Published Date: 2010-04-17 17:00:03
Subject: PRO/AH/EDR> Influenza pandemic (H1N1) (30): WHO update
Archive Number: 20100417.1250

INFLUENZA PANDEMIC (H1N1) (30): WHO UPDATE
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Date: Fri 16 Apr 2010
Source: WHO Global Alert and Response (GAR) Disease Outbreak News
[abbreviated & edited]
<http://www.who.int/csr/don/2010_04_16/en/index.html>


Pandemic (H1N1) 2009 - update 96
--------------------------------
As of Sun 11 Apr 2010, worldwide more than 214 countries and overseas
territories or communities have reported laboratory confirmed cases
of pandemic influenza H1N1 2009, including over 17 798 deaths. WHO is
actively monitoring the progress of the pandemic through frequent
consultations with the WHO Regional Offices and member states and
through monitoring of multiple sources of information.

Situation update
----------------
The most active areas of pandemic influenza virus transmission
currently are in parts of the tropical zones of the Americas, West
Africa, Eastern Africa, and South East Asia. Although pandemic
influenza continues to be the predominant circulating influenza virus
worldwide, seasonal influenza type B virus circulation continues to
be predominant in East Asia, and is being detected across other parts
of Asia, and Europe at low levels. Sporadic detections of seasonal
influenza H3N2 viruses have been reported across Asia, Eastern
Europe, and Eastern Africa most notably in recent weeks in Indonesia
and Tanzania. Few seasonal H1N1 viruses were reported in the Russian
Federation and Northern China in the last week.

In East Asia, pandemic influenza activity continued to decline and is
now at very low levels. The predominant virus associated with
influenza-like-illness in the area is now influenza type B viruses,
which continue to circulate in China, Mongolia, and Republic of
Korea. The Republic of Korea reports an increasing trend of
respiratory disease activity associated with detections of influenza
type B viruses and small numbers of pandemic H1N1. In China,
outbreaks of acute respiratory infections associated with B virus
detections are reported but none due to pandemic H1N1. The overall
level of respiratory disease activity is similar to the level
observed during the same period of 2007-2008 and 2008-2009 seasons.
Small numbers of seasonal H3N2 and sporadic seasonal H1N1 viruses
were detected in Northern China. In Mongolia, rates of influenza-like
illness (ILI) continue to decline and are associated with influenza
type B only.

In South and Southeast Asia, the most active areas of influenza
transmission are Thailand and Singapore, where pandemic H1N1 is the
dominant influenza virus, with co-circulation at lower levels of
influenza type B and H3N2. Overall, the intensity of transmission is
relatively low. In Thailand, respiratory disease activity has
decreased since the previous week. 4 percent of sentinel respiratory
samples from ILI patients and 2.6 percent of sentinel respiratory
samples from hospitalized patients with pneumonia were found to be
positive for pandemic H1N1. Malaysia continues to report occasional
outbreaks of respiratory disease in 3 states, Johor, Pahang, and
Melaka. Only Melaka state has reported pandemic H1N1 laboratory
confirmed cases, with 4 cases treated in the Intensive Care Unit
(ICU). In India overall pandemic H1N1 activity is very low in most
states, although in western India pandemic H1N1 cases continue to be
reported in low numbers.

In Europe, pandemic influenza activity has continued to decrease in
recent weeks and is at very low intensity in all countries. The
overall proportion of sentinel respiratory samples testing positive
for influenza remained low (5.4 percent), and the number of influenza
type B virus detections exceeded that of influenza A. In Italy, 50
percent (7/14) of sentinel respiratory samples tested positive for
influenza, all of which were seasonal influenza type B viruses.

In the northern temperate zones of the Americas, overall pandemic
influenza transmission remained low as pandemic influenza H1N1 virus
continues to circulate at very low levels in some areas. In temperate
countries of the southern hemisphere, overall respiratory disease
activity remained low.

In tropical zones of the Americas, limited data suggest that overall
influenza activity remains low with localized areas of active
transmission in a number of countries. In Cuba, a slight increase of
confirmed cases of pandemic virus was reported during the most recent
reporting week. In Mexico, available data suggest that localized
active transmission of pandemic influenza virus continues to occur
around Mexico City but is very low nationally. In Peru, the number of
pneumonia cases has increased over the last 2 weeks, especially in
children less than 5 years of age, however there is no virological
information available to indicate the cause of these cases. The lack
of an associated increase in other age groups may indicate a cause
other than influenza. Increased levels of ILI have also been reported
across much of Brazil over the previous 2 weeks particularly in
northern Brazil.

In North Africa limited available data suggest that respiratory
disease activity remained low. In sub-Saharan Africa, West Africa
continues to see community transmission of pandemic influenza virus
with Ghana currently being the primary focus of transmission (45
percent of all clinical specimens tested were positive for pandemic
influenza) but smaller numbers of cases were also seen in Senegal and
Niger. Pandemic influenza virus transmission appears to have peaked
in Senegal approximately one month ago. Guinea has now reported their
1st cases of pandemic H1N1. In East Africa, cases of pandemic
influenza H1N1 continue to be detected in Rwanda, though in declining
numbers. Small numbers of seasonal influenza H3N2 and influenza type
B viruses were detected during the last week in Rwanda, Kenya, and
South Africa. Notably, Tanzania has also recently reported
significant transmission of seasonal influenza H3N2. No increases in
respiratory disease activity or pandemic influenza have yet been
noted in South Africa.

In the South Pacific, Vanuatu and Nauru reported an increasing trend
of respiratory diseases activity for this week, but this trend was
not associated with laboratory confirmed detections of pandemic H1N1
virus.

In other temperate countries out of the southern hemisphere,
Australia and New Zealand, influenza activity continues to be low,
with mostly detections of pandemic H1N1 and sporadic seasonal
influenza viruses.

The Global Influenza Surveillance Network (GISN) continues monitoring
the global circulation of influenza viruses, including pandemic,
seasonal, and other influenza viruses infecting, or with the
potential to infect, humans including seasonal influenza.

[For more information on virological surveillance and antiviral
resistance, please see the full text of the weekly virology update
via the URL at the top of this report.]

Region / Deaths*
----------------
WHO Regional Office for Africa (AFRO) / 168
WHO Regional Office for the Americas (AMRO) / at least 8274
WHO Regional Office for the Eastern Mediterranean (EMRO) / 1019
WHO Regional Office for Europe (EURO) / at least 4776
WHO Regional Office for South-East Asia (SEARO) / 1757
WHO Regional Office for the Western Pacific (WPRO) / 1804
Total* / at least 17 798

* The reported number of fatal cases is an under representation of
the actual numbers as many deaths are never tested or recognized as
influenza related.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[A feature of the weekly updates is a map of influenza activity and
virus subtypes, accessible at
<http://www.who.int/csr/disease/swineflu/Global_influenzapositive_FluTransmissionZones_week05.png>.
The displayed data reflect the most recent data reported to Flunet
(<http://gamapserver.who.int/GlobalAtlas/home.asp>), WHO regional
offices, or on Ministry of health websites in the preceding 2 weeks.

In summary, the most active areas of pandemic influenza (H1N1) virus
transmission currently are in parts of the tropical zones of the
Americas, West Africa, Eastern Africa, and South East Asia. Although
pandemic influenza continues to be the predominant circulating
influenza virus worldwide, seasonal influenza type B virus
circulation continues to be predominant in East Asia, and is being
detected across other parts of Asia, and Europe at low levels.
Sporadic detections of seasonal influenza H3N2 viruses have been
reported across Asia, Eastern Europe, and Eastern Africa.

The global total number of fatalities due to influenza pandemic
(H1N1) virus infection has increased by 847 since the previous update
of 21 Mar 2010. - Mod.CP]

See Also

Influenza pandemic (H1N1) (29): seasonal vaccine
Influenza pandemic (H1N1) (28): Hong Kong SAR, Norway, D222G mutation
20100409.1147
Influenza pandemic (H1N1) (27): USA (GA) 20100330.1004
Influenza pandemic (H1N1) (26): WHO update 20100327.0965
Influenza pandemic (H1N1) (25): oseltamivir resistance 20100326.0961
Influenza pandemic (H1N1) (24): mutation analysis 20100313.0820
Influenza pandemic (H1N1) (23): WHO Update 20100313.0805
Influenza pandemic (H1N1) (22): Canada (SK), reassortment 20100305.0734
Influenza pandemic (H1N1) (21): Norway, D222G mutation 20100305.0729
Influenza pandemic (H1N1) (20): China, update 20100303.0702
Influenza pandemic (H1N1) (19): reassortment 20100302.0689 2009
Influenza pandemic (H1N1) (18): WHO update 20100221.0587
Influenza pandemic (H1N1) (17): WHO Update 20100216.0546
Influenza pandemic (H1N1) (16): myocarditis in children 20100215.0526
Influenza pandemic (H1N1) (15): update 20100214.0522
Influenza pandemic (H1N1) (14): Finland, cross-reacting antibody 20100205.0392
Influenza pandemic (H1N1) (13): vaccine recall 20100204.0379
Influenza pandemic (H1N1) (12): vaccine distribution, WHO update 20100202.0359
Influenza pandemic (H1N1) (11): WHO statement to CE, corr. 20100129.0312
Influenza pandemic (H1N1) (11): WHO statement to CE 20100126.0289
Influenza pandemic (H1N1) (10): PAHO update 20100121.0240
Influenza pandemic (H1N1) (09): WHO update 20100119.0221
Influenza pandemic (H1N1) (08): USA (vaccine safety), Mongolia 20100117.0194
Influenza pandemic (H1N1) (07): China, travel alert 20100115.0180
Influenza pandemic (H1N1) (06): USA (SD) Native Americans 20100114.0160
Influenza pandemic (H1N1) (05): vaccine update 20100112.0143
Influenza pandemic (H1N1) (04): Australia (WA), i/v zanamivir 20100111.0127
Influenza pandemic (H1N1) (03): USA (WI) minorities 20100109.0103
Influenza pandemic (H1N1) (02): PAHO update 20100108.0093
Influenza pandemic (H1N1) (01): China, 2009 20100105.0040
...................................cp/mj/lm

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