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INFLUENZA A (H1N1) - WORLDWIDE (02): CASE COUNTS
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] WHO - global update
[2] PAHO - America's region update
[3] CDC - USA update
[4] Mexico - MOH update
[5] Canada - Health Protection Agency
[6] Newly confirmed countries with cases
[7] News briefs
******
[1] WHO - global update
Date: 30 Apr 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR) [edited]
<http://www.who.int/csr/don/2009_04_30_a/en/index.html>
Influenza A(H1N1) - update 6
---------------------------------
The situation continues to evolve rapidly. As of 17:00 GMT, 30 Apr
2009, 11 countries have officially reported 257 cases of influenza A
(H1N1) infection.
The United States Government has reported 109 laboratory confirmed
human cases, including one death. Mexico has reported 97 confirmed
human cases of infection, including 7 deaths.
The following countries have reported laboratory confirmed cases with
no deaths: Austria (1), Canada (19), Germany (3), Israel (2),
Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the
United Kingdom (8).
Further information on the situation will be available on the WHO
website on a regular basis.
WHO advises no restriction of regular travel or closure of borders.
It is considered prudent for people who are ill to delay
international travel and for people developing symptoms following
international travel to seek medical attention, in line with guidance
from national authorities.
There is also no risk of infection from this virus from consumption
of well-cooked pork and pork products. Individuals are advised to
wash hands thoroughly with soap and water on a regular basis and
should seek medical attention if they develop any symptoms of
influenza-like illness.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
******
[2] PAHO - America's region
Date: 30 Apr 2009
Source: PAHO Epidemiological Alerts Vol. 6, No. 16 [edited]
<http://new.paho.org/hq/index.php?option=com_content&task=view&id=1289&Itemid=569>
Influenza cases by a new sub-type: Regional Update ([30 Apr 2009])
-------------------------------------
On 18 Apr 2009, the National IHR Focal Point of the United States
notified the laboratory confirmation of 2 human cases of swine
influenza A/H1N1 in 2 children of 9 and 10 years old living in the
State of California (one in the County of San Diego and the other one
in Imperial County).
To date, the United States has confirmed a total of 109 human cases
of swine influenza A H1N1: 1 in Arizona, 14 in California, 1 in
Indiana, 2 in Kansas, 2 in Massachusetts, 1 in Michigan, 1 in Nevada,
50 in New York City, 1 in Ohio, 10 in South Carolina and 26 in Texas.
Other suspected cases are being investigated. Five hospitalizations
and a death have been registered. The dead case is a child of 22
months old from Mexico who died in a hospital of Houston, Texas area.
The most recent cases detected as well as the registered death
suggest that more serious cases could appear in the United States.
From [17 to 29 Apr 2009], Mexico has reported 1918 suspected cases of
influenza with severe pneumonia, including 84 deaths. The suspected
cases were recorded in all Mexican states, most of them in the
Federal District, Guanajuato, State of Mexico, Aguascalientes,
Queretaro and San Luis Potosi. The majority of these have occurred in
previously healthy young adult people. There have been few cases in
individuals under 3 or over 59 years old. 933 of the suspected cases
are currently hospitalized.
The number of probable cases of swine influenza A H1N1 remains at
286, and a total of 97 cases has been confirmed. The considerable
variation in the number of confirmed cases as of today [30 Apr 2009]
is due to the recent laboratory confirmation of samples collected in
previous weeks. The number of confirmed dead cases remains at 7. This
figure is also subject to variations depending on the new laboratory
information.
In Canada to date, 19 human cases of swine influenza A H1N1 have been
confirmed (2 in Alberta, 4 in the province of New Scotland, 6 in
British Columbia and 7 in Ontario), some of them with recent trip
history to Cancun, Mexico. All the cases developed a mild form of
influenza-like illness. Two of the cases presented, in addition,
gastrointestinal symptoms. All of them are currently recovered, and
none required hospitalization. Laboratory tests were conducted in
Winnipeg, Canada. "Indigenous" transmission is not discarded, since
not all the confirmed cases have trip history to Mexico.
The press has reported information on suspected cases in several
countries of the region; however this information has not been
confirmed.
International Health Regulations (IHR):
At the request of the Director-General (DG) of WHO, the IHR Emergence
Committee has been summoned and is advising the DG on the event. On
its 1st day of deliberation, [25 Apr 2009], it concluded that the
present event constitutes a Public Health Emergency of International
Concern.
On [29 Apr 2009], the DG decided to elevate the pandemic alert to
Phase 5. In order to come to this urgent decision, the DG considered
epidemiological information from the most affected countries, as well
as the result of the scientific meeting held that same day. The
latter indicated existence of sustained outbreaks of swine influenza
A H1N1 at the community level in more countries within the region.
The decision to increase the pandemic level of the alert should
permit Member States to provide the required leadership and
coordination as well as to consider the possibility of executing
their contingency plans.
The DG recommends not closing borders or restricting travel. However,
it is prudent for people who are sick to delay travel. Moreover,
returning travelers who have become sick should seek medical
attention in line with guidance from national authorities.
Production of seasonal vaccine should continue, but at the same time,
WHO is making all the efforts to facilitate the process of
development of a vaccine against swine influenza A H1N1.
The committee will continue to advise the DG on the basis of the
available information.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
[For a map of distribution of cases in the Americas region, see
<http://new.paho.org/hq/index.php?option=com_content&task=view&id=1289&Itemid=569>.
- Mod.MPP]
******
[3] CDC - USA update
Date: 30 Apr 2009
Source: CDC H1N1 flu website [edited]
<http://www.cdc.gov/swineflu/>
The Swine Flu website, last updated 30 Apr 2009, 10:30 AM ET: U.S.
Human Cases of H1N1 Flu Infection (As of [30 Apr 2009], 10:30 AM ET
[GMT-4])
----------------------------------------
States: No. of lab. confirmed cases / Deaths
Arizona: 1 / 0
California: 14 / 0
Indiana: 1 / 0
Kansas: 2 / 0
Massachusetts: 2 / 0
Michigan: 1 / 0
Nevada: 1 / 0
New York: 50 / 0
Ohio: 1 / 0
South Carolina: 10 / 0
Texas: 26 / 1
Total counts: 109 cases / 1 death
In response to an intensifying outbreak in the United States and
internationally caused by a new influenza virus of swine origin, the
World Health Organization raised the worldwide pandemic alert level
to Phase 5 on [29 Apr 2009]. A Phase 5 alert is a "strong signal that
a pandemic is imminent and that the time to finalize the
organization, communication, and implementation of the planned
mitigation measures is short."
The United States government has declared a public health emergency
in the United States. CDC's response goals are to reduce transmission
and illness severity and provide information to help health care
providers, public health officials and the public address the
challenges posed by this emergency. CDC is issuing and updating
interim guidance daily in response to the rapidly evolving situation.
CDC's Division of the Strategic National Stockpile (SNS) continues to
send antiviral drugs, personal protective equipment, and respiratory
protection devices to all 50 states and U.S. territories to help them
respond to the outbreak. The swine influenza A (H1N1) virus is
susceptible to the prescription antiviral drugs oseltamivir and
zanamivir. In addition, the federal government and manufacturers have
begun the process of developing a vaccine against this new virus.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
******
[4] Mexico - MOH update
Date: 30 Apr 2009
Source: Secretaria de Salud website (MOH) [trans. Mod.MPP, edited]
<http://portal.salud.gob.mx/contenidos/noticias/influenza/estadisticas.html>
Statistics:
Cumulative number of cases as of 29 Apr 2009
---------------
Cases:
Total Severe Acute Respiratory infection Influenza A(H1N1) suspected: 1918
Total probable cases of Influenza A(H1N1): 286
Total confirmed cases of Influenza A(H1N1): 99
Deaths:
Total deaths Influenza A(H1N1) suspected: 84
Total deaths Influenza A(H1N1) confirmed: 8
--
Communicated by:
ProMED-mail <promed@promedmail.org>
******
[5] Canada - Health Protection Agency
Date: 30 Apr 2009
Source: Health Protection Agency [edited]
<http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/surveillance-eng.php>
The Public Health Agency is committed to sharing information about
the human swine influenza cases with Canadians. This page will be
updated as PHAC receives confirmation of human swine influenza cases
from provinces and territories.
Province: Confirmed cases of human swine influenza
Alberta: 6
British Columbia: 11
Nova Scotia: 8
Quebec: 1
Ontario: 8
Total: 34
--
Communicated by:
ProMED-mail <promed@promedmail.org>
******
[6] Newly confirmed countries with cases
a. Netherlands
Date: 30 Apr 2009
From: R.A.M. Fouchier <r.fouchier@erasmusmc.nl>
Mexican influenza virus detected in the Netherlands on [Wed 29 Apr 2009]
------------------------
The National Influenza Centre (NIC) of the Netherlands, a cooperation
between the National Institute for Public Health and the Environment
(RIVM) in Bilthoven and Erasmus MC in Rotterdam, detected the 1st
case of infection with the Mexican influenza virus in the Netherlands.
The patient is a 3-year-old child that traveled with the family from
Mexico to The Netherlands on [27 Apr 2009], arriving in Amsterdam
around midday. The child developed fever (greater than 39.5 C) the
same evening and respiratory symptoms. In compliance with national
advisories, the case was notified to public health authorities, and a
nasopharyngeal specimen was collected on [28 Apr 2009] for diagnostic
testing.
The clinical specimen arrived for testing on [29 Apr 2009] and was
found positive for influenza A virus by real-time quantitative
reverse transcription polymerase chain reaction (Q-RT-PCR) with
primers specific for the matrix gene. Q-RT-PCR tests performed in
parallel with primers specific for the hemagglutinin gene of human
A/H3N2 and A/H1N1 viruses were negative, but RT-PCR tests based on
avian/swine N1 and the novel influenza virus H1 tested positive.
Based on these results, contact tracing and oseltamivir treatment of
the case and contacts were initiated. Additional generic RT-PCR tests
with conserved primers against H1 and N1 were done, and sequence
analyses of the PCR fragments in both laboratories yielded nearly
full-length hemagglutinin (HA) and neuraminidase (NA) gene sequences.
The HA gene of A/Netherlands/602/2009 (H1N1) displayed one to a few
nucleotide differences as compared to sequences from human cases of
infection in Mexico and the USA. The NA gene displayed 3 or more
nucleotide differences to sequences from Mexico and the USA. The
sequence of the NA gene indicates that the virus is sensitive to
neuraminidase inhibitors. The sequences were deposited in the GISAID
database
(<http://platform.gisaid.org>).
Virus isolation in eggs and cell cultures, full genome sequencing,
and additional laboratory investigations are ongoing.
The patient is currently doing reasonably well, with only mild
symptoms. She is under treatment with oseltamivir. Close contacts of
the patient are on prophylactic oseltamivir, after being swabbed for
virological evaluation. The contacts in the flight (same row, and 2
rows in either direction) are being approached by the health
authorities and will be treated with antivirals and monitored if
needed.
For the National Institute for Public Health and the Environment,
Bilthoven: M. Koopmans, H. Ruijs, B. Wilbrink, A. Meijer, M. Jonges,
M. van der Lubben, J. van Steenbergen, R.A. Coutinho
For Erasmus MC, Rotterdam: R.A.M. Fouchier, C.A.B. Boucher, M.
Schutten, G.F. Rimmelzwaan, A.D.M.E. Osterhaus
--
R.A.M. Fouchier
<r.fouchier@erasmusmc.nl>
******
b. Germany - 1st human to human transmission
Date: 30 Apr 2009
Source: Bavarian Press release (URL not available) [edited]
Press release from Bavarian health institute (data from 30 Apr 2009
11:00 GMT+2):
-----------------------------------
There are an actual 5 probable cases in addition to the 2 confirmed
cases of influenza A/H1N1 in Bavaria, according to the Bavarian
health institute. These cases fulfill the clinical picture and had
contact with infected persons or have been tested positive, but the
test has not been confirmed by a national reference center (RKI).
Statement from the local Rural District Office of Landshut (from 30
Apr 2009): Two of these suspected cases were infected during stay in
the regional hospital in Mallersdorf (ICU) with the confirmed case,
who is now being treated in the university clinic of Regensburg, and
before the case was isolated. One is a patient who shared the room
with the confirmed case in the ICU of the regional hospital, and the
2nd patient is a nurse. Both are not severely ill and are staying at
home but show the typical clinical symptoms of influenza. They are
receiving Tamiflu and are being treated in a daycare setting.
--
Communicated by:
Dr. Oliver Schmetzer
Max-Delbruck-Centrum for molecular medicine
Molecular Immunotherapy
Robert-Roessle-Str. 10
13125 Berlin
Germany
<oliver.schmetzer@gmx.net>
******
[7] News briefs
Date: 30 Apr 2009
[Below are links to newswires with information on suspected cases in
countries and other events of potential interest. The newswires are
full of reports of suspected cases in many countries. Reports have
been filtered and discarded as more information becomes available
during the day. - Mod.MPP]
Americas
Honduras - 1st case confirmed influenza type A, subclassification
pending. Specimens sent to CDC/Atlanta
<http://www.laprensahn.com/Especiales/Ediciones/2009/04/30/Noticias/Confirman-1er.-caso-de-influenza-tipo-A-en-Honduras>
Costa Rica - 2 cases confirmed
<http://insidecostarica.com/dailynews/2009/april/30/nac01.htm>
Europe
Scotland - probable case, contact of cases returning from Mexico
(local human to human transmission)
<http://www.guardian.co.uk/world/2009/apr/30/swine-flu-case-probable-scotland>
Pacific
Japan - suspected case, travel to British Columbia, Canada
<http://home.kyodo.co.jp/modules/fstStory/index.php?storyid=436501>
--
Communicated by:
ProMED-mail Rapporteur A-lan Banks
ProMED-mail Rapporteur Kunihiko Iizuka
[To summarize the current situation as of 30 Apr 2009, there have
been a total of 257 cases of influenza A (H1N1) infection officially
reported coming from 11 countries. The USA has reported 109,
laboratory confirmed cases coming from 11 states, and one death in a
Mexican child visiting in the USA. This represents an increase of 18
newly confirmed cases in the past 24 hours and a new state reporting
cases (South Carolina). Canada has reported 34 cases from 5 provinces
with no deaths, representing an increase of 15 newly confirmed cases
and a new province reporting cases (Quebec) in the past 24 hours.
Mexico has reported 1918 suspected cases of severe pneumonia related
to H1N1, 286 cases of probable influenza A(H1N1) infection and 99
confirmed influenza A(H1N1) cases, with 84 suspected deaths and 8
confirmed deaths. The major increase in confirmed cases in Mexico in
the past 24 hours represents laboratory result availability and not a
major increase in the reported number of new cases.
There are reports of spread to contacts of cases in Germany and
Scotland. With the exception of Mexico, there does not appear to be
significant community based spread elsewhere as yet. - Mod.MPP]
[see also:
Influenza A (H1N1) - worldwide 20090430.1636
Influenza A (H1N1) "swine flu": worldwide (07), update, pandemic 5
20090429.1622
Influenza A (H1N1) "swine flu": worldwide (06) 20090429.1614
Influenza A (H1N1) "swine flu": worldwide (05) 20090428.1609
Influenza A (H1N1) "swine flu": worldwide (04) 20090428.1601
Influenza A (H1N1) "swine flu": worldwide (03) 20090428.1600
Influenza A (H1N1) "swine flu": Worldwide (02) 20090427.1586
Influenza A (H1N1) "swine flu": Worldwide 20090427.1583
Influenza A (H1N1) virus, human: worldwide 20090426.1577
Influenza A (H1N1) virus, human - New Zealand, susp 20090426.1574
Influenza A (H1N1) virus, human - N America (04) 20090426.1569
Influenza A (H1N1) virus, human - N America (03) 20090426.1566
Influenza A (H1N1) virus, human - N America (02) 20090425.1557
Influenza A (H1N1) virus, human - N America 20090425.1552
Acute respiratory disease - Mexico, swine virus susp 20090424.1546
Influenza A (H1N1) virus, swine, human - USA (02): (CA, TX) 20090424.1541
Influenza A (H1N1) virus, swine, human - USA: (CA) 20090422.1516
Influenza A (H1N1) virus, swine, human - Spain 20090220.0715
2008
----
Influenza A (H1N1) virus, swine, human - USA (TX) 20081125.3715
2007
----
Influenza A (H2N3) virus, swine - USA 20071219.4079
Influenza, swine, human - USA (IA): November 2006 20070108.0077]
...................................................mpp/msp/lm
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