seek medical attention.

If the symptoms are mild, their usual GPs, the nearest Pandemic Preparedness Clinic or polyclinics, would be able to assess them.

- CNA/ir
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channelnewsasia.com - 52 new H1N1 cases bring total infected in Singapore to 1,055

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Hong Kong: HA update on Designated Flu Clinic and admitted human swine influenza patients (7/5/09)

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Hong Kong: Twenty-six new cases of human swine influenza (7/5/09)

A spokesman for the Department of Health said there had been 26 newly confirmed cases of human swine influenza (Influenza A H1N1) in the 24 hours to 2.30pm today (July 5).

The new cases involve 14 males and 12 females, aged between 2 and 57.

This brings to 953 the total number of human swine influenza cases (HSI) in Hong Kong.
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Ingresa en la UCI un estadounidense de la base de Rota por gripe A · ELPAÍS.com

Ingresa en la UCI un estadounidense de la base de Rota por gripe A

El enfermo regresó recientemente de Estados Unidos y fue tratado con antivirales

EFE - Cádiz - 04/07/2009

Un estadounidense de la base militar de Rota ingresó anoche en la UCI del hospital Puerta del Mar de Cádiz en estado grave y con síntomas de gripe A, según ha informado hoy la delegación provincial de Salud.

El paciente -que reside en la base militar, pero sobre quien se desconoce si es soldado o familiar- presenta complicaciones respiratorias y está estable dentro de la gravedad.

El enfermo había regresado recientemente de un viaje a Estados Unidos y mostró los primeros síntomas de estar contagiado del virus H1N1 el martes pasado, por lo que comenzó un tratamiento con antivirales, según fuentes de la base militar. Ante el empeoramiento de su estado de salud, fue trasladado anoche al hospital.

La delegación de Salud ha insistido en que este caso es "absolutamente independiente" del de las 15 enfermeras afectadas por el virus en Cádiz, que se recuperan en sus domicilios.
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Ingresa en la UCI un estadounidense de la base de Rota por gripe A · ELPAÍS.com

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Australia. Sydney man dies with swine flu - ABC News (Australian Broadcasting Corporation)

Sydney man dies with swine flu

A Sydney man who had been diagnosed with swine flu has died - the 11th death related to the virus in Australia.

The New South Wales Department of Health says the 57-year-old had significant underlying medical conditions, including diabetes.

He died in Westmead hospital on Friday.

It is the second case of a swine flu-related death in NSW.

Last Monday a 45-year-old man became the first person with swine flu to die in the state, and the 10th in Australia.

Doctors say he also had underlying medical issues.

A three-year-old Victorian boy was the first child in Australia to die with the virus.

The circumstances surrounding the death are unclear.

Seven Victorians and two Western Australians have also died with swine flu.

Authorities say people with symptoms of the flu should seek medical help if their condition deteriorates.
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Sydney man dies with swine flu - ABC News (Australian Broadcasting Corporation)

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Japan. Osaka sent paper on Tamiflu-resistant virus to journal before announcement

The Osaka prefectural government sent a research paper to a U.S. medical journal on the first case in Japan of a genetic mutation of the new strain of influenza A virus resistant to Tamiflu about a week before making the finding public, local officials said Sunday. ''It's not that we intentionally placed priority on the manuscript and delayed the announcement,'' said Tatsuya Oshita, an official of the prefectural government's health and medical care department. ''As it turned out, we dealt with the matter in a way that could be criticized and we are sorry.''

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The Canadian Press: Tamiflu resistant H1N1 from Hong Kong more worrying than earlier findings

Tamiflu resistant H1N1 from Hong Kong more worrying than earlier findings

By Helen Branswell
TORONTO

All cases of Tamiflu resistance are not created equal. So while the first three instances of swine flu infection with Tamiflu-resistant viruses were reported in the past week, it was Number 3, not Number 1 that put influenza experts on edge.

Public health authorities in Hong Kong announced Friday they have found a case of Tamiflu resistance in a woman who hadn't taken the drug. That means she was infected with swine flu viruses that were already resistant to Tamiflu, the main weapon in most countries' and companies' pandemic drug arsenals.

The two earlier cases, reported from Denmark and Japan, involved people who had been taking the medication. While always unwelcome, that type of resistance is known to occur with seasonal strains and may be less of a threat to the long-term viability of this key flu drug.

"It was not at all surprising to see resistance in patients on treatment but seeing it in someone who was not treated, it certainly is more concerning," says Dr. Malik Peiris, a flu expert at the University of Hong Kong.

There is currently no evidence Tamiflu-resistant viruses are spreading widely. Still, some experts see the Hong Kong case as a warning Tamiflu's role in this pandemic may not be as long-lived as pandemic planners would like.

"I think it's too early to judge," says Dr. Frederick Hayden, an expert on influenza antivirals who teaches at the University of Virginia. "But I think that possibility has existed from the beginning."

"And it's something that needs to be certainly considered in making determinations about things like antiviral stockpiling, management of patients with more serious illness in hospital and how the available drugs will be used."

Some experts say this early sign of resistance should prompt a rethink of how often and in which circumstances Tamiflu is used to battle the novel H1N1 virus.

"It ... probably highlights the importance of not using these antiviral drugs indiscriminately, given that the disease is relatively mild," says Peiris, whose hospital monitored the woman who was found to be carrying the resistant virus.

"In people who don't have underlying risk factors, it probably should not be treated with Tamiflu, basically."

Others suggest countries should limit how often they use the drug to prevent infection, a regimen known as prophylaxis. In prophylaxis, people who've been exposed to the virus are given one pill a day for 10 days, compared to the treatment regime of two pills a day for five days.

Some countries, including Canada, have been reserving prophylaxis for people at high risk from this flu, such as pregnant women.

But others have taken a different approach, using Tamiflu to try to curb spread of the virus. For instance, Britain has made the drug widely available to contacts of confirmed cases, though it announced this past week it was changing that policy.

The World Health Organization is drafting guidance for countries on the use of antivirals. While the WHO advises rather than instructs, it has been stressing that saving these drugs for treatment makes the most sense, says Dr. Keiji Fukuda, the agency's top flu expert.

"In general we have been pushing the advice that using these drugs for treatment is definitely the priority use of them," says Fukuda, the acting assistant director general for health security and environment.

"And I think this is not just from a theoretical resistance perspective, but also from the fact that if you have limited amounts of antiviral drugs, then you need to make some choices about how you use them."

From their first sighting, the new H1N1 viruses have been resistant to two older flu drugs, amantadine and rimantadine. That left the only two other influenza drugs, oseltamivir (Tamiflu) and zanamivir (Relenza), as the sole options for treatment and prophylaxis.

There is a risk inherent in using the drug to prevent illness. If people who are already infected but aren't yet experiencing symptoms are put on prophylaxis, there won't be enough drug in their systems to kill all the viruses they house. Those that survive develop resistance to the drug.

And that, it appears, may be what happened in the resistance cases in Denmark and Japan. In both instances the women involved had been given Tamiflu prophylaxis after a contact developed swine flu.

But the Hong Kong case was different. A 16-year old girl travelling from San Francisco was stopped in Hong Kong's airport in mid-June after setting off a fever detection device.

She was taken to hospital where she tested positive for swine flu. She had not been taking antivirals and declined to be treated with the drug. She was kept in isolation until she recovered.

Dr. Jennifer McKimm-Breschkin, an influenza expert from Australia and a member of the team that developed Relenza, says this case shows resistant swine flu viruses can spread.

It was previously thought flu viruses that developed resistance to the drug would be crippled in the process and would not transmit to others. But that belief was shattered in 2008 when it was discovered Tamiflu-resistant versions of the seasonal H1N1 viruses were spreading rapidly around the globe. They have since all but wiped out Tamiflu-susceptible seasonal H1N1 viruses.

"This is a patient that hasn't been treated, who has gone from San Francisco to Hong Kong. What that means is that she has caught a resistant virus in San Francisco," says McKimm-Breschkin, virology project leader at the Commonwealth Science and Research Organization - known as CSIRO - in Melbourne. (McKimm-Breschkin does not receive royalties for sales of Relenza.)

"So that means this virus has been transmitted from somebody who's presumably been treated. Which means it's been fit enough to transmit. And that is of a lot more concern than just resistance in a treated patient."

Experts have worried the seasonal H1N1 viruses might reassort or swap genes with the swine H1N1. If swine flu picked up with neuraminidase gene - the N in a flu virus' name - from the seasonal H1N1, it would acquire the resistance its seasonal cousin has developed.

Authorities in Hong Kong have not yet told the WHO whether that is what has happened in this case.

But whether the Hong Kong resistance case is due to reassortment, or from the fact that some swine flu viruses have developed resistance on their own, the situation demands careful monitoring, Fukuda and others say.

"The really big question for any finding of antiviral drug resistance with these viruses is whether it's an isolated event or whether it's a tip of a larger phenomenon," he explains.

"The bottom line, as is so often the bottom line with influenza, is that the real answer to the current situation is monitoring as closely as possible - which in this instance is really being done since an extraordinary number of viruses are being collected and looked at."

- Follow Canadian Press Medical Writer Helen Branswell's flu updates on Twitter at CP-Branswell
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The Canadian Press: Tamiflu resistant H1N1 from Hong Kong more worrying than earlier findings

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UK. The Observer profile: Liam Donaldson - the nation's own flu fighter

Liam Donaldson: The nation's own flu fighter

The chief medical officer is steering the country through the increasing epidemic. Meanwhile, not one to take notice of the libertarians, he wants to go even further with the smoking ban. And he's got Kate Moss in his sights

Andrew Anthony
The Observer, Sunday 5 July 2009

Sars, binge drinking, MRSA, MMR, avian flu, swine flu: in the last decade they have all been the headline subject of major health scares. And the man whose job it is to evaluate the risks, develop a strategy and issue advice on each of these matters is the chief medical officer, Sir Liam Donaldson.

It's not an enviable task. If he appears to do too little, he stands accused of complacency. If he is seen to intervene too actively, it's said that he's stirring up panic. The difficulty of plotting a suitable course is further complicated by the fact that health threats can change and develop with confusing speed.

The current concern about H1N1 or, as its more popularly known, swine flu perfectly illustrates the point. Just a few weeks ago, Donaldson was advising schools to shut down if there were cases of the virus among pupils. Now schools are told to remain open and there are predictions of 100,000 cases a week of H1N1 by late August. But at the same time, Donaldson maintains that allowing the intentional spread of the virus is "seriously flawed thinking".

Needless to say, many parents are uncertain about what they should do. And some see a contradiction in the policy of keeping schools open while advising parents to try to prevent their children from contracting the virus.

But Donaldson knows that in matters of public health it's preferable to hedge your bets. "We don't yet know enough about the risk profile of the virus," he said last week with typical caution.

If that sounds like a certain amount of backside covering, then it's understandable. Donaldson has spent many years and a lot of effort arguing that we need to prepare for a pandemic virus. Avian flu looked like it might be a contender in 2005, and Donaldson warned that 750,000 global deaths was "not impossible". In the event, the figure stayed in the low hundreds. But as a consequence of the CMO's precautionary approach, Britain has one of the largest stockpiles of flu drugs in the world.

At first, in its Mexican stage, H1N1 looked like it might be the virus that Donaldson has long been expecting. Yet even if swine flu does turn out to be something only slightly more troubling than normal influenza, it would be unfair to accuse the chief medical officer of having got it wrong. Instead, in calmly preparing for the worst, while also allowing for the most positive outcome, he's done what we expect of our public servants.

Donaldson is any many ways a modernising public servant with an old-fashioned sense of public service. Now 60, he produced the 2000 report on embryology that recommended legalising stem cell research. And he has acted as a reformer in restructuring the NHS, particularly on the issue of patient empowerment. Yet he tends to invoke "the public" the way Jacobins used to refer to the republic. "My bottom line is that I would go to the wall for the public," he said during the Sars scare, "because that is who I am there to serve."

Public service runs in the family. His father was Dr Raymond "Paddy" Donaldson, a medical officer of health on Teesside and a charismatic figure in public health in the Sixties and Seventies.

Born in Middlesbrough, Sir Liam started out as a doctor but, like his father, soon moved into public health. "Although I enjoyed surgery," he later explained, "I realised that doing that for my whole life meant that I'd be treating a succession of individual patients rather than hundreds of thousands of people. I really wanted to be involved in that population-level work."

The scale of the language here is telling. He relates a story of when he was a surgeon in the late Sixties and he was unable to give a comforting answer to the mother of child with leukaemia. Dealing with the public directly was too limiting and frustrating for him. His ambition lay with the masses in total, the public as a policy ideal.

He held a number of bureaucratic posts in the NHS in the north of England, before becoming director of the Northern Regional Health Authority. He was appointed chief medical officer in 1998.

The position is unusual in that it blurs a number of normally rigid lines.

In essence, the CMO is a civil servant, and yet he or she also has a measure of political autonomy, as well as a distinctive media profile, providing the face of medical reassurance during periods of public concern.

Donaldson has proved able to negotiate the different roles with great effectiveness. "He's very clever at knowing what the media want," says one observer, "and directing the debate where he wants it to go."

His most notable success, and the one with which his name may remain most closely associated, has been the banning of smoking in public places. In 2002 he proposed such a ban and was told by the government that it would "never happen". Five years later it was law.

Alan Milburn had been health secretary in 2002. Both Newcastle United fans, the pair had worked on the 2000 NHS plan together and enjoyed a close working and social relationship. But Milburn resigned and was replaced by John Reid, who was determined to limit any smoking ban.

Donaldson stuck to his guns and, effectively opposing his boss, drove the campaign for the ban, which came into force in 2007. Although there is data to suggest that the ban has already had a beneficial impact on health, Donaldson is not satisfied. He wants to see smoking brought down to the "gold standard" of California, where only 14% of the population smokes. "The first thing you see when you walk into a supermarket is a wall of cigarette packets," he said. "We need to do something about that, and let's get the cigarette out of Kate Moss's mouth.

"It's this kind of desire to encroach on areas of public life that many see as private that has led to accusations of nanny state interventionism. Earlier this year he employed the phrase "passive drinking" to describe the effects of alcohol on non-drinkers.

Again, it was a clever piece of headline grabbing, but to the libertarian lobby - many of whom are yet to accept the concept of passive smoking, let alone drinking - it also seems an outlandish piece of scaremongering.

Donaldson was arguing in support of his contention that alcohol prices should rise to a minimum of 50p per unit. He was rebuffed by Gordon Brown, who saw no need to explore new ways to increase his unpopularity, but remained characteristically undeterred. "It will upset people," he said. "It will ruffle feathers, people will not see immediately why they should participate in it, but we need to face up to this as a country."

After 11 years in the job, in which he's worked under two prime ministers and five health secretaries, Donaldson is viewed as a wily survivor. He is a private man, and even those who work with him know very little about his family or interests, aside from his devotion to Newcastle United.

He keeps an office and staff on the first floor of Richmond House, the department of health in Whitehall, maintaining a practical and symbolic detachment from the minister on the fourth floor. He also maintains a safe distance from the medical profession, a piece of tightrope walking that, as he put it, "leads in a straight line to the public".

When the training system for junior doctors that he instituted resulted in a glut of unemployed doctors, the BMA called for his resignation. He simply pointed out that the BMA had agreed to the proposals, thus making a non-drama out of a non-crisis.

While he has not always been fully on message with the government, Donaldson's conception of public duty and the responsibilities of the state are broadly in unison with Labour. He and Brown, for example, were in agreement on making organ donation an opting-out policy, although they were thwarted at the first attempt.

But for all his tenacious political skills, it's not thought that he would survive long under a Conservative government, where his statist instincts would almost certainly represent an ideological challenge.

His record is impressive in terms of longevity and social impact. One observer called him the "most radical member of the government". But his successes are in one sense also his failures. He used the media to raise public concern for health but saw public anxiety grow as well, most disastrously in the MMR scare, where a rogue study upended health policy.

And as the state has expanded its health responsibilities, many individuals have relinquished their own, most notably in the case of obesity. Donaldson would like to see a "fat tax" on unhealthy foods. It's hard to imagine David Cameron swallowing that.

If, as seems likely, he is moved out of Richmond House next year, a plum job awaits him at the World Health Organisation. In which case it would be a fitting ending for a man who thinks in terms of populations. The most far-reaching of public servants would at last get to serve the most far-reaching of publics.

The Donaldson lowdown
Born: 3 May 1949 in Middlesbrough. His father was Dr "Paddy" Donaldson, a well-known figure in public health in the Sixties and Seventies. His mother, June, had been a nurse and a lieutenant in the Indian army.

Best of times: His 2000 report on stem cell research that paved the way for its legalisation, and the 2007 ban on smoking in public places.

Worst of times: Though he spoke out against the infamous study linking the MMR vaccine to autism, he found it very difficult to counter the hysteria over the vaccine which followed the report's publication.

What he says: "Let's try and imagine a country where nobody is physically or sexually assaulted because of alcohol. Let's try and imagine a country where nobody dies in an accident caused by alcohol; where no child has to cower in the corner while its mother is beaten by a drunken partner; where the streets are welcoming for all on a Saturday night; and where the streets are free of urine and vomit on a Sunday morning."

What others say: "The government should issue one of those spooky public information films, warning people to stay away from Donaldson. I would go further and ban him from all public spaces, though I can see the sense in allowing him to sit by himself in a sealed room, talking piffle." Rod Liddle in the Times.
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The Observer profile: Liam Donaldson - the nation's own flu fighter | Politics | The Observer

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Australia. National H1N1 Influenza 09 - Update 12 noon 5th July 2009 - 1200 AEST on 5 July 2009 (Dept. of Health, edited)

Australian Government - Department of Health and Ageing

National H1N1 Influenza 09 - Update 12 noon 5th July 2009 - 1200 AEST on 5 July 2009

[Original Document: LINK. EDITED.]

National case update

Australia has 5298 confirmed cases of H1N1 Influenza 09, an increase of 44 cases since noon yesterday.

The total number of Australian deaths associated with H1N1 Influenza 09 is currently 10, with seven reported in Victoria, one in NSW, one Western Australia and one in South Australia.

Most of the new cases were recorded in the Northern Territory and Queensland.
Since yesterday, there have been 26 new cases recorded in Queensland and 18 in the NT

The national breakdown of cases is:

ACT 206,
NSW 1267,
NT 353,
Qld 857,
SA 502,
Tas 95,
Vic 1724,
WA 294.

Hospitalisations

There are currently 88 people in hospital around Australia with H1N1 Influenza 09 and 24 of these are in intensive care units.

There are 42 patients in hospital in Victoria, 22 in NSW, 7 in the Northern Territory, 4 in South Australia, 3 in the ACT, 6 in Queensland, 3 in Western Australia, and 1 in Tasmania.

ICU admissions: Of the 24 people currently in Intensive Care Units, 15 of these are in Victoria; 4 in NSW, 2 in Queensland, 2 in South Australia and 1 in the Northern Territory.

The total number of hospitalisations in Australia since H1N1 Influenza 09 was identified is 478.

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Abstract. Mapping the sequence mutations of the 2009 H1N1 influenza A virus neuraminidase relative to drug and antibody binding sites

Discovery notes - Open Access

Mapping the sequence mutations of the 2009 H1N1 influenza A virus neuraminidase relative to drug and antibody binding sites

[Full Open Access Article: LINK. EDITED.]

Sebastian Maurer-Stroh*1, Jianmin Ma1, Raphael Tze Chuen Lee1, Fernanda L Sirota1 and Frank Eisenhaber1,2

Address: 1Biomolecular Function Discovery Division, Bioinformatics Institute (BII), Agency for Science Technology and Research (A*STAR), 30 Biopolis Street, #07-01, Matrix, 138671, Singapore and 2Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, 117543 Singapore

Email: Sebastian Maurer-Stroh* - sebastianms@bii.a-star.edu.sg; Jianmin Ma - majm@bii.a-star.edu.sg; Raphael Tze Chuen Lee - leetc@bii.astar.edu.sg; Fernanda L Sirota - fernanda@bii.a-star.edu.sg; Frank Eisenhaber - franke@bii.a-star.edu.sg
* Corresponding author

Abstract

In this work, we study the consequences of sequence variations of the "2009 H1N1" (swine or Mexican flu) influenza A virus strain neuraminidase for drug treatment and vaccination. We find that it is phylogenetically more closely related to European H1N1 swine flu and H5N1 avian flu rather than to the H1N1 counterparts in the Americas. Homology-based 3D structure modeling reveals that the novel mutations are preferentially located at the protein surface and do not interfere with the active site. The latter is the binding cavity for 3 currently used neuraminidase inhibitors: oseltamivir (Tamiflu®), zanamivir (Relenza®) and peramivir; thus, the drugs should remain effective for treatment. However, the antigenic regions of the neuraminidase relevant for vaccine development, serological typing and passive antibody treatment can differ from those of previous strains and already vary among patients.

Reviewers: This article was reviewed by Sandor Pongor and L. Aravind.
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7/04/2009

Macedonia confirms first two cases of H1N1 flu virus (AlertNet, edited)

Macedonia confirms first two cases of H1N1 flu virus

04 Jul 2009 19:42:46 GMT
Source: Reuters
SKOPJE, July 4 (Reuters)

Macedonia has confirmed its first cases of the new H1N1 flu virus in two patients who caught the virus abroad, said Health Minister Bujar Osmani on Saturday.

"With the new data we have confirmed our first two positive cases of H1N1," Osmani told a news conference.

The country's National Pandemic Flu Committee said the virus was not yet being transmitted from human-to-human, and Macedonia did not need additional anti-viral drugs.

The two patients were in a stable condition, with one being treated at the country's Clinic for Infectious Diseases in Skopje, while the other has already been discharged and was being monitored at home, said Osmani.

He did not name the patients or say whether they were Macedonian or foreign citizens.

(Reporting by Kole Casule; Editing by Sophie Hares)
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Reuters AlertNet - Macedonia confirms first two cases of H1N1 flu virus

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H1N1 flu infection tops 1,000 cases in China: state TV

The number of people confirmed to have been infected with influenza H1N1 has topped 1,000 cases in mainland China, the state TV network CCTV said Saturday. Citing statistics from the Health Ministry, tests have shown 1,002 people in mainland China have been infected with the new flu, the network said.

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Large-scale antibody test on new flu planned in Osaka

A large-scale antibody test will be conducted on the new H1N1 influenza, ahead of an anticipated second wave of the new flu later this year, at an Osaka Prefecture school hit in May by Japan's worst group infection, prefectural government officials said Saturday. By detecting cases left unnoticed due to a lack of symptoms, the test, which would be the largest of its kind in the country, will allow health officials to measure the epidemic's real magnitude and devise more effective countermeasures, the officials said.

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Argentina unificará a nivel nacional los tratamientos contra la gripe A · ELPAÍS.com

Argentina unificará a nivel nacional los tratamientos contra la gripe A

Hasta ahora cada provincia decidía cómo hacer frente a la epidemia

SOLEDAD GALLEGO-DÍAZ - Buenos Aíres - 04/07/2009

El ministro de Salud argentino, Juan Manzur, ha anunciado hoy que, por primera vez, se van a tomar medidas de coordinación a nivel nacional para evitar que cada provincia y municipio aplique protocolos sanitarios distintos para tratar a los enfermos de gripe A y hacer frente a la crisis sanitaria, como ocurre ahora.

El gobierno empezó también a distribuir fondos extraordinarios para hacer frente a la crisis sanitaria provocada por la epidemia de gripe A, lo que incluye comprar nuevas provisiones de los antivirales indicados para el virus H1N1, dado que muchos especialistas no creen que se llegue al "pico" del contagio hasta dentro de dos semana

Buena parte de las clínicas y hospitales privados de Buenos Aires han dejado de recibir partidas de Tamiflu y sus médicos se limitan a escribir la receta, que tendrá que ser llevada por un familiar del enfermo al hospital público Muñiz, especializado en infectología, donde se ha centralizado un servicio de farmacia especial. La falta de suministros a las hospitales privados ha hecho que en algunos de ellos, por ejemplo, el Hospital Español, se hayan decidido a comprar tela para fabricar ellos mismos los barbijos o mascarillas que necesita el personal sanitario y los enfermos.

"En los hospitales públicos no faltan los antivirales ni los insumos necesarios. El único problema es al escasez de personal para hacer frente a una emergencia sanitaria de este tamaño. No sucede lo mismo en todas las privadas, donde no hay antivirales ni mascarillas ni alcohol en gel", asegura el doctor Ignacio Ardanza, que trabaja en los dos tipos de establecimiento sanitario. Organizaciones profesionales de personal sanitario aseguran que, al menos en la provincia de Buenos Aires, hay hasta un tercio de médicos y enfermeras que están también "griposos", lo que exige todavía mayor esfuerzo a los que continúan al pie del cañón. El problema es aún mayor porque nadie sabe como va a evolucionar exactamente la epidemia. El precedente de México no sirve, según muchos especialistas, porque allí los casos de la gripe A se detectaron en verano y en Argentina acaba de empezar el invierno austral.

El Gran Buenos Aires (capital federal y las localidades que la rodean) se va adaptando poco a poco a la crisis sanitaria. En los ayuntamientos en los que se ha dado orden de cerrar bares, restaurantes y otros centros de reunión, el de San Isidro, por ejemplo, la orden se cumple poco y mal. Quizás, porque quinientos metros más para allá, en la municipalidad de al lado, nadie ha dado esa orden y todo esta abierto. Esta claro que la coordinación no esta siendo una de las prioridades del gobierno provincial ni del gobierno de la nación y que cada ayuntamiento y cada provincia actúa como mejor le parece. Incluso cada obispado, porque en algunas provincias se han suspendido las misas y los oficios religiosos, como en Entre Ríos, y en otras, no.

Pese a que los expertos consideran que el virus H1N1 presenta una incidencia y una gravedad poco normal entre los jóvenes, el viernes por la noche abrieron en Buenos Aires, ciudad y provincia, numerosas discotecas, en las que centenares de adolescentes bailaron multitudinariamente, sin hacer el menos caso a las llamadas de prudencia. "Hemos limpiado todo muy bien", aseguraba tranquilamente el responsable de una de estas discotecas ante las cámaras de televisión. "Mis viejos me pidieron que no viniera, pero yo quiero estar con mis amigos y no me da miedo la gripe", confiaba a la misma cámara una jovencita, rodeada de decenas de compañeros. La mayoría de los cines y teatros tenia previsto abrir también el fin de semana, con la esperanza de cubrir, al menos, la mitad del aforo.

El efecto de la nueva y apresurada campaña de contención no se apreciará hasta mañana lunes, cuando comience la semana laboral y las vacaciones escolares y se compruebe hasta qué punto se paraliza realmente la actividad económica y burocrática habitual. Los bancos y algunas empresas han pedido ya a sus clientes que procuren hacer sus gestiones a través de Internet, teléfono o cajeros automáticos. La compañía telefónica Movistar, por ejemplo, ha enviado un sms a sus clientes en el que recomienda que "como medida preventiva contra la gripe A", se realicen los trámites a través de su página web.

Las autoridades de la provincia y de la capital, que han pedido que el cierre escolar no se tome como unas vacaciones sino que se intente algún aprovechamiento educativo, preparaban a toda marcha cuadernos de deberes para entregarlos a los alumnos, con la exigencia de devolverlos completados a primeros de agosto, cuando se reanuden las clases. En algunos barrios del cinturón de Buenos Aires, el cierre de los colegios provocó un problema añadido, porque la pobreza de algunas familias hace que la alimentación de los niños dependa en buena parte de los comedores de los colegios públicos. Las autoridades provinciales prometieron que las cocinas seguirían funcionando y las madres podrían acudir a retirar normalmente las raciones.
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Argentina unificará a nivel nacional los tratamientos contra la gripe A · ELPAÍS.com

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Syria identifies first H1N1 flu case (AlertNet, edited)

Syria identifies first H1N1 flu case

04 Jul 2009 12:58:18 GMT
Source: Reuters
DAMASCUS, July 4 (Reuters)

Syria has identified its first confirmed case of the H1N1 flu virus, a Health Ministry official said on Saturday.

A Syrian woman who came from Australia at the end of last month was diagnosed with the virus, said Mahmoud Krayem, head of ministry's epidemics division. "Her condition is stable".
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Reuters AlertNet - Syria identifies first H1N1 flu case

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Gripe A: Brasil dar á el antiviral sólo a los pacientes graves

Gripe A: Brasil dar á el antiviral sólo a los pacientes graves

11:56 Las autoridades dijeron que buscan evitar que el virus mute y genere resistencia. En la Argentina, los ministros de Salud de la Provincia y la Capital hicieron declaraciones opuestas sobre a quién suministrarle la medicación.

Brasil decidió modificar el protocolo de atención de pacientes con síntomas de gripe A para que sólo sea prescripto el uso de antivirales en casos graves.

La decisión se tomó por temor a que el virus mute y genere resistencias.

El Ministerio de Salud brasileño informó que los antivirales sólo serán suministrados a pacientes con un cuadro de salud más comprometido, pues el consumo generalizado puede tornar más agresivo al virus en momentos en que crecen los casos "autóctonos" dentro de Brasil.

Científicos brasileños detectaron en San Pablo un tipo de virus en el que se observaron mutaciones genéticas respecto del que ingresó al país a través de personas contaminadas en el exterior. Según el ministro de Salud, José Gomes Temporao, el 99% de los casos de esa dolencia se curan sin mayores complicaciones, por lo que recomendó a la población evitar acudir a los 68 centros de alta complejidad ante los primeros síntomas, publicó hoy la prensa local.

En otro cruce de declaraciones, el ministro de Salud porteño Jorge Lemus y el ministro de Salud de la provincia de Buenos Aires, Claudio Zin, volvieron a contradecirse haciendo referencia a qué camino tomar para la distribución del Tamiflú. Mientras Lemus busca una medida en sintonía con la decisión brasileña, Zin apunta a que la solución está en distribuir el medicamento a todo paciente con síntomas de gripe.

En una entrevista al diario Crítica, Lemus planteó una idea parecida a la de los brasileños y afirmó que el medicamento no se le puede suministrar a todo el mundo. El ministro porteño afirmó que un principio el Tamiflú se les daba a todos los pacientes con gripe, pero que ahora, con la etapa de mitigación, eso ya no era posible. Además Lemus advirtió sobre el riesgo que implica darle el antiviral a todos los enfermos, ya que esto haría que el virus se vuelva resistente, y afirmó que hoy en día en la Capital el remedio es suministrado sólo a los pacientes con factores de riesgo.

El Ministerio de Salud de la provincia de Buenos Aires, Claudio Zin, anticipó ayer a Clarín.com que analiza aplicar una drástica medida para frenar la expansión del virus: darle el antiviral Tamiflu a todos los pacientes que presenten síntomas de gripe. "La idea sería que a partir del lunes, para el martes, la gente que concurre a una guardia y tenga 38 o 39 grados de fiebre, dolor de garganta o de cabeza, o las tres cosas juntas -algo así como el resumen de una gripe-, reciba el medicamento por cinco días", explicó.

Zin señaló que esta "sería una medida de fondo", ya que todas las demás que se tomen son sólo "paliativas".

" Esto hizo en su momento México, hizo Chile y ahora me parece que llegó nuestro momento ", agregó.

Con respecto a si cuentan con la cantidad necesaria de antivirales, sostuvo que está esperando ver con el Ministerio de Salud de la Nación –ya que es el encargado de comprar el medicamento- qué partidas tienen disponible.
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Gripe A: Brasil dar á el antiviral sólo a los pacientes graves

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ECDC Health Content. Pathogenicity and transmissibility of pandemic influenza A(H1N1)v – results from an animal model (July 4, 2009, edited)

Scientific Advances - Influenza A(H1N1)

Pathogenicity and transmissibility of pandemic influenza A(H1N1)v – results from an animal model

Two studies conducted in the US and Europe have been published this week in the journal Science both investigating how pandemic influenza A(H1N1)v virus behaves in an animal model - ferrets. Their results of the studies have important implications for humans since ferrets show transmissibility and disease severity features for seasonal influenza A viruses (H1N1 and H3N2 subtypes) and animal influenza viruses (H5 and H7 types) very similar to what is seen in humans. They are considered by many the best available animal model for how influenza behaves in humans.

Transmission and Pathogenesis of Swine-Origin 2009 A(H1N1) Influenza Viruses in Ferrets and Mice (Maines et al.) – United States

Maines TR et al. Transmission and Pathogenesis of Swine-Origin 2009 A(H1N1) Influenza Viruses in Ferrets and Mice. Science 2009. Published online July 2 2009; Abstract available at: http://www.scienceonline.org/cgi/content/abstract/1177238

This investigated the virulence and transmissibility of three different isolates of the pandemic virus. These were compared with a representative 2007 season influenza A(H1N1) virus – the A/Brisbane/59/2007. The ferrets received intranasal inoculations of the three pandemic influenza virus isolates. After 24 h, one lot of animals was distributed into different cages with communication holes pierced in the walls of the cages leading to uninnoculated ferrets - to assess the efficiency of droplet transmission - and another lot of animals was placed sharing the same environment - to check for direct contact transmission. Inoculated and contact animals were assessed for clinical signs and for detection by titration of the virus in convalescent sera over two-weeks. Clinical signs of influenza was associated two of the three pandemic virus inoculations and a marked weight loss occurred for all three. Ferrets inoculated with the pandemic viruses displayed high titres of infectious virus in nasal washes at 1 day post-infection and these were maintained for 5 days. This was similar to what happened with the seasonal influenza strain. However unlike the seasonal influenza strain, the pandemic viruses were detected in the intestinal tract and in the lower respiratory tract at higher titres. However reassuringly there was no viraemia or infectious virus in the brain, kidney, liver and spleen tissues of the ferrets with the pandemic viruses

Although direct contact transmission was effective with all three pandemic viruses, the respiratory droplet transmission was significantly reduced compared to that of the seasonal influenza virus. The authors further corroborated this by characterizing the binding specificity of the viral haemagglutinin to the sialylated glycan receptors in a human host using dose-dependent direct receptor binding and human lung tissue binding assays techniques which this group are familiar with.

To further evaluate the pathogenicity of influenza A(H1N1)v mice were inoculated with the three same isolates of the pandemic virus before determining the virus replication, the morbidity (measured by weight loss), the 50% mouse infection dose and the 50% lethal dose. This found that the pandemic virus was not lethal, but still infectious in mice replicating efficiently in their lungs, without prior host adaptation, like the 1918-9 Spanish influenza virus (which this groups has worked with). Unlike avian influenza A(H5N1) viruses however the pandemic viruses did not replicate systemically in the mice.

The authors commented that the lack of efficient respiratory droplet transmission suggests that additional virus adaptation in mammals may be required to reach the transmissible phenotypes observed with seasonal influenza or with the 1918 pandemic virus. They suggested that further adaptation of the polymerase basic protein 2 (PB2) of any influenza A(H1N1) viruses would be critical for efficient droplet respiratory transmission but that this might only need a simple mutant selection or re-assortment of the pandemic virus.

Pathogenesis and Transmission of Swine-Origin 2009 A/H1N1 Influenza Virus in Ferrets (Munster et al.) – The Netherlands

Munster VJ et al. Pathogenesis and Transmission of Swine-Origin 2009 A(H1N1) Influenza Virus in Ferrets. Science 2009. Published online July 2 2009; abstract available at: http://www.scienceonline.org/cgi/content/abstract/1177127

This second study also used the ferret model in order to investigate clinical signs, viral shedding, tissue distribution, pathology and airborne transmission of the influenza A(H1N1)v virus, comparing it with a seasonal influenza virus. For this study the authors used only one strain of influenza A(H1N1)v virus, isolated from a pandemic virus isolated in The Netherlands, and the comparison seasonal influenza strain of choice for this study was also from the 2007 season – A/Netherlands/26/2007. Two groups of ferrets were inoculated with the pandemic virus and the animals were observed for clinical signs and weighed daily. Both viruses caused typical influenza illness for ferrets but the maximum weight loss for animals inoculated with the seasonal influenza strain was somewhat lower than for the pandemic strain. The recovery of the ferrets inoculated with the pandemic virus was also slower by 2 days when compared to the seasonal influenza group. On days 2 and 3 after inoculation virus titres in both nose and throat swabs were significantly higher for animals inoculated with the influenza A(H1N1)v virus than for seasonal influenza and the total viral shedding from the throat at the end of the study period was 1.5-fold higher in animals inoculated with the pandemic virus. Larger areas of the lungs were affected for animals inoculated with the pandemic virus, compared to the seasonal influenza strain. As in the American study the pandemic virus did not show many signs of involving organs outside the respiratory tract, though somewhat more than for the seasonal influenza strain. Unlike the American studies it proved possible to demonstrate short-distance airborne ferret to ferret transmission for both seasonal and the pandemic virus.

The authors of the study conclude that these results match observations in humans, where generally mild disease but efficient human-to-human transmission has been observed. The influenza A(H1N1)v virus in this model did not cause mortality in the animals and did not replicate systemically, these being effects more typical of infections with avian influenza A(H5N1) viruses or with the Spanish 1918 pandemic virus. Reportedly, these results prove that, whilst the pandemic virus may be a relatively mild pathogen in humans, it is somewhat more pathogenic than seasonal influenza virus in ferrets, with wider distribution of virus replication and associated lesions in the respiratory tract of these animals. Since the pandemic virus replicates in the same sites as seasonal A(H1N1) and A(H3N2) influenza viruses, the possibility of re-assortment of this virus with seasonal influenza viruses, and more importantly with avian A(H5N1) viruses, is a serious concern. This re-assortment could also imply the apparition of antiviral resistant strains of the pandemic virus. The possibility of an isolated mutation cannot be ruled out either.

ECDC Comment (3/07/2009):

Understanding the pathogenesis and transmission of the influenza A/H1N1v is essential for planning of appropriate Public Health responses to the current pandemic. In the two pandemicly published articles different influenza A/H1N1v isolates from patients with varying severity of their clinical symptoms have been compared with a contemporary seasonal H1N1 virus for their ability to cause disease in mice and ferrets. In addition, their ability to transmit to naïve ferrets has also been assessed.

To date, these are the first studies that have tried to analyse the pathogenicity and transmissibility characteristics of the influenza A(H1N1)v virus. The results of the first study (Maines et al.) might be considered more representative since they used three different strains of the pandemic virus as opposed to only one strain used in the second study (Munster et al.). Additionally, the first study was carried out over a longer period (two versus one week). However there are important common findings for the pandemic virus:
Significant but not lethal pathogenicity from the pandemic A(H1N1)v – somewhat more than for seasonal A(H1N1) but considerably less than that seen for A(H5N1) (bird flu) in ferrets.
In contrast to the seasonal influenza A H1N1 confined to the nasal cavity the pandemic influenza A/H1N1v isolates also replicated in the trachea, bronchi and bronchioles. No ferrets died from their infection,
Droplet respiratory expression (but not transmission) occurring with the pandemic virus was higher than with seasonal influenza though not reaching the levels when using a 1918 pandemic virus.
Successful and efficient ferret to ferret transmission but,
Respiratory droplet transmission was significantly reduced compared to respiratory droplet transmission of the seasonal influenza virus.
No systemic replication of the A(H1N1)v
Pandemic viruses being found at higher levels in the lower respiratory tract of the infected individuals,
Pandemic viruses in the intestinal tracts of the animals, which is consistent with some report of a explains the higher frequency of gastrointestinal symptoms observed in individuals affected by the pandemic virus.
An ability of both viruses to infect the same cells in the respiratory tract (upper and lower) so increasing the risk of reassortment when co-infection occurs in humans.

It is possible to speculate that droplet respiratory transmission was diminished in ferrets infected with the influenza A(H1N1)v virus when compared to the normal seasonal influenza viruses in the US study at least might be encouraging. However ferrets are ferrets and humans are humans and this study is not a replacement for human studies of viral expression. A conclusion from the Netherlands study that pandemic A(H1N1)v virus is more pathogenic than seasonal A(H1N1) needs some interpretation before extending to humans. The control used seasonal A(H1N1) which on a case by case basis is less pathogenic in humans than seasonal A(H3N2). Also the picture in humans is coloured by the welcome absence of infections in older people. More experience and data are needed before similar conclusions can be drawn from humans. What finally is evident, and we need to be vigilant of is that the pandemic virus is here to stay, co-circulating with seasonal influenza strains, maybe re-assorting with them or with more pathogenic strains like the avian influenza viruses, or even mutating by giving origin to (yet again) a pandemic influenza virus. These publications confirm the clinical picture observed in humans with the pandemic strain and is suggestive that we will continue to see severe disease in some individuals even without any further genetic changes in the circulating influenza A/H1N1v strains. Should a more significant genetic change to the circulating viral strains occur, the ferret and the mouse models may serve as appropriate models to assess any changed pathogenicity. A baseline has been established by these research groups.
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ECDC Health Content

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Influenza A(H1N1)v infection Update 4 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection Update 4 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]

Main developments in past 24 hours

10,203 cases reported from the EU and EFTA countries, with 109 new cases reported in the past 24 hours;
2,766 new cases are reported from non-EU and EFTA countries;
The Cook Islands reported its first confirmed case;
New Zealand reported its first 3 fatal cases;
28 new fatal cases are reported from Non EU and EFTA countries.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 4 July, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer:
the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.

Epidemiological update

A total of 30 out of the 31 EU and EFTA countries are now reporting cases. In the past 24 hours, 109 new cases were confirmed in 11 EU and EFTA countries (Table1). The cumulative number of cases in the EU and EFTA countries is now 10,203, including 4 deaths.

Outside of the EU and EFTA countries, a total of 2,766 new cases have been reported from 15 countries, including 28 new fatal cases. The latest reported deaths due to influenza A(H1N1)v came from Argentina (18), Canada (4), Costa Rica (1), Chile (2) and the first 3 fatal cases were reported from New Zealand. A total of 83,524 cases are reported outside of the EU and EFTA countries, including 408 deaths (Table 2). The Cook Islands reported their first case.

Pathogenicity and transmissibility of the pandemic virus A(H1N1)v in animal models

Two important studies were published this week in the Journal Science. They are confirming the observation in humans that the pandemic virus is of comparable or somewhat higher transmissibility in ferrets (the most commonly used animal model for human influenza) compared to seasonal influenza A(H1N1). They also confirmed that the pandemic strain transmits in ferrets and the theoretical opportunity for reassortment of viruses in human respiratory tracts. An extended summary of the two studies and ECDC comment is available at http://ecdc.europa.eu/en/health_content/sciadv/090704_sciadv.aspx.

Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 04 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

[Country - Confirmed cases reported in the last 24h* - Cumulative number of confirmed cases - Deaths among confirmed cases**]

Austria ... - 16 - ...
Belgium 3 - 52 - ...
Bulgaria ... - 10 - ...
Cyprus 12 - 95 - ...
Czech Republic ... - 15 - ...
Denmark ... - 63 - ...
Estonia ... - 13 - ...
Finland ... - 43 - ...
France ... - 318 - ...
Germany ... - 505 - ...
Greece 25 - 134 - ...
Hungary ... - 12 - ...
Iceland ... - 4 - ...
Ireland 12 - 63 - ...
Italy 16 - 146 - ...
Latvia ... - 1 - ...
Lithuania ... - 3 - ...
Luxemburg ... - 6 - ...
Malta 9 - 11 - ...
Netherlands ... - 135 - ...
Norway ... - 41 - ...
Poland 5 - 25 - ...
Portugal 10 - 38 - ...
Romania ... - 41 - ...
Slovakia ... - 18 - ...
Slovenia 5 - 12 - ...
Spain ... - 776 - 1
Sweden 8 - 84 - ...
Switzerland 4 - 76 - ...
United Kingdom ... - 7447 - 3

Total 109 - 10,203 - 4

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
(*) Cases reported between 3 July 17:00 hours and 4 July 17:00 hours
(**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 04 July 2009, 17:00 hours (CEST) outside of the EU and EFTA countries

[Country - Confirmed cases reported in the last 24h* - Cumulative number of confirmed cases - Deaths among confirmed cases**]

OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

Bosnia and Herzegovina ... - 1 - ...
Channel Islands ... - 16 - ...
Island of Man ... - 1 - ...
Monaco ... - 1 - ...
Montenegro ... - 9 - ...
Russian Federation ... - 3 - ...
Serbia ... - 15 - ...
Ukraine ... - 1 - ...

MEDITERRANEAN AND MIDDLE-EAST

Algeria ... - 5 - ...
Bahrain ... - 15 - ...
Egypt ... - 67 - ...
Iran ... - 1 - ...
Iraq ... - 11 - ...
Israel ... - 577 - ...
Jordan ... - 22 - ...
Kuwait ... - 35 - ...
Lebanon ... - 47 - ...
Morocco ... - 17 - ...
Occupied Palestinian Territory ... - 30 - ...
Oman ... - 3 - ...
Qatar ... - 10 - ...
Saudi Arabia ... - 89 - ...
Tunisia ... - 3 - ...
Turkey ... - 40 - ...
United Arab Emirates ... - 8 - ...
Yemen ... - 7 - ...

AFRICA

Cape Verde ... - 3 - ...
Ethiopia 3 - ...
Ivory Coast ... - 2 - ...
Kenya ... - 12 - ...
Mauritius ... - 1 - ...
South Africa 1 - 13 - ...
Uganda ... - 1 - ...

NORTH AMERICA

Canada 900 - 8883 - 29
Mexico ... - 10262 - 119
***USA ... - 33902 - 170

CENTRAL AMERICA AND CARIBBEAN

Antigua and Barbuda ... - 2 - ...
Aruba ... - 5 - ...
Bahamas ... - 6 - ...
Barbados ... - 12 - ...
Bermuda ... - 2 - ...
British Virgin Islands ... - 2 - ...
Cayman Islands ... - 14 - ...
Costa Rica 50 - 277 - 3
Cuba 12 - 85 - ...
Dominica ... - 1 - ...
Dominican Republic ... - 108 - 2
El Salvador 1 - 277 - ...
Guatemala ... - 262 - 2
Honduras ... - 123 - 1
Jamaica ... - 32 - ...
Martinique ... - 2 - ...
Netherlands Antilles 15 - ...
Nicaragua 11 - 321 - ...
Panama ... - 417 - ...
Suriname ... - 11 - ...
Trinidad-Tobago 12 - 65 - ...
Saint Lucia ... - 1 - ...
Argentina 496 - 2083 - 44
Bolivia ... - 283
Brazil 19 - 756 - 1
Chile 784 - 8160 - 16
Colombia ... - 101 - 2
Ecuador ...- 163 - ...
Paraguay ... - 103 - ...
Peru ... - 549 - ...
Uruguay ... - 196 - 1
Venezuela ... - 204 - ...

NORTH-EAST AND SOUTH ASIA

Bangladesh 12 - ...
China (mainland) ... - 916 - ...
Hong Kong SAR China 44 - 901 - ...
India ... - 104 - ...
Japan 15 - 1517 - ...
Macao SAR China ... - 47 - ...
Nepal ... - 5 - ...
South Korea ... - 210 - ...
Sri Lanka ... - 17 - ...
Taiwan ... - 72 - ...

SOUTH-EAST ASIA

Brunei Darussalam ... - 93 - 1
Cambodia ... - 7 - ...
Indonesia ... - 8 - ...
Laos Peoples Democratic Republic ... - 3 - ...
Malaysia ... - 411 - ...
Myanmar ... - 1 - ...
Philippines ... - 1709 - 1
Singapore 91 - 969 - ...
Thailand ... - 1414 - 3
Vietnam ... - 131 - ...

AUSTRALIA AND PACIFIC

Australia 296 - 5254 - 10
Cook Islands 1 - 1 - ...
Fiji ... - 10 - ...
French New Caledonia ... - 6 - ...
French Polynesia ... - 2 - ...
New Zealand 33 - 945 - 3
Papua New Guinea ... - 1 - ...
Republic of Palau ... - 1 - ...
Samoa ... - 1 - ...
Vanuatu ... - 2 - ...

TOTAL 2,766 - 83,524 - 408

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
(*) Cases reported between 3 July 17:00 hours and 4 July 17:00 hours
(**) Deaths are included in the cumulative number of confirmed cases
(***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)
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India. Update on influenza A [H1N1] as on 4th July, 2009 20:35 IST (PIB Press Release, edited)

Update on influenza A [H1N1] as on 4th July, 2009 20:35 IST

World Health Organization has reported 89,921 laboratory confirmed cases of influenza A/H1N1 infection from 125 countries as on 3rd July 2009. There have been 382 deaths.

Health screening of passengers coming from affected countries is continuing in 22 International airports.

53,068 passengers have been screened on 3.7.2009 of which 39,761 passengers were from affected countries.

224 doctors and 112 paramedics are manning 77 counters at these airports.

A cumulative total of 2,834,716 passengers have been screened.

One new case has been reported today.

A 23 year old Thai National travelled from Bangkok to Mumbai by Thai Airways flight TG 317 reaching Mumbai on 28.06.09 and proceeded further to Kandla port to board a ship of which he is a crew. He was detected at the screening at Kandla port and isolated at the Kandla Port Trust Hospital on 1.07.09. Four other crew members in close contact with this case have also been placed under quarantine. They have been put on chemoprophylaxis.

The indigenous positive case [66 year old female] at Delhi, covered in earlier reports, is stable.

871 persons have been tested so far of which 129 are positive for Influenza A H1N1 [Swine].

255 out of the 837 persons have been identified through entry screening, twenty seven through contact tracing and the rest were self reported.

Of the 129 positive cases, 90 have been discharged. Rest of them remain admitted to the identified health facility.

The situation is being monitored.

DS/MT
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PIB Press Release

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Research Article's Abstracts - July 4 2009 Issue

In this post: Research Article's Abstracts.

Contents:
Replication and pathogenesis associated with H5N1, H5N2, and H5N3 low-pathogenic avian influenza virus infection in chickens and ducks.
Safety and Immunogenicity of Multiple and Higher Doses of an Inactivated Influenza A/H5N1 Vaccine.
"Prepandemic" immunization for novel influenza viruses, "swine flu" vaccine, guillain-barré syndrome, and the detection of rare severe adverse events.
Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans.
Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza.
Perspective -- Emergence of Influenza A (H1N1) Viruses.
Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico.
Spread of a Novel Influenza A (H1N1) Virus via Global Airline Transportation.
The Persistent Legacy of the 1918 Influenza Virus.
Live vaccination with an H5-hemagglutinin-expressing infectious laryngotracheitis virus recombinant protects chickens against different highly pathogenic avian influenza viruses of the H5 subtype.
New influenza A(H1N1) vaccine: How ready are we for large-scale production?
Plant-produced potato virus X chimeric particles displaying an influenza virus-derived peptide activate specific CD8+ T cells in mice.
Influenza control in the 21st century: Optimizing protection of older adults.
Use of MDCK cells for production of live attenuated influenza vaccine.
A prime-boost vaccination of mice with heterologous H5N1 strains.
TLR9 agonist, but not TLR7/8, functions as an adjuvant to diminish FI-RSV vaccine-enhanced disease, while either agonist used as therapy during primary RSV infection increases disease severity.
Effects of oseltamivir on influenza-related complications in children with chronic medical conditions.
Impact of electronic health record-based alerts on influenza vaccination for children with asthma.
Influenza virus infection and the risk of serious bacterial infections in young febrile infants.
Effect of Hemagglutinin-Neuraminidase Inhibitors BCX 2798 and BCX 2855 on Growth and Pathogenicity of Sendai/Human Parainfluenza Type 3 Chimera Virus in Mice.
See original abstract following the link at the end of the post. EDITED.
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1: Arch Virol. 2009 Jul 3. [Epub ahead of print]

Replication and pathogenesis associated with H5N1, H5N2, and H5N3 low-pathogenic avian influenza virus infection in chickens and ducks.

Mundt E, Gay L, Jones L, Saavedra G, Tompkins SM, Tripp RA.
Department of Population Health, Poultry Diagnostic and Research Center, College of Veterinary Medicine, University of Georgia, Athens, 30602, GA, USA, emundt@uga.edu.

A comparative study examining replication and disease pathogenesis associated with low-pathogenic H5N1, H5N2, or H5N3 avian influenza virus (AIV) infection of chickens and ducks was performed. The replication and pathogenesis of highly pathogenic AIV (HPAIV) has received substantial attention; however, the behavior of low-pathogenic AIVs, which serve as precursors to HPAIVs, has received less attention. Thus, chickens or ducks were inoculated with an isolate from a wild bird [A/Mute Swan/MI/451072/06 (H5N1)] or isolates from chickens [A/Ck/PA/13609/93 (H5N2), A/Ck/TX/167280-4/02 (H5N3)], and virus replication, induction of a serological response, and disease pathogenesis were investigated, and the hemagglutinin and neuraminidase (NA) gene sequences of the isolates were determined. Virus isolated from tracheal and cloacal swabs showed that H5N1 replicated better in ducks, whereas H5N2 and H5N3 replicated better in chickens. Comparison of the NA gene sequences showed that chicken-adapted H5N2 and H5N3 isolates both have a deletion of 20 amino acids in the NA stalk region, which was absent in the H5N1 isolate. Histopathological examination of numerous organs showed that H5N2 and H5N3 isolates caused lesions in chickens in a variety of organs, but to a greater extent in the respiratory and intestinal tracts, whereas H5N1 lesions in ducks were observed mainly in the respiratory tract. This study suggests that the H5N1, H5N2, and H5N3 infections occurred at distinct sites in chicken and ducks, and that comparative studies in different model species are needed to better understand the factors influencing the evolution of these viruses.

PMID: 19575275 [PubMed - as supplied by publisher]
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2: J Infect Dis. 2009 Jul 1. [Epub ahead of print]

Safety and Immunogenicity of Multiple and Higher Doses of an Inactivated Influenza A/H5N1 Vaccine.

Beigel JH, Voell J, Huang CY, Burbelo PD, Lane HC.
National Institute of Allergy and Infectious Diseases and 2National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland.

Background.
H5N1 avian influenza represents an episodic zoonotic disease with the potential to cause a pandemic, and antiviral resistance is of considerable concern. We sought to generate high-titer H5N1 antibodies in healthy volunteers for the purpose of developing hyperimmune intravenous immunoglobulin.

Methods.
We conducted a dose-escalating, unblinded clinical trial involving 75 subjects aged 18-59 years. Three cohorts of twenty-five subjects were enrolled sequentially and received 90, 120, or 180 mug of H5N1 A/Vietnam/1203/04 vaccine in 4 doses administered approximately 28 days apart.

Results.
No statistically significant dose-related increases in the geometric mean titers (GMTs) of serum hemagglutination inhibition antibody were observed when the 90-mug, 120-mug, and 180-mug cohorts were compared. When the cohorts were analyzed together to determine the effect of additional vaccinations, the GMTs of hemagglutination inhibition antibody after the first, second, third, and fourth vaccinations were 1:15.7, 1:22.2, 1:36.0, and 1:32.0, respectively (first vaccination vs. baseline, [Formula: see text]; second vs. first vaccination, [Formula: see text]; and third vs. second vaccination, [Formula: see text]). The microneutralization GMTs after the first, second, third, and fourth vaccinations were 1:17.5, 1:33.1, 1:55.7, and 1:68.4, respectively ([Formula: see text] for all comparisons).

Conclusion.
The results of our study suggest that a third and fourth dose of the H5N1 A/Vietnam/1203/04 vaccine may result in higher hemagglutination inhibition and microneutralization GMTs, compared with the GMTs resulting from fewer doses. There was no benefit to increasing the dose of the vaccine.

Trial registration. Clinical Trials.gov identifier: NCT00383071 .
PMID: 19569973 [PubMed - as supplied by publisher]
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3: J Infect Dis. 2009 Aug 1;200(3):321-8.

"Prepandemic" immunization for novel influenza viruses, "swine flu" vaccine, guillain-barré syndrome, and the detection of rare severe adverse events.

Evans D, Cauchemez S, Hayden FG.
The Wellcome Trust and 2MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Diseases Epidemiology, Imperial College London, London, United Kingdom; and 3The Wellcome Trust, London and University of Virginia, Charlottesville, Virginia.

The availability of immunogenic, licensed H5N1 vaccines and the anticipated development of vaccines against "swine" influenza A(H1N1) have stimulated debate about the possible use of these vaccines for protection of those exposed to potential pandemic influenza viruses and for immunization or "priming" of populations in the so-called "prepandemic" (interpandemic) era. However, the safety of such vaccines is a critical issue in policy development for wide-scale application of vaccines in the interpandemic period. For example, wide-scale interpandemic use of H5N1 vaccines could lead to millions of persons receiving vaccines of uncertain efficacy potentially associated with rare severe adverse events and against a virus that may not cause a pandemic. Here, we first review aspects of the 1976 National Influenza Immunization Programme against "swine flu" and its well-documented association with Guillain-Barré syndrome as a case study illustration of a suspected vaccine-associated severe adverse event in a mass interpandemic immunization setting. This case study is especially timely, given the recent spread of a novel influenza A(H1N1) virus in humans in Mexico and beyond. Following this, we examine available safety data from clinical trials of H5N1 vaccines and briefly discuss how vaccine safety could be monitored in a postmarketing surveillance setting.

PMID: 19563262 [PubMed - in process]
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4: N Engl J Med. 2009 Jun 29. [Epub ahead of print]

Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans.

Faix DJ, Sherman SS, Waterman SH.
Naval Health Research Center, San Diego, CA 92106, dennis.faix@med.navy.mil, Naval Medical Center, San Diego, CA 92134, Centers for Disease Control and Prevention, San Diego, CA 92138.

PMID: 19564634 [PubMed - as supplied by publisher]
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5: N Engl J Med. 2009 Jun 29. [Epub ahead of print]

Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza.

Chowell G, Bertozzi SM, Colchero MA, Lopez-Gatell H, Alpuche-Aranda C, Hernandez M, Miller MA.
From the Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD (G.C., M.A.M.); the Mathematical, Computational and Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, Tempe (G.C.); the National Institute of Public Health, Center for Evaluation Research and Surveys, Cuernavaca, Mexico (S.M.B., M.A.C.); the University of California, Berkeley (S.M.B.); and the Mexican Ministry of Health, Mexico City (H.L.-G., C.A.-A., M.H.).

This article (10.1056/NEJMoa0904023) was published on June 29, 2009, at NEJM.org.

BACKGROUND:
In the spring of 2009, an outbreak of severe pneumonia was reported in conjunction with the concurrent isolation of a novel swine-origin influenza A (H1N1) virus (S-OIV), widely known as swine flu, in Mexico. Influenza A (H1N1) subtype viruses have rarely predominated since the 1957 pandemic. The analysis of epidemic pneumonia in the absence of routine diagnostic tests can provide information about risk factors for severe disease from this virus and prospects for its control.

METHODS:
From March 24 to April 29, 2009, a total of 2155 cases of severe pneumonia, involving 821 hospitalizations and 100 deaths, were reported to the Mexican Ministry of Health. During this period, of the 8817 nasopharyngeal specimens that were submitted to the National Epidemiological Reference Laboratory, 2582 were positive for S-OIV. We compared the age distribution of patients who were reported to have severe pneumonia with that during recent influenza epidemics to document an age shift in rates of death and illness.

RESULTS:
During the study period, 87% of deaths and 71% of cases of severe pneumonia involved patients between the ages of 5 and 59 years, as compared with average rates of 17% and 32%, respectively, in that age group during the referent periods. Features of this epidemic were similar to those of past influenza pandemics in that circulation of the new influenza virus was associated with an off-season wave of disease affecting a younger population.

CONCLUSIONS:
During the early phase of this influenza pandemic, there was a sudden increase in the rate of severe pneumonia and a shift in the age distribution of patients with such illness, which was reminiscent of past pandemics and suggested relative protection for persons who were exposed to H1N1 strains during childhood before the 1957 pandemic. If resources or vaccine supplies are limited, these findings suggest a rationale for focusing prevention efforts on younger populations.

Copyright 2009 Massachusetts Medical Society.
PMID: 19564633 [PubMed - as supplied by publishe
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6: N Engl J Med. 2009 Jun 29. [Epub ahead of print]

Perspective -- Emergence of Influenza A (H1N1) Viruses.

Zimmer SM, Burke DS.
From the School of Medicine (S.M.Z.) and the Graduate School of Public Health (D.S.B.), University of Pittsburgh, Pittsburgh.

This article (10.1056/NEJMra0904322) was published on June 29, 2009, at NEJM.org.

PMID: 19564632 [PubMed - as supplied by publisher]
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7: N Engl J Med. 2009 Jun 29. [Epub ahead of print]

Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico.

Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quiñones-Falconi F, Bautista E, Ramirez-Venegas A, Rojas-Serrano J, Ormsby CE, Corrales A, Higuera A, Mondragon E, Cordova-Villalobos JA;
the INER Working Group on Influenza. From the National Institute of Respiratory Diseases (INER) (R.P.-P., D.R.-Z., F.Q.-F., E.B., A.R.-V., J.R.-S., C.E.O., A.C., A.H., E.M.), Biologicals and Reactives of Mexico (BIRMEX) (S.P.L.), and the Secretariat of Health (M.H., J.A.C.-V.) - all in Mexico City.

This article (10.1056/NEJMoa0904252) was published on June 29, 2009, at NEJM.org.

BACKGROUND:
In late March 2009, an outbreak of a respiratory illness later proved to be caused by novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Mexico. We describe the clinical and epidemiologic characteristics of persons hospitalized for pneumonia at the national tertiary hospital for respiratory illnesses in Mexico City who had laboratory-confirmed S-OIV infection, also known as swine flu.

METHODS:
We used retrospective medical chart reviews to collect data on the hospitalized patients. S-OIV infection was confirmed in specimens with the use of a real-time reverse-transcriptase-polymerase-chain-reaction assay.

RESULTS:
From March 24 through April 24, 2009, a total of 18 cases of pneumonia and confirmed S-OIV infection were identified among 98 patients hospitalized for acute respiratory illness at the National Institute of Respiratory Diseases in Mexico City. More than half of the 18 case patients were between 13 and 47 years of age, and only 8 had preexisting medical conditions. For 16 of the 18 patients, this was the first hospitalization for their illness; the other 2 patients were referred from other hospitals. All patients had fever, cough, dyspnea or respiratory distress, increased serum lactate dehydrogenase levels, and bilateral patchy pneumonia. Other common findings were an increased creatine kinase level (in 62% of patients) and lymphopenia (in 61%). Twelve patients required mechanical ventilation, and seven died. Within 7 days after contact with the initial case patients, a mild or moderate influenza-like illness developed in 22 health care workers; they were treated with oseltamivir, and none were hospitalized.

CONCLUSIONS:
S-OIV infection can cause severe illness, the acute respiratory distress syndrome, and death in previously healthy persons who are young to middle-aged. None of the secondary infections among health care workers were severe.

Copyright 2009 Massachusetts Medical Society.
PMID: 19564631 [PubMed - as supplied by publisher]
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8: N Engl J Med. 2009 Jun 29. [Epub ahead of print]

Spread of a Novel Influenza A (H1N1) Virus via Global Airline Transportation.

Khan K, Arino J, Hu W, Raposo P, Sears J, Calderon F, Heidebrecht C, Macdonald M, Liauw J, Chan A, Gardam M. St. Michael's Hospital, Toronto, ON M5B 1W8, Canada, khank@smh.toronto.on.ca, University of Manitoba, Winnipeg, MB R3T 2N2, Canada, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada, Ryerson University, Toronto, ON M5B 2K3, Canada, Queen's University, Kingston, ON K7L 3N6, Canada, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada, University Health Network, Toronto, ON M5G 2C4, Canada.

PMID: 19564630 [PubMed - as supplied by publisher]
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9: N Engl J Med. 2009 Jun 29. [Epub ahead of print]

The Persistent Legacy of the 1918 Influenza Virus.

Morens DM, Taubenberger JK, Fauci AS.
From the National Institute of Allergy and Infectious Diseases, Bethesda, MD.

This article (10.1056/NEJMp0904819) was published on June 29, 2009, at NEJM.org.
PMID: 19564629 [PubMed - as supplied by publisher]
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10: Vaccine. 2009 Jun 29. [Epub ahead of print]

Live vaccination with an H5-hemagglutinin-expressing infectious laryngotracheitis virus recombinant protects chickens against different highly pathogenic avian influenza viruses of the H5 subtype.

Pavlova SP, Veits J, Mettenleiter TC, Fuchs W.
Institute of Molecular Biology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Südufer 10, 17493 Greifswald - Insel Riems, Germany.

Recently, we described an infectious laryngotracheitis virus (ILTV, gallid herpesvirus 1) recombinant, which had been attenuated by deletion of the viral dUTPase gene UL50, and abundantly expressed the hemagglutinin (HA) gene of a H5N1 type highly pathogenic avian influenza virus (HPAIV) of Vietnamese origin. In the present study, efficacy of this vectored vaccine (ILTV-DeltaUL50IH5V) against different H5 HPAIV was evaluated in 6-week-old chickens. After a single ocular immunization all animals developed HA-specific antibodies, and were protected against lethal infection not only with the homologous HPAIV isolate A/duck/Vietnam/TG24-01/05 (H5N1, clade 1, hemagglutinin amino acid sequence identity 100%), but also with heterologous HPAIV A/swan/Germany/R65/2006 (H5N1, clade 2.2, identity 96.1%) or HPAIV A/chicken/Italy/8/98 (H5N2, identity 93.8%). No symptoms of disease were observed after challenge with the H5N1 viruses, and only 20% of H5N2 challenged animals developed minimal clinical signs. Real-time RT-PCR analyses of oropharyngeal swabs revealed limited challenge virus replication, but the almost complete absence of HPAIV RNA from cloacal swabs indicated that no generalized infections occurred. Thus, unlike several previous vectors, ILTV-DeltaUL50IH5V was able to protect chickens against different HPAIV isolates of the H5 subtype. Vaccination with HA-expressing ILTV also allowed differentiation of immunized from AIV-infected animals by serological tests for antibodies against influenza virus nucleoprotein.

PMID: 19573638 [PubMed - as supplied by publisher]
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11: Vaccine. 2009 Jun 26. [Epub ahead of print]

New influenza A(H1N1) vaccine: How ready are we for large-scale production?

Collin N, de Radiguès X, Kieny MP;
the World Health Organization H1N1 Vaccine Task Force. World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.

The threat of an influenza pandemic has emerged once again, this time in the form of a new strain of influenza A(H1N1) virus. Fortunately, the international community, including influenza vaccine manufacturers, has been increasing its preparedness for such an event, triggered by the need to stem the spread of the highly pathogenic avian influenza A(H5N1) virus over recent years. Today, the development of a pandemic influenza vaccine in the fastest possible time is a global priority. However, two major issues need to be taken into consideration: how long will it take to produce sufficient pandemic vaccine doses to immunize the global population at risk, including poor populations that have no resources to purchase the vaccine; and how will pandemic vaccine production affect availability of trivalent vaccine for the forthcoming 2009-2010 influenza seasons. To address these questions, WHO carried out a survey in May 2009 among influenza vaccine manufacturers on their planned seasonal and pandemic production with a view to developing recommendations on the distribution and use of influenza vaccine in the case of a pandemic.

PMID: 19563891 [PubMed - as supplied by publishe
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12: Vaccine. 2009 Jun 26. [Epub ahead of print]

Plant-produced potato virus X chimeric particles displaying an influenza virus-derived peptide activate specific CD8+ T cells in mice.

Lico C, Mancini C, Italiani P, Betti C, Boraschi D, Benvenuto E, Baschieri S.
ENEA C.R. Casaccia, Sezione Genetica e Genomica Vegetale, Via Anguillarese 301, 000123 Roma, Italy.

Plant viruses can be genetically modified to produce chimeric virus particles (CVPs) carrying heterologous peptides. The efficacy of plant-produced CVPs in inducing antibody responses specific to the displayed peptide has been extensively demonstrated. To determine if plants can be used to produce CVPs able to activate peptide-specific major histocompatibility complex (MHC) class I-restricted CD8+ T cells, potato virus X (PVX) has been engineered to display the H-2D(b)-restricted epitope ASNENMETM of influenza A virus nucleoprotein (NP). Engineering criteria were devised to comply not only with plant virus genetic stability and infectivity but also with antigen processing rules. The immunological properties of different doses of endotoxin-free preparations of CVPs or unmodified PVX have been evaluated by s.c. immunizing C57BL/6J mice and testing at different time intervals splenocyte responses by interferon gamma (IFN-gamma) enzyme-linked immunospot (ELISPOT) assay. These experiments demonstrated that CVPs activate ASNENMTEM-specific CD8+ T cells. Remarkably, the best response was achieved without adjuvant co-delivery. These results represent the proof of concept that well-designed plant virus carriers of epitopes produced in plant can reasonably be used into peptide vaccine formulations aimed to activate cell-mediated immune responses.

PMID: 19563889 [PubMed - as supplied by publisher]
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13: Vaccine. 2009 Jun 23. [Epub ahead of print]

Influenza control in the 21st century: Optimizing protection of older adults.

Monto AS, Ansaldi F, Aspinall R, McElhaney JE, Montaño LF, Nichol KL, Puig-Barberà J, Schmitt J, Stephenson I.
University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA.

Older adults (>/=65 years of age) are particularly vulnerable to influenza illness. This is due to a waning immune system that reduces their ability to respond to infection, which leads to more severe cases of disease. The majority ( approximately 90%) of influenza-related deaths occur in older adults and, in addition, catastrophic disability resulting from influenza-related hospitalization represents a significant burden in this vulnerable population. Current influenza vaccines provide benefits for older adults against influenza; however, vaccine effectiveness is lower than in younger adults. In addition, antigenic drift is also a concern, as it can impact on vaccine effectiveness due to a mismatch between the vaccine virus strain and the circulating virus strain. As such, vaccines that offer higher and broader protection against both homologous and heterologous virus strains are desirable. Approaches currently available in some countries to meet this medical need in older adults may include the use of adjuvanted vaccines. Future strategies under evaluation include the use of high-dose vaccines; novel or enhanced adjuvantation of current vaccines; use of live attenuated vaccines in combination with current vaccines; DNA vaccines; recombinant vaccines; as well as the use of different modes of delivery and alternative antigens. However, to truly evaluate the benefits that these solutions offer, further efficacy and effectiveness studies, and better correlates of protection, including a precise measurement of the T cell responses that are markers for protection, are needed. While it is clear that vaccines with greater immunogenicity are required for older adults, and that adjuvanted vaccines may offer a short-term solution, further research is required to exploit the many other new technologies.

PMID: 19559118 [PubMed - as supplied by publishe
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14: Vaccine. 2009 Jun 24. [Epub ahead of print]

Use of MDCK cells for production of live attenuated influenza vaccine.

Liu J, Shi X, Schwartz R, Kemble G. MedImmune, LLC., 3055 Patrick Henry Drive, Santa Clara, CA 95054, United States.

To develop a cell-based live attenuated influenza vaccine (LAIV) manufacturing process, several different cell lines were evaluated by comparing the titer of viruses after infection with LAIV strains. While several cell lines have been reported to support influenza virus replication, the degree of replication and the ability to support replication of LAIV strains have not been systematically examined. MDCK cells, which have been considered as potential substrates for influenza vaccine production were evaluated in addition to Vero, MRC-5, WI-38 and FRhL cells. MRC-5, WI-38 and FRhL cells produced low to moderate titers of virus with titers equal or below 5.0log(10) TCID(50)/mL. Both Vero and MDCK cells could support a higher level of virus replication for certain strains, however, Vero cells only produced high titers when grown in the presence of serum. MDCK cells supported high levels of vaccine virus production for multiple different LAIV subtypes in both serum containing and serum-free media. These results suggest that MDCK cell-based production can be used as an alternative production platform to the currently used egg-based LAIV production system.

PMID: 19559113 [PubMed - as supplied by publisher]
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15: Vaccine. 2009 May 18;27(23):3121-5.

A prime-boost vaccination of mice with heterologous H5N1 strains.

Ikeno D, Kimachi K, Kudo Y, Goto S, Itamura S, Odagiri T, Tashiro M, Kino Y.
The Chemo-Sero-Therapeutic Research Institute, Kikuchi Research Center, Kawabe Kyokushi, Kikuchi, Kumamoto, Japan. ikeno-da@kaketsuken.or.jp

We evaluated the priming effect of an H5N1 pandemic vaccine in a mouse model to investigate strategies for influenza pandemic vaccination. For priming, an alum-adjuvanted inactivated whole H5N1 vaccine (NIBRG-14, clade 1) was used. As booster vaccines, several formulations of Indo05/05/2005(H5N1)PR8-IBCDC-RG2 vaccines (clades 2-1)were evaluated, including split, whole, alum-adjuvanted split, and alum-adjuvanted whole vaccines. Any type of booster vaccination elicited a significant HI antibody response despite the difference in antigenicity between the priming and booster vaccines. The split vaccine elicited a much stronger booster response than the alum-adjuvanted whole vaccine. When the mice were primed with the H1N1 or H3N2 vaccines, this did not affect the booster response to the H5N1 vaccine. These results indicated that an alum-adjuvanted whole vaccine is able to confer immunological memory to haemagglutinin even if the primed and boosted vaccine strains are in different clades and, once vaccinated, a split vaccine is preferred to evoke recall responses.

PMID: 19514127 [PubMed - indexed for MEDLINE]
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16: Vaccine. 2009 May 18;27(23):3045-52. Epub 2009 Apr 3.

TLR9 agonist, but not TLR7/8, functions as an adjuvant to diminish FI-RSV vaccine-enhanced disease, while either agonist used as therapy during primary RSV infection increases disease severity.

Johnson TR, Rao S, Seder RA, Chen M, Graham BS.
Vaccine Research Center, Viral Pathogenesis Laboratory, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892-3017, USA. teresaj@nih.gov

Agonists for TLR7, TLR8, and TLR9 have been shown to enhance vaccine immunogenicity. We evaluated the impact of TLR activation on RSV disease in a murine model by administering TLR7/8 and TLR9 agonists during FI-RSV immunization or RSV infection. CpG administered during immunization reduced disease following challenge as evidenced by decreased lung pathology, illness, and cytokines. In marked contrast, TLR7/8 agonist had little impact. To evaluate potential therapeutic use, TLR agonists were administered during primary infection. Although type 2 cytokine responses decreased and type 1 cytokines and MIP-1-alpha/beta increased, both TLR7/8 and TLR9 agonists increased clinical symptoms and pulmonary inflammation when administered during primary infection. Thus, TLR9-induced signaling during FI-RSV immunization reduced vaccine-enhanced disease whereas immunostimulatory properties of TLR agonists enhanced disease severity when used during RSV infection. Immunomodulation elicited by TLR9 agonist confirms the adjuvant potential of TLR agonists during RSV immunization. However, in contrast to work done with HIV-1 vaccines, the inability of TLR7/8 agonist to boost type 1 vaccine-induced RSV immunity demonstrates pathogen-TLR specificity. These data reveal that the timing of administration of immunomodulatory agents is critical. Furthermore, these data underscore that amplification of anti-viral immune responses may result in immunopathology rather than immune-mediated protection.

PMID: 19428918 [PubMed - indexed for MEDLINE]
PMCID: PMC2680782 [Available on 2010/05/18]
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17: Pediatrics. 2009 Jul;124(1):170-8.

Effects of oseltamivir on influenza-related complications in children with chronic medical conditions.

Piedra PA, Schulman KL, Blumentals WA.
Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas 77030, USA. ppiedra@bcm.tmc.edu

OBJECTIVE:
This study investigated the influence of oseltamivir on influenza-related complications and hospitalizations for children and adolescents, 1 to 17 years of age, with chronic medical conditions or neurologic or neuromuscular disease.

METHODS:
In a retrospective study, outcomes for patients who were given oseltamivir within 1 day after influenza diagnosis were compared with those for patients who received no antiviral therapy. Anonymous data from MarketScan databases (Thomson Reuters, Cambridge, MA) were used to identify patients from 6 influenza seasons between 2000 and 2006. The study outcomes were frequencies of pneumonia, respiratory illnesses other than pneumonia, otitis media, and hospitalization.

RESULTS:
Oseltamivir was prescribed for 1634 patients according to the study criteria, and 3721 patients received no antiviral therapy for their influenza. After adjustment for demographic and medical history variables, oseltamivir was associated with significant reductions in the risks of respiratory illnesses other than pneumonia, otitis media and its complications, and all-cause hospitalization in the 14 days after influenza diagnosis. Analyses for 30 days after influenza diagnosis also showed significant risk reductions for respiratory illnesses other than pneumonia, otitis media and its complications, and all-cause hospitalization with oseltamivir.

CONCLUSION:
When it was prescribed at influenza diagnosis, oseltamivir was associated with reduced risks of influenza-related complications and hospitalizations for children and adolescents at high risk of influenza complications.

PMID: 19564297 [PubMed - in process]
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18: Pediatrics. 2009 Jul;124(1):159-69.

Comment in: Pediatrics. 2009 Jul;124(1):375-7.

Impact of electronic health record-based alerts on influenza vaccination for children with asthma.

Fiks AG, Hunter KF, Localio AR, Grundmeier RW, Bryant-Stephens T, Luberti AA, Bell LM, Alessandrini EA.
Pediatric Generalist Research Group, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. fiks@email.chop.edu

OBJECTIVE:
The goal was to assess the impact of influenza vaccine clinical alerts on missed opportunities for vaccination and on overall influenza immunization rates for children and adolescents with asthma.

METHODS:
A prospective, cluster-randomized trial of 20 primary care sites was conducted between October 1, 2006, and March 31, 2007. At intervention sites, electronic health record-based clinical alerts for influenza vaccine appeared at all office visits for children between 5 and 19 years of age with asthma who were due for vaccine. The proportion of captured immunization opportunities at visits and overall rates of complete vaccination for patients at intervention and control sites were compared with those for the previous year, after standardization for relevant covariates. The study had >80% power to detect an 8% difference in the change in rates between the study and baseline years at intervention versus control practices.

RESULTS:
A total of 23 418 visits and 11 919 children were included in the study year and 21 422 visits and 10 667 children in the previous year. The majority of children were male, 5 to 9 years of age, and privately insured. With standardization for selected covariates, captured vaccination opportunities increased from 14.4% to 18.6% at intervention sites and from 12.7% to 16.3% at control sites, a 0.3% greater improvement. Standardized influenza vaccination rates improved 3.4% more at intervention sites than at control sites. The 4 practices with the greatest increases in rates (>or=11%) were all in the intervention group. Vaccine receipt was more common among children who had been vaccinated previously, with increasing numbers of visits, with care early in the season, and at preventive versus acute care visits.

CONCLUSIONS:
Clinical alerts were associated with only modest improvements in influenza vaccination rates.

PMID: 19564296 [PubMed - in process]
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19: Pediatrics. 2009 Jul;124(1):30-9.

Influenza virus infection and the risk of serious bacterial infections in young febrile infants.

Krief WI, Levine DA, Platt SL, Macias CG, Dayan PS, Zorc JJ, Feffermann N, Kuppermann N;
Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Department of Pediatrics and Emergency Medicine, Schneider Children's Hospital/Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA. wkrief@NSHS.edu

OBJECTIVE:
We aimed to determine the risk of SBIs in febrile infants with influenza virus infections and compare this risk with that of febrile infants without influenza infections.

PATIENTS AND METHODS:
We conducted a multicenter, prospective, cross-sectional study during 3 consecutive influenza seasons. All febrile infants or=5 x 10(4) colony-forming units per mL or >or=10(4) colony-forming units per mL in association with a positive urinalysis. Bacteremia, bacterial meningitis, and bacterial enteritis were defined by growth of a known bacterial pathogen. SBI was defined as any of the 4 above-mentioned bacterial infections.

RESULTS:
During the 3-year study period, 1091 infants were enrolled. A total of 844 (77.4%) infants were tested for the influenza virus, of whom 123 (14.3%) tested positive. SBI status was determined in 809 (95.9%) of the 844 infants. Overall, 95 (11.7%) of the 809 infants tested for influenza virus had an SBI. Infants with influenza infections had a significantly lower prevalence of SBI (2.5%) and UTI (2.4%) when compared with infants who tested negative for the influenza virus. Although there were no cases of bacteremia, meningitis, or enteritis in the influenza-positive group, the differences between the 2 groups for these individual infections were not statistically significant.

CONCLUSIONS:
Febrile infants <or=60 days of age with influenza infections are at significantly lower risk of SBIs than febrile infants who are influenza-negative. Nevertheless, the rate of UTI remains appreciable in febrile, influenza-positive infants.

PMID: 19564280 [PubMed - in process]
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20: Antimicrob Agents Chemother. 2009 Jun 29. [Epub ahead of print]

Effect of Hemagglutinin-Neuraminidase Inhibitors BCX 2798 and BCX 2855 on Growth and Pathogenicity of Sendai/Human Parainfluenza Type 3 Chimera Virus in Mice.

Watanabe M, Mishin VP, Brown SA, Russell CJ, Boyd K, Babu YS, Taylor G, Xiong X, Yan X, Portner A, Alymova IV.

Departments of Infectious Diseases, Immunology, Biostatistics, and Animal Resource Center, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA; BioCryst Pharmaceuticals, Inc., 2190 Parkway Lake Drive, Birmingham, AL 35244, USA; Center for Biomolecular Science, University of St. Andrews, North Haugh, St. Andrews, Fife KY16 9ST, Scotland.

Human parainfluenza virus type 3 (hPIV-3) is a major respiratory tract pathogen affecting young children, but no vaccines or antiviral drugs have yet been developed against it. We developed a mouse model to evaluate the efficacy of the novel parainfluenza virus hemagglutinin-neuraminidase (HN) inhibitors BCX 2798 and BCX 2855 against a recombinant Sendai virus in which the fusion and HN surface glycoproteins were substituted with those of hPIV-3 (rSeV[hPIV-3FHN]). In the prophylactic model, 129x1/SvJ mice were infected with a 90% or 20% lethal dose of the virus and treated intranasally for 5 days with 10 mg/kg/day of either compound, starting 4 h before infection. Prophylactic treatment of mice with either compound did not prevent their death in a 90% lethal model of rSeV(hPIV-3FHN) infection. However, it significantly reduced virus lung titers, weight loss, and mortality in mice infected with a 20% lethal virus dose. In the therapeutic model, mice were infected with a nonlethal dose of the virus (100 PFU/mouse) and treated intranasally with 1 or 10 mg/kg/day of either compound for 5 days, starting 24 or 48 h postinfection. Treatment of mice with either compound significantly reduced virus titer in the lungs, subsequently causing a reduction in the number of immune cells and level of cytokines in the bronchoalveolar lavage, and histopathologic changes in the airways. Our results indicate that BCX 2798 and BCX 2855 are effective inhibitors of hPIV-3 HN in our mouse model and may be promising candidates for prophylaxis and treatment of hPIV-3 infection in humans.

PMID: 19564364 [PubMed - as supplied by publisher]
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Hong Kong: HA update on Designated Flu Clinic and admitted human swine influenza patients (4/7/09)

The following is issued on behalf of the Hospital Authority:

Regarding the services of the eight Designated Flu Clinics (DFCs) and the confirmed human swine influenza patients admitted to public hospitals, the Hospital Authority (HA) spokesman provided the following updates today (July 4):

The Designated Flu Clinics today (as at 5pm) provide treatment to a total of 239 patients.

The HA spokesman reminded the public that the eight DFCs have ceased the provision of general outpatient services. Patients with other illnesses are advised to seek medical treatment at other general outpatient clinics in the district or private practitioners.

Chronic patients who have been pre-scheduled for follow up at the eight DFCs should proceed to their corresponding clinics with drug refill service according to their date of original appointment and bring along the appointment slip and Identity Card.

As at 2.30pm today, there were 26 newly confirmed cases of human swine influenza in the past 24 hours.

This brings to 927 the total number of confirmed human swine influenza cases in Hong Kong.

Currently, a total of five confirmed cases are staying in public hospitals for treatment.

Their condition are stable and none required intensive care.

Among the confirmed cases was a female nurse in Queen Mary Hospital (QMH).

She developed flu symptoms on June 25 and attended the Staff Clinic of QMH on the same day.

Respiratory sample of the nurse was taken for laboratory test on influenza and confirmed the positive result of human swine influenza. She is now under isolation with paracetamol prescription at home.

Her condition is stable. She works in an obstetric and gynecology ward of QMH and has been following strictly the HA Infection Control Guidelines for patient care.

She wears a surgical mask when she is on duty and practicing hand hygiene during her clinical duty.

QMH has traced the close contacts of the nurse including patients and staff working in the ward.

Up to the present moment, no patient or other staff was found to be having upper respiratory symptoms. The hospital will continue to follow the HA Infection Control Guidelines and implement relevant hygiene measures to protect patients and staff.
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Hong Kong: Twenty-six new cases of human swine influenza (7/4/09)

A spokesman for the Department of Health said there had been 26 newly confirmed cases of human swine influenza (Influenza A H1N1) in the 24 hours to 2.30pm today (July 4).

The new cases involve 13 males and 13 females, aged between 3 and 52.

This brings to 927 the total number of human swine influenza cases (HSI) in Hong Kong.
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Australia. National H1N1 Influenza 09 Update - 12 noon 4th July 2009 (1200 AEST on 4 July 2009) (Dept. of Health, edited)

Australian Government - Department of Health and Ageing

National H1N1 Influenza 09 Update - 12 noon 4th July 2009 (1200 AEST on 4 July 2009)

[Original Document: LINK. EDITED.]

National case update

Australia has 5254 confirmed cases of H1N1 Influenza 09, an increase of 296 cases since noon yesterday.

The total number of Australian deaths associated with H1N1 Influenza 09 is currently 10, with seven reported in Victoria, one in NSW, one Western Australia and one in South Australia.

Most of the new cases were recorded in NSW, Northern Territory, Queensland and Victoria.

Since yesterday, there have been 110 new cases in NSW, 65 in the NT, 85 in Queensland, 3 in Tasmania and 33 in Victoria.

The national breakdown of cases is: ACT 206, NSW 1267, NT 335, Qld 831, SA 502, Tas 95, VIC 1724, WA 294.

Hospitalisations

There are currently 93 people in hospital around Australia with H1N1 Influenza 09 and 24 of these are in intensive care units.
National breakdown of hospitalisations: There are currently 3 in the ACT, 22 in NSW, 12 in the NT, 6 in Qld, 4 in SA, 1 in Tas, 42 in Victoria and 3 in WA.

ICU admissions: Of the 24 people currently in Intensive Care Units, 15 of these are in Victoria; 4 in NSW, 3 in Qld and 2 in SA

The total number of hospitalisations in Australia since H1N1 Influenza 09 was identified is 473.

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Swine Flu Death Toll in Argentina Climbs - NYTimes.com

Swine Flu Death Toll in Argentina Climbs

By ALEXEI BARRIONUEVO
Published: July 3, 2009
RIO DE JANEIRO

The death toll from swine flu in Argentina continued to rise as President Cristina Fernández de Kirchner said she would not rule out closing major public venues where the virus could spread more quickly.

Dr. Juan Manzur, the new health minister, said Friday that 44 people had died from swine flu and that the country had 2,800 confirmed flu cases. The numbers reflected a sharp increase compared with a week earlier, when there were 26 deaths and 1,587 cases.

Swine flu has killed more people in Argentina than in any other country in South America, where the winter flu season is just beginning. The death rate of 1.6 percent is more than three times the world average, Claudio Zin, the health minister of Buenos Aires Province, said Friday.

Argentina passed Canada this week as the country with the third-highest death toll from the flu, but it remains behind Mexico and the United States. Dr. Manzur said that officials now suspect that there are 100,000 cases of swine flu in the country, compared with 320,000 cases of other types of flu.

The government has been slow in confirming cases, doctors said, because it only has one state laboratory doing the testing.

Mrs. Kirchner tried Friday to calm an anxious public but did not discount the possibility that officials would close movie theaters, discos and other public places to try to contain the flu’s spread.

“We cannot rule out anything,” she said. “Measures will be taken as they are deemed necessary.”

Argentina was ill-prepared for the global swine flu pandemic, and some private health officials have said that Mrs. Kirchner’s government should have declared a state of emergency before national congressional elections last Sunday.

That would probably have entailed delaying the elections, which Mrs. Kirchner had moved up by four months in a bid to increase the chances that her husband, former President Néstor Kirchner, could prevail in his race for Congress. He failed to come in first, hurting the couple’s chances that one of them could win the presidency in 2011.

Several doctors, including some who were advising the health ministry, have said that Graciela Ocaña, the former health minister, had recommended calling a national state of emergency and delaying the elections, but was overruled. Ms. Ocaña resigned Monday and has yet to discuss the issue publicly.

Some private doctors said declaring a national state of emergency would allow the health authorities to put together a coordinated plan to contain the spread of swine flu as Mexico did.

Mrs. Kirchner has resisted making a national declaration, but the city and province of Buenos Aires have declared health emergencies to give officials greater access to funds and free rein to close schools and other public places.

Even as some officials are closing schools and extending winter vacations to keep young people isolated and indoors, huge public gatherings continue to be held.In Buenos Aires, people waited in long lines on Friday to purchase 3,500 available tickets for a championship soccer match on Sunday. The match is scheduled to be played in a packed 48,000-seat stadium.

Several media outlets reported that two more people died Friday, identified only as young adults in the city of Rosario, increasing the unofficial total to 46. Dr. Manzur said more deaths than the 44 confirmed were being studied to see if they were caused by swine flu.

The outbreak is expected to cost the economy up to $2.9 billion this year, deepening an economic contraction to 3 percent from 2.2 percent, according to estimates by economists at HSBC bank in Buenos Aires.

Charles Newbery contributed reporting from Buenos Aires.
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Swine Flu Death Toll in Argentina Climbs - NYTimes.com

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Canada. Latest Ontario death raises H1N1 flu toll to 33

Latest Ontario death raises H1N1 flu toll to 33

Updated Fri. Jul. 3 2009 5:28 PM ET
The Canadian Press

Ontario is now reporting 12 deaths associated with the swine flu for a national total of 33.

A 37-year-old Toronto man who had underlying medical conditions tested positive for the virus.

Ontario now has more than 3,150 confirmed cases of H1N1.

Quebec is also reporting another death related to swine flu today, although that province's health department gave no information about its 14th victim.

Twenty-one new cases of swine flu have been confirmed by the department in Quebec, bringing the provincial total to 2,129.

There have been 12 deaths in Ontario, four in Manitoba, two in Saskatchewan and one in Alberta.

Across Canada, there have been nearly 8,000 cases of the H1N1 since the outbreak began, and most have been mild.

Ontario reports an average of 9,000 cases of seasonal flu each year, and approximately 500 deaths.

Nationwide, the common flu sends about 20,000 Canadians to hospital each year. The Public Health Agency's website says between 4,000 and 8,000 Canadians can die of influenza and its complications annually, depending on the severity of the season.

The number of deaths in Ontario jumped to 12 even though the province's weekly bulletin lists 10 fatalities. A spokesman said that's because information on the latest deaths had not yet been officially submitted through the public health information system.
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CTV.ca | Latest Ontario death raises H1N1 flu toll to 33

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New Zealand. Teen swine flu victim not diagnosed | Otago Daily Times Online

Teen swine flu victim not diagnosed

Sat, 4 Jul 2009
News: National

A Hamilton teenager with swine flu died at home without being diagnosed with the illness.

He was one three New Zealanders to have died in the past week with swine flu more than likely to have been the cause, the Ministry of Health confirmed today.

Zachary Wilson, 19, had been ill for three or four days but had not been to hospital before he died last Sunday, said Waikato District Health Board medical officer of health Dr Felicity Dumble.

"What's become apparent with this situation is how quickly this can develop, and somebody can present with what looks like a common cold that may progress to more like influenza and then it can rapidly become something very serious." Some efforts were made to treat Mr Wilson's symptoms, although no further details were made available.

Mr Wilson's family, who had been devastated by his death, wanted people to be aware how quickly someone's condition could deteriorate, Dr Dumble told reporters.

Given the wide spread of swine flu, health authorities were focusing on treating people who were sick rather than routine testing.

Mr Wilson's case of swine flu was discovered following an autopsy.

The coroner would examine if any other medical conditions had played a part in Mr Wilson's death, she said.

However, he had a history of asthma which, along with other factors such as diabetes and cardiovascular conditions, was more likely to cause complications.

Although people had been advised to stay at home if possible to avoid spreading the illness and adding to pressure on the health system, anyone whose condition worsened should seek medical attention, Dr Dumble said.

Some deaths were expected as a result of swine flu, she said.

"It's really important that people are aware that influenza is a serious illness and it does kill." Signs to look watch out for included a rapidly worsening condition, a difficulty being woken, confusion or irritability, a fever of about 38.3 degrees, fits, and not keeping down fluids.

Chief Coroner Neil MacLean said a 42-year-old man with underlying medical conditions had also died on Thursday in Christchurch.

It was "strongly probable" that the H1N1 virus (swine flu) was a major factor in the deaths of both men, he said.

Meanwhile, Capital and Coast District Health Board said a young girl with underlying medical conditions died this morning in Wellington Hospital. She had earlier tested positive to swine flu.

Health Minister Tony Ryall said he, along with the ministry, expressed sincere condolences to each of the families involved.

Swine flu continued to spread throughout the community and would be around for some time, but there was no cause for alarm, Mr Ryall said.

Director of Public Health Mark Jacobs said there was no need for New Zealand health authorities to change their management approach at this stage, but vigilance would remain.

"For most New Zealanders, swine flu will be a mild illness, but in some instances, the infection can cause more severe illness and in a few tragic instances, death," he said.

As of today, the total number of confirmed cases in New Zealand was 945, up from 912 yesterday.
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Teen swine flu victim not diagnosed | Otago Daily Times Online

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CHILE. REPORTE SEMANAL - FECHA: 03/07/09 - INFLUENZA A (H1N1) (Min. Salud, edited)

CHILE - MINISTERIO DE SALUD

REPORTE SEMANAL - FECHA: 03/07/09 - INFLUENZA A (H1N1)

[Original Document: LINK. EDITED.]

A continuación, se presenta el informe sobre la situación de la infección por nueva influenza A (H1N1) en Chile, con datos disponibles hasta el 03 de julio de 2009.

1. Resumen

Desde el 17 de mayo, fecha en que el Instituto de Salud Pública confirmó el primer caso de infección por Nueva Influenza A (H1N1), hasta el 02 de julio se han confirmado por laboratorio 8.160 casos. La confirmación de los casos se realiza por PCR específico en tiempo real en el Instituto de Salud Pública y algunos establecimientos privados de salud.

Cabe destacar que, al igual que los países del resto del mundo, el Ministerio de Salud informa los casos confirmados con diagnóstico de laboratorio y no con criterio clínico.

Hasta el momento, el virus de la Nueva Influenza Humana A (H1N1) ha demostrado una alta transmisibilidad en la población, como es lo esperado en invierno donde se dan las condiciones óptimas para su circulación.

En relación a los casos confirmados por laboratorio, 3.8% ha requerido hospitalización y 0,2% (16 casos) ha fallecido. Esta situación es similar a la observada en Estados Unidos, donde también existe un bajo el porcentaje de hospitalización (7,8%) y de fallecimientos (0,2%).

El 78.9% de los casos confirmados están recuperados; un 17.3% está con tratamiento, recuperándose en su domicilio.

Los niños en edad escolar (entre los 5 y 19 años) han sido los más afectados, concentrando el 53% del total de casos confirmados.

2. Casos, hospitalizaciones y defunciones notificadas.

Tabla 1 - Casos acumulados de Influenza A(H1N1) confirmados por PCR, según lugar de confirmación y tipo de caso. Fuente: Departamento de Epidemiología.- Ministerio de Salud de Chile

[Tipo de caso - Casos acumulados hasta el 02 de julio]

Total casos confirmados por PCR en el Instituto de Salud Pública 1839
Total casos confirmados por PCR en establecimientos privados 6321
Total casos de IRA Grave confirmadas por PCR 318
Total defunciones confirmadas por PCR 16

3. Casos confirmados por laboratorio.

[Gráfico 1.- Distribución de casos confirmados de Influenza A(H1N1), según fecha de confirmación. Chile, 2009.]
Fuente: Departamento de Epidemiología.- Ministerio de Salud de Chile
(...)

[Tabla 3, gráfico 2.- Distribución de casos confirmados de Influenza A(H1N1) según edad. Chile, mayo a julio 2009.]

[Grupo Edad (años) - Población - Casos - Tasas específicas por cien mil hab.]

0-4 - 1 .246.153 - 1008 - 80,9
5-9 - 1 .255.622 - 1610 - 128,2
10-14 - 1 .360.847 - 1790 - 131,5
15-19 - 1 .483.285 - 892 - 60,1
20-24 - 1 .434.300 - 494 - 34,4
25-29 - 1 .290.814 - 454 - 35,2
30-34 - 1 .183.619 - 328 - 27,7
35-39 - 1 .236.753 - 372 - 30,1
40-44 - 1 .237.907 - 261 - 21,1
45-49 - 1 .217.407 - 249 - 20,5
50 y más - 3 .982.166 - 602 - 15,1

(...)

4. MEDIDAS ADOPTADAS

Para hacer frente al aumento de la demanda por enfermedades respiratorias provocadas por la concomitancia de brotes de Virus Sincicial Respiratorio (VRS) y Nueva Influenza Humana AH1N1, el Ministerio de Salud dispuso por segundo fin de semana consecutivo (sábado 4 y domingo 5 de julio) la apertura extraordinaria de consultorios y Servicios de Atención Primaria de Urgencia (SAPU). Sólo en la Región Metropolitana esta disposición se traducirá en 136 consultorios abiertos el sábado 4 de julio, y 56 consultorios y 86 SAPU el domingo 5 de julio. En el resto del país, se ha dispuesto la apertura de un consultorio por comuna en aquellas que no tienen SAPU. Esta medida regirá en Iquique, Viña del Mar, Valparaíso, Maule, Talcahuano, Concepción, Araucanía Sur, Valdivia, Osorno y Relonacaví.
En relación a un eventual cambio de guías clínicas de manejo de Nueva Influenza Humana, por un aumento de casos en menores de 5 años a causa de este virus, el Ministerio de Salud aclara que hasta la fecha no hay cambios en el manejo de dichos protocolos. Sin embargo, se encuentra estudiando un posible desplazamiento del Virus Respiratorio Sincicial (VRS) en este grupo etáreo. Actualmente se registra el peak de Virus Respiratorio Sincicial, por lo que esta Secretaría de Estado reunirá mayor evidencia epidemiológica y espera a fines de la próxima semana adoptar una decisión al respecto, que será oportunamente difundida. Cabe destacar que el Ministerio de Salud está permanentemente cambiando las guías clínicas de acuerdo a la evolución de la situación epidemiológica, proceso normal en el abordaje de una pandemia.
Se sumaron más establecimientos privados donde se entregará antivirales para los pacientes de Fonasa, Modalidad Libre Elección y para los pacientes que acuden a consultas privadas pequeñas.
Con el propósito de no incrementar la transmisión de Nueva Influenza Humana en la Región de Tarapacá, las autoridades de Salud y eclesiásticas concordaron la cancelación de la Festividad de La Tirana. Durante el año en el pueblo de La Tirana viven alrededor de 600 personas. Sin embargo, los días previos a la fiesta y el mismo 16 de julio, se congregan en esta localidad entre 150 a 200 mil peregrinos, lo que fue uno de los principales factores que tuvo en cuenta la autoridad sanitaria para adoptar la decisión de suspender la celebración. La duplicación de consultas por Nueva Influenza Humana en el Servicio de Salud de Iquique, unido al significativo aumento de la población flotante en la región durante la semana de festividades, también pesaron para determinar que la celebración de La Tirana fuese cancelada.
Otros refuerzos adoptados para enfrentar la contingencia sanitaria han sido:

Destinación de 3 mil 500 millones de pesos para ampliar la capacidad de atención en los centros de atención primaria.
Reforzamiento de los Servicios de Atención Primaria de Urgencia (SAPU) desde las 17 a las 23 horas.
Priorización de la atención de cuadros respiratorios desde las 08:00 hasta las 17:00 horas en consultorios.
Suspensión las cirugías electivas en todos los hospitales de la RM para disponer de camas intermedias e intensivas para adultos.
En la Atención Primaria de la RM, suspensión de las actividades electivas, controles de “niño sano” y de enfermos crónicos, por al menos dos semanas.
Adquisición de 75 equipos de ventilación (36 no invasivos, 31 convencionales y 8 de alta frecuencia).
Compra de 950 mil tratamientos de antivirales que son distribuidos gratuitamente a la población (OPS entregará 200 mil tratamientos adicionales).

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Canada. Surveillance - H1N1 Flu Virus (Human Swine Flu) - Public Health Agency of Canada (July 3, 2009, edited)

Pandemic (H1N1) 2009 Outbreak Epidemiological Update

The Public Health Agency of Canada (PHAC) is committed to sharing information about Pandemic H1N1 2009 virus cases with Canadians.

Confirmed cases are posted Monday, Wednesday and Friday at 16:00 EDT.

Laboratory-Confirmed Cases of H1N1 Flu Virus July 3, 2009, 15h00 EDT

Epidemiological Update

As of 3 July, 2009 15:00 EDT, a total of 8,883 laboratory-confirmed cases of Pandemic H1N1 2009 virus, including 663 hospitalizations and 29 deaths, have been reported in Canada from all provinces and territories.

[Table 1: Summary of laboratory-confirmed cases of Pandemic H1N1 2009 virus reported to the Public Health Agency of Canada, by province/territory, as of 3 July 2009, 15:00 EDT.]

[Province / Territory - New: Laboratory-confirmed cases(1) reported as of July 3, 2009 - Hospitalizations reported as of July 3, 2009 - Deaths reported as of July 3, 2009 / Total: Laboratory-confirmed cases (including today’s cases) - Hospitalizations(2,3) - Total deaths(2)]
British Columbia(4) 28 - 1 - 0 / 298 - 7 - 0
Alberta 191 - 11 - 0 / 1071 - 45 - 1
Saskatchewan(4) 35 - 1 - 0 / 774 - 10 - 2
Manitoba(4) 86 - 0 - 2 / 685 - 83 - 4
Ontario(4) 303 - 24 - 1 / 3464 - 162 - 10
Quebec(4,5) 186 - 67 - 1 / 2020 - 314 - 12
New Brunswick 1 - 0 - 0 / 10 - 0 - 0
Nova Scotia 33 - 4 - 0 / 171 - 5 - 0
Prince Edward Island 2 - 0 - 0 / 5 - 0 - 0
Newfoundland 3 - 1 - 0 / 35 - 1 - 0
Yukon 0 - 0 - 0 / 1 - 0 - 0
Northwest Territories 2 - 0 - 0 / 9 - 0 - 0
Nunavut 30 - 16 - 0 / 340 - 36 - 0
Total 900 - 125 - 4 / 8883 - 663 - 29
(1) Note: P/Ts may choose to announce cases that have been confirmed after 15:00 EDT. These cases will be reflected in the next epidemiological update.
(2) Number of deaths and hospitalizations are included in the number of cases.
(3) Hospitalizations are not reported until investigation forms are received which can cause a delay in the reporting.
(4) British Columbia, Saskatchewan, Manitoba, Ontario and Quebec are now reporting case counts on a weekly basis.
(5) Quebec searches systematically for influenza H1N1 among all ILI hospitalized patients which may explain high numbers.
(...)
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Surveillance - H1N1 Flu Virus (Human Swine Flu) - Public Health Agency of Canada

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Indonesia ::: Total confirmed novel H1N1 flu reaches 20 cases

Jakarta – Twelve new positive novel H1N1 cases in Indonesia have been confirmed. This has added the total number of laboratory confirmed to 20 patients.
According to the data of General Directorate of Disease Control and Environmental Health, Ministry of Health, Jakarta, the twelve new cases are AR (23), RA (10 months), HR(40), IG (33),N (34), [...]

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Access to swine flu vaccine a 'critical question': WHO - Yahoo! News

Access to swine flu vaccine a 'critical question': WHO

Fri Jul 3, 7:43 pm ET
CANCUN (AFP)

Universal access to a swine flu vaccine remains a "critical question," the World Health Organization (WHO) said Friday.

Speaking during a summit on the A(H1N1) virus, WHO assistant director-general Keiji Fukuda said guaranteeing the vaccine is distributed to underdeveloped nations will require "political goodwill."

Fukuda was speaking at the close of the summit, which began Thursday at the Mexican beach resort town of Cancun.

The American continent remains the world region worst affected by the swine flu, which first appeared in Mexico in late April.

The virus has infected 89,921 people in 125 countries and territories and caused 382 deaths worldwide, according to the WHO's latest figures.

"One of the important results (of the summit) was that we recognized that we face technical problems, but also problems of political will," Fukuda said.

Access to a future A(H1N1) vaccine was a central theme of the specially-convened WHO summit, which brought together experts and ministers from about 50 countries.

Cuauhtemoc Ruiz, coordinator for the Pan-American Health Organization, said the vaccine is likely to be available in "three or four months," but it could be up to a year before "sufficient quantities" are produced.

The laboratories working to produce the vaccine, he said, can make 2.5 billion doses in six months.

WHO director-general Margaret Chan said laboratories are looking at various possibilities, including creating a vaccine by adding a new component to the existing vaccine used for seasonal flu.If it works, the method could triple production.

But there are fears that most of the stock that will be produced has already been reserved by the United States and European countries.

Summit host Mexico appealed for "solidarity" in providing access to any future vaccine.

Mexican Health Minister Jose Angel Cordova said that money should not be "the only factor taken into consideration" in distributing the vaccine, so that poor nations are not penalized.

Mexican President Felipe Calderon also called for guarantees that developing countries would have access to the vaccine once it becomes commercially available.

Questions remain about whether countries in the Americas will be able to afford a sufficient amount of the vaccine to handle the epidemic and health authorities are worried that a new wave of cases could emerge in autumn when seasonal flu returns.

Meanwhile, new swine flu infections were reported Friday in Brazil and Peru.

Brazil's Health Ministry announced 19 new infections, raising the total number of cases in the country to 756.

One person in Brazil has died from the virus so far.

In Peru, the Health Ministry confirmed 90 new cases, raising the number of infections in the country to 811.

A second international conference on swine flu has been scheduled for August, and will be held in China.
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Access to swine flu vaccine a 'critical question': WHO - Yahoo! News

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7/03/2009

Espana. Detectado el virus H1N1 en una enfermera de un hospital de Cádiz

La Delegación Provincial de la Consejería de Salud de Cádiz ha informado hoy de que las pruebas analíticas practicadas a una enfermera del Hospital de Puerto Real (Cádiz) de 46 años han confirmado la existencia del virus de la gripe AH1N1 en su organismo, según un comunicado que detalla que esta persona se encuentra en buen estado de salud y sólo sufre una sintomatología leve.

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Uruguay's confirmed A/H1N1 flu deaths rise to four (Xinhua, edited)

Uruguay's confirmed A/H1N1 flu deaths rise to four

www.chinaview.cn 2009-07-04 02:35:19
MONTEVIDEO, July 3 (Xinhua)

A 56-year-old woman has died of A/H1N1 flu, raising Uruguay's total death toll in the new flu outbreak to four, hospital authorities said on Friday.

The patient had suffered from diabetes and severe obesity, and was a smoker. Both factors were believed to have helped worsen the situation, said Guido Manini, director of the Military Hospital in Uruguay's capital, Montevideo.

Two other patients, one 54-year-old in Montevideo and the other 60-year-old in Maldonado, 140 km from the capital, died of A/H1N1 flu on Thursday. Both had suffered health problems before contracting the flu, Uruguay's Public Health Ministry said earlier.

Uruguay's first confirmed death from the flu occurred on Monday, said the ministry, adding that the country now has a total of 132 confirmed infections. Uruguay's first confirmed flu cases were detected on May 27, in two young people who had traveled to Argentina.

Editor: Yan
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Uruguay's confirmed A/H1N1 flu deaths rise to four_English_Xinhua

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Singapore. 91 new confirmed cases of Influenza A (H1N1-2009) (Min. of Health, edited)

SINGAPORE - MINISTRY OF HEALTH

FOR IMMEDIATE RELEASE

91 new confirmed cases of Influenza A (H1N1-2009)

[Original Document: LINK. EDITED.]

Situational Report

ingapore has confirmed 91 new cases (879th – 969th case) of Influenza A (H1N1-2009) today, bringing the total tally to 969 confirmed cases. Investigations are on-going for the remaining 97 cases. Of the 89 cases investigated yesterday, there were 61 local cases and 28 imported cases.

Coping with Influenza A (H1N1- 2009)

2. H1N1 is now a global pandemic. It is widely circulating in all countries and communities. The virus is here to stay, just like other influenza strains. Fortunately, the current strain remains mild, except for high-risk individuals with underlying medical conditions where complications and even deaths may occur. Our focus is on caring for those with more severe illness.

3. Many countries no longer track the number of infected cases or report them. The listing of countries with reported confirmed cases is therefore becoming misleading.

4. Likewise, travel advisory is also becoming less useful as the risk of picking up the virus at home or in any other country has evened. That is why the WHO does not recommend any travel advisory.

5. Instead, the approach in managing this virus should be largely based on personal responsibility. All Singaporeans should observe good personal hygiene at all times. If they are unwell with flu-like symptoms (fever, cough, sore throat, runny nose), they should promptly seek medical attention. If the symptoms are mild, their usual GPs, or the nearest Pandemic Preparedness Clinic or polyclinics, would be able to assess them.

PPC and polyclinic doctors have been especially equipped to assess the patient's condition and treat him/her. Laboratory testing for Influenza A (H1N1-2009) is not available in PPCs and polyclinics and is not necessary before they commence treatment.

Based on the severity of the illness and other risk factors, they may refer patients to hospitals for further management.

6. MOH will continue, for the moment, to list the countries with reported confirmed cases and/or exported H1N1 cases to Singapore, on MOH’s website at www.moh.gov.sg. But we intend to cease such listing, as more countries stop reporting their cases.

Breakdown of Total Confirmed Cases

DETAILS OF NEWLY INVESTIGATED CASES

[Classification - New cases - Total]

(1) LOCAL 61 - 504

A) Community clusters

Riverlife Church 0 - 10
Butter Factory 0 - 44
Workplace 0 - 3
Republic Polytechnic 4 - 95
Fishermen of Christ Church 0 - 13
Maju Camp 0 - 23
NUS Orientation Camp 0 - 6
Pulau Tekong Camp 1 - 10
Clementi Camp 1 - 58
Police Coast Guard (Brani Base) 1 - 8
Social (Party) 0 - 4
Social (Tour Group) 10 - 16
Raffles Institution Boarding 0 - 4
Jurong Camp 1 - 7
NUH Cluster 4 - 5

B) Local transmission from imported case. 1 - 17
C) Unlinked 38 - 181

(2) IMPORTED 28 - 368

TOTAL 89 - 872

BREAKDOWN OF TOTAL IMPORTED CASES

[Countries - Number of cases]

Singapore 500
Australia 99
The Philippines 88
Indonesia 69
United States 43
Thailand 33
UK 14
Hong Kong 12
Japan 4
Canada 3
New Zealand 3
Malaysia 1
Chile 1
Korea 1
Cruise 1

Total 872

MINISTRY OF HEALTH 3 July 2009

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EuroFlu - Continued pandemic H1N1 influenza detections in the European Region, with two countries reporting influenza activity above baseline levels (June 3, 2009, edited)

EuroFlu - Weekly Electronic Bulletin Week 26 : 22/06/2009-28/06/2009 03 July 2009, Issue N° 312

Continued pandemic H1N1 influenza detections in the European Region, with two countries reporting influenza activity above baseline levels

This is the first bulletin published by EuroFlu, the WHO/Euro platform for the surveillance of influenza in the 53 countries of the European Region.The 2008-2009 influenza season is considered to be over and was described in the EISS Bulletin of week 22/2009. Pandemic H1N1 influenza detections were first reported in the European Region in week 18/2009 and as of week 24/2009, bulletins present developments regarding this strain.

Summary:

In week 26/2009, most countries reporting in the European Region indicated low levels of influenza activity. For the first time this summer, England and Luxembourg reported ILI consultation rates above their national baselines and this highlights the need to carefully monitor the spread of pandemic H1N1 influenza in Europe in the coming weeks.

Epidemiological situation - week 26/2009:

For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were medium in two countries (England and Luxembourg) and low in all other countries that reported this indicator. For the geographical spread indicator, England reported local activity and all other countries reported sporadic or no activity.

Cumulative epidemiological situation - weeks 16-26/2009:

Seasonal influenza activity was over in almost all countries in the European Region by week 16/2009, with the intensity returning to levels typically seen outside the winter season. Until this week, detections of pandemic H1N1 influenza have not caused increased levels of ILI or ARI in countries of the European Region. However, national baseline thresholds for ILI were reached in England) and Luxembourg in week 26/2009.

Virological situation - week 26/2009:

The total number of respiratory specimens collected by sentinel physicians in week 26/2009 was 574 of which 46 (8%) were positive for influenza virus: 38 type A (35 H1v and three A unsubtyped) and eight type B. In addition, 409 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals) were reported positive for influenza virus: 394 type A (246 subtype H1v, ten subtype H3 and 138 not subtyped) and 15 type B.

Cumulative virological situation - weeks 16/2009-26/2009:

Of 2037 virus detections (sentinel and non-sentinel) since week 16/2009, 1558 (76%) were type A (769 subtype H1v, 270 subtype H3, 113 subtype H1 and 406 not subtyped) and 479 (24%) were type B. The increasing trend for pandemic H1N1 influenza over these weeks is presented here.

Based on the antigenic and/or genetic characterisation of 2139 influenza viruses reported from week 40/2008 to week 26/2009, 1271 (59%) were A/Brisbane/10/2007 (H3N2)-like, 91 (4%) A/Brisbane/59/2007 (H1N1)-like, 18 (1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 759 (35%) as B/Malaysia/2506/2004-/B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here).

No reports for pandemic H1N1 (A/California/7/2009-like, the current virus strain recommended by WHO for vaccine preparation (click here)) have been made in week 26/2009.

However, in previous weeks when the characterisation data was more complete, there have been reports of the pandemic H1N1 strain.

Antiviral susceptibility reports since week 40/2008 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N3) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors.

All pandemic H1N1 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).

Comment:

This is the first EuroFlu bulletin published by WHO Euro and data for a relatively large number of countries in the Region are missing. As of 3 July 2009, there have been a total of 10652 laboratory confirmed cases of pandemic H1N1 influenza and four associated deaths in the European Region. For a detailed epidemiological description of pandemic H1N1 detections in the European Region (April–May 2009), please click here. On 11 June 2009 WHO raised the pandemic alert level to phase 6 (click here) and worldwide 77201 cases of pandemic H1N1 infection have now been reported (1 July 2009). For more information, please go to the dedicated web pages of WHO (click here) and ECDC (click here).

Influenza activity in most countries in Europe remains at baseline levels, indicating that the pandemic virus is not spreading widely in the community. Of the two countries reporting ILI-levels above their national baselines, England has the highest number of laboratory confirmed cases of pandemic H1N1 influenza in the European Region (6929 confirmed cases, 65% of all confirmed cases in the region) so an increasing ILI consultation rate could be expected (click here). Luxembourg only has 4 confirmed cases of influenza A(H1N1)v and no virological detections since week 21/2009 (click here) so the increased ILI consultation rate (now reaching 2% of consultations) may be due to other respiratory pathogens which are currently not being tested for and a heightened awareness due to pandemic H1N1 influenza. It will be important to closely monitor these trends over the coming weeks to see if the increases are temporary or whether it represents the start of increased influenza activity in countries across the European Region.

Background:

The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries in the WHO European Region. Of these countries, 14 reported both clinical and virological data, six reported virological data only and five reported clinical data only in week 26/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK) and the European Centre for Disease Prevention and Control in Stockholm (Sweden).
(...)
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EuroFlu - Bulletin Review

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WHO sees swine flu tailing off in summer - Yahoo! News

WHO sees swine flu tailing off in summer

GENEVA (AFP)

The World Health Organisation still expects the swine flu pandemic to subside in the northern hemisphere over the summer, despite its persistence in the likes of the United States and Britain.

Sylvie Briand, interim head of the WHO's influenza programme, said that cases of flu should still be expected but transmission would slow down thanks to the combined impact of the heat and school holidays.

"First of all there's a climactic aspect, knowing that flu viruses survive better in the cold than in the heat," Briand told AFP.

"The other important element is the density of contact between people. Children are on holiday and we don't have the outbreaks in schools like we had in the United States at the beginning of the epidemic," she added.

Even if the influenza A(H1N1) virus is new, "I think we will nonetheless have the same seasonal nature and transmission will decline in the northern hemisphere this summer, with a weak proportion of severe cases," Briand said.

England's Health Secretary Andy Burnham said Tuesday that 100,000 cases a day could occur across England, Northern Ireland, Scotland and Wales by the end of August if the current infection rate is maintained, stressing it was a projection.

In Washington, the White House said it would hold a high-level meeting next week bringing together top government officials to prepare for the possibility of a more severe outbreak of A(H1N1) influenza.

The meeting was called after the US Centers for Disease Control and Prevention (CDC) estimated that at least one million people in the United States have had swine flu, basing the projection partly on computer models.

British authorities have indicated that officially reported infections may fall well short of the true number of cases.

At the WHO Briand suggested this was largely expected.

"Of course, because there are already a lot of cases where people have few symptoms where they just have a light cough and don't go to the doctor," she said.

"There are even asymptomatic cases of people who are carrying the virus and do not even know it."

Briand said the WHO was thinking of ending its global reporting of laboratory-confirmed cases of swine flu in each country, because it had become "almost unmanageable" to confirm all the cases.

"This data does account for a certain reality and especially the number of countries infected, which shows that most of the earth is now infected," said Briand.

However, "after a certain moment, counting is of little interest and represents just a considerable loss of time for countries," she explained.

The latest data released by the WHO Friday showed that 125 countries and territories have been infected since the new A(H1N1) influenza virus was uncovered in Mexico and the United States last April

Some 89,921 cases were confirmed by laboratory tests, including 382 deaths.
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WHO sees swine flu tailing off in summer - Yahoo! News

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Argentina, con 100.000 casos confirmados, se convierte en el país más afectado por la gripe A · ELPAÍS.com

Argentina, con 100.000 casos confirmados, se convierte en el país más afectado por la gripe A

Hace casi una semana la cifra era de 1.587 infectados. Los ciudadanos creen que el Gobierno, centrado en las elecciones legislativas del pasado domingo y en sus resultados, ha ocultado información

SOLEDAD GALLEGO-DÍAZ - Buenos Aires - 03/07/2009

"Si tose y tiene fiebre, pida un barbijo (mascarilla)", dice un cartel bien grande a la entrada del hospital. Un par de enfermeros distribuye las mascarillas e intenta que los posibles pacientes de gripe no se mezclen con otros.

Es bastante inútil, porque la inmensa mayoría tose como un perro y lo más probable es que tenga gripe y, muy posiblemente, la nueva gripe. En menos de una semana, lo que va desde el día antes de las elecciones, el pasado domingo, y hoy viernes, los casos oficiales de gripe A han pasado de 1.587 a 100.000, lo que coloca a Argentina como el país del mundo con más infectados. La epidemia está completamente descontrolada en Argentina y en Buenos Aires especialmente, y los ciudadanos empiezan a creer que las autoridades han actuado irresponsablemente. "Parece mentira. Fueron muchísimo más serios los mexicanos que nosotros. Esto es un desastre", se queja María Elena, enfermera del centro sanitario.

"Le decimos a la gente que compre alcohol en gel y se lave continuamente las manos y que use barbijo si tiene que coger transportes colectivos, y resulta que no hay alcohol en prácticamente ninguna farmacia y que los barbijos se han agotado". Nadie parece haberse ocupado de organizar un aumento de la producción ni nada por el estilo. "Yo llevo recorridas ocho y ya desisto", confirma Rubén Mateo, a la puerta de una farmacia que ha colgado un cartel anunciando que el alcohol no llegará, probablemente, hasta la semana que viene. Lo que sí hay son existencias suficientes de Tamiflu en todos los hospitales, que se están entregando a los contagiados.

Los argentinos empiezan a darse cuenta ahora del alcance de la epidemia de gripe A. Oficialmente se reconocen 44 muertos, pero la mayoría de los medios de comunicación habla ya de 55 (hace una semana eran 28). Como parece imposible que los casos hayan pasado de mil y pico a cien mil en seis días, la mayoría empieza a pensar que las autoridades han estado ocultado la información. "Ha sido una desgracia: el estallido de la epidemia ha coincidido con la campaña electoral de las legislativas y todo el mundo ha estado más preocupado de los resultados electorales que por lo que estaba pasando en los hospitales". La ministra de Salud, Gabriela Ocaña, intentó incluso que se aplazaran las elecciones pero, por lo que se ve, la miraron como si estuviera loca. Ocaña dimitió al día siguiente de los comicios. Y el nuevo ministro tardó cuatro horas en reconocer cien mil contagiados.

Deprisa y corriendo se lanzan ahora medidas de contención, una tras otra. Hoy, decenas de empleados de la municipalidad pegaban carteles por toda la capital pidiendo a la gente que se lave las manos, se tape la boca si tose, se quede en casa y llame al médico si se encuentra mal,. La decisión más importante ha sido la de cerrar todos los colegios durante un mes. ¿Y qué harán los padres que tienen que ir a trabajar? Los argentinos funcionan con una cosa que se llama "flexibilidad". Lo explicó muy bien el subsecretario de Relaciones Laborales, Álvaro Ruiz: "Si tienen hijos menores de 14 años y nadie que pueda ocuparse de ellos, se pide a las empresas que tengan flexibilidad". "Si hay alguien enfermo en la familia y hay que cuidarle, se pide a las empresas flexibilidad". Lo único claro es que las mujeres embarazadas, los enfermos oncológicos y diabéticos, y quienes padecen enfermedades respiratorias crónicas podrán pedir quince días de vacaciones pagadas. Por lo demás, no está claro en qué consiste la flexibilidad para las empresas privadas, ni cómo se van a recuperar tantos días lectivos perdidos.

¿Hay que cerrar cines, teatros, centros comerciales, gimnasios? Pues no se sabe. Unos ayuntamientos, como el de Quilmes o los de algunas capitales de provincia, han decidido echar el cierre total. Otros, como el de la capital federal, simplemente "aconseja" que no se acuda a lugares con alta concentración de personas. El Gobierno de la nación, que intenta sacudirse la parálisis anterior, ha encontrado una fórmula estupenda: recomienda la "autoreclusión". Es decir, que la gente se quede en casa todo lo que pueda.

Una vez más, la sociedad argentina se enfrenta a un problema serio por sus propios medios y los ciudadanos adoptan las decisiones que mejor les parecen para salir del atolladero, sin instrucciones claras por parte de las autoridades. Unos conductores de autobús o del metro llevan barbijo, otros no. Algunas dependientas de los supermercados intentaron colocarse una mascarilla o guantes para manejar el dinero (gran vector de contagio). La inmensa mayoría, no. "Yo no creo que tengan que ponerse mascarilla", explica Juan Ruiz, encargado de un súper en el elegante barrio de Recoleta. "Si se lo ponen, los clientes creen que están enfermas y se asustan". Las clientas hacen sus compras a cuerpo gentil sin taparse la boca y manejan también el dinero sin la menor precaución. "Actuemos con responsabilidad", pide el gobernador de la provincia de Buenos Aires, Daniel Scioli. Lo curioso es que lo dice en un acto de inauguración de unas obras públicas en las que se han juntado dos centenares de personas, bien apiñadas, para aplaudirle.

Parece que el miedo ha empezado a correr tanto como la enfermedad y, por primera vez, empiezan a verse bares y restaurante semivacíos. Los dueños aseguran que han alejado las mesas para que los clientes estén más separados entre sí, de acuerdo con las instrucciones que ha repartido el gremio, pero la verdad es que no se nota mucho. Los irreductibles, los porteños que no saben vivir sin el café ni la charla en el bar de la esquina, intentan resistir sentados en las terrazas al aire libre. En Buenos Aires no llueve desde hace días y el invierno está siendo muy suave.

"Este fin de semana ayudará a tranquilizar algo las cosas", confía el nuevo ministro de Salud, Juan Manzur, aunque reconoce que la epidemia está en plena expansión, sin controlar, y la situación es "muy delicada", sobre todo porque los hospitales están desbordados. "No descartamos tomar otras medidas más drásticas. Veremos". De momento, el domingo hay fútbol, la final del torneo de clausura (media liga) entre el Vélez y el Huracán, y el estadio estará a tope. Eso sí, la mayoría de los equipos han suspendido las concentraciones previas y los jugadores esperarán en sus casas. Y los responsables del club anfitrión dicen que si hace falta distribuirán alcohol y barbijos. Pero, ¿alguien se imagina a los integrantes de la barra brava del Huracán con mascarilla?
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Argentina, con 100.000 casos confirmados, se convierte en el país más afectado por la gripe A · ELPAÍS.com

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Bangkok Post : Flu death toll in Thailand rises to 6

Flu death toll in Thailand rises to 6

By: BangkokPost.com
Published: 3/07/2009 at 07:12 PM

The Public Health Ministry on Friday afternoon revealed that a Thai man, aged 30, of Bangkok has died of H1N1 flu, adding up the death toll in Thailand to 6.

Earlier today, the ministry said another 154 Thai people were additionally listed as having had the H1N1 flu, bringing up the total to 1,710.

As of Friday morning, the death toll was 5.

The World Health Organisation today disclosed that the global death toll stood at 337 while the number of people having contracted the flu in 121 countries was over 80,000.
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Bangkok Post : Flu death toll in Thailand rises to 6

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Tamiflu-Resistant Swine Flu Virus Found in Hong Kong - Bloomberg

Tamiflu-Resistant Swine Flu Virus Found in Hong Kong
Bloomberg
This marks the first known case of Tamiflu resistance in a swine flu patient not treated with the drug, which has been stockpiled by governments worldwide to fight pandemic influenza. The specimen was collected from a 16-year-old girl who flew from San ...

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UK. Fourth person in Britain dies after contracting swine flu - Telegraph

Fourth person in Britain dies after contracting swine flu

A teenager in London has become the fourth person in Britain to die after contracting swine flu, it has emerged.

by Rebecca Smith, Medical Editor
Published: 3:00PM BST 03 Jul 2009

The 19-year-old man from south London, had 'serious' underlying health problems and it was confirmed after he had died that he had contracted swine flu.

The latest death comes after ministers warned there will be 100,000 new cases of swine flu per day by the end of next month.

Despite the warnings, new research has shown that the public is ignoring advice on how to limit the spread of the virus by washing hands more frequently or disinfecting surfaces more regularly.

Dr Simon Tanner, director of public health for London, said: "There are people out there in the community, and we've talked about one today – precious individuals that have got really difficult medical conditions – who are particularly vulnerable when the population has a virus like this in it."

"We've all got a responsibility for their sake," he said.

Jacqui Fleming, 38, of Glasgow, was the first person in the UK to die after contracting the virus last month.

The second victim was a 73-year-old man from the Inverclyde area of Scotland. Then a week ago, six-year-old Sameerah Ahmad became the youngest UK victim to date.

All the people who have died after contracting swine flu already suffered from underlying health problems.

Sir Liam Donaldson, who confirmed yesterday that the UK has moved past the stage of containing the swine flu outbreak and into the "treatment phase", said there was no need for people to resort to the internet to self-medicate.

Sir Liam said: "There's generally a growth in people ordering drugs from the internet worldwide and there's a lot of concern among health authorities that people might buy counterfeit drugs.

"I think this is a similar situation – people shouldn't buy Tamiflu from the internet.

"We have got a massive stockpile in this country and everybody can have access to it through the National Health Service."

Meanwhile research carried out by the Institute of Psychiatry at King's College London and the Health Protection Agency has found that three quarters of people are not concerned about the outbreak of H1N1 and two thirds have not followed any of the measures advised to limit its spread.

A telephone survey of 997 adults between 8 and 12 May asked nine questions including if they had followed advice to wash hands more frequently, increase cleaning of surfaces and discuss with friends and relatives what to do if they fell ill.

Two thirds had not done any of these things.

Being uncertain about the severity of the outbreak and believing that it had been exaggerated were associated with a lower likelihood of change, lead author James Rubin, senior research fellow at the Institute of Psychiatry wrote in the British Medical Journal online.
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Fourth person in Britain dies after contracting swine flu - Telegraph

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Influenza A(H1N1)v infection - Update 3 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 3 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]

Main developments in past 24 hours

More than 10,000 cases reported from the EU and EFTA countries, with 641 new cases reported in the past 24 hours;
8586 new cases are reported from non-EU and EFTA countries;
Two countries report cases for the first time: Uganda and Aruba;
A total of 45 new fatal cases are reported;
Japan and Hong Kong announce one case of resistance to oseltamivir each.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 3 July, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer:
the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.

Epidemiological update

A total of 30 out of the 31 EU and EFTA countries are now reporting cases. In the past 24 hours, 641 new cases were confirmed in 17 EU and EFTA countries (Table1). The cumulative number of cases in the EU and EFTA countries is now 10,094, including 4 deaths.

Outside of the EU and EFTA countries, a total of 8568 new cases, including 45 new fatal ones, have been reported. The latest reported deaths due to influenza A(H1N1)v came from the USA, which reported 43 deaths in the last week, Australia (1) and Brunei (1).

A total of 80,758 cases are reported outside of the EU and EFTA countries, including 380 deaths (Table 2). Uganda and Aruba reported their first cases.

Following the change in response strategy in the UK from “containment” to “treatment”, following the announcement of an estimated 100,000 new cases per week at the expected peak of the outbreak towards the end of August, guidance on the practical implementation of the new strategy is provided, using the following link: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_102019.

In addition to the isolated case of oseltamivir resistance reported earlier this week by Denmark, Japan and Hong Kong announced two more cases. The patient from Japan had received oseltamivir as a preventive measure, being a close contact from a confirmed case. In Hong Kong, the person was identified being infected after entry screening procedures at the airport. Further laboratory testing identified the resistant strain. This case refused any treatment with oseltamivir after the diagnosis of influenza A(H1N1)v.

European influenza surveillance network – update week 26

The weekly bulletin of the European influenza surveillance network is published on the ECDC website: http://ecdc.europa.eu/en/Activities/Surveillance/EISN/Newsletter/SUN_EISN_INFL_Bulletin_2009week26.pdf

The update of week 26 states that the influenza activity in the EU remains at, or below, baseline levels, apart from the UK, which reports medium activity. A total of 204 influenza A(H1N1)v infections were detected during the reporting period (22-28 June). Influenza A(H1N1)v was the dominant type reported in Denmark, Greece, Hungary, Ireland, and the UK (England).

Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 03 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

[Country - Confirmed cases reported in the last 24h* - Cumulative number of confirmed cases - Deaths among confirmed cases**]

Austria 1 - 16 - ...
Belgium ... - 49 - ...
Bulgaria ... - 10 - ...
Cyprus 25 - 83 - ...
Czech Republic ... - 15 - ...
Denmark 6 - 63 - ...
Estonia ... - 13 - ...
Finland ... - 43 - ...
France 7 - 318 - ...
Germany 35 - 505 - ...
Greece ... - 109 - ...
Hungary 1 - 12 - ...
Iceland ... - 4 - ...
Ireland 2 - 51 - ...
Italy ... - 130 - ...
Latvia ... - 1 - ...
Lithuania ... - 3 - ...
Luxemburg 2 - 6 - ...
Malta ... - 2 - ...
Netherlands 1 - 135 - ...
Norway ... - 41 - ...
Poland 1 - 20 - ...
Portugal 5 - 28 - ...
Romania 5 - 41 - ...
Slovakia ... - 18 - ...
Slovenia 3 - 7 - ...
Spain 20 - 776 - 1
Sweden 2 - 76 - ...
Switzerland 7 - 72 - ...
United Kingdom 518 - 7447 - 3

Total 641 - 10094 - 4

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
(*) Cases reported between 2 July 17:00 hours and 3 July 17:00 hours
(**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 03 July 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h* - Cumulative number of confirmed cases - Deaths among confirmed cases**]

OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

Bosnia and Herzegovina ... - 1 - ...
Channel Islands 3 - 16 - ...
Island of Man ... - 1 - ...
Monaco ... - 1 - ...
Montenegro ... - 9 - ...
Russian Federation ... - 3 - ...
Serbia 2 - 15 - ...
Ukraine ... - 1 - ...

MEDITERRANEAN AND MIDDLE-EAST

Algeria ... - 5 - ...
Bahrain ... - 15 - ...
Egypt ... - 67 - ...
Iran ... - 1 - ...
Iraq ... - 11 - ...
Israel 35 - 577 - ...
Jordan ... - 22 - ...
Kuwait 1 - 35 - ...
Lebanon ... - 47 - ...
Morocco ... - 17 - ...
Occupied Palestinian Territory ... - 30 - ...
Oman ... - 3 - ...
Qatar ... - 10 - ...
Saudi Arabia 8 - 89 - ...
Tunisia ... - 3 - ...
Turkey 3 - 40 - ...
United Arab Emirates ... - 8 - ...
Yemen ... - 7 - ...

AFRICA

Cape Verde ... - 3 - ...
Ethiopia 1 - 3 - ...
Ivory Coast ... - 2 - ...
Kenya 11 - 12 - ...
Mauritius ... - 1 - ...
South Africa 1 - 12 - ...
Uganda 1 - 1 - ...

NORTH AMERICA

Canada ... - 7983 - 25
Mexico 1234 - 10262 - 119
***USA 6177 - 33902 - 170

CENTRAL AMERICA AND CARIBBEAN

Antigua and Barbuda ... - 2 - ...
Aruba 5 - 5 - ...
Bahamas ... - 6 - ...
Barbados 2 - 12 - ...
Bermuda ... - 2 - ...
British Virgin Islands 1 - 2 - ...
Cayman Islands 1 - 14 - ...
Costa Rica ... - 227 - 2
Cuba 27 - 73 - ...
Dominica ... - 1 - ...
Dominican Republic ... - 108 - 2
El Salvador 50 - 276 - ...
Guatemala ... - 262 - 2
Honduras ... - 123 - 1
Jamaica ... - 32 - ...
Martinique ... - 2 - ...
Netherlands Antilles 1 - 15 - ...
Nicaragua ... - 310 - ...
Panama ... - 417 - ...
Suriname ... - 11 - ...
Trinidad-Tobago ... - 53 - ...
Saint Lucia ... - 1 - ...

SOUTH AMERICA

Argentina ... - 1587 - 26
Bolivia 78 - 283 - ...
Brazil 57 - 737 - 1
Chile ... - 7376 - 14
Colombia 8 - 101 - 2
Ecuador ... - 163 - ...
Paraguay 3 - 103 - ...
Peru ... - 549 - ...
Uruguay ... - 196 - 1
Venezuela 10 - 204 - ...

NORTH-EAST AND SOUTH ASIA

Bangladesh 5 - 12 - ...
China (mainland) 49 - 916 - ...
Hong Kong SAR China 29 - 857 - ...
India ... - 104 - ...
Japan 148 - 1502 - ...
Macao SAR China 13 - 47 - ...
Nepal 2 - 5 - ...
South Korea ... - 210 - ...
Sri Lanka 2 - 17 - ...
Taiwan ... - 72 - ...

SOUTH-EAST ASIA

Brunei Darussalam 27 - 93 - 1
Cambodia 1 - 7 - ...
Indonesia ... - 8 - ...
Laos Peoples Democratic Republic ... - 3 - ...
Malaysia ... - 411 - ...
Myanmar ... - 1 - ...
Philippines ... - 1709 - 1
Singapore 95 - 878 - ...
Thailand ... - 1414 - 3
Vietnam ... - 131 - ...

AUSTRALIA AND PACIFIC

Australia 390 - 4958 - 10
Fiji ... - 10 - ...
French New Caledonia ... - 6 - ...
French Polynesia ... - 2 - ...
New Zealand 87 - 912 - ...
Papua New Guinea ... - 1 - ...
Republic of Palau ... - 1 - ...
Samoa ... - 1 - ...
Vanuatu ... - 2 - ...

TOTAL 8568 - 80758 - 380

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
(*) Cases reported between 2 July 17:00 hours and 3 July 17:00 hours
(**) Deaths are included in the cumulative number of confirmed cases
(***) Cases in the US include both probable and confirmed cases.

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India. Suspect case of influenza a H1N1 in Kerala tests negative 15:38 IST (PIB Press Release, edited)

Suspect case of influenza a H1N1 in Kerala tests negative 15:38 IST

A 51 year old male, a known case of diabetes for 30 years, hypertension, coronary artery disease and dyslipedemia, travelled from U.K. on 14th March, 2009 transiting Dubai and Mumbai and reached Trivandrum on 12th June by King Fisher Flight.

As per the database of Airport Health Organization (specifically maintained for Influenza A H1N1) he had reached Mumbai at about 4.00 A.M. on 12th June by Air India flight IC 684 from Dubai and he did not have any symptoms at the time of entry screening on 12th June, 2009.

He developed symptoms of fever, cough on 23rd June, 2009 and took medication for viral fever at his native place. His condition deteriorated and he reported to a private hospital at Kottayam, Kollam district in Kerala on 1st July, 2009. His condition deteriorated and expired within two hours of reaching the hospital on 1.7.2009. There has been speculation in certain sections of the media that his death was due to Influenza A [H1N1]. This is not correct.

His throat and nasal swab have tested negative for Influenza A H1N1(swine) at National Institute of Communicable Diseases, Delhi.

*****
DS/GK
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PIB Press Release

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India. Update on Influenza a [H1N1] as on 3rd July, 2009 19:40 IST (PIB Press Release, edited)

Update on Influenza a [H1N1] as on 3rd July, 2009 19:40 IST

World Health Organization has reported 77,201 laboratory confirmed cases of influenza A/H1N1 infection from 120 countries as on 1st July 2009. There have been 332 deaths. No further update is available.

Health screening of passengers coming from affected countries is continuing in 22 International airports.

51,212 passengers have been screened on 2.7.2009 of which 36,131 passengers were from affected countries.

224 doctors and 112 paramedics are manning 77 counters at these airports.

A cumulative total of 2,781,648 passengers have been screened.

Twelve new cases are reported today: Bangalore (6), Calicut (2), Delhi (2) Hyderabad (1) and Amritsar (1).

The two cases in Delhi are
(i) a 17 year old male who travelled from Brisbane, Australia to Delhi transiting Bangkok and reaching Delhi on 1.7.09 by Thai Airways (TG 315). He was detected at the airport and isolated at airport health facility
(ii) a six and half old girl travelled from Newark, USA and reached Delhi on 29.6.09 by continental airlines (CO 82). She reported to the health facility on 2nd July with symptoms of headache and fever.

The two cases from Calicut, Kerala, are 8 year old male and 12 year old female, have traveled from Abu Dhabi to Calicut by Air India Express flight (IX 348) and reached Calicut on 27.6.2009. The mother of these children had earlier tested positive.

The lone case from Hyderabad is 30 year old male who traveled from Los Angles to Hyderabad transiting London and reaching Hyderabad on 1.7.09. He was detected at the airport screening and admitted in the identified health facility.

The case from Amritsar is 11 year old male who travelled from Toronto and landed Amritsar on 1.7.09 by Air India flight AI 188. He was detected at the airport screening and admitted to the identified health facility.

The six cases from Bangalore are
(i) a 27 year old male who travelled from Seoul, South Korea transiting Hong Kong by Korean Airlines [KA 152] reaching Hyderabad on 28.6.2009. He complained of fever and cough and admitted to the identified health facility
(ii) a 26 year old male travelled from Japan transiting Bangkok reaching Bangalore by AI 352 on 28.6.2009. He reported to the health facility with complaints of weakness, cough and headache on and reported to health facility on 2.7.2009;
(iii) to (iv) a 42 year old male and 9 year old female are from the family group who travelled by Air India 144 Newark New Jersey to Bangalore on 25.6.2009. They developed symptoms of fever, sore throat and cough on 1.7.2009 and admitted to the identified facility. Two other members of this family who had travelled together had tested positive earlier. The remaining two, 23 yr old male and 17 year old female are close family contacts of the family mentioned above and they have no travel history.

The indigenous positive case [66 year old female] at Delhi, covered in earlier reports, is stable.

There has been speculation in certain sections of the media that death of a patient from Kerala was due to Influenza A [H1N1]. This is not correct. His throat and nasal swab have tested negative for Influenza A H1N1(swine) at National Institute of Communicable Diseases, Delhi. A press release to this effect has been issued earlier today.

837 persons have been tested so far of which 128 are positive for Influenza A H1N1 [Swine].

245 out of the 837 persons have been identified through entry screening, twenty seven through contact tracing and the rest were self reported.

Of the 128 positive cases, 82 have been discharged. Rest of them remain admitted to the identified health facility.

The situation is being monitored.

MN/
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PIB Press Release

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Human infection with new influenza A (H1N1) virus: WHO Consultation on suspension of classes and restriction of mass gatherings to mitigate the impact of epidemics caused by influenza A (H1N1), May 2009 (WHO, WER, Jule 3, 2009, edited)

Weekly epidemiological record - 3 JULY 2009, 84th YEAR No. 27, 2009, 84, 269–280 - http://www.who.int/wer
[Original Document: LINK. EDITED.]

Human infection with new influenza A (H1N1) virus: WHO Consultation on suspension of classes and restriction of mass gatherings to mitigate the impact of epidemics caused by influenza A (H1N1), May 2009

On 27 May 2009, WHO convened via teleconference a technical consultation of public health officials from 6 countries,(1) as well as experts(2) in law and ethics, disease prevention and control, and management of mass gatherings and emergency situations.

The purpose of the teleconference was to share experiences and early lessons learnt from recent outbreaks of new influenza A (H1N1) virus infection in communities or closed settings. As of 27 May 2009, >13 000 laboratory-confirmed cases of human infection with new influenza A (H1N1) virus had been officially reported to WHO.(3)

School settings

Countries in which laboratory-confirmed, albeit mild, cases of influenza A (H1N1) virus infection had occurred provided specific examples of outbreaks among schoolchildren or in academic settings, as well as the detailed measures taken to mitigate the spread of infection within schools and among communities. In most cases, decisions to suspend attendance at school had been taken by local rather than national authorities. The exception was Mexico, in which nationwide school closures had been mandated for 2 weeks in May 2009.

All countries agreed that school suspensions had been effective in mitigating the spread of influenza A (H1N1) virus infection; however, such measures were often prohibitively expensive.(4) School closures during the early phases of an outbreak had reduced transmission within schools, but had not always been effective (or their measurable effect) in reducing levels of community transmission.

The legal aspects of school closures and non-discrimination should be closely monitored. Epidemiological considerations should take precedence over racial or ethnic stereotypes, while at the same time recognizing that special provisions may be necessary for schools in countries or areas containing poor populations. While school closures may reduce transmission within school settings, such measures may not affect transmission in community settings. Care therefore needs to be taken when evaluating how school closures will impact transmission.

Mass gatherings

Countries reporting to WHO, with the exception of Mexico, had not instituted restrictions on mass gatherings and were maintaining vigilance for any upcoming events in their respective countries. In Mexico, public participation in mass gatherings during national football matches had been banned in May 2009.

Community-level social distancing measures and use of masks

The Government of Mexico has encouraged its citizens to use masks, particularly when in contact with cases of influenza A (H1N1) virus infection. In Japan, efforts to enact social distancing have included encouraging commuters, in particular, to wear masks. Additional guidelines established in Mexico for mitigating the spread of illness include recommendations on hygiene and implementation of hygiene measures, particularly in schools, as well as guidelines for social distancing in restaurants, stadiums and enclosed areas.

Recommendations

The WHO technical consultation made the following recommendations:

When considering school suspensions and/or restrictions on mass gatherings, authorities should ask “what is the legal authority and what are the legal processes” for such suspensions and/or restrictions? Decisions should be consistent and well-documented, and be taken within the parameters of each country’s individual sovereignty and existing laws. Care should be taken to avoid discrimination based on nationality, ethnic origin, religion, gender and disability, etc. Furthermore, any decision that results in social isolation, restrictions on the right to travel and assemble, or impacts that commerce, trade and economic stability should be avoided.
When considering mitigating the spread of influenza A (H1N1) virus infection in school settings, full school closures may not be warranted but class suspensions may be.
Strategies regarding personal hygiene should be evaluated relative to the type of school (nursery/day care, elementary, junior, or senior high school) and their effectiveness in reducing transmission.
Good communication is vital as situations surrounding this pandemic are fluid and change daily. Public health officials should convey strong, consistent, easily-understood and actionable messages to the general public and health-care providers. Messaging should encourage people to be aware of the potential for illness, to engage in conscientious public hygiene measures (for example, hand hygiene and cough etiquette) and to seek medical attention as needed. At the same time, public health announcements should reconcile the potential for indifference and the under-allocation of resources versus that of panic and over-allocation of resources.

(1) Canada, Japan, Mexico, Spain, the United Kingdom and the United States.
(2) Representatives from the Johns Hopkins Bloomberg School of Public Health; the European Centre for Disease Control and Prevention; the Department of Health of Hong Kong SAR; and an independent consultant.
(3) Latest figures of laboratory-confirmed cases of new influenza A (H1N1) as officially reported to WHO by States Parties to the International Health Regulations (2005) are available at http://www.who.int/csr/don/en/ .
(4) For additional information on cost analysis of school suspensions and/or closures, see: Cauchemez S, et al [unpublished article]. Closing schools during an influenza pandemic: a review; Cauchemez S et al. Estimating the impact of school closure on influenza transmission from Sentinel data. Nature, 2008, 452(7188):750–U6; Cowling BJ et al. Effects of school closures, 2008 winter influenza season, Hong Kong. Emerging Infectious Diseases, 2008, 14(10):1660–1662; Heymann A et al. Influence of school closure on the incidence of viral respiratory diseases among children and on health care utilization. Pediatric Infectious Disease Journal, 2004, 23:675–677; Sadique MZ, Adams EJ, Edmunds WJ. Estimating the costs of school closure for mitigating an influenza pandemic. Public Health, 2008, 8:135; Vynnycky E, Edmunds WJ. Analyses of the 1957 (Asian) influenza pandemic in the United Kingdom and the impact of school closures. Epidemiology and Infection, 2008, 136(2):166–179.

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WHO | Pandemic (H1N1) 2009 - update 57

Pandemic (H1N1) 2009 - update 57

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the International Health Regulations (2005) - 3 July 2009 09:00 GMT

The breakdown of the number of laboratory-confirmed cases is given in the following table and map.
Map of the spread of pandemic (H1N1) 2009: number of laboratory confirmed cases and deaths [png 190kb]

[Country, territory and area - Cumulative total / Newly confirmed since the last reporting period (Cases - Deaths)]
Algeria 5 - 0 / 3 - 0
Antigua and Barbuda 2 - 0 / 0 - 0
Argentina 1587 - 26 / 0 - 0 [CFR 16.38]
Australia 4568 - 9 / 478 - 2 [CFR 1.97 x 1,000]
Austria 15 - 0 / 0 - 0
Bahamas 6 - 0 / 0 - 0
Bahrain 15 - 0 / 0 - 0
Bangladesh 12 - 0 / 11 - 0
Barbados 12 - 0 / 2 - 0
Belgium 49 - 0 / 2 - 0
Bermuda, UKOT 1 - 0 / 0 - 0
Bolivia 283 - 0 / 78 - 0
Bosnia and Hezegovina 1 - 0 / 1 - 0
Brazil 737 - 1 / 57 - 0 [CFR 1.35]
British Virgin Islands, UKOT 2 - 0 / 1 - 0
Brunei Darussalam 85 - 0 / 56 - 0
Bulgaria 10 - 0 / 0 - 0
Cambodia 7 - 0 / 1 - 0
Canada 7983 - 25 / 0 - 0 [CFR 3.13]
Cap Verde 3 - 0 / 0 - 0
Cayman Islands, UKOT 14 - 0 / 1 - 0
Chile 7376 - 14 / 1165 - 2 [CFR 1.89]
China 1814 - 0 / 296 - 0
Colombia 101 - 2 / 8 - 0 [CFR 19.8]
Costa Rica* 227 - 2 / -52 - 0 [CFR 8.81]
Cote d'Ivoire 2 - 0 / 0 - 0
Cuba 73 - 0 / 27 - 0
Cyprus 70 - 0 / 22 - 0
Czech Republic 15 - 0 / 6 - 0
Denmark 63 - 0 / 8 - 0
Dominica 1 - 0 / 0 - 0
Dominican Republic 108 - 2 / 0 - 0 [CFR 18.5]
Ecuador 163 - 0 / 0 - 0
Egypt 67 - 0 / 0 - 0
El Salvador 253 - 0 / 27 - 0
Estonia 13 - 0 / 0 - 0
Ethiopia 3 - 0 / 1 - 0
Fiji 2 - 0 / 0 - 0
Finland 43 - 0 / 17 - 0
France 300 - 0 / 23 - 0
French Polynesia, FOC 2 - 0 / 0 - 0
Martinique, FOC 2 - 0 / 0 - 0
France, New Caledonia, FOC 6 - 0 / 0 - 0
Germany 470 - 0 / 53 - 0
Greece 109 - 0 / 17 - 0
Guatemala 254 - 2 / 0 - 0 [CFR 7.87]
Honduras 123 - 1 / 5 - 0 [CFR 8.13]
Hungary 11 - 0 / 1 - 0
Iceland 4 - 0 / 0 - 0
India 104 - 0 / 0 - 0
Indonesia 8 - 0 / 0 - 0
Iran 1 - 0 / 0 - 0
Iraq 11 - 0 / 0 - 0
Ireland 51 - 0 / 10 - 0
Israel 577 - 0 / 71 - 0
Italy 130 - 0 / 7 - 0
Jamaica 32 - 0 / 0 - 0
Japan 1446 - 0 / 180 - 0
Jordan 22 - 0 / 2 - 0
Kenya 12 - 0 / 11 - 0
Korea, Republic of 202 - 0 / 0 - 0
Kuwait 35 - 0 / 1 - 0
Laos 3 - 0 / 0 - 0
Latvia 1 - 0 / 0 - 0
Lebanon 47 - 0 / 8 - 0
Lithuania 3 - 0 / 2 - 0
Luxembourg 4 - 0 / 0 - 0
Malaysia 112 - 0 / 0 - 0
Malta 2 - 0 / 2 - 0
Mauritius* 1 - 0 / -6 - 0
Mexico 10262 - 119 / 1582 - 3 [CFR 11.59]
Montenegro 9 - 0 / 5 - 0
Morocco 17 - 0 / 0 - 0
Myanmar 1 - 0 / 0 - 0
Nepal 5 - 0 / 2 - 0
Netherlands 134 - 0 / 6 - 0
Netherlands, Aruba 5 - 0 / 5 - 0
Netherlands Antilles, Curaçao 8 - 0 / 1 - 0
Netherlands Antilles, Sint Maarten 7 - 0 / 0 - 0
New Zealand 912 - 0 / 201 - 0
Nicaragua 308 - 0 / 15 - 0
Norway 41 - 0 / 9 - 0
Oman 3 - 0 / 0 - 0
Palau 1 - 0 / 1 - 0
Panama 417 - 0 / 0 - 0
Papua New Guinea 1 - 0 / 0 - 0
Paraguay 103 - 0 / 7 - 0
Peru 538 - 0 / 0 - 0
Philippines 1709 - 1 / 848 - 0 [CFR 0,58]
Poland 19 - 0 / 4 - 0
Portugal 27 - 0 / 10 - 0
Qatar 10 - 0 / 0 - 0
Romania 36 - 0 / 8 - 0
Russia 3 - 0 / 0 - 0
Saint Lucia 1 - 0 / 0 - 0
Samoa 1 - 0 / 0 - 0
Saudi Arabia 89 - 0 / 8 - 0
Serbia 15 - 0 / 3 - 0
Singapore 878 - 0 / 177 - 0
Slovakia 18 - 0 / 5 - 0
Slovenia 5 - 0 / 1 - 0
South Africa 12 - 0 / 11 - 0
Spain 760 - 1 / 43 - 0 [CFR 1.31]
Sri Lanka 17 - 0 / 2 - 0
Suriname 11 - 0 / 0 - 0
Sweden 74 - 0 / 5 - 0
Switzerland 72 - 0 / 16 - 0
Thailand 1414 - 3 / 0 - 0 [CFR 2.12]
Trinidad and Tobago 53 - 0 / 0 - 0
Tunisia 3 - 0 / 0 - 0
Turkey 40 - 0 / 8 - 0
Uganda 1 - 0 / 1 - 0
Ukraine 1 - 0 / 0 - 0
United Arab Emirates 8 - 0 / 0 - 0
United Kingdom 7447 - 3 / 909 - 0 [CFR 0.40]
Guernsey, Crown Dependency 5 - 0 / 0 - 0
Isle of Man, Crown Dependency 1 - 0 / 0 - 0
Jersey, Crown Dependency 11 - 0 / 3 - 0
United States of America 33902 - 170 / 6185 - 43 [CFR 5.01]
Uruguay 195 - 1 / 0 - 0 [CFR 5.12]
Vanuatu 2 - 0 / 0 - 0
Venezuela 204 - 0 / 11 - 0
Viet Nam 131 - 0 / 8 - 0
West Bank and Gaza Strip 30 - 0 / 17 - 0
Yemen 7 - 0 / 0 - 0
Grand Total 89921 - 382 / 12720 - 50 [CFR 4.24]
Chinese Taipei has reported 61 confirmed cases of pandemic (H1N1) 2009 with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above.
Cumulative and new figures are subject to revision
Abbreviations
UKOT: United Kingdom Overseas Territory
FOC: French Overseas Collectivity
Netherlands Antilles, Curaçao : 3 confirmed cases: The three confirmed cases are crew members of a cruise ship. They did not leave the boat during their illness nor during the 24 hours preceding the onset of symptoms.
Norway: 7 confirmed cases are crew members and passengers of a cruise ship. They did not leave the boat during their illness nor during the 24 hours preceding the onset of symptoms.
(*): The data has been revised on the basis of further laboratory confirmation
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[RED figures indicate new fatality cases; GREEN figures indicate new cases. CFR=Case-Fatality Rate, expressed as Total Number of Deaths/Total Number of Cases*1,00

A TIME'S MEMORY

H1N1 Influenza - Case Count

7/06/2009

7/05/2009

7/04/2009

7/03/2009