News
1 October 2009
Pandemic (H1N1) 2009 influenza: Update 19: Current status of the pandemic
The World Health Organization (WHO) reports that as of 20 September, more than 300,000 confirmed cases of pandemic influenza (H1N1) 2009 have occurred, with 3,917 deaths from 191 countries and territories [1]. As most countries have stopped counting individual cases, this represents a significant underestimate of the actual number of cases.
Influenza-like illness (ILI) is increasing in many of the countries of the northern hemisphere, including the United States, Canada, the United Kingdom, Israel and Japan, as examples. Tropical countries in the Americas and Asia report variable activity; in South Asia pandemic influenza is active, whereas in some countries of South East Asia there is declining transmission. Mexico has experienced a third peak of infection during the month of September that exceeds the case numbers seen during the initial stages in April 2009 [2]. In temperate countries of the southern hemisphere, transmission has declined or returned to baseline.
Between 19 April and 12 September 2009, 61% of influenza viruses isolated worldwide were the pandemic (H1N1) 2009 strain and this continues to be the predominant virus isolated in most regions of the world [3]. Of the more than 10,000 clinical isolates of pandemic (H1N1) virus tested for drug resistance, only 28 have been found to be resistant to oseltamivir (not to zanamivir) [4]. Risk factors for resistance have been found to be prolonged treatment of illness in severely immunocompromised persons, and the use of drug for post-exposure prophylaxis.
Hajj travel
Hajj, the annual pilgrimage to Mecca, is scheduled to fall between the 25th and 29th of November 2009. The Hajj represents the largest gathering of Muslim pilgrims in the world. Guidance has been developed by the Ministry of Health of the Kingdom of Saudi Arabia for prevention of illness during the Hajj that includes recommendations for the prevention of influenza. These guidelines are summarised in the NaTHNaC health information sheet [5] and are:
- All Hajj pilgrims must receive vaccination against 2009-2010 seasonal influenza at least two weeks before applying for a visa. Proof of vaccination is required to obtain the visa, without exception.
- There will be screening of passengers on arrival at all ports into Saudi Arabia; if persons are suspected to have pandemic influenza, they will be temporarily quarantined and admitted to hospital for further testing.
Pilgrims should check the NaTHNaC website and that of the Foreign and Commonwealth Office for any changes or updates to these recommendations.
Vaccines
Pandemic (H1N1) 2009 influenza vaccines have been licensed by several regulatory authorities throughout the world [6, 7]. Countries are performing vaccine trials and completing plans for the rollout of vaccine. Concern has been raised about access to vaccine in low-income countries, and several high-income countries have made donations of pandemic vaccine that will be coordinated by WHO. Side effects from pandemic influenza vaccines are expected to be similar to those of seasonal influenza vaccines: local soreness at the injection site and occasional fever, headache, and muscle or joint aches.
Advice for travellers
Travellers need to be aware that some countries have put into place health screening of arriving passengers [8, 9]. Travellers should check with their tour operator, and they can also check the country pages of the Foreign and Commonwealth Office for specific information. Travellers should obtain travel insurance that covers trip cancellation and any potential disruptions to their trip, such as quarantine.
Those who are ill with an ILI (fever, cough, sore throat, runny nose, body aches, headache, chills and fatigue) should delay their travel, and seek medical advice. The Department of Health launched the National Pandemic Flu Service on 23 July 2009. Travellers can consult this service for guidance on managing an ILI, however, if they have serious underlying health conditions, are pregnant, or are calling about children under one year of age, they should contact their GP directly.
Further advice on the prevention of pandemic influenza during travel can be found on the NaTHNaC Health Information Sheet: Pandemic (H1N1) 2009 influenza: Advice for travellers.
Further information is available at the following sources:
NaTHNaC Country Information pages: http://www.nathnac.org/ds/map_world.aspx
NaTHNaC Outbreak Surveillance Database: http://www.nathnac.org/countrysearch.aspx
Centers for Disease Control and Prevention, 2009 H1N1 Flu (Swine flu): http://www.cdc.gov/h1n1flu/
European Centre for Disease Prevention and Control. Pandemic (H1N1) 2009: http://ecdc.europa.eu/en/healthtopics/Pages/Influenza_A
Foreign and Commonwealth Office. Swine flu pandemic: http://www.fco.gov.uk/en/travelling-and-living-overseas/swine-flu
Health Protection Agency, Swine Influenza (influenza A H1N1v): http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAuto
ListName/Page/1240732817665?p=1240732817665
National Pandemic Flu Service: http://www.direct.gov.uk/pandemicflu
NHS Choices: http://www.nhs.uk/Pages/HomePage.aspx
WHO, Pandemic (H1N1) 2009: http://www.who.int/csr/disease/swineflu/en/index.html
References
1. World Health Organization. Pandemic (H1N1) 2009 - update 67. 25 September 2009. [Accessed 30 September 2009]. Available at: http://www.who.int/csr/don/2009_09_25/en/index.html
2. Secretaría de Salud. Situación actual de la epidemica. 29 September 2009. [Accessed 30 September 2009]. Available at: http://portal.salud.gob.mx/
3. World Health Organization. Pandemic (H1N1) 2009 – update 67. Weekly update (Virological surveillance data). 25 September 2009. [Accessed 30 September 2009]. Available at: http://www.who.int/csr/disease/swineflu/laboratorysurveillance
4. World Health Organization. Antiviral use and the risk of drug resistance. Pandemic (H1N1) 2009 briefing note 12. 25 September 2009. [Accessed 30 September 2009]. Available at: http://www.who.int/csr/disease/swineflu/notes/h1n1_antiviral_
5. National Travel Health Network and Centre. Advice for pilgrims for the Hajj and Umrah season of 1430 (2009). September 2009. Available at: http://www.nathnac.org/pro/factsheets/Hajj_Umrah.htm
6. World Health Organization. Pandemic influenza vaccine: current status. Pandemic (H1N1) 2009 briefing note 11. 24 September 2009. [Accessed 30 September 2009]. Available at: http://www.who.int/csr/disease/swineflu/notes/pandemic_
influenza_vaccines_20090924/en/index.html
7. European Centre for Disease Control and Prevention. ECDC Interim Guidance. Use of specific pandemic influenza vaccines during the H1N1 2009 pandemic. August 2009. [Accessed 30 Septemebr 2009]. Available at: http://ecdc.europa.eu/en/publications/Publications/Forms/
8. Centers for Disease Control and Prevention. Possible novel H1N1 flu screening for international travellers. 14 July 2009. [Accessed 30 September 2009]. Available at: http://wwwn.cdc.gov/travel/content/news-announcements/delays-H1N1-screening.aspx
9. NaTHNaC. Pandemic (H1N1) 2009 influenza: Update 16: Potential health screening of international travellers. 20 July 2009. Available at: http://www.nathnac.org/pro/clinical_updates/flu_200709.htm
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