News
28 July 2009
Pandemic (H1N1) 2009 influenza: Update 17: Current status of the pandemic
Pandemic influenza has now affected more than 150 countries. The World Health Organization is no longer updating the number of confirmed cases for each country, but summarises the progress of the pandemic on a regular basis [1]. However, the European Centre for Disease Prevention and Control (ECDC) has collated the number of confirmed cases, where available [2]. The number of confirmed cases underestimates the actual number of cases. Countries that have reported more than 1,000 cases are listed in the table.
Argentina |
Australia |
Brazil |
Canada |
Chile |
China (mainland) |
Germany |
Hong Kong SAR China |
Israel |
Japan |
Malaysia |
Mexico |
New Zealand |
Peru |
Philippines |
Singapore |
South Korea |
Spain |
Taiwan |
Thailand |
United Kingdom |
United States |
Countries with widespread community transmission of pandemic influenza have generally shifted their efforts from individual case detection to reporting trends, often using existing influenza surveillance schemes [3, 4]. These procedures include observing for influenza-like illness (ILI) (fever, cough, sore throat, runny nose, body aches, headache, chills and fatigue) in the community, detecting clusters of severe or fatal disease, confirmation of hospitalisations and deaths from pneumonia and influenza, and monitoring virus for changes in type or drug resistance. A small number of oseltamivir (Tamiflu®)-resistant viruses have been detected, however, these findings have not changed policy toward the use of anti-viral treatment [5].
As the pandemic has progressed there is increasing information about the clinical spectrum of illness. For most persons pandemic influenza is a mild, self-limited respiratory illness with or without fever and occasional gastrointestinal symptoms such as vomiting or diarrhoea [6]. However, certain groups have more severe disease characterised by primary viral pneumonia that can progress to respiratory failure, multi-organ failure and death. Persons at risk for more severe disease are pregnant women, particularly in the second and third trimesters of pregnancy, persons with chronic respiratory disease including asthma, chronic heart or kidney disease, and immunosuppression. Extreme obesity has also been found to increase the risk of complications.
Most cases of pandemic influenza continue to occur in younger people with the median age reported to be 12 to 17 years, and age-specific notification rates are highest in the 10 to 19 year and 20 to 29 year age groups [7, 8]. However as disease spreads further in the community the average age is likely to increase [7]. Older persons are more likely to be admitted to hospital [6]. For example in California, US, the median age of all cases is 17 years, of hospitalised cases 26 years, and fatal cases 45 years [6].
WHO has made recommendations for pandemic influenza vaccine use, and human trials have been initiated [7, 9]. They have identified three objectives for countries to adopt: protecting the integrity of the healthcare system and critical infrastructure; reducing morbidity and mortality; and reducing transmission of virus within the community [9].
Advice for travellers
Travellers need to be aware that some countries have put into place health screening of arriving passengers [10, 11]. Travellers can check the country pages of the Foreign and Commonwealth Office for specific information, or the website of the International Air Transport Association. 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 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.
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.
The current pandemic alert level is at phase 6, indicating widespread global transmission. Consistent with this, the WHO do not recommend closure of borders, nor do they recommend international travel restrictions.
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, H1N1 Flu (Swine flu): http://www.cdc.gov/h1n1flu/
European Centre for Disease Prevention and Control: http://ecdc.europa.eu/
Foreign and Commonwealth Office. Swine flu outbreak: 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
International Air Transport Association. Influenza A(H1N1) - measures adopted by governments worldwide: http://www.iata.org/whatwedo/safety_security/safety/health_safe
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 59.
Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005). 27 July 2009. [Accessed 28 July 2009]. Available at: http://www.who.int/csr/don/2009_07_27/en/index.html
2. European Centre for Disease Prevention and Control. ECDC Situation Report. Pandemic influenza (H1N1) 2009. Update 27 July 2009. [accessed 28 July 2009]. Available at: http://ecdc.europa.eu/en/files/pdf/Health_topics/Situation_Repor
3. World Health Organization. Pandemic (H1N1) 2009 briefing note 3 (revised). Changes in reporting requirements for pandemic (H1N1) 2009 virus infection. 16 July 2009. [Accessed 28 July 2009]. Available at: http://www.who.int/csr/disease/swineflu/notes/h1n1_surveillanc
4. Centers for Disease Control and Prevention. H1N1 monitoring. Questions and answers. [Accessed 28 July 2009]. Available at: http://www.cdc.gov/h1n1flu/reportingqa.htm
5. World Health Organization. Virtual press conference with Dr. Keith Fukuda. 7 July 2009. [Accessed 28 July 2009]. Available at: http://www.who.int/mediacentre/multimedia/swineflupressbriefin
6. World Health Organization. Human infection with pandemic A (H1N1) 2009 influenza virus: clinical observations in hospitalised patients, Americas, July 2009 – update. Wkly Epidemiol Rec. 84:305-8, 2009. Available at: http://www.who.int/wer/2009/wer8430/en/index.html
7. World Health Organization. Pandemic (H1N1) 2009 briefing note 4. Preliminary information important for understanding the evolving situation. 24 July 2009. [Accessed 28 July 2009]. Available at: http://www.who.int/csr/disease/swineflu/notes/h1n1_situation_2
8. European Centre for Disease Prevention and Control. Pandemic (H1N1) 2009: Analysis of individual case reports in EU and EEA countries. 24 July 2009. [Accessed 28 July 2009]. Available at: http://www.ecdc.europa.eu/en/files/pdf/Health_topics/090724_In
fluenza_A(H1N1)_Analysis_of_individual_data_EU_EEA-EFTA.pdf
9. World Health Organization. Strategic Advisory Group of Experts of Immunization – report of the extraordinary meeting on the influenza A (H1N1) 2009 pandemic, 7 July 2009. Wkly Epidemiol Rec. 84: 301-4, 2009. Available at: http://www.who.int/wer/2009/wer8430/en/index.html
10. Centers for Disease Control and Prevention. Possible novel H1N1 flu screening for international travellers. 14 July 2009. [Accessed 28 July 2009]. Available at: http://wwwn.cdc.gov/travel/content/news-announcements/delays-H1N1-screening.aspx
11. NaTHNaC. Pandemic (H1N1) 2009 influenza: Update 16: Potential health screening of international travellers. 20 July 2009. [Accessed 28 July 2009]. Available at: http://www.nathnac.org/travel/news/flu_200709.htm
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