Singapore. 145 new confirmed cases of Influenza A (H1N1-2009) (Min. of Health, June 28, 2009, edited)

SINGAPORE - MINISTRY OF HEALTH

FOR IMMEDIATE RELEASE

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

[Original Document: LINK. EDITED.]


Singapore has confirmed 145 new cases (455th to 599th cases) of Influenza A (H1N1-2009) today, bringing the total tally to 599 confirmed cases.

Though the number of infected cases has increased, the severity of the disease remains relatively mild.

Singaporeans should carry on with their usual activities whilst observing good personal hygiene at all times.

In addition to these 145 new cases, 77 other cases were pending investigation yesterday. Of these 222 cases, 117 have been investigated. They comprise 94 local cases, and 23 imported cases. The remaining 105 cases are still being investigated.

The 94 new local cases comprise 19 new cases in the Republic Polytechnic cluster, 8 new cases in the Butter Factory cluster, 2 new cases in the Pulau Tekong cluster and one new case in the Maju Camp cluster.

In addition - there are 3 new clusters one from Clementi Camp comprising 43 new cases and 2 previously unlinked case, one from Police Coast Guard comprising 3 new cases and 1 previously unlinked case and Social (Party) comprising 1 new case and 3 previously unlinked cases.


DETAILS OF NEWLY INVESTIGATED CASES

[Classification - New cases - Total]

• (1) LOCAL
• A) Community clusters
• Riverlife Church 0 - 10
• Butter Factory 8 - 39
• Workplace 0 - 2
• Republic Polytechnic 19 - 49
• Fishermen of Christ Church 0 - 13
• Maju Camp 1 - 19
• NUS Orientation Camp 0 - 4
• Pulau Tekong Camp 2 - 7
• Clementi Camp 43 - 45
• Police Coast Guard (Brani Base) 3 - 4
• Social (Party) 1 - 4
• B) Local transmission from imported case. 2 - 12
• C) Unlinked 15 - 39
• (2) IMPORTED 23 - 247

• TOTAL 117 - 494

BREAKDOWN OF TOTAL CONFIRMED CASES (AS AT 28 JUN)

[Countries - Number of cases]

• Singapore 247
• Australia 80
• Philippines 64
• United States 38
• Indonesia 26
• Thailand 12
• UK 11
• Hong Kong 10
• Canada 3
• Chile 1
• New Zealand 1
• Cruise# 1
• Total 494
  

Advisory

With more local cases of infection appearing, it is important that all of us exercise good hygiene practices, such as covering the mouth with a tissue when coughing and sneezing. Those who are unwell are encouraged to see a doctor and to stay away from work, school or crowded places.

While most who have contracted H1N1 have recovered uneventfully or are in stable condition in hospitals, there are certain groups of people who have a higher risk of developing complications from H1N1, such as young children, those with co-morbidities, and pregnant women.

By being socially responsible, we can help protect these members of the community from being infected.

For those planning to travel, we encourage them to be informed of developments globally so that they can take the necessary precautions when travelling. The list of countries with confirmed cases and/or exported H1N1 cases is available on MOH’s website at www.moh.gov.sg.

For more information on Influenza A (H1N1-2009), please access MOH’s website, call our hotline at 1800-333 9999, or visit www.flu.gov.sg.

MINISTRY OF HEALTH 28 June 09

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Thailand. Team to study first fatalities - Nationmultimedia.com

INFLUENZA 2009 - Team to study first fatalities

By Pongphon Sarnsamak
The Nation
Published on June 29, 2009

A Public Health Ministry academic team will today consider the risk factors behind the first two deaths linked to type A (H1N1) influenza that have been reported since the virus hit Thailand on late April.

The move came after the Ministry's Bureau of Epidemiology reported a 42-year-old-man, who had not been categorised as a high risk patient of influenza A (H1N1), died on Saturday morning.

Citing information from the United States and Mexico, Dr Tawee Chotepitayasunon, chairman of the ministry's influenza academic team, said high risk patients of influenza A (H1N1) - children under five, pregnant women and elderly people with chronic conditions like heart disease, high blood pressure and diabetes - would be tested.

But this victim, who recently returned from abroad, had no congenital disease. He fell ill on June 18 with fever and a running nose. He had gone to a pub in Bangkok with friends before developing flu-like symptoms.

He was admitted to hospital on June 23 with a high fever, coughing and pneumonia. He was also given oseltamivir, but his condition worsened, and he died on Saturday morning. The other victim, a 40-year old woman, a heart patient, died on June 20 after five days of treatment.

" We need to know how people with mild symptoms progress to severe symptoms and die. We need more research to find out the other risk factors indicating a change in health conditions when the virus infects humans," he said.

" We hope we will come up with new information that helps us know clearly about this new flu virus as we now only know about its spread and severity," he said.

Yesterday the Public Health Ministry reported 80 new cases of Type-A (H1N1) influenza cases, lifting the confirmed cases in Thailand to 774. Of the new cases, 68 are students and three from the general public, he said, adding that 20 patients are still hospital. Another three cases were under the close watch of doctors, including two navy conscripts in Chonburi province.

Department of Medical Service's director-general, Dr Rawat Vitruthvej said one navy conscript is in critical condition with difficulty breathing. His condition has improved slightly and he is being supported by a medical team from Rajavithi hospital. A-57-year-old woman, admitted to private hospital, is gradually recovering but remains in intensive care unit.

Public Health Minister Witthaya Kaewparadai urged provincial health officers and medical workers at hospitals nationwide to be ready for the type-A (H1N1)influenza.

" Medical teams should be prepared to respond immediately for cases in critical condition," he said.

He also expressed concern over seasonal flu infection among students as the virus has already spread and infected 10,000 people across country.

However, he was certain the Public Health Ministry could handle the pandemic and contain the spread of the virus, despite the death at the weekend.

However former deputy health minister Vicharn Meenchainant said the government has failed to control the spread of disease, charging it had hidden information and delayed treatment for patients with the new flu virus.

"The government is trying to inform the public the disease has no severity, but it is still spreading and has a virulence higher than seasonal flu. Moreover, it is not clear use of the current antiviral drug can control the disease," he said.

"More and more people will die if the government does not take action for this situation seriously," he said.

Witthaya said the Public Health Ministry did not hide any information over the spread of disease. " We should not politicise this issue as it is one of the life and death of people," he said.
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Brazil registers first H1N1 flu death - ministry (AlertNet, edited)

Brazil registers first H1N1 flu death - ministry

28 Jun 2009 19:21:25 GMT
Source: Reuters
SAO PAULO, June 28 (Reuters)

Brazil had its first death from the H1N1 influenza, or swine flu, on Sunday, after a 50-year-old man succumbed to the virus which he picked up in Argentina, the health ministry said in a statement.

He first showed symptoms on June 15 while on a trip to Argentina, which has had several deaths due to the flu. After returning to Brazil on June 19, he was admitted to a hospital the following day where he was confirmed to have the H1N1 virus.

The ministry has in recent days warned Brazilians against traveling in Argentina and Chile.

It also said the total confirmed cases of the deadly flu had reached 627 in Brazil.

Officials expect further deaths as the virus spreads during the coming winter months, which began a week ago in Brazil.

Currently, 114 countries have confirmed cases of the H1N1 flu, according to the World Health Organization.

(Reporting by Reese Ewing) (reese.ewing@thomsonreuters.com; +5511 8160-4173)
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Reuters AlertNet - Brazil registers first H1N1 flu death - ministry

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Australia. Swine flu vaccine likely to be delayed

Swine flu vaccine likely to be delayed

Jill Stark
June 28, 2009

A VACCINE for swine flu might not be available until next winter even though an apparently effective sample has already been created in a Melbourne laboratory.

Scientists at CSL say they have developed a vaccine believed to protect against the virus. Human trials will be conducted first to determine what dose of the drug is most effective.

Despite five swine-flu-related deaths in Australia, the Federal Government has ruled out releasing the vaccine early to vulnerable groups such as the elderly or those with chronic illnesses.

Rachel David from the Parkville laboratory said results of the trial — involving 240 healthy adults from South Australia — would determine when the 10 million doses ordered by the Government would be distributed.

Dr David said that while developing the vaccine had been relatively simple it was still unclear what dosage would sufficiently stimulate the body's immune system to help fight the disease.

The earliest the vaccine would be ready for use was mid to late August but if the virus continued to produce relatively mild symptoms the Government could decide to delay the roll-out until next winter.

"If this was a real emergency, if this virus was killing half the people it infected like the original bird flu then of course we'd dispense with the trial process and just go ahead and make a guesstimate of the dose, but we're not in anything like that situation," Dr David said.

"The virus that's circulating is not that different in terms of its effect from the normal flu. You could go ahead and run a vaccination program as early as August, but that's not a decision that CSL can make, it's a decision for the Therapeutic Goods Administration, the Government and public health experts.

"Five Australians infected with swine flu have died — the latest a Perth woman, 26, who was being treated for an underlying medical condition in Royal Perth Hospital.

Dr David said CSL usually tested a flu vaccine for six months to determine optimal dosage but if the pandemic worsened the Government might intervene to speed up the process. Releasing the vaccine before proper testing in a bid to protect people with underlying medical conditions was a difficult decision, she said. "If the dose was not adequate they'd have to give everyone a booster, which would be really tough."

A spokeswoman for the Department of Health and Ageing said the Government would not release the vaccine before the results of the human trial were known. "It will be evaluated by the TGA for safety and efficacy under the normal processes … it must be sure it is safe," she said.

Professor Raina MacIntyre, an infectious diseases expert at the University of NSW, said a swine flu scare in the 1970s led to the rushing out of a vaccine that had serious neurological side effects.

"In an ideal world you'd want to have your vaccine before the epidemic even starts, which is what we do with the normal seasonal flu," she said. "But that wasn't possible because we're in the southern hemisphere and were about to go into our winter when the whole thing happened in April."
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Canada. Critics say 'mild' a misleading term for H1N1

Critics say 'mild' a misleading term for H1N1

Updated Sun. Jun. 28 2009 12:37 PM ET
The Canadian Press
TORONTO

Officialdom's mantra about H1N1 -- "it is overwhelmingly mild" -- might seem incongruous if we knew the number of children, teens and young adults in ICU beds right now alive only because a breathing machine has taken over for their ravaged lungs.

The heavy reliance on the word "mild " could be creating a false impression of what is actually going on and what the world may face in coming months, some experts worry.

Peter Sandman, a risk communications guru from Princeton, N.J., suggests if authorities are trying to ensure people don't panic about the new H1N1 outbreak, they are concerned about the wrong thing.

"In North America, swine flu panic is much rarer than swine flu deaths," Sandman says.

"The problem isn't panic or even excessive anxiety. The problem is complacency, both about what's going to happen and about what might happen."

When the new H1N1 virus burst onto the world's radar, it was, for awhile, the hottest story of the 24-7 news cycle. The long threatened pandemic, it seemed, was finally underway.

But instead of the 60-plus per cent death rate of H5N1 avian flu -- seen for years as the pandemic frontrunner -- the wire was tripped by a seemingly wimpy virus that is causing a lot of flu, but is no viral monster.

In many places, public health officials have bent over backwards to tamp down anticipated panic. The results? Within a few weeks, most people appeared to be convinced the pandemic was (past tense) a non-event, a blip of flu activity over-hyped by the sensationalist media hoard.

"When we're told that swine flu is mild, we don't think, `It will infect a half to a third of the world population and kill a few million people, mostly young people, before it's over,"' says Sandman. "We think, `It's like having a bad cold."'

Well, H1N1 isn't over. And it's not like a bad cold sweeping the globe.

But officials and experts are having a hard time striking the balance in messages to the public, unclear what they are dealing with now and what it might become.

"I think the problem is we don't know how to paint this picture properly," says Dr. Allison McGeer, a flu expert at Toronto's Mount Sinai Hospital.

"Because it's perfectly true that most cases are mild. But it doesn't mean that you shouldn't worry about it."

Regular flu, as anyone who has had it know, is no walk in the park.

And with this new flu, a small subset of people gets very, very sick. Their lungs are overwhelmed by an aggressive viral pneumonia one doctor described as looking like a "white out" on an X-ray. A number of hospitals are struggling to keep these people alive.

Generally much younger than the typical hospitalized flu patient, many of these people have been on ventilators for weeks. And every day, officials in some part of the globe announce that a 15-year-old boy, a 24-year-old woman or an otherwise healthy pregnant woman in her third trimester has lost the battle.

"When you look at those things then you begin to say `Well, is it really accurate, is it really fair to say that this is a mild phenomenon?"' says Dr. Keiji Fukuda, the World Health Organization's top flu expert.

Fukuda and his team have been warning for some time that the unusual age pattern of severe cases, the odd out-of-season spread and the fact that the virus is killing some previously healthy young adults makes the term moderate a more appropriate severity assessment.

That pattern, seen in previous pandemics, makes flu watchers sit up and take notice. "What it really leads you to conclude is that boy, we'd better watch this pretty carefully," Fukuda says.

There still isn't a good estimate of the percentage of total swine flu cases that becomes gravely ill, or the percentage that succumbs to the virus's onslaught. Currently the numbers may seem small; 23 deaths in Canada, 127 in the U.S., 263 worldwide. (Swine flu has already beat bird flu in terms of death tolls.)

But as a human pathogen this virus is still a baby, despite its rapid global spread. No one knows what it is going to be when it grows up.

Some things are clear though. Since most people seem to have no immunity to the virus -- some people over 60 may have some -- huge numbers will probably catch this flu over the next couple of years. In a relatively tight time frame, lots of people will come down with the flu -- far more than would be seen during a regular flu year.

To understand that impact, think back to elementary school arithmetic and fractions. If the denominator (the total number of cases) gets substantially bigger, the number of people falling gravely ill will rise sharply, even if the proportion of severe cases (the numerator) doesn't change.

And sheer numbers could make the outbreak get nasty, fast.

Several centres in North America are already struggling under the load of critically ill patients -- and this is summer, the season when flu viruses don't transmit as efficiently as they do during the cold winter months.

"If this is as bad as it's going to get, this is still not going to be a cakewalk," says Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

"We still have relatively few people in the population getting sick. We don't know -- 10 per cent? Five per cent? We don't know yet."

"But if in fact we're stretching medical resources, particularly in the pediatric community now in many communities, people will start to die with higher frequency with the same disease spectrum if care is compromised and we can't get every kid on a pediatric vent(ilator)," Osterholm warns.

"Even if the disease severity doesn't change but this fall we see more people get sick at the same time, we're in trouble. Now, add in the potential for this virus to obviously change and cause more severe illness -- I mean none of this is good. I don't know how we can sit here and say `Oh, this is mild."

'Some people worry the constant refrain that swine flu is mild may be keeping people who are becoming severely ill from seeking care as soon as they should. They also worry young people -- the demographic least likely to get a shot for seasonal flu -- may decide they don't need to bother when H1N1 vaccine is ready.

McGeer thinks by that time the virus will have issued its own assessment.

"Unfortunately I think the number of deaths in the end is going to be high enough that people will get the message and generally will get their vaccine."
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Influenza A(H1N1)v infection - Update 28 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 28 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 26 new cases were reported in EU and EFTA countries;
• 1713 new cases were reported from non-EU and EFTA countries;
• The total of fatal cases worldwide is 320;
• One additional death was reported in the UK since yesterday;
• 7 new fatal cases have been reported from non-EU and EFTA countries by Chile (5) Thailand (2);
• Myanmar reported its first case.
  

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 28 June, 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

The number of EU and EFTA countries reporting cases is 29 out of 31.

In the past 24 hours, 26 new cases were confirmed in 7 EU and EFTA countries (Table1).

73 year old man, who had serious underlying health conditions, had died in Scotland after having been hospitalized in an intensive care unit for 15 days, which brings the total number of deaths in EU and EFTA countries to two.

The cumulative number of cases in the EU and EFTA countries is now 6118, including two deaths.

Outside of the EU and EFTA countries, a total of 65460 cases, including 318 deaths, have been reported, representing an increase of 1713 from yesterday (Table 2). There were 8 new deaths since the last report.


Update on the impact of the pandemic in the United States

The transmission of the pandemic virus in North America is running some weeks ahead of Europe and the American Centers for Disease Prevention and Control (CDC) are analysing data of international importance. Therefore ECDC is looking at their reports especially carefully assuming there will be many similarities between the pandemic in the USA compared to the situation in the European Union and EFTA countries.

CDC are making weekly data-releases as part of their FluView series with accompanying weekly media presentations which are immediately converted into transcripts.(1,2) The most recent update was published on June 26th (http://www.cdc.gov/media/transcripts/2009/t090626.htm )

It noted continued transmission of influenza A(H1N1)v in the USA albeit with marked heterogeneity from area to area.

Overall the USA is experiencing a steady increase in the number of reported cases.

The most recent weekly update documented the largest number of cases (over 6000) reported in a week since the beginning of the outbreak including 27,717 laboratory confirmed cases overall, with over 3000 hospitalizations and 127 fatalities.(1,2)

Higher rates of illness are still being observed in persons less than 50 years of age with the highest rates in people less than 25 years of age and very few people over 60.

Nearly 80% of people who were hospitalized due to the influenza A(H1N1)v infection and reported to CDC were under 50 years of age with the median age of hospitalization being 19 years reflecting high rates of hospitalisation in children under 2 years of age.

The median age of those who died due to influenza A(H1N1)v infection is substantially higher at 37 years.

Individuals with underlying health conditions notably asthma, diabetes, heart disease, chronic lung disease remain at higher risk of hospitalisation along with pregnant women and young children. One risk factor of hospitalisation and death that is being reappraised by CDC is obesity. People with morbid or extreme obesity appear at increased risk of hospitalisation with A(H1N1)v and CDC considers that this is because of diminished respiratory function and that therefore presumably mild obesity is unlikely to be a risk factor for experiencing severe disease when people are infected with A(H1N1)v.

1) CDC Mediabriefing on Investigation of Human Cases of Novel Influenza A (H1N1) June 26th 2009 26th (http://www.cdc.gov/media/transcripts/2009/t090626.htm)
2) CDC FluView 2008-2009 Influenza Season Week 24 ending June 20, 2009 http://www.cdc.gov/flu/weekly/


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 28 June 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**]

1. Austria ... - 12 - ...
2. Belgium 1 - 41 - ...
3. Bulgaria ... - 7 - ...
4. Cyprus ... - 20 - ...
5. Czech Republic ... - 9 - ...
6. Denmark 1 - 44 - ...
7. Estonia ... - 13 - ...
8. Finland ... - 27 - ...
9. France ... - 239 - ...
10. Germany ... - 366 - ...
11. Greece ... - 73 - ...
12. Hungary ... - 8 - ...
13. Iceland ... - 4 - ...
14. Ireland 4 - 37 - ...
15. Italy ... - 102 - ...
16. Latvia ... - 1
    
17. Lithuania ... - 1
18. Luxembourg ... - 3 - ...
19. Netherlands ... - 118 - ...
20. Norway ... - 24 - ...
21. ***Poland 1 - 14 - ...
22. Portugal 2 - 11 - ...
23. Romania 1 - 24 - ...
24. Slovakia ... - 9 - ...
25. Slovenia ... - 4 - ...
26. Spain ... - 541 - ...
27. Sweden ... - 67 - ...
28. Switzerland 16 - 49 - ...
29. United Kingdom ... - 4250 - 2

• Total 26 - 6118 - 2

• 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 27 June 17:00 hours and 28 June 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) This case patient is an USA citizen who was confirmed and hospitalized while travelling in Poland
  

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 28 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

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

• EASTERN EUROPE AND CENTRAL ASIA

1. Montenegro ... - 1 - ...
2. Serbia 3 - 5
   
3. Russian Federation ... - 3 - ...
4. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 2 - ...
2. Bahrain ... - 15 - ...
3. Egypt 7 - 50 - ...
4. Iran ... - 1 - ...
5. Iraq 3 - 10 - ...
6. Israel ... - 375 - ...
7. Jordan ... - 15 - ...
8. Kuwait ... - 26 - ...
9. Lebanon ... - 25 - ...
10. Morocco ... - 9 - ...
11. Occupied Palestinian Territory ... - 9 - ...
12. Oman ... - 3 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia 14 - 62 - ...
15. Tunisia ... - 2
    
16. Turkey ... - 26 - ...
17. United Arab Emirates 1 - 8 - ...
18. Yemen ... - 6 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 2
3. Ivory Coast ... - 2
   
4. South Africa ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 7775 - 21
2. Mexico ... - 8617 - 116
3. **USA ... - 27717 - 127

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2
   
2. Bahamas ... - 4
   
3. Barbados ... - 10 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 1 - ...
6. Cayman Islands ... - 9 - ...
7. Costa Rica ... - 222 - 1
8. Cuba ... - 46 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador ... - 226 - ...
12. Guatemala ... - 262 - 2
13. Honduras ... - 119 - 1
14. Jamaica ... - 19 - ...
15. ***Martinique ... - 2 - ...
16. ****Netherlands Antilles ... - 4 - ...
17. Nicaragua ... - 277 - ...
18. Panama ... - 403 - ...
19. Suriname ... - 11 - ...
20. Trinidad-Tobago ... - 25 - ...

• SOUTH AMERICA

1. Argentina ... - 1587 - 26
2. Bolivia ... - 59 - ...
3. Brazil 69 - 591 - ...
4. Chile 1025 - 6211 - 12
5. Colombia ... - 73 - 2
6. Ecuador ... - 125 - ...
7. Paraguay ... - 79 - ...
8. Peru 146 - 506 - ...
9. Uruguay ... - 195 - ...
10. Venezuela ... - 153 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh ... - 7 - ...
2. China ... - 570 - ...
3. Hong Kong SAR 90 - 596 - ...
4. India ... - 80 - ...
5. Japan ... - 1049 - ...
6. Korea (South) ... - 142 - ...
7. Macao ... - 13 - ...
8. Sri Lanka ... - 8 - ...
9. Taiwan ... - 61 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 11 - ...
2. Cambodia ... - 5
   
3. Indonesia ... - 2
   
4. Laos PDR ... - 3
5. Malaysia ... - 68 - ...
6. Myanmar 1 - 1
7. Philippines ... - 861 - 1
8. Singapore ... - 365 - ...
9. Thailand 155 - 1209 - 2
10. Vietnam ... - 63 - ...

• AUSTRALIA AND PACIFIC

1. *****Australia 183 - 3702 - 5
2. Fiji ... - 2
   
3. ***French Polynesia ... - 2 - ...
4. New Zealand 16 - 523 - ...
5. Papua New Guinea ... - 1 - ...
6. Samoa ... - 1 - ...
7. Vanuatu ... - 2
   

• TOTAL 1713 - 65460 - 318

• 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.
• (a) Cases reported between 27 June 17:00 hours and 28 June 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.
• (***) The cases in Martinique and French Polynesia were reported by France
• (****) Three of the cases are reported to occur in a cruise ship in Curacao.
• (*****) One Australian case reported from a cruise ship.

(...)

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Indonesia reports 6 more new flu cases

Indonesia reported six more cases of the H1N1 flu virus on Sunday, with three Australians being among those infected, raising the country's confirmed cases to eight, Health Minister Siti Fadilah Supari said. Supari told a press conference that the three Australians -- two boys aged 10 and 12 and a 14-year-old girl -- tested positive for the virus on the resort island of Bali.

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145 new H1N1 cases raise total infected in Singapore to 599

145 new H1N1 cases raise total infected in Singapore to 599

Posted: 28 June 2009 2149 hrs
SINGAPORE:

Singapore confirmed 145 new cases of H1N1 on Sunday, bringing the tally to 599.

The Ministry of Health says that though the number of infected cases has increased, the severity of the disease remains relatively mild.

It advises Singaporeans to carry on with their usual activities whilst observing good personal hygiene at all times.

In addition to these 145 new cases, 77 other cases were pending investigation on Saturday.

Of these 222 cases, 117 have been investigated. They comprise 94 local cases and 23 imported cases. The remaining 105 cases are still being investigated.

The 94 new local cases comprise 19 new cases in the Republic Polytechnic cluster, eight new cases in the Butter Factory cluster, two new cases in the Pulau Tekong cluster and one new case in the Maju Camp cluster.

In addition, there are three new clusters - one from Clementi Camp comprising 43 new cases and two previously unlinked case; one from Police Coast Guard (Brani Base) comprising three new cases and one previously unlinked case; and one from social party comprising one new case and three previously unlinked cases.

- CNA/ir
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channelnewsasia.com - 145 new H1N1 cases raise total infected in Singapore to 599

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Swine flu: Scottish man is second Briton to die from H1N1 virus - guardian.co.uk

Scottish man dies from swine flu

73-year-old man from Glasgow, who had been in intensive care for 15 days, is second Briton to die from swine flu virus

Severin Carrell, Scotland correspondent
* guardian.co.uk, Sunday 28 June 2009 11.57 BST

An elderly man from the Glasgow area has become the second Briton to die from swine flu.

The 73-year-old, who had other very serious underlying health problems and has not yet been named, died at the Royal Alexandra hospital in Paisley late on Saturday night. He had been in intensive care for 15 days, health officials said.

Nicola Sturgeon, the Scottish health secretary, said: "Our thoughts are with the family and friends of the patient at this tragic and very sad time. The family have asked for the patient's identity to be kept private."

''Although it is concerning that the patient had swine flu, we are aware that the patient had very serious underlying health issues."

A family spokesman said: "Our beloved relative was private in life and we would ask that his privacy continues to be respected as we try to come to terms with our loss."

The first Briton to succumb to the H1N1 virus, Jacqui Fleming, also died at the Royal Alexandra after giving birth prematurely to her third child. She was the first person outside the Americas to die with the virus.

Fleming also had significant underlying health problems, and had been critically ill for several weeks before she died. Her baby, named Jack by her partner, William McCann, died the following day.Health officials have repeatedly stressed that the virus appears to be relatively mild, despite its rapid transmission around the world.

The latest official figures show that 4,322 Britons have so far contracted the virus, with significant outbreaks now in Birmingham, London and the Glasgow area, but health experts believe the real figure will be much higher.

In the United States, specialists at the Centers for Disease Control in Atlanta estimate that at least one million Americans may have had swine flu and not been diagnosed, although the official figures on Friday put confirmed US cases at 27,717, with 127 deaths.

However, the virus is now spreading quickly in the southern hemisphere, where it is winter – the traditional season for flu epidemics.

In Australia, where confirmed cases stood at 3,280, four people have now died, all with underlying health problems. There have been 21 deaths reported by the World Health Organisation in Argentina and seven in Chile. The last WHO update put total cases at 59,814 with 263 deaths.
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Swine flu: Scottish man is second Briton to die from H1N1 virus | World news | guardian.co.uk

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La gripe A se cobra su segunda víctima en Reino Unido · ELPAÍS.com

La gripe A se cobra su segunda víctima en Reino Unido

El fallecido, de 73 años, sufría también otros problemas de salud y estaba ingresado en un hospital escocés.

ELPAÍS.com/AGENCIAS - Madrid/Londres - 28/06/2009

Un hombre de 73 años se ha convertido en la segunda víctima mortal de la gripe A en Reino Unido.

El fallecido, que estaba ingresado en un hospital escocés, tenía otros problemas de salud y su estado se había deteriorado en los últimos días.

La primera víctima británica, y que fue también la primera europea, murió el pasado 14 de junio. La paciente, una mujer de 38 años, estaba siendo tratada de gripe en el hospital Royal Alexandra de la localidad escocesa de Paisley, el mismo centro médico donde ha muerto la segunda víctima, presentaba otros problemas de salud que se agravaron la gripe y murió tras dar a luz prematuramente.

Casos graves en España
El hombre, de 32 años, ingresado en un hospital de Tarragona se encuentra en estado crítico después de que su salud empeorara en la últimas horas debido a una complicación de los problemas de respiración que ya sufría antes de contraer la gripe, según informa la Cadena Ser. Joan Guix, director en Tarragona de la Agencia de Protección de la Salud Pública, ya señaló ayer que al contagio de la gripe H1N1 se sumó el débil estado de salud anterior del hombre, situación que ha disminuido sus defensas inmunológicas.

La paciente hospitalizada en Madrid es una embarazada de origen marroquí de 19 años que se encuentra en la unidad de cuidados intensivos (UCI) del Hospital Gregorio Marañón. Los médicos del centro sanitario mantienen preparada una UCI en la unidad de neonatología por si en cualquier momento fuera necesario practicar una cesárea de urgencia debido al delicado estado de la mujer, según las mismas fuentes, aunque por ahora la salud del feto no corre peligro.
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La gripe A se cobra su segunda víctima en Reino Unido · ELPAÍS.com

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India. Update on influenza A [H1N1] As On 28th June 2009 18:2 IST (PIB Press Release, edited)

Update on influenza A [H1N1] As On 28th June 2009 18:2 IST


World Health Organization has reported 59814 laboratory confirmed cases of influenza A/H1N1 infection from 112 countries as on 26th June 2009. There have been 263 deaths. No further update is available.


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

51,648 passengers have been screened on 27.6.2009 of which 39,181 passengers were from affected countries.

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

A cumulative total of 2,533,934 passengers have been screened.

Four new cases are reported today: Hyderabad (1), Gurgaon (1), Kolkata (1) and Mumbai (1).

The case in Hyderabad is a 10 year old male child who had travelled from USA to Hyderabad transiting Frankfurt and Mumbai (AI 144) and reaching Hyderabad on 25.6.2009 (AI 140). He had self reported at the identified health facility on 26.6.09.

The case in Gurgaon is an indigenous case and is the sister (12/F) of another positive case reported on 26.6.09.

The case in Kolkata is a five and half year old female child who travelled from Bangkok by Thai Airways TG 313 reaching Kolkata on 26.6.09. Since she was found having symptoms at the airport, she was admitted in the isolation facility.

The case in Mumbai is 45 year old female, mother of the case reported on 26.6.09. She also travelled from USA to Delhi reaching Delhi on 22.6.09 and from Delhi to Mumbai by train, reaching Mumbai on 26.6.09 and self reported at identified health facility. The contacts are being traced.

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

676 persons have been tested so far of which 93 are positive for Influenza A H1N1 [Swine]. .

191 out of the 676 persons have been identified through entry screening, twenty seven through contact tracing and the rest were self reported.

Of the 93 positive cases, 61 have been discharged. Rest of them remains admitted to the identified health facility.

The situation is being monitored.

DS/NCJ/RK
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PIB Press Release

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Australia. National tally of confirmed cases of H1N1 Influenza 09 - As at 5pm, 28 June 2009 (Dept. of Health, edited)

Australian Government - Department of Health and Ageing

National tally of confirmed cases of H1N1 Influenza 09 - As at 5pm, 28 June 2009

[Original Document: LINK. EDITED.]


The information contained in this situation report uses the most accurate currently available data.

Given the rapidly changing nature of the incident, recipients should be aware of the potential for later confirmation or clarification.


Current Australian confirmed cases of, and deaths associated with, H1N1 Influenza 09 (1700 AEST on 28 June 2009)

[Jurisdiction - Confirmed Cases - Deaths]

• Australian Capital Territory 162 - 0
• New South Wales 857 - 0
• Northern Territory 160 - 0
• Queensland 557 - 0
• South Australia 262 - 1*
• Tasmania 71 - 0
• Victoria 1560 - 3**
• Western Australia 229 - 1

• Total 3858 - 5

• (*) Case confirmed with H1N1 Influenza 09, cause of death includes pneumonia.
• (**) Laboratory results confirmed H1N1 Influenza 09 subsequent to death for one of the cases.

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Hong Kong: DH advises four secondary schools to start summer break (6/28/09)

The Department of Health (DH) today (June 28) advised four secondary schools to start their summer break tomorrow to stop the possible spread of human swine influenza (Influenza A H1N1) in the schools.

The advice was made following the confirmation of five human swine influenza cases in the schools.

The first case involved a 14-year-old boy, a Form 3 student of Kiangsu-Chekiang College (Shatin). He had onset of influenza symptoms on June 25 and last attended school on June 26.

The second case involved a 13-year-old girl, a Form 2 student of Lee Kau Yan Memorial School in Wong Tai Sin. The girl had onset of symptoms on June 26. She attended school on the same day.

The third case involved a 16-year-old boy, a Form 4 student of Diocesan Boys' School (DBS)in Kowloon City. He had onset of respiratory symptoms on June 15 and developed fever on June 25. He last attended school on June 25.

The fourth case is a Form 3 student of DBS, aged 15. He had onset of symptoms on June 26 and he attended school the same day.

The fifth case involved a 12-year-old girl, a Grade 8 student of German Swiss International School on the Peak. She developed influenza symptoms and attended school on June 26. All of them are in stable condition. Investigations into the cases are ongoing.

The spokesman called on parents to pay attention to the health condition of their children, and to remind them to observe good personal and environmental hygiene.
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Hong Kong: HA update on Designated Flu Clinics and discharged human swine influenza patients (6/28/09)

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 (June 28):

The Designated Flu Clinics today (as at 5pm) provide treatment to a total of 189 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 66 newly confirmed cases of human swine influenza in the past 24 hours.

This brings to 695 the total number of confirmed human swine influenza cases in Hong Kong.

Among them, a total of 554 confirmed cases have been discharged from public hospitals upon recovery, the remaining cases in hospitals have been stable (none required intensive care and there were no fatal cases).
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Indonesia ::: Eight confirmed A/H1N1 flu cases

Jakarta – Number of A/H1N1 positive patients in Indonesia has reached 8 cases.
“There are 6 additional positive cases, three Australian and three Indonesian. All of them are introduced cases from foreign countries,” said Health Minister, Siti Fadilah Supari in her residenc, South Jakarta, on Sunday.
Three Australians, who are reported to have A/H1N1 infection, are currently [...]

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Abstract. Hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) in Italy

Hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) in Italy

Floriana Campanile, Dafne Bongiorno, Sonia Borbone and Stefania Stefani

Annals of Clinical Microbiology and Antimicrobials 2009, 8:22doi:10.1186/1476-0711-8-22
Published: 24 June 2009


Abstract (provisional)

The aim of our study was to trace the dynamic changes of hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) lineages in Italy, comparing the genotypic backgrounds of contemporary isolates over a period of 17 years, with those of a sample of early MRSA strains from 1980. In total, 301 non-repetitive MRSA clinical isolates, recovered from 19 Italian hospitals between 1990 and 2007 were selected and analyzed for their antibiotic resistance, typed by PFGE and SCCmec, grouped into clonal-types and further characterized using Multi Locus Sequence Typing (MLST). A sample of fifteen early MRSA strains from 1980 was also used for comparison. The most interesting feature was the recent increase of ST228-MRSA-I (formerly the Italian clone; PFGE E) over the period 2000-2007 (57%), when compared to the period 1990-1999 (29%), and its stability to date, associated with a decrease of the highly epidemic ST247-MRSA-IA (formerly the Iberian clone; PFGE A), (23% from 1990 to 1999, 6% from 2000 to 2007). ST1-MRSA-I (1 out of 2 strains carrying ccrA2B2), ST8-MRSA-I (4 strains), ST15-MRSA-I (1 out of 4 carrying ccrA2B2) and ST30-MRSA-I (2 out of 5 carrying no ccrAB-types and ccrC) were the predominant earliest STs among the MRSA strains in 1980. A temporal shift in the susceptibility levels to glycopeptides was observed: strains with vancomycin MIC of [greater than or equal to] 2 mg/L increased from 19.4% to 35.5%. In conclusion, we describe the alternation of MRSA clones that occurred in hospitals from 1990 to 2007 and the increase of the glycopeptide MIC levels, reflecting a worldwide trend. We document the detection of ST1, ST8, ST15 and ST30 in the 1980 isolates; we hypothesize their possible latency and their appearance as the current CA-MRSA clones.
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Abstract | Hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) in Italy

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Hong Kong: Sixty-six new cases of human swine influenza (6/28/09)

A spokesman for the Department of Health said there had been 66 newly confirmed cases of human swine influenza (Influenza A H1N1) in the 24 hours to 2.30pm today (June 28).

This brings to 695 the total number of human swine influenza cases in Hong Kong.

The new cases involve 33 males and 33 females, aged between 10 months and 62.
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Japan. 3 Russian participants in Kanazawa ice show found with new flu

Three Russian nationals visiting Kanazawa, Ishikawa Prefecture, to take part in a figure skating show have been confirmed infected with the new stain of influenza, the Kanazawa municipal government said Sunday. The three -- a woman in her 20s, and a man and woman in their 30s who are performers and show staff -- are in stable condition and resting at their hotel, it said, adding they require no hospitalization.

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Australia. Adelaide nurses test positive to swine flu - ABC News (Australian Broadcasting Corporation)

Adelaide nurses test positive to swine flu

Two nurses in South Australia and a prisoner in New South Wales have been confirmed as having swine flu.

SA Health says two nurses at Adelaide hospitals have tested positive for the swine flu virus.

One nurse works at the Royal Adelaide and the second works at Lyell McEwin.

A total of seven patients who came into contact with the nurses have been given Tamiflu, but SA Health says they are not seriously ill.

The state's chief medical officer, Professor Paddy Phillips, says the virus is spreading among the community as expected.

"Clearly there's going to be more staff members, healthcare workers as well as policemen, firemen, office workers, all types of workers will be coming down with this bug," he said.

"Our aim is to protect those who are vulnerable and whose immune systems are suppressed by illness or medications."

The New South Wales prisoner is the second to have tested positive to swine flu in the state's prison system.

A Corrective Services Department spokeswoman says the 35-year-old male inmate was jailed a week ago and is now in isolation after contracting the H1N1 virus.

She will not identify the prison concerned but says the infection is not related to another positive test at Silverwater Jail in Sydney's west.

A female inmate tested positive on Friday and is also in isolation. It is thought she contracted the virus from a visitor.
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Adelaide nurses test positive to swine flu - ABC News (Australian Broadcasting Corporation)

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A/H1N1 flu knocks at doors of African countries in sub-Sahara (Xinhua, edited)

A/H1N1 flu knocks at doors of African countries in sub-Sahara

www.chinaview.cn 2009-06-28 15:25:58
by Xie Meihua
NAIROBI, June 28 (Xinhua)

The A/H1N1 flu which once spared the African continent as it was ravaging the most parts of the world is now knocking at doors of African countries in the sub-Sahara region with at least three countries reporting confirmed cases of the virus in the past weeks.

South Africa was the first one which reported its first confirmed case of A/H1N1 flu in the region on June 18. The country's health department announced that the patient, a 12-year-old boy, arrived in South Africa at OR Tambo international Airport from the United States a couple of days ago. The boy, a U.S. citizen, had flu-like symptoms and was admitted to a private hospital two days after arrival. The health department said the patient was kept in isolation and discharged after a few days in hospital, and that He was well and recovering in isolation at home around Gauteng. All contacts had been followed up and given necessary advice and treatment, the department also said. Exactly One week later on June 25, South Africa announced the second case of the A/H1N1 flu. Spokesman for the health department Fidel Hadebe said a 29-year-old rugby player, who livesin France and arrived in the country, took ill a couple of days ago. "He was admitted to a hospital (in Pretoria, Gauteng) where specimens were taken from him for testing. The results came back on Thursday (June 25) and they were positive," he said. "The fact that we have a fast turn around time to trace the H1N1 influenza is indicative that we are prepared to deal with it and there is no need for people to worry," Hadebe said.

Ethiopia confirmed its first cases of A/H1N1 flu on June 20.At a joint press conference, Liya Kebede, the general manager of St. Paulos Hospital in Ethiopia's capital Addis Ababa, said the virus was detected in two of three students who came here from the United States following an examination. She said the examination was made on the students upon their arrival at the Addis Ababa Bole International Airport after their arrivals. At the same time, Ahmed Emano, head of public relations of the country's Ministry of Health, told journalists the biopsy of the students which was sent abroad for confirmation showed that they had the virus. Ahmed said the result demonstrated that the checkup service made in the country was reliable.

Two cases of A/H1N1 flu were diagnosed in Cote d'Ivoire on Saturday (June 27). The western African country made the announcement after the World Heath Organization (WHO) analyzed the two suspected cases reported several days ago and found them positive. Two women were tested positive for A/H1N1 virus after they were suspected of suffering from the pandemic on June 19, when they disembarked from a passenger plane from Brussels, Belgium. After finding the first suspected case, 48 people who approached the woman and 57 other passengers on the same flight with her were put under epidemiologic surveillance, surveillance director Daniel Ekra said. The two patients were admitted to hospital and in good conditions, Ekra said, adding that "all the measures are being taken to contain the spread of the virus in Cote d'Ivoire." Other African countries in the sub-Sahara region have been on high alert, attempting to keep the epidemic out of their doors.

Zimbabwe Health and Child Welfare Minister Dr Henry Madzorera warned on Friday that the potential for the pandemic to cause a disaster was real and that his ministry had put intervention measures in place. "The continued spread of the pandemic and the fact that cases have been diagnosed in Egypt and South Africa puts Zimbabwe at a real risk, hence the need for an informed population and a ready health services system," he said. "The ministry has put in place a national taskforce to oversee the necessary preparedness and response required at every level ofservice delivery," he said. He added that the taskforce had membership from all sectors and would be responsible for putting in place preparedness and response plans, which he said would be ready for circulation in the next two weeks. Asked if the country's ports of entry were ready to deal with cases of the flu, he said, "The ministry has made an assessment of these places for purposes of strengthening awareness, surveillance and preparedness and response capacity of the ministry staff, immigration and other workers at ports of entry and other stakeholders."

In Kenya where a suspected case of the A/H1N1 was cleared on Saturday, Public Heath and Sanitation Minister Beth Mugo tried to ease the panic of the public triggered by the suspected case. The minister downplayed the case, saying the reported case "was just a scare" and the disease was treatable. She said Kenya had strengthened surveillance at airports and other border entry points following the outbreak of the disease.

The A/H1N1 flu, which was first detected in Mexico late in April, has spread quickly to other regions of the world including Africa. The A/H1N1 flu develops symptoms of fever, cough, sore throat, headache and fatigue. In mid June, the World Health Organization (WHO) raised the pandemic alert status from phase 5 to phase 6, which meant that the disease had reached the emergency level. According to WHO's official tally, a total of 55,867 cases and 238 deaths were confirmed worldwide as of Wednesday.
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A/H1N1 flu knocks at doors of African countries in sub-Sahara_English_Xinhua

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Australia. National tally of confirmed cases of H1N1 Influenza 09 - As at 6 am, 28 June 2009 (Dept. of Health, edited)

Australian Government - Department of Health and Ageing

National tally of confirmed cases of H1N1 Influenza 09 - As at 6 am, 28 June 2009

[Original Document: LINK. EDITED.]


The information contained in this situation report uses the most accurate currently available data.

Given the rapidly changing nature of the incident, recipients should be aware of the potential for later confirmation or clarification.


Current Australian confirmed cases of, and deaths associated with, H1N1 Influenza 09 (0600 AEST on 28 June 2009)

[Jurisdiction - Confirmed Cases - Deaths]

• Australian Capital Territory 156 - 0
• New South Wales 751 - 0
• Northern Territory 139 - 0
• Queensland 552 - 0
• South Australia 262 - 1*
• Tasmania 71 - 0
• Victoria 1560 - 3**
• Western Australia 211 - 1

• Total 3702 - 5

• (*) Case confirmed with H1N1 Influenza 09, cause of death includes pneumonia.
• (**) Laboratory results confirmed H1N1 Influenza 09 subsequent to death.

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