Health Professionals

Clinical Updates

1 May 2009

Swine influenza in humans: Update 4.

Current status of the outbreak

Cases of human swine influenza A (H1N1) are being identified in countries throughout the world. The WHO does not consider it feasible to contain the outbreak, and has focused on mitigation of the consequences of the outbreak. They do not recommend closure of borders. The current pandemic influenza alert level remains at level 5, indicating that there is human-to-human transmission of swine influenza occurring in at least two countries of a WHO region, in this case, North America [1, 2].

Countries reporting laboratory-confirmed cases are listed in the table below. In addition, there are many persons worldwide with an influenza-like illness (ILI) who are being evaluated.

Country*

Date of Last Report

Confirmed Cases

Deaths

Austria [3]

29 April 2009

1

0

Canada [4]

30 April 2009

34

0

Germany [5]

1 May 2009

4

0

Israel [3]

28 April 2009

2

0

Mexico [6]

30 April 2009

312

12

Netherlands [3]

30 April 2009

1

0

New Zealand [7]**

1 May 2009

4

0

Spain [8]

1 May 2009

13

0

Switzerland [9]

1 May 2009

1

0

United Kingdom [10]

30 April 2009

8

0

United States [11]

30 April 2009

109

1

* Costa Rica and Peru were listed on 30 April 2009 as having confirmed cases, but these are now being investigated further.

** an additional 12 cases have tested positive for influenza A and have had close contact with a confirmed case.

Advice for travellers

The Foreign and Commonwealth Office advises against all non-essential travel to Mexico. There are no other travel restrictions at present, and the WHO has recommended not closing international borders.

Travellers should consider the necessity of going to swine influenza affected areas, the risk of acquiring swine influenza at the destination, and the level of medical care including access to anti-viral medications in the event of an ILI.

Influenza is transmitted via the respiratory route and travellers should exercise sensible precautions:

  • if you are ill with a respiratory illness you should delay travel
  • follow public health guidance at your destination
  • avoid crowding or mass gatherings
  • avoid close contact (within 2 meters) with persons who are ill with an ILI
  • wash hands with soap and water; use waterless alcohol-based hand gels when soap and water is not available
  • avoid touching your nose, mouth or eyes, to prevent the spread of germs
  • cover your nose and mouth with a tissue when you cough or sneeze and dispose of the tissue promptly
  • keep hard surfaces (e.g. door handles, countertops) clean using a normal cleaning solution
  • assure that children follow similar advice
  • swine influenza is not passed through properly handled and prepared pork; the virus is killed by cooking to temperatures of 70°C
  • there is little evidence of the effectiveness of wearing masks at a mass level, however, properly fitted special grade masks can be worn in situations such as healthcare settings
  • receive appropriate vaccines for your destination, including seasonal influenza vaccine if you come under the recommended risk groups (see NaTHNaC Health Information Sheet on Influenza)

Travellers who have visited affected areas should monitor their health for seven days after the visit. If you develop a febrile illness with cough, sore throat, headache or muscle aches, within seven days you should:

  • check your symptoms on NHS Direct (www.nhsdirect.nhs.uk) or NHS Choices (www.nhs.uk), and if you remain concerned, contact your GP or NHS Direct (0845 4647) and inform them of your travel history
  • limit contact with other people
  • cover your nose and mouth with a tissue when you cough or sneeze and dispose of the tissue promptly
  • wash hands with soap and water
  • keep hard surfaces (e.g. door handles, countertops) clean using a normal cleaning solution

There is guidance for health professionals who evaluate persons with suspected swine influenza on the Health Protection Agency website, listed below.

Further information is available at the following sources:

Health Protection Agency, Swine Influenza: http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListN

ame/Page/1240732817665?p=1240732817665

Health Protection Agency: Algorithm for the management of returning travellers and visitors from countries affected by swine influenza A/H1N1. S5. 30 April 2009. Accessed 30 April 2009. Available at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/124073281

9361 

WHO, Influenza A (H1N1): http://www.who.int/csr/disease/swineflu/en/index.html

European Centre for Disease Prevention and Control: http://ecdc.europa.eu/

Centers for Disease Control and Prevention, H1N1 Flu (Swine flu): http://www.cdc.gov/h1n1flu/

NaTHNaC Country Information pages: http://www.nathnac.org/ds/map_world.aspx

NHS Choices: http://www.nhs.uk/Pages/HomePage.aspx  

References

1. Swine influenza. Statement by WHO Director-General, Dr. Margaret Chan. 29 April 2009. [Accessed 1 May 2009]. Available at: http://www.who.int/mediacentre/news/statements/2009/h1n1_2

0090429/en/index.html

2. World Health Organization. Current WHO phase of pandemic alert. 29 April 2009. [Accessed 1 May 2009]. Available at: http://www.who.int/csr/disease/avian_influenza/phase/en/index.

html

3. World Health Organizartion. Influenza A (H1N1) – update 7. 1 May 2009. [Accessed 1 May 2009]. Available at: http://www.who.int/csr/don/2009_05_01/en/index.html  

4. Health Canada. Cases of Human Swine Influenza in Canada. 30 April 2009. [Accessed 1 May 2009]. Available at:  http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/surveillance-eng.php

5. Robert Koch Institut. Situationseinschätzung zur Neuen Influenza. 1 May 2009. [Accessed 1 May 2009]. Available at: http://www.rki.de/cln_161/nn_200120/DE/Content/InfAZ/I/Influenz

a/IPV/Schweineinfluenza__Situation.html

6. Secretaria de Salud, Mexico. Estadisticas. 30 April 2009. [Accessed 1 May 2009]. Available at:  http://portal.salud.gob.mx/contenidos/noticias/influenza/estadisti

cas.html

7. Ministry of Health, New Zealand. Mexican Swine Influenza, update 17. 1 May 2009. [Accessed 1 May 2009]. Available at: http://www.moh.govt.nz/moh.nsf/indexmh/influenza-a-h1n1-update-seventeen-010509

8. Ministrerio de Sanidad y Política Social, Spain.  Comunicado sobre el brote humano de gripe A/H1N1. 1 May 2009. [Accessed 1 May 2009]. Available at:

http://www.msc.es/gabinetePrensa/notaPrensa/desarrolloNota

Prensa.jsp?id=1485

9. Office Federal de la Sante, Switzerland. Nouveau virus Influenza A/H1N1. 1 May 2009. [Accessed 1 May 2009]. Available at: http://www.bag.admin.ch/influenza/06411/index.html?lang=fr

10. Health Protection Agency. Update on confirmed swine flu cases in England. 30 April 2009. [Accessed 1 May 2009]. Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb

_C/1240899135838

11. Centers for Disease Control and Prevention, US. H1N1 flu (swine flu). 30 April 2009. [Accessed 1 May 2009]. Available at: http://www.cdc.gov/h1n1flu/