Health Professionals

Clinical Updates

30 April 2009

Swine influenza in humans: Update 3. WHO upgrading of pandemic influenza alert to level 5.

The World Health Organization has reviewed the epidemiologic data from countries most affected by human swine influenza A (H1N1) and has  concluded that there are sustained community level outbreaks with human to human spread, in two or more countries within a WHO region [1]. This finding triggers the upgrading of the pandemic influenza alert from level 4 to level 5 [1, 2]. This is a strong signal that a pandemic can occur and that countries should activate their pandemic preparedness plans.

Current status of the outbreak

Cases of human swine influenza A (H1N1) continue to be identified in countries throughout the world. The WHO does not consider containment of the outbreak as a feasible goal, and has focused on mitigation of the consequences of the outbreak [3]. They do not recommend closure of borders.

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

Country

Date of Last Report

Confirmed Cases

Deaths

Austria [4]

29 April 2009

1

0

Canada [5]

29 April 2009

19

0

Costa Rica [6]

30 April 2009

2

0

Germany [4]

29 April 2009

3

0

Israel [4]

28 April 2009

2

0

Mexico [7]*

29 April 2009

99

8

Netherlands [8]

30 April 2009

1

0

New Zealand [9]**

30 April 2009

3

0

Peru [6]

30 April 2009

1

0

Spain [10]

30 April 2009

10

0

United Kingdom [11]

29 April 2009

5

0

United States [4]

29 April 2009

91

1

* there are 1,918 suspect and 286 probable cases being investigated

** a further 13 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:

  • it is prudent that if you are ill with a respiratory illness to 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 and muscle aches, 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

Further information is available at the following sources:

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

Name/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, Swine Influenza: 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, Swine Influenza (flu): http://www.cdc.gov/swineflu/

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 30 April 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 30 April 2009. Available at: http://www.who.int/csr/disease/avian_influenza/phase/en/index.h

tml

3. World Health Organization. Swine influenza. 27 April 2009. [Accessed 30 April 2009]. Available at: http://www.who.int/mediacentre/news/statements/2009/h1n1_2

0090427/en/index.html

4. NaTHNaC. Swine influenza in humans: Update 2. 29 April 2009. [Accessed 30 April 2009]. Available at: http://www.nathnac.org/pro/clinical_updates/flu_290409.htm

5. Health Canada. Cases of Human Swine Influenza in Canada. 29 April 2009. [Accessed 30 April 2009]. Available at:  http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/surveillance-eng.php

6. European Centre for Disease Prevention and Control. Infections of novel influenza virus  A (H1N1). 30 April 2009. [Accessed 30 April 2009]. Available at: http://www.ecdc.europa.eu/en/files/pdf/Health_topics/Situation_

Report_300409-0830-Final.pdf  

7. Secretaria de Salud, Mexico. Estadisticas. 29 April 2009. [Accessed 30 April 2009]. Available at:  http://portal.salud.gob.mx/contenidos/noticias/influenza/estadisti

cas.html

8. Ministerie van Volksgezondheir, Welzijn en Sport, Netherlands. Eerste besmetting Mexicaanse griep. 30 April 2009. [Accessed 30 April 2009]. Available at: http://www.minvws.nl/nieuwsberichten/pg/2009/eerste-besmetting.asp

9. Ministry of Health, New Zealand. Mexican Swine Influenza, update 14. 30 April 2009. [Accessed 30 April 2009]. Available at: http://www.moh.govt.nz/moh.nsf/indexmh/mexican-swine-influenza-update-fourteen-300409?Open

10. Ministrerio de Sanidad y Política Social, Spain.  Comunicado sobre el brote humano de nueva gripe. 30 April 2009. [Accessed 30 April 2009]. Available at:

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

Prensa.jsp?id=1478

11. Health Protection Agency. Swine flu cases confirmed in England. 29 April 2009. [Accessed 30 April 2009]. Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb

_C/1240899135838