Announcement

Collapse
No announcement yet.

Archive. ECDC: Pandemic Influenza H1N1 2009, Situation Updates (August 4 - December 31, 2009)

Collapse
This is a sticky topic.
X
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • 2009 pandemic influenza A (H1N1) – December 22, 2009 Update (ECDC, edited)

    2009 pandemic influenza A (H1N1) – December 22, 2009 Update (ECDC, edited)

    [Source Full PDF Document: LINK. EDITED.]
    ECDC DAILY UPDATE

    2009 pandemic influenza A (H1N1) – December 22, 2009 Update

    Main developments in the past

    This report is based on official information provided by national public health websites or through other of communication channels. Reported number of confirmed and intensive care, by country, as of 22 December on the number of confirmed fatal cases for the world and Europe is presented in Table 2.
    (…)

    The ECDC has re-designed its 2009 influenza A (H1N1) pandemic webpage.
    The new design takes into account user feedback and has been implemented to facilitate easier navigation of the page and smooth access to the news, surveillance, guidance and scientific advice –documents that the ECDC produces to help the member states and the international community to deal with the pandemic. It also features direct links to current articles on the pandemic in Eurosurveillance.
    Access to the pandemic webpage is through the same main webpage banner link as before and can be easily found from the ECDC main page: LINK
    For more information go directly to the new webpage: LINK

    Updates from US and Canada
    From U.S. Centers for Disease Control and Prevention (CDC) weekly influenza surveillance report:
    • During the week of December 6-12, 2009, influenza activity decreased over the previous week across all key indicators.
    • Most indicators, however, remain higher than normal for this time of year.
    • Visits to doctors for influenza-like illness (ILI) nationally decreased slightly this week over last week. This is the seventh consecutive week of national decreases in ILI after four consecutive weeks of sharp increases.
    • While ILI has declined, visits to doctors for influenza-like illness remain slightly elevated nationally.
    • Influenza hospitalizations and hospitalization rates decreased in all age groups.
    • The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report decreased over the previous week, but remains elevated for this time of year.
    • This proportion has been higher than expected for eleven consecutive weeks.
    • In addition, 9 flu-related pediatric deaths were reported this week: 8 of these deaths were associated with laboratory confirmed 2009 H1N1, and one was associated with an influenza A virus that was not subtyped.
    • Since April 2009, CDC has received reports of 276 laboratory-confirmed pediatric deaths: 232 due to 2009 H1N1, 42 pediatric deaths that were laboratory confirmed as influenza, but the flu virus subtype was not determined, and two pediatric deaths that were associated with seasonal influenza viruses.
    • Laboratory-confirmed deaths are thought to represent an undercount of the actual number. CDC has provided estimates about the number of 2009 H1N1 cases and related hospitalizations and deaths (see ECDC Daily update 15th December, 2009 and CDC at LINK).
    • 391 (6.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
    • Over 99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
    • The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold for the eleventh consecutive week.
    • Nine influenza-associated pediatric deaths were reported. Eight of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype was undetermined.
    • The proportion of outpatient visits for influenza-like illness (ILI) was 2.6% which is above the national baseline of 2.3%. Five of the 10 regions reported ILI at or above region-specific baseline levels. Regions 3, 6, 7, 8 and 10 reported ILI below their region specific baselines.
    • Eleven states reported geographically widespread influenza activity, 20 states reported regional influenza activity, the District of Columbia, Puerto Rico, and 11 states reported local influenza activity, the U.S. Virgin Islands and eight states reported sporadic influenza activity, and Guam reported no influenza activity.
    • For more information:
      • U.S. Centers for Disease Control and Prevention “What's New on the H1N1 Flu Site”: LINK
      • U.S. Centers for Disease Control and Prevention Weekly Influenza Surveillance Report: LINK
      • Overview of Influenza Surveillance in the United States: LINK


    From the Public Health Agency of Canada:
    • On week 49 (December 6-12, 2009), the overall influenza activity continued to decline for the fourth consecutive week in Canada.
    • The ILI consultation rate was below the expected range for this time of the year and only 6.6% of the specimens tested were positive for influenza. The Pandemic (H1N1) 2009 strain still accounted for nearly 100% of the positive influenza A subtyped specimens this week.
    • The number of hospitalized cases (159 vs. 307), ICU admissions (40 vs. 83) and deaths (21 vs. 33) reported this week are about half of those reported last week. Among reporting provinces and territories (PTs) this week, hospitalized cases occurred in only six provinces (BC, AB, SK, ON, QC & NS). Deaths reported this week were also from the same five provinces except MB (BC, AB, SK, MB, ON & QC).
    • From August 30 to December 12, 2009, a total of 6,779 hospitalized cases including 1,081 (15.9%) cases admitted to an intensive care unit (ICU) as well as 313 (4.6%) deaths had been reported.
    • For more information:
      • Public Health Agency of Canada: LINK
      • Public Health Agency of Canada FluWatch: LINK


    Epidemiologic update
    All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 1 671 deaths have been reported since April 2009 (Table 2). Since week 41 the numbers of deaths each has shown a steady increase almost doubling every fortnight over the last six weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. The reported cumulative fatal pandemic (H1N1) cases in the world have now passed 10 000 cases (Table 2). However, because of lack of laboratory confirmation and underreporting among other factors, this is likely to be a gross underestimation of the true number of fatalities associated with the pandemic. Available updates on hospital admissions, per Member State, can be found in Table 1.

    Table 1. Reported number of confirmed 2009 pandemic influenza A(H1N1) cases admitted to hospitals and intensive care, by country, as of 22 December 2009, 9.00 CEST in EU and EFTA countries.
    [Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]
    1. Austria (17.12.) - 172 – … – … – …
    2. Belgium (17.12.) – … – … – … – …
    3. Bulgaria (13.12) – … – … – … – …
    4. Cyprus(23.11) – … – … – … – 6
    5. Czech Republic (16.12.) – … – … – … – …
    6. Denmark (16.12.) – … – … – … – …
    7. Estonia (16.12.) – … – … – … – …
    8. Finland (18.12.) - 9 – … - 3 – …
    9. France (21.12.) – … – … – 221 – 918
    10. Germany (11.12.) – … – … – … – …
    11. Greece (16.12.) – … – … – … – …
    12. Hungary (13.12.) – … – … – … – …
    13. Iceland (10.12.) – 3 – 180 – 1 – 20
    14. Ireland (16.12.) – 152 – 1015 – 9 – 84
    15. Italy (18.12.) – … - 832 – … – 448
    16. Latvia (17.12.) – … – … – … – …
    17. Liechtenstein (17.12.) – … – … – … – …
    18. Lithuania (21.12.) – … – … – … – …
    19. Luxembourg (16.11.) – … – … – 0 – 0
    20. Malta (04.09.) – … - 46 – … – 1
    21. Netherlands (18.12.) – 50 – 2124 – 4 – 203
    22. Norway (14.12.) – 14 – 1298 – 5 – 170
    23. Poland (15.12.) – … – … – … – …
    24. Portugal (13.12.) - 133 – … - 25 – …
    25. Romania (21.12.) – … – … – … – …
    26. Slovakia (02.12.) – 38 – 81 – 8 – 31
    27. Slovenia (17.12.) - 76 – … – … – …
    28. Spain (17.12.) – … – … – … – …
    29. Sweden (17.12.) – 18 - 1169 – … – …
    30. Switzerland (17.12.) – 23 - 345 – … – 66
    31. United Kingdom* (17.12.) - 523 – … - 113 – …

    Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
    (…) denotes no information readily available in official sources.
    * Data includes information for England only. Other cumulative hospitalisations are: Scotland (1423), Wales (433) and Northern Ireland (573).

    Table 2. Reported number of new and cumulative confirmed fatal 2009 pandemic influenza A(H1N1) cases in EU and EFTA countries, as 22 December 2009, 9.00 CEST, and in the rest of the world by country, as of 21 December 2009, 16.00 CEST.
    [Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]
    • EU and EFTA countries
      • Austria … – 3
      • Belgium … – 17
      • Bulgaria … – 35
      • Cyprus … – 3
      • Czech Republic … – 38
      • Denmark … – 21
      • Estonia … – 7
      • Finland … – 36
      • France 4 – 200*
      • Germany … – 119
      • Greece … – 51
      • Hungary … – 36
      • Iceland … – 2
      • Ireland … – 22
      • Italy … – 178
      • Latvia 7 – 24
      • Lithuania … – 14
      • Luxembourg … – 2
      • Malta … – 3
      • Netherlands … – 51
      • Norway … – 29
      • Poland … – 97
      • Portugal 6 – 52
      • Romania 2 – 34
      • Slovakia … – 25
      • Slovenia … – 13
      • Spain … – 232
      • Sweden … – 20
      • Switzerland … – 9
      • United Kingdom … – 298
        • Total 19 – 1671
    • Other European countries and central Asia
      • Albania … – 5
      • Armenia … – 2
      • Belarus … – 20
      • Bosnia and Herzegovina … – 7
      • Croatia … – 22
      • Former Yugoslav Republic of Macedonia … – 14
      • Georgia 1 – 6
      • Kosovo … – 10
      • Moldova 1 – 17
      • Montenegro … – 2
      • Russia … – 19
      • Serbia 3 – 41
      • Ukraine … – 202
        • Total 5 – 367
    • Mediterranean and Middle-East
      • Algeria … – 32
      • Bahrain … – 7
      • Egypt 9 – 89
      • Iran … – 147
      • Iraq 3 – 40
      • Israel … – 69
      • Jordan … – 16
      • Kuwait … – 27
      • Lebanon … – 3
      • Libya … - 1
      • Morocco … – 33
      • Occupied Palestinian Territory … – 17
      • Oman … – 30
      • Qatar … – 8
      • Saudi Arabia … – 97
      • Syria … – 103
      • Tunisia … – 9
      • Turkey … – 415
      • United Arab Emirates … – 6
      • Yemen … – 25
        • Total 12 – 1174
    • Africa
      • Ghana … – 1
      • Madagascar … – 3
      • Mauritius … – 8
      • Mozambique … – 2
      • Namibia … – 1
      • Sao Tome & Principe … – 2
      • South Africa 1 – 93
      • Sudan … – 1
      • Tanzania … – 1
        • Total 1 – 112
    • North America
      • Canada … – 397
      • Mexico … – 780
      • USA … – 2038
        • Total … – 3215
    • Central America and Caribbean
      • Bahamas … – 4
      • Barbados … – 3
      • Cayman Islands … – 1
      • Costa Rica … – 47
      • Cuba 9 – 41
      • Dominican Republic … – 23
      • El Salvador … – 31
      • Guatemala … – 18
      • Honduras … – 16
      • Jamaica … – 6
      • Nicaragua … – 11
      • Panama … – 11
      • Saint Kitts and Nevis … – 2
      • Saint Lucia … – 1
      • Suriname … – 2
      • Trinidad-Tobago … – 5
        • Total 9 – 222
    • South America
      • Argentina … – 617
      • Bolivia … – 58
      • Brazil … – 1632
      • Chile … – 150
      • Colombia … – 190
      • Ecuador … – 96
      • Paraguay … – 52
      • Peru … – 203
      • Uruguay … – 33
      • Venezuela 1 – 117
        • Total 1 – 3148
    • North-East and South Asia
      • Afghanistan … – 17
      • Bangladesh … – 6
      • China (Mainland) … - 442
      • Hong Kong SAR China … – 45
      • India … – 777
      • Japan 34 – 107
      • Macao SAR China … – 2
      • Maldives … – 1
      • Mongolia … – 26
      • Pakistan … – 1
      • South Korea … – 132
      • Sri Lanka … – 23
      • Taiwan … – 35
        • Total 34 – 1614
    • South-East Asia
      • Brunei Darussalam … – 1
      • Cambodia … – 6
      • Indonesia … – 10
      • Laos Peoples Democratic Republic … – 1
      • Malaysia … – 77
      • Philippines … – 30
      • Singapore … – 19
      • Thailand … – 190
      • Vietnam … – 47
        • Total … – 381
    • Australia and Pacific
      • Australia … – 191
      • Cook Islands … – 1
      • Marshall Islands … – 1
      • New Zealand … – 20
      • Samoa … – 2
      • Solomon Islands … – 1
      • Tonga … – 1
        • Total … – 217
    • TOTAL 81 – 12121

    * Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in La Rιunion, 1 in Martinique, 2 in Mayotte, 5 in Guadeloupe and 168 in mainland France.
    (…)
    -
    ------

    Comment


    • 2009 influenza A (H1N1) pandemic 23 December 2009 9.00 CEST (ECDC, edited)

      2009 influenza A (H1N1) pandemic 23 December 2009 9.00 CEST (ECDC, edited)

      [Source Full PDF Document: LINK. EDITED.]
      ECDC DAILY UPDATE
      2009 influenza A (H1N1) pandemic 23 December 2009 9.00 CEST

      Main developments in the past 24 hours
      • Reminder of schedules for ECDC Daily Update and WISO for Holiday period;
      • WHO update: Pandemic (H1N1) 2009 briefing note 20
      • Swedish vaccination coverage estimated at 61 per cent, may exceed 70
      • European Medicines Agency report to be released on the 23rd of December
      • A total of 1 702 fatal cases in Europe and EFTA countries and 10 496 in the rest of the world have been …


      This report is based on official information provided by national public health websites or through other official communication channels. Reported number of confirmed 2009 pandemic influenza A (H1N1) cases admitted to hospitals and intensive care, by country, as of 23 December 2009, 9.00 CEST in EU and EFTA countries are in Table 1. An update on the number of confirmed fatal cases for the world and Europe is presented in Table 2.

      ECDC Holiday Period Schedule
      During the Holiday Period (24 December, 2009 to 3 January, 2010) and the following week (4-8 January, 2010), ECDC will follow a modified weekday publication schedule for the regular ECDC 2009 influenza A (H1N1) pandemic newsletters. No newsletters will be produced on the Friday 25th of December (Christmas Day) or Wednesday the 6th of January (Epiphany), which are ECDC and Public Holidays in Sweden. During the above mentioned period, the ECDC Daily Update will be published during the regular weekdays and on the 31st of December (New Years Eve), but released at 14:00 in the afternoon (2 pm) instead of the regular time of 9:00 in the morning. The ECDC Weekly Influenza Surveillance Overview (WISO) will be produced on Thursday the 24th of December. The next WISO is scheduled for Friday the 8th of January. An additional WISO may be produced on the 31st of December (New Years Eve). The New Years Eve WISO issue is produced only if major changes in the situation are detected.
      Please note:
      In contrast to what was announced on the 21st and 22nd of December, no WISO will be published on the 5th of January. The regular schedule for the ECDC 2009 influenza A (H1N1) pandemic newsletters will resume on Monday the 11th of January, 2010.

      WHO 2009 influenza A(H1N1) pandemic remains moderate but affects young
      WHO released the Pandemic (H1N1) 2009 briefing note 20 on the 22nd of December, 2009. In the note, WHO discusses the challenges relating to accurately assessing the epidemiology of the pandemic. Efforts to assess the severity of the H1N1 influenza pandemic sometimes compare numbers of confirmed deaths with those estimated for seasonal influenza, either nationally or worldwide. WHO continues to assess the impact of the influenza pandemic as moderate, and points out that younger age groups are affected more by the 2009 influenza A(H1N1) pandemic than usually is the case in seasonal influenza. This is also evident among the severe and fatal cases.
      For further information: LINK

      Swedish vaccination coverage estimated at 61 per cent
      The Swedish National Board of Health and Welfare estimates that 61 percent of the Swedish population have already been vaccinated against the 2009 pandemic influenza A(H1N1) virus. This is revealed in a report released on the 22nd of December. Of the 39 percent who have not yet been vaccinated, approximately one third respond that they will do so. This would give a vaccination coverage of approximately 70 percent.
      For furher information: LINK

      EMA (European Medicines Agency) report to be released on the 23rd of December
      EMA will publish its fourth pandemic pharmacovigilance weekly update later today on the agency webpage.
      For further information: LINK

      Epidemiologic update
      All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 1 702 deaths have been reported since April 2009 (Table 2). Since week 41 the numbers of deaths each has shown a steady increase almost doubling every fortnight over the last six weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. The reported cumulative fatal pandemic (H1N1) cases in the world have now passed 10 000 cases (Table 2). However, because of lack of laboratory confirmation and underreporting among other factors, this is likely to be a gross underestimation of the true number of fatalities associated with the pandemic. Available updates on hospital admissions, per Member State, can be found in Table 1.

      Table 1. Reported number of confirmed 2009 pandemic influenza A(H1N1) cases admitted to hospitals and intensive care, by country, as of 23 December 2009, 9.00 CEST in EU and EFTA countries.
      [Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]
      1. Austria (17.12.) - 172 – … – … – …
      2. Belgium (17.12.) – … – … – … – …
      3. Bulgaria (13.12) – … – … – … – …
      4. Cyprus(23.11) – … – … – … – 6
      5. Czech Republic (16.12.) – … – … – … – …
      6. Denmark (16.12.) – … – … – … – …
      7. Estonia (16.12.) – … – … – … – …
      8. Finland (22.12.) - 10 – … - 5 – …
      9. France (21.12.) – … – … – 221 – 918
      10. Germany (11.12.) – … – … – … – …
      11. Greece (16.12.) – … – … – … – …
      12. Hungary (13.12.) – … – … – … – …
      13. Iceland (10.12.) – 3 – 180 – 1 – 20
      14. Ireland (16.12.) – 152 – 1015 – 9 – 84
      15. Italy (22.12.) – … - 832 – … – 448
      16. Latvia (17.12.) – … – … – … – …
      17. Liechtenstein (17.12.) – … – … – … – …
      18. Lithuania (21.12.) – … – … – … – …
      19. Luxembourg (16.11.) – … – … – 0 – 0
      20. Malta (04.09.) – … - 46 – … – 1
      21. Netherlands (18.12.) – 50 – 2124 – 4 – 203
      22. Norway (14.12.) – 14 – 1298 – 5 – 170
      23. Poland (15.12.) – … – … – … – …
      24. Portugal (13.12.) - 133 – … - 25 – …
      25. Romania (21.12.) – … – … – … – …
      26. Slovakia (22.12.) – 51 – 260 – 18 – 94
      27. Slovenia (17.12.) - 76 – … – … – …
      28. Spain (17.12.) – … – … – … – …
      29. Sweden (17.12.) – 18 - 1169 – … – …
      30. Switzerland (17.12.) – 23 - 345 – … – 66
      31. United Kingdom* (17.12.) - 523 – … - 113 – …

      Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
      (…) denotes no information readily available in official sources.
      * Data includes information for England only. Other cumulative hospitalisations are: Scotland (1423), Wales (433) and Northern Ireland (573).

      Table 2. Reported number of new and cumulative confirmed fatal 2009 pandemic influenza A(H1N1) cases in EU and EFTA countries, as 23 December 2009, 9.00 CEST, and in the rest of the world by country, as of 22 December 2009, 16.00 CEST.
      [Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]
      • EU and EFTA countries
        • Austria … – 3
        • Belgium … – 17
        • Bulgaria … – 35
        • Cyprus … – 3
        • Czech Republic … – 38
        • Denmark 2 - 23
        • Estonia … – 7
        • Finland … – 36
        • France … - 200*
        • Germany … – 119
        • Greece … – 51
        • Hungary … – 36
        • Iceland … – 2
        • Ireland ... – 22
        • Italy 9 - 187
        • Latvia … – 24
        • Lithuania … – 14
        • Luxembourg … – 2
        • Malta … – 3
        • Netherlands … – 51
        • Norway … – 29
        • Poland 12 - 109
        • Portugal … – 52
        • Romania 3 – 37
        • Slovakia 5 - 30
        • Slovenia … – 13
        • Spain … – 232
        • Sweden … – 20
        • Switzerland … – 9
        • United Kingdom … – 298
          • Total 31 – 1702
      • Other European countries and central Asia
        • Albania 1 – 6
        • Armenia … – 2
        • Belarus … – 20
        • Bosnia and Herzegovina … – 7
        • Croatia … – 22
        • Former Yugoslav Republic of Macedonia … – 14
        • Georgia 1 - 7
        • Kosovo … – 10
        • Moldova … – 17
        • Montenegro … – 2
        • Russia … – 19
        • Serbia … – 41
        • Ukraine … – 202
          • Total 2 – 369
      • Mediterranean and Middle-East
        • Algeria 4 – 36
        • Bahrain … – 7
        • Egypt 4 - 93
        • Iran … – 147
        • Iraq … – 40
        • Israel 2 - 71
        • Jordan … – 16
        • Kuwait … – 27
        • Lebanon 2 - 5
        • Libya … - 1
        • Morocco 3 – 36
        • Occupied Palestinian Territory 5 – 22
        • Oman … – 30
        • Qatar … – 8
        • Saudi Arabia … – 97
        • Syria 7 – 110
        • Tunisia … – 9
        • Turkey … – 415
        • United Arab Emirates … – 6
        • Yemen … – 25
          • Total 27 - 1201
      • Africa
        • Ghana … – 1
        • Madagascar … – 3
        • Mauritius … – 8
        • Mozambique … – 2
        • Namibia … – 1
        • Sao Tome & Principe … – 2
        • South Africa … – 93
        • Sudan … – 1
        • Tanzania … – 1
          • Total … – 112
      • North America
        • Canada … – 397
        • Mexico … – 780
        • USA … – 2038
          • Total … – 3215
      • Central America and Caribbean
        • Bahamas … – 4
        • Barbados … – 3
        • Cayman Islands … – 1
        • Costa Rica … – 47
        • Cuba … – 41
        • Dominican Republic … – 23
        • El Salvador … – 31
        • Guatemala … – 18
        • Honduras … – 16
        • Jamaica … – 6
        • Nicaragua … – 11
        • Panama … – 11
        • Saint Kitts and Nevis … – 2
        • Saint Lucia … – 1
        • Suriname … – 2
        • Trinidad-Tobago … – 5
          • Total … – 222
      • South America
        • Argentina … – 617
        • Bolivia … – 58
        • Brazil … – 1632
        • Chile … – 150
        • Colombia … – 190
        • Ecuador … – 96
        • Paraguay … – 52
        • Peru … – 203
        • Uruguay … – 33
        • Venezuela 1 – 118
          • Total 1 – 3149
      • North-East and South Asia
        • Afghanistan … – 17
        • Bangladesh … – 6
        • China (Mainland) … - 442
        • Hong Kong SAR China 4 – 49
        • India 12 - 789
        • Japan … – 107
        • Macao SAR China … – 2
        • Maldives … – 1
        • Mongolia … – 26
        • Pakistan … – 1
        • South Korea … – 132
        • Sri Lanka … – 23
        • Taiwan … – 35
          • Total 16 - 1630
      • South-East Asia
        • Brunei Darussalam … – 1
        • Cambodia … – 6
        • Indonesia … – 10
        • Laos Peoples Democratic Republic … – 1
        • Malaysia … – 77
        • Philippines … – 30
        • Singapore … – 19
        • Thailand … – 190
        • Vietnam … – 47
          • Total … – 381
      • Australia and Pacific
        • Australia … – 191
        • Cook Islands … – 1
        • Marshall Islands … – 1
        • New Zealand … – 20
        • Samoa … – 2
        • Solomon Islands … – 1
        • Tonga … – 1
          • Total … – 217
      • TOTAL 77 – 12198

      * Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in La Rιunion, 1 in Martinique, 2 in Mayotte, 5 in Guadeloupe and 168 in mainland France.
      (…)
      -
      -------

      Comment


      • 2009 influenza A (H1N1) pandemic 28 December 2009 14.00 CEST (ECDC, edited)

        2009 influenza A (H1N1) pandemic 28 December 2009 14.00 CEST (ECDC, edited)

        [Source Full PDF Document: LINK. EDITED.]
        ECDC DAILY UPDATE
        2009 influenza A (H1N1) pandemic 28 December 2009 14.00 CEST

        Main developments in the past 5 days
        • Weekly Influenza Surveillance Overview published December 24th and covering Week 51 (Dec 14th to 20th) found that most reporting countries were observing declining trends with the most reported influenza activity being in South Eastern Europe
        • A total of 1 803 fatal cases in Europe and EFTA countries and 10 879 in the rest of the world have been reported up to date.
        • ECDC published a summary on the D222G/D222N mutations in the pandemic virus


        This report is based on official information provided by national public health websites or through other official communication channels. Reported number of confirmed 2009 pandemic influenza A (H1N1) cases admitted to hospitals and intensive care, by country, as of 28 December 2009, 14.00 CEST in EU and EFTA countries are in Table 1. An update on the number of confirmed fatal cases for the world and Europe is presented in Table 2.

        Epidemiologic update
        Officially Reported Deaths in the EU
        All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 1 803 deaths have been reported since April 2009 (Table 2) with 148 reported in Week 51. From week 41 to 51 the numbers of deaths each had shown a steady increase almost doubling every fortnight over six weeks. The fall in week 52 is to be expected as it represents official reports placed on national web-sites and a number of Member States have not been doing this in what was a holiday week. A similar phenomenon can be expected for the coming weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. The reported cumulative fatal pandemic (H1N1) cases in the world have now passed 10 000 cases (Table 2). However, because of lack of laboratory confirmation and underreporting among other factors, this is likely to be a gross underestimation of the true number of fatalities associated with the pandemic. Available updates on hospital admissions, per Member State, can be found in Table 1.

        Weekly Influenza Surveillance Overview December 14th to 20th
        The Weekly Influenza Surveillance Overview, which presents data from the European Influenza Surveillance Network (EISN), was published on December 24th, covering the period from December 14th to 20th. Due to the short week of reporting (Christmas week), epidemiological data were only obtainable from 20 countries
        According to the Sentinel surveillance of influenza-like illness (ILI)/acute respiratory illness (ARI), all countries reporting data to EISN experienced influenza activity that was is still widespread and continue to be above baseline levels since week 40/2009. Eighteen of the 20 reporting countries indicated a decreasing trend in consultations, out of which 14 countries reported a decline for the second consecutive week. One country and one part of the UK reported stable levels. Only one country (Bulgaria) reported an increasing trend in consultations for ILI/ARI.
        Bulgaria and Greece were the only countries to report high intensity of influenza indicating influenza activity now highest in the South East part of the EU.
        According to the Virological surveillance, sentinel physicians collected 969 respiratory specimens, of which 318 (33%) were positive for influenza virus. This proportion has now decreased for the fourth consecutive week. Of the 14 991 viruses detected by sentinel networks and subtyped since week 40/2009, 14 897 (99%) were the 2009 pandemic influenza virus.
        According to the Hospital surveillance of severe acute respiratory infection (SARI), 257 SARI cases were reported. Out of these, 29 (11%) were known to have required ICU admission, and one required ventilatory support. One in five SARI cases had no known underlying medical condition. Of 183 isolates subtyped during the week, 179 (98%) were the 2009 pandemic influenza virus.
        The full Weekly influenza surveillance overview from week 51 is available here: LINK

        ECDC Summary on Pandemic 2009 Virus Mutation 222G/D222N
        ECDC Summary on Pandemic 2009 Virus Mutation D222G/D222N published in its Public Health Developments Series - December 23rd
        Recently, several countries have reported finding mutations of the 2009 pandemic virus. One particular mutation has come to attention, especially following a formal notification by Norway through the International Health Regulations and Early Warning and Response System reporting mechanisms.(1) The particular change a substitutions in a specific codon of the Haemagglutinin (HA) gene and is called either D222G and D222N depending on the precise change. The variants have been especially found in a number of severe cases of pandemic influenza including deaths and it has been suggested that the variants could cause more efficient infection of deeper airways resulting in a more serious disease profile. No direct evidence for this exists and cases have also been found in mild infections. The D222G and D222N variants, and sometimes mixtures thereof have been described in viruses and sequences derived directly from clinical specimens of 2009 pandemic influenza A(H1N1) cases in at least 20 countries, including Brazil, China, France, Italy, Japan, Mexico, Norway, Spain, the Ukraine and the USA. These mutations are not new in this pandemic, they have been found in cased going back to April 2009.
        To date no connection between cases, suggestive of transmission, has been found and it seems that the appearance in various countries is more the result of routine sequencing rather than spread of the mutation.
        It is also unclear if the association with severe cases is coincidental or not, perhaps resulting from preferred sequencing of specimens and viruses from severe cases/deaths.
        After considering the current available virological, epidemiological and clinical findings and following discussions on an earlier draft with WHO and its European-based Collaborating Centre ECDC has come to a preliminary formulation namely that the G222D/N variants exist in a small proportion of sporadic severe, as well as mild cases of 2009 pandemic influenza A(H1N1) infection and that these represents natural variation of the virus with no special association with severity of the disease course.
        As such and while they do not transmit they should have a minimal impact on public health and pandemic response.
        Current data suggests that the cases involving variant viruses in different parts of the world are unrelated and the underlying mutation events probably occurred independently from each other in the infected individuals as a consequence of the natural variability of influenza viruses and their inability to correct random coding errors.
        However because of that inherent variability and ability to surprise the 2009 A(H1N1) will need on-going combined virological, epidemiological and clinical surveillance and study.(2)
        1. WHO Pandemic (H1N1) 2009 briefing note 17. LINK
        2. ECDC 2009 pandemic influenza A(H1N1) virus mutations reported to be associated with severe disease ECDC Public Health development December 23rd 2009

        Table 1. Reported number of confirmed 2009 pandemic influenza A(H1N1) cases admitted to hospitals and intensive care, by country, as of 28 December 2009, 14.00 CEST in EU and EFTA countries.
        [Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]
        1. Austria (17.12.) - 172 – … – … – …
        2. Belgium (17.12.) – … – … – … – …
        3. Bulgaria (13.12) – … – … – … – …
        4. Cyprus(23.11) – … – … – … – 6
        5. Czech Republic (23.12.) – … – … – … – …
        6. Denmark (16.12.) – … – … – … – …
        7. Estonia (23.12.) – … – … – … – …
        8. Finland (23.12.) - 11 – … - 3 – …
        9. France (22.12.) – … – … – 221 – 935
        10. Germany (22.12.) – … – … – … – …
        11. Greece (23.12.) – … – … – … – …
        12. Hungary (23.12.) – … – … – … – …
        13. Iceland (10.12.) – 3 – 180 – 1 – 20
        14. Ireland (23.12.) – 150 – 1027 – 10 – 87
        15. Italy (24.12.) – … - 832 – … – 452
        16. Latvia (17.12.) – … – … – … – …
        17. Liechtenstein (17.12.) – … – … – … – …
        18. Lithuania (21.12.) – … – … – … – …
        19. Luxembourg (16.11.) – … – … – 0 – 0
        20. Malta (04.09.) – … - 46 – … – 1
        21. Netherlands (18.12.) – 50 – 2124 – 4 – 203
        22. Norway (23.12.) – 5 – 1310 – 4 – 170
        23. Poland (22.12.) – … – … – … – …
        24. Portugal (23.12.) - 95 – … - 20 – …
        25. Romania (21.12.) – … – … – … – …
        26. Slovakia (22.12.) – 51 – 260 – 18 – 94
        27. Slovenia (17.12.) - 76 – … – … – …
        28. Spain (23.12.) – … – … – … – …
        29. Sweden (17.12.) – 18 - 1169 – … – …
        30. Switzerland (23.12.) – 11 - 389 – … – 72
        31. United Kingdom* (24.12.) - 454 – … - 103 – …

        Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
        (…) denotes no information readily available in official sources.
        * Data includes information for England only. Other cumulative hospitalisations are: Scotland (1439), Wales (437) and Northern Ireland (574).

        Table 2. Reported number of new and cumulative confirmed fatal 2009 pandemic influenza A(H1N1) cases in EU and EFTA countries, as 28 December 2009, 14.00 CEST, and in the rest of the world by country, as of 27 December 2009, 16.00 CEST.
        [Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]
        • EU and EFTA countries
          • Austria … – 3
          • Belgium … – 17
          • Bulgaria … – 35
          • Cyprus … – 3
          • Czech Republic 10 – 48
          • Denmark 2 – 25
          • Estonia 1 – 8
          • Finland … – 36
          • France … - 200*
          • Germany 13 – 132
          • Greece 8 – 59
          • Hungary 9 – 45
          • Iceland … – 2
          • Ireland … – 22
          • Italy 1 – 188
          • Latvia 3 – 27
          • Lithuania 1 – 15
          • Luxembourg 1 – 3
          • Malta … – 3
          • Netherlands … – 51
          • Norway … – 29
          • Poland 7 – 116
          • Portugal 5 – 57
          • Romania 12 – 49
          • Slovakia … – 30
          • Slovenia … – 13
          • Spain 24 – 256
          • Sweden 2 – 22
          • Switzerland … – 9
          • United Kingdom 2 – 300
            • Total 101 – 1803
        • Other European countries and central Asia
          • Albania … – 6
          • Armenia … – 2
          • Belarus … – 20
          • Bosnia and Herzegovina … – 7
          • Croatia 1 – 23
          • Former Yugoslav Republic of Macedonia … – 14
          • Georgia … – 7
          • Kosovo … – 10
          • Moldova 5 – 22
          • Montenegro 3 – 5
          • Russia … – 19
          • Serbia 6 – 47
          • Ukraine … – 202
            • Total 15 – 384
        • Mediterranean and Middle-East
          • Algeria 6 – 42
          • Bahrain … – 7
          • Egypt 16 – 109
          • Iran … – 147
          • Iraq … – 40
          • Israel … – 71
          • Jordan … – 16
          • Kuwait … – 27
          • Lebanon … – 5
          • Libya … - 1
          • Morocco … – 36
          • Occupied Palestinian Territory … – 22
          • Oman … – 30
          • Qatar … – 8
          • Saudi Arabia … – 97
          • Syria … – 110
          • Tunisia … – 9
          • Turkey … – 415
          • United Arab Emirates … – 6
          • Yemen … – 25
            • Total 22 – 1223
        • Africa
          • Ghana … – 1
          • Madagascar … – 3
          • Mauritius … – 8
          • Mozambique … – 2
          • Namibia … – 1
          • Sao Tome & Principe … – 2
          • South Africa … – 93
          • Sudan … – 1
          • Tanzania … – 1
            • Total … – 112
        • North America
          • Canada 4 – 401
          • Mexico 20 – 800
          • USA 122 – 2160
            • Total 146 – 3361
        • Central America and Caribbean
          • Bahamas … – 4
          • Barbados … – 3
          • Cayman Islands … – 1
          • Costa Rica … – 47
          • Cuba … – 41
          • Dominican Republic … – 23
          • El Salvador … – 31
          • Guatemala … – 18
          • Honduras … – 16
          • Jamaica … – 6
          • Nicaragua … – 11
          • Panama … – 11
          • Saint Kitts and Nevis … – 2
          • Saint Lucia … – 1
          • Suriname … – 2
          • Trinidad-Tobago … – 5
            • Total … – 222
        • South America
          • Argentina … – 617
          • Bolivia … – 58
          • Brazil … – 1632
          • Chile … – 150
          • Colombia 3 – 193
          • Ecuador … – 96
          • Paraguay … – 52
          • Peru 2 – 205
          • Uruguay … – 33
          • Venezuela 3 – 121
            • Total 8 – 3157
        • North-East and South Asia
          • Afghanistan … – 17
          • Bangladesh … – 6
          • China (Mainland) 67 - 509
          • Hong Kong SAR China 2 – 51
          • India 91 – 880
          • Japan … – 107
          • Macao SAR China … – 2
          • Maldives … – 1
          • Mongolia … – 26
          • Pakistan … – 1
          • South Korea 16 – 148
          • Sri Lanka 12 – 35
          • Taiwan … – 35
            • Total 188 – 1818
        • South-East Asia
          • Brunei Darussalam … – 1
          • Cambodia … – 6
          • Indonesia … – 10
          • Laos Peoples Democratic Republic … – 1
          • Malaysia … – 77
          • Philippines … – 30
          • Singapore … – 19
          • Thailand 1 – 191
          • Vietnam 3 – 50
            • Total 4 – 385
        • Australia and Pacific
          • Australia … – 191
          • Cook Islands … – 1
          • Marshall Islands … – 1
          • New Zealand … – 20
          • Samoa … – 2
          • Solomon Islands … – 1
          • Tonga … – 1
            • Total … – 217
        • TOTAL 484 – 12682

        * Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in La Rιunion, 1 in Martinique, 2 in Mayotte, 5 in Guadeloupe and 168 in mainland France.
        (…)
        -
        -------

        Comment


        • 2009 influenza A (H1N1) pandemic 29 December 2009 14.00 CEST (ECDC, edited)

          2009 influenza A (H1N1) pandemic 29 December 2009 14.00 CEST (ECDC, edited)

          [Source Full PDF Document: LINK. EDITED.]
          ECDC DAILY UPDATE
          2009 influenza A (H1N1) pandemic 29 December 2009 14.00 CEST

          Main developments in the past 24 hours
          • United States reports for the week 50 a continued decrease of influenza activity. Also visits to doctors for influenza-like illness, flu-associated hospitalizations, and flu-associated deaths all declined from the previous week. In week fifty there have been 9 deaths in children attributed to influenza bringing the total to 221 since late august
          • The seventh Harvard pandemic survey has found that immunisation uptake in the United States has increased substantially recently, especially in children among whom it is estimated that 38% have now been immunised. Just over half of Adults state they do not intend to be immunised and 35% of parents stated they did not intend to have their children immunised.
          • A total of 1 832 fatal cases in Europe and EFTA countries and 10 944 in the rest of the world have been reported up to date.


          This report is based on official information provided by national public health websites or through other official communication channels. Reported number of confirmed 2009 pandemic influenza A (H1N1) cases admitted to hospitals and intensive care, by country, as of 29 December 2009, 14.00 CEST in EU and EFTA countries are in Table 1. An update on the number of confirmed fatal cases for the world and Europe is presented in Table 2.

          Epidemiologic update
          Officially Reported Deaths in the EU
          All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 1 832 deaths have been reported since April 2009 (Table 2). From week 41 to 51 the numbers of deaths had shown a steady increase almost doubling every fortnight over six weeks. The fall observed in week 52 was to be expected as it represents official reports placed on national web-sites and a number of Member States have not been doing this in what was a holiday week. A similar phenomenon can be expected for the coming week. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe.
          The reported cumulative fatal pandemic (H1N1) cases in the world have now passed 10 000 cases (Table 2). However, because of lack of laboratory confirmation and underreporting among other factors, this is recognised to be a gross underestimation of the true number of fatalities associated with the pandemic. Available updates on hospital admissions, per Member State, can be found in Table 1.

          Updates from the United States
          Routine weekly report from U.S. Centers for Disease Control and Prevention (CDC) weekly influenza surveillance report (FluView):
          During the week 50 (December 13-19), 2009, influenza activity in the United States continued to decrease over the previous week across all key indicators. This is the eighth consecutive week of national decreases in ILI after five consecutive weeks of sharp increases. Visits to doctors for influenza-like illness, flu-associated hospitalizations, and fluassociated deaths all declined from the previous week.
          Other key features are:
          • 306 (6.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza. Of these o all subtyped influenza A viruses being 2009 influenza A(H1N1) viruses (there were no A(H3) or seasonal A(H1) viruses o 3 viruses (1%) were influenza type B.
          • The proportion of deaths attributed to pneumonia and influenza (P&I) has declined to be below the epidemic threshold having been above that level since September.
          • Nine influenza-associated paediatric deaths were reported. Eight of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype was undetermined. Since late August there have been 221 deaths in children due to influenza.
          • The proportion of outpatient visits for influenza-like illness (ILI) was 2.3% which is at the national baseline of 2.3% and seven of the 10 US regions reported ILI below region-specific baseline levels.
          • However as before the state by state picture is more heterogeneous. Seven states (Alabama, California, Delaware, Maine, Nevada, New Jersey, and Virginia) reported geographically widespread influenza activity, 18 states reported regional influenza activity, the District of Columbia, Puerto Rico, and 13 states reported local influenza activity, the U.S. Virgin Islands and 11 states reported only sporadic influenza activity, Guam and one state reported no influenza activity.

          From U.S. Centers for Disease Control and Prevention Weekly Influenza Surveillance Report (FluView): LINK
          For background information on how influenza surveillance is undertaken in the United States see LINK

          Influenza Immunisation in the United States
          Because of the diversity of providers of immunisation in the US rapid estimates of the uptake of pandemic and seasonal vaccine are made through population surveys undertaken by telephone polls which also investigate attitudes to the infection and immunisation. Two of these surveys have been reported in the last week.
          One is the seventh in the series relating to the pandemic from the Harvard School of Public Health while the other was described briefly at the most recent regular press briefing by CDC. The latter was only referred to briefly as broadly validating the Harvard findings. The Harvard poll has been described in some detail in a press release through which it is also possible to access detailed tables and some simple powerpoint charts which are posted on the internet.
          The poll was conducted for the Harvard School by an independent polling company and interviews were conducted from December 16-17th accessing 1,637 respondents aged 18 and older. The poll found that concern over the pandemic had declined since September when 52% of adult Americans said they were concerned that they or a family member would become sick with the pandemic virus in the coming 12 months. That figure had now declined to 40% In the United States vaccine prioritisation was initially towards adults in risk groups (those with chronic conditions, pregnant women) people caring for babies under six months, young adults aged 18-24 years, all children and all health and emergency personel. As more vaccine became available immunisation has subsequently been offered and recommended to all adults.
          The survey found that among adults in the initial priority groups 22% reported they had been immunised, another 31% said they intended to be immunised while 44% said they did not intend to be immunised. Looking at adults overall 14% reported they had now been immunised and another 27% said they intended to be immunised while 55% stated they did not intend to get immunised. Parents in the survey with eligible children (babies under 6 months cannot be immunised) reported that 38% had now had their children immunised, an increase from 14% when the poll was undertaken in late October / early November. Another 24% stated they intended to get their children immunised. Just over a third of parents (35%) reported they did not intend to get their children immunised citing as reasons safety concerns (38%), a belief that tha pandemic is less serious than originally thought (32%) or that their child was not at risk of severe disease (28%). The survey report cites that the margin of error is +/-2.93% at the 95% confidence level for figures involving all respondents but larger margins for sub-groups .
          These Harvard Surveys are part of a programme of research on the public’s response to public health emergencies called the Harvard Opinion Research Program. The surveys on the public attitudes to the pandemic go back to late April. They are undertaken through a cooperative arrangement with the United States CDC and the US National Public Health Information Coalition.

          Table 1. Reported number of confirmed 2009 pandemic influenza A(H1N1) cases admitted to hospitals and intensive care, by country, as of 29 December 2009, 14.00 CEST in EU and EFTA countries.
          [Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]
          1. Austria (17.12.) - 172 – … – … – …
          2. Belgium (24.12.) – … – … – … – …
          3. Bulgaria (13.12) – … – … – … – …
          4. Cyprus(23.11) – … – … – … – 6
          5. Czech Republic (23.12.) – … – … – … – …
          6. Denmark (23.12.) – … – … – 4 – 68
          7. Estonia (23.12.) – … – … – … – …
          8. Finland (23.12.) - 11 – … - 3 – …
          9. France (28.12.) – … – … – 209 – 985
          10. Germany (22.12.) – … – … – … – …
          11. Greece (23.12.) – … – … – … – …
          12. Hungary (23.12.) – … – … – … – …
          13. Iceland (10.12.) – 3 – 180 – 1 – 20
          14. Ireland (23.12.) – 150 – 1027 – 10 – 87
          15. Italy (24.12.) – … - 832 – … – 452
          16. Latvia (17.12.) – … – … – … – …
          17. Liechtenstein (23.12.) – … – … – … – …
          18. Lithuania (21.12.) – … – … – … – …
          19. Luxembourg (16.11.) – … – … – 0 – 0
          20. Malta (04.09.) – … - 46 – … – 1
          21. Netherlands (28.12.) – 31 – 2156 – 6 – 209
          22. Norway (23.12.) – 5 – 1310 – 4 – 170
          23. Poland (22.12.) – … – … – … – …
          24. Portugal (23.12.) - 95 – … - 20 – …
          25. Romania (21.12.) – … – … – … – …
          26. Slovakia (22.12.) – 51 – 260 – 18 – 94
          27. Slovenia (17.12.) - 76 – … – … – …
          28. Spain (23.12.) – … – … – … – …
          29. Sweden (17.12.) – 18 - 1169 – … – …
          30. Switzerland (23.12.) – 11 - 389 – … – 72
          31. United Kingdom* (24.12.) - 454 – … - 103 – …

          Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
          * Data includes information for England only. Other cumulative hospitalisations are: Scotland (1439), Wales (437) and Northern Ireland (574).

          Table 2. Reported number of new and cumulative confirmed fatal 2009 pandemic influenza A(H1N1) cases in EU and EFTA countries, as 29 December 2009, 14.00 CEST, and in the rest of the world by country, as of 29 December 2009, 14.00 CEST.
          [Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]
          • EU and EFTA countries
            • Austria … – 3
            • Belgium … – 17
            • Bulgaria … – 35
            • Cyprus … – 3
            • Czech Republic … – 48
            • Denmark … – 25
            • Estonia … – 8
            • Finland … – 36
            • France 23 - 223*
            • Germany … – 132
            • Greece … – 59
            • Hungary … – 45
            • Iceland … – 2
            • Ireland … – 22
            • Italy … – 188
            • Latvia … – 27
            • Lithuania 1 – 16
            • Luxembourg … – 3
            • Malta … – 3
            • Netherlands 2 – 53
            • Norway … – 29
            • Poland … – 116
            • Portugal … – 57
            • Romania … – 49
            • Slovakia … – 30
            • Slovenia … – 13
            • Spain … – 256
            • Sweden … – 22
            • Switzerland … – 9
            • United Kingdom 3 – 303
              • Total 29 – 1832
          • Other European countries and central Asia
            • Albania … – 6
            • Armenia 1 – 3
            • Belarus … – 20
            • Bosnia and Herzegovina … – 7
            • Croatia … – 23
            • Former Yugoslav Republic of Macedonia … – 14
            • Georgia 3 – 10
            • Kosovo … – 10
            • Moldova 3 – 25
            • Montenegro … – 5
            • Russia … – 19
            • Serbia 3 – 50
            • Ukraine … – 202
              • Total 10 – 394
          • Mediterranean and Middle-East
            • Algeria … – 42
            • Bahrain … – 7
            • Egypt … – 109
            • Iran … – 147
            • Iraq … – 40
            • Israel … – 71
            • Jordan … – 16
            • Kuwait … – 27
            • Lebanon … – 5
            • Libya … - 1
            • Morocco 14 – 50
            • Occupied Palestinian Territory 1 – 23
            • Oman … – 30
            • Qatar … – 8
            • Saudi Arabia … – 97
            • Syria … – 110
            • Tunisia 6 – 15
            • Turkey … – 415
            • United Arab Emirates … – 6
            • Yemen 2 – 27
              • Total 23 – 1246
          • Africa
            • Ghana … – 1
            • Madagascar … – 3
            • Mauritius … – 8
            • Mozambique … – 2
            • Namibia … – 1
            • Sao Tome & Principe … – 2
            • South Africa … – 93
            • Sudan 4 – 5
            • Tanzania … – 1
              • Total 4 – 116
          • North America
            • Canada … – 401
            • Mexico 23 – 823
            • USA … – 2160
              • Total 23 – 3384
          • Central America and Caribbean
            • Bahamas … – 4
            • Barbados … – 3
            • Cayman Islands … – 1
            • Costa Rica … – 47
            • Cuba … – 41
            • Dominican Republic … – 23
            • El Salvador … – 31
            • Guatemala … – 18
            • Honduras … – 16
            • Jamaica … – 6
            • Nicaragua … – 11
            • Panama … – 11
            • Saint Kitts and Nevis … – 2
            • Saint Lucia … – 1
            • Suriname … – 2
            • Trinidad-Tobago … – 5
              • Total … – 222
          • South America
            • Argentina … – 617
            • Bolivia … – 58
            • Brazil … – 1632
            • Chile … – 150
            • Colombia … – 193
            • Ecuador … – 96
            • Paraguay … – 52
            • Peru … – 205
            • Uruguay … – 33
            • Venezuela … – 121
              • Total … – 3157
          • North-East and South Asia
            • Afghanistan … – 17
            • Bangladesh … – 6
            • China (Mainland) … - 509
            • Hong Kong SAR China … – 51
            • India … – 880
            • Japan … – 107
            • Macao SAR China … – 2
            • Maldives … – 1
            • Mongolia … – 26
            • Nepal 2 – 2
            • Pakistan … – 1
            • South Korea … – 148
            • Sri Lanka … – 35
            • Taiwan … – 35
              • Total 2 – 1820
          • South-East Asia
            • Brunei Darussalam … – 1
            • Cambodia … – 6
            • Indonesia … – 10
            • Laos Peoples Democratic Republic … – 1
            • Malaysia … – 77
            • Philippines … – 30
            • Singapore … – 19
            • Thailand … – 191
            • Vietnam 3 – 53
              • Total 3 – 388
          • Australia and Pacific
            • Australia … – 191
            • Cook Islands … – 1
            • Marshall Islands … – 1
            • New Zealand … – 20
            • Samoa … – 2
            • Solomon Islands … – 1
            • Tonga … – 1
              • Total … – 217
          • TOTAL 94 – 12776

          * Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in La Rιunion, 1 in Martinique, 2 in Mayotte, 5 in Guadeloupe and 191 in mainland France.
          (…)
          -
          -------

          Comment


          • 2009 influenza A (H1N1) pandemic 30 December 2009 14.00 CEST (ECDC, edited)

            2009 influenza A (H1N1) pandemic 30 December 2009 14.00 CEST (ECDC, edited)

            [Source Full PDF Document: LINK. EDITED.]

            ECDC DAILY UPDATE
            2009 influenza A (H1N1) pandemic 30 December 2009 14.00 CEST

            Main developments in the past 24 hours
            • France: Estimations of the numbers of persons infected with or immunised against 2009 (H1N1) – mid December.
            • Documentation of changing transmissibility of the 1968 H3N2 influenza pandemic and a larger second winter wave.
            • A total of 1 869 fatal cases in Europe and EFTA countries and 10 997 in the rest of the world have been reported up to date.


            This report is based on official information provided by national public health websites or through other official communication channels. Reported number of confirmed 2009 pandemic influenza A (H1N1) cases admitted to hospitals and intensive care, by country, as of 30 December 2009, 14.00 CEST in EU and EFTA countries are in Table 1. An update on the number of confirmed fatal cases for the world and Europe is presented in Table 2.

            Epidemiologic update
            Officially Reported Deaths in the EU
            All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 1 869 deaths have been reported since April 2009 (Table 2). From week 41 to 51 the numbers of deaths each had shown a steady increase almost doubling every fortnight over six weeks. The fall observed in week 52 was to be expected as it represents official reports placed on national web-sites and a number of Member States have not been doing this in what was a holiday week. A similar phenomenon can be expected for the coming weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. The reported cumulative fatal pandemic (H1N1) cases in the world have now passed 10 000 cases (Table 2). However, because of lack of laboratory confirmation and underreporting among other factors, this is likely to be a gross underestimation of the true number of fatalities associated with the pandemic.
            Available updates on hospital admissions, per Member State, can be found in Table 1.

            France: Estimations of the numbers of persons infected with or immunised against 2009 (H1N1) – mid December
            The French public health centre, the Institut de Veille Sanitaire has recently issued estimates of the numbers of persons who have been infected with the pandemic 2009(H1N1) in France as of December 17th. Using the results of two primary care sentinel systems and working back from these with these with assumptions concerning the proportions of those with symptoms that consult a doctor (51%) and the proportions of infections that are without symptoms (30%) they derived estimates that were around 7.9M or 14.8M persons depending on the base sentinel systems.(1)
            The population of Metropolitan France (the French mainland plus Corsica) was around 62.4M (2009 provisional estimates for January 2009 from INSEE ) so this would translate to around 13% or 24% of the population. An opportunity for the validation of one of these estimates comes from seroepidemiological work undertaken by INVS with its collaborators who have been using residual blood specimens from pregnant women. the estimations were considered to be comparable with an estimate of the numbers of persons (men and women) aged 20-39 years infected to be around 1.05M (with confidence intervals 0.58M to 1.54M). The estimate for this age-group from the more system with the figure of 7.9M would have been around 0.95M. Hence the seroepidemiology results provided more validation for the lower 7.9M estimate. In the same publication INVS cite official estimates of the numbers of persons who have been immunised with at least one dose of a specific pandemic vaccine by December 13th of around 3.3M. Hence on this basis INVS considers that the maximum number of persons in France that have either been infected or immunised would be between 11.2M and 18.1M. These figures will be relevant for predicting the future number of infections and will be revised by INVS after the present wave of infection.
            1) Institut de Veille Sanitaire Estimations du nombre d’infections de grippe A(H1N1)2009 en France mιtropolitaine au 17 dιcembre 2009 LINK

            Changing transmissibility of the 1968 H3N2 influenza pandemic
            Enquiries about what will happen next with the 2009 pandemic influenza A (H1N1) and inter-pandemic influenza in the approaching decade are important for public health reasons, notably in informing vaccine strategies. ECDC has been asked to consider possible scenarios and one useful source of information comes from reviewing previous pandemics and how they influenced the following pattern of seasonal influenza.(1)
            The general assumption is that pandemic viruses adapt to humans and settle down to become less serious with time. However there is also potential for the public health impact worsening with the second wave of the 1918 pandemic being more lethal than the first.(1,2) In comparison the 1957 H2N2 pandemic settled down quite quickly though in the UK and US there was a second lower peak in attributed mortality the second winter after the Christmas and New Year. (2-4) It has been noted that in a number of countries the last 1968 (Hong Kong) H3N2 pandemic occurred in two winter waves, with the second more severe than the first (Figure).(2,5,6)
            The increase in outbreak size and mortality between the first and second winters could be explained by a change in transmissibility. A recent publication reports on this following a systematic review of morbidity and serologic data of the first and second winters from the 1968 influenza pandemic from different settings, and basic and effective reproduction numbers for both waves of the were estimated. The overall data came from 15 countries (with multiple sites from a number of these). For ten pair of data sets comparable information was available for the two waves. (6)
            The basic and effective reproduction numbers were estimated from 46 and 17 data sets for the first and second waves, respectively, based on the growth rate and/or final size of the epidemic. Estimates of the basic reproduction number (R0) were in the range of 1.06–2.06 for the first wave and, assuming cross-protection, 1.21–3.58 in the second. Within each wave, there was little geographic variation in transmissibility. In the 10 settings for which data were available for both waves, R0 was estimated to be higher during the second wave than during the first. This might partly explain the larger and more lethal outbreaks in the second wave as compared with the first. There is no information on any changes in the virological characteristics of the virus paralleling its seeming change in behaviour. This potential for change in viral behaviour will have consequences for future pandemic mitigation strategies and the authors also conclude that it is possible that the 2009 Pandemic Influenza A (H1N1) will cause a second wave, and the results of this study indicates that pandemic influenza virus may become more transmissible between successive waves.
            However, they also state that it is difficult to predict if the 2009 Pandemic Influenza A (H1N1) virus will continue to behave as it has done up to now.(6) What will be available for the 2009 pandemic now and was scarcely available in previous pandemics is serology indicating the proportions of the population that are immune from either infection or immunisation. However even that cannot allow for changes in the behaviour of the pandemic such as seems to have happened in 1968.
            1) Kilbourne ED. Influenza pandemics of the 20th century. Emerg Infect Dis. 2006 12 No.1 Jan Available from: LINK
            2) ECDC Visual presentations of previous pandemics in one country. ECDC web presentation 2009
            3) Henderson DA Courtney B, Inglesby TV, Toner E, Nuzzo JB Public Health and Medical Responses to the 1957-58 Influenza Pandemic Biosecurity and Bioterrorism, Volume 7, Number 3, 2009
            4) ECDC Comparison between the 1957 and 2009 pandemics – a close but imperfect fit ECDC Scientific Advance October 1st 2009
            5) Rizzo C, Bella A, Viboud C, Simonsen L, Miller MA, Rota MC, et al. Trends for influenza-related deaths during pandemic and epidemic seasons, Italy, 1969–2001. Emerg Infect Dis. 2007 13 No. 5. May Available from: LINK
            6) Jackson C, Vynnycky E, Mangtani P. Estimates of the transmissibility of the 1968 (Hong Kong) Influenza Pandemic: Evidence of Increased Transmissibility Between Successive Waves.Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine. In American Journal of Epidemiology Advance Access published online on December 10, 2009. Available from: LINK
            Figure available as powerpoint from ECDC Downloadable Powerpoints or as pdf from LINK

            Table 1. Reported number of confirmed 2009 pandemic influenza A(H1N1) cases admitted to hospitals and intensive care, by country, as of 30 December 2009, 14.00 CEST in EU and EFTA countries.
            [Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]
            1. Austria (17.12.) - 172 – … – … – …
            2. Belgium (24.12.) – … – … – … – …
            3. Bulgaria (13.12) – … – … – … – …
            4. Cyprus(23.11) – … – … – … – 6
            5. Czech Republic (23.12.) – … – … – … – …
            6. Denmark (30.12.) – … – … – 2 – 70
            7. Estonia (29.12.) – … – … – … – …
            8. Finland (23.12.) - 11 – … - 3 – …
            9. France (28.12.) – … – … – 209 – 985
            10. Germany (22.12.) – … – … – … – …
            11. Greece (23.12.) – … – … – … – …
            12. Hungary (23.12.) – … – … – … - …
            13. Iceland (10.12.) – 3 – 180 – 1 – 20
            14. Ireland (23.12.) – 150 – 1027 – 10 – 87
            15. Italy (24.12.) – … - 832 – … – 452
            16. Latvia (17.12.) – … – … – … – …
            17. Liechtenstein (23.12.) – … – … – … – …
            18. Lithuania (21.12.) – … – … – … – …
            19. Luxembourg (16.11.) – … – … – 0 – 0
            20. Malta (04.09.) – … - 46 – … – 1
            21. Netherlands (28.12.) – 31 – 2156 – 6 – 209
            22. Norway (23.12.) – 5 – 1310 – 4 – 170
            23. Poland (22.12.) – … – … – … – …
            24. Portugal (23.12.) - 95 – … - 20 – …
            25. Romania (21.12.) – … – … – … – …
            26. Slovakia (22.12.) – 51 – 260 – 18 – 94
            27. Slovenia (17.12.) - 76 – … – … – …
            28. Spain (23.12.) – … – … – … – …
            29. Sweden (17.12.) – 18 - 1169 – … – …
            30. Switzerland (23.12.) – 11 - 389 – … – 72
            31. United Kingdom* (24.12.) - 454 – … - 103 – …

            Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
            (…) denotes no information readily available in official sources.
            * Data includes information for England only. Other cumulative hospitalisations are: Scotland (1439), Wales (437) and Northern Ireland (574).

            Table 2. Reported number of new and cumulative confirmed fatal 2009 pandemic influenza A(H1N1) cases in EU and EFTA countries, as 30 December 2009, 14.00 CEST, and in the rest of the world by country, as of 30 December 2009, 14.00 CEST.
            [Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]
            • EU and EFTA countries
              • Austria … – 3
              • Belgium … – 17
              • Bulgaria … – 35
              • Cyprus … – 3
              • Czech Republic 8 – 56
              • Denmark 1 – 26
              • Estonia 2 – 10
              • Finland … – 36
              • France … - 223*
              • Germany … – 132
              • Greece … – 59
              • Hungary … – 45
              • Iceland … – 2
              • Ireland … – 22
              • Italy … – 188
              • Latvia … – 27
              • Lithuania … – 16
              • Luxembourg … – 3
              • Malta … – 3
              • Netherlands … – 53
              • Norway … – 29
              • Poland 6 - 122
              • Portugal 13 - 70
              • Romania 4 – 53
              • Slovakia … – 30
              • Slovenia … – 13
              • Spain … – 256
              • Sweden 3 – 25
              • Switzerland … – 9
              • United Kingdom … – 303
                • Total 37 – 1869
            • Other European countries and central Asia
              • Albania … – 6
              • Armenia … – 3
              • Belarus … – 20
              • Bosnia and Herzegovina … – 7
              • Croatia … – 23
              • Former Yugoslav Republic of Macedonia … – 14
              • Georgia … – 10
              • Kosovo 4 – 14
              • Moldova … – 25
              • Montenegro … – 5
              • Russia … – 19
              • Serbia 2 – 52
              • Ukraine … – 202
                • Total 6 – 400
            • Mediterranean and Middle-East
              • Algeria … – 42
              • Bahrain … – 7
              • Egypt … – 109
              • Iran … – 147
              • Iraq … – 40
              • Israel … – 71
              • Jordan … – 16
              • Kuwait … – 27
              • Lebanon … – 5
              • Libya … - 1
              • Morocco … – 50
              • Occupied Palestinian Territory … – 23
              • Oman … – 30
              • Qatar … – 8
              • Saudi Arabia … – 97
              • Syria … – 110
              • Tunisia 3 – 18
              • Turkey … – 415
              • United Arab Emirates … – 6
              • Yemen … – 27
                • Total 3 – 1249
            • Africa
              • Ghana … – 1
              • Madagascar … – 3
              • Mauritius … – 8
              • Mozambique … – 2
              • Namibia … – 1
              • Sao Tome & Principe … – 2
              • South Africa … – 93
              • Sudan … – 5
              • Tanzania … – 1
                • Total … – 116
            • North America
              • Canada … – 401
              • Mexico … – 823
              • USA … – 2160
                • Total … – 3384
            • Central America and Caribbean
              • Bahamas … – 4
              • Barbados … – 3
              • Cayman Islands … – 1
              • Costa Rica … – 47
              • Cuba … – 41
              • Dominican Republic … – 23
              • El Salvador … – 31
              • Guatemala … – 18
              • Honduras … – 16
              • Jamaica 1 – 7
              • Nicaragua … – 11
              • Panama … – 11
              • Saint Kitts and Nevis … – 2
              • Saint Lucia … – 1
              • Suriname … – 2
              • Trinidad-Tobago … – 5
                • Total 1 – 223
            • South America
              • Argentina … – 617
              • Bolivia … – 58
              • Brazil … – 1632
              • Chile … – 150
              • Colombia 3 – 196
              • Ecuador … – 96
              • Paraguay … – 52
              • Peru … – 205
              • Uruguay … – 33
              • Venezuela … – 121
                • Total 3 – 3160
            • North-East and South Asia
              • Afghanistan … – 17
              • Bangladesh … – 6
              • China (Mainland) … - 509
              • Hong Kong SAR China … – 51
              • India 18 – 898
              • Japan … – 107
              • Macao SAR China … – 2
              • Maldives … – 1
              • Mongolia … – 26
              • Nepal … – 2
              • Pakistan … – 1
              • South Korea 22 – 170
              • Sri Lanka … – 35
              • Taiwan … – 35
                • Total 40 – 1860
            • South-East Asia
              • Brunei Darussalam … – 1
              • Cambodia … – 6
              • Indonesia … – 10
              • Laos Peoples Democratic Republic … – 1
              • Malaysia … – 77
              • Philippines … – 30
              • Singapore … – 19
              • Thailand … – 191
              • Vietnam … – 53
                • Total … – 388
            • Australia and Pacific
              • Australia … – 191
              • Cook Islands … – 1
              • Marshall Islands … – 1
              • New Zealand … – 20
              • Samoa … – 2
              • Solomon Islands … – 1
              • Tonga … – 1
                • Total … – 217
            • TOTAL 90 – 12866

            * Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in La Rιunion, 1 in Martinique, 2 in Mayotte, 5 in Guadeloupe and 191 in mainland France.
            (…)
            -
            ------

            Comment


            • 2009 influenza A (H1N1) pandemic 31 December 2009 14.00 CEST (ECDC, edited)

              2009 influenza A (H1N1) pandemic 31 December 2009 14.00 CEST (ECDC, edited)

              [Source Full PDF Document: LINK. EDITED.]
              ECDC DAILY UPDATE
              2009 influenza A (H1N1) pandemic 31 December 2009 14.00 CEST

              Main developments in the past 24 hours
              • WHO review of current influenza status – pandemic activity is seen just to the East of the EU
              • Pandemic influenza 2009 A(H1N1) is predominating over seasonal influenza in all of the Northern Hemisphere
              • WHO’s Director General states it is premature to consider the pandemic as completed
              • First published report of transmission of antiviral resistant pandemic 2009 H1N1 virus in the community – Viet Nam July 2009 - remains an unusual event
              • Fourth European Medicines Agency pandemic pharmacovigilance report
              • A total of 1 923 fatal cases in Europe and EFTA countries and 11 047 in the rest of the world have been reported up to date.


              This report is based on official information provided by national public health websites or through other official communication channels. Reported number of confirmed 2009 pandemic influenza A (H1N1) cases admitted to hospitals and intensive care, by country, as of 31 December 2009, 14.00 CEST in EU and EFTA countries are in Table 1. An update on the number of confirmed fatal cases for the world and Europe is presented in Table 2.

              Epidemiologic update
              Officially Reported Deaths in the EU
              All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 1 923 deaths have been reported since April 2009 (Table 2). From week 41 to 51 the numbers of deaths each had shown a steady increase almost doubling every fortnight over six weeks. The fall observed in week 52 was to be expected as it represents official reports placed on national web-sites and a number of Member States have not been doing this in what was a holiday week. A similar phenomenon can be expected for the coming weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. The reported cumulative fatal pandemic (H1N1) cases in the world have now passed 10 000 cases (Table 2). However, because of lack of laboratory confirmation and underreporting among other factors, this is likely to be a gross underestimation of the true number of fatalities associated with the pandemic. Available updates on hospital admissions, per Member State, can be found in Table 1.

              Influenza activity in the world WHO Pandemic (H1N1) 2009 - update 81
              WHO released its last Pandemic (H1N1) 2009 of the year - update 81 on the 30th of December, describing the current influenza activity in the world as of 27th of December. Features of this update (not including the EU/EEA countries and United States where ECDC has reviewed the situation in the past week) include.
              • The most active areas of pandemic influenza transmission globally currently are to the East of the European Union. Focal increases in rates of Influenza like illness or acute respiratory infection have taken place during recent weeks in Georgia, Montenegro, and Ukraine.
              • In the Northern Africa region, limited available data indicates that active, high intensity transmission is occurring along the Mediterranean coast (Algeria, Tunisia, and Egypt).
              • In Central Asia, limited data available suggest that influenza virus circulation remains active, but transmission may have recently peaked in some places.
              • In West Asia, Israel, Iran, Iraq, Oman, and Afghanistan also appear to have passed their peak period of transmission within the past month, though both areas continue to have some active transmission and levels of respiratory disease activity have not yet returned to baseline levels.
              • In East Asia, influenza transmission remains active but appears to be declining overall.
              • In Southern Asia, influenza activity continues to be intense, particularly in northern India, Nepal, and, Sri Lanka.
              • In the tropical regions of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for focal increases in respiratory disease activity in a few countries.
              • In the temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

              For further information: LINK

              Predominance of influenza 2009 A(H1N1) over Seasonal Influenza A(H3N2) in the Northern Hemisphere
              The U.S. Centers for Disease Control and Prevention (CDC) has updated its global map showing the extent of cocirculation in the Northern Hemisphere of the two current type A influenzas: 2009 A(H1N1) and Seasonal influenza A(H3N2) using data from the United States, Canada, Europe, China, and Japan as of late December. These data display how the 2009 pandemic influenza A (H1N1) continues to be the most predominantly strain across all the Northern continents. The highest proportion of seasonal influenza A (H3N2) viruses is observed in China where the influenza A viruses were still making up about 2.5% in week 50-51. It should be noted that there remain many countries, especially in the tropics where very little is known about the level circulation of these viruses.
              Map available at: LINK

              Pandemic Press briefing by WHO’s Director General
              Margaret Chan, the WHO Director General held a press briefing on December 28th about the 2009 pandemic and this has been widely reported in the media. Her main messages were:
              • It is premature to consider the pandemic as completed. The influenza activity remains high in certain parts of Europe and Asia. It is important to note that the recent peaking in areas such as N America & parts of Europe was early. The pandemic is a global and not regional event and we should expect to continue to see the peaks of influenza activity come and go and move to different areas of the world.
              • The world has been fortunate that this pandemic has so far been moderate but there are still gaps in the health care systems around the world.
              • The world is now better prepared to cope with future pandemic situations, and the work on pandemic preparedness over the last few years, much of it stimulated by ‘bird flu’ has significantly improved global readiness. The world is however not yet ready for a severe, hard-hitting pandemic.
              • WHO continues to work with partners towards the delivery of pandemic vaccine to 95 developing countries The first shipments are expected towards the first week of January. WHO is investigating whether superfluous vaccines in some better resourced countries could be made available to developing countries.

              Sources: BBC News Web-site December 30th The head of the World Health Organisation (WHO) has warned the global swine flu pandemic is not yet over WHO

              First published report of transmission of antiviral resistant pandemic 2009 H1N1 virus in the community – Viet Nam July 2009 - remains an unusual event
              Public health researchers in Viet Nam have recently reported convincing community transmission of oseltamivir-resistant 2009 pandemic Influenza A(H1N1) virus infection among healthy persons (1,2). Transmission of the resistant virus occurred in Vietnamese students who met and socialized during a prolonged train trip in July 2009.(1) Oseltamivir resistance was identified through the detection of the H275Y substitution and careful investigations did not detect further transmission.(1) To date this would seem to be an unusual event as though antiviral resistance testing being carried out in a number of countries have occasionally detected isolated cases of resistant pandemic 2009 H1N1 virus in community the numbers of these has not increased over time.[2,3] This is a very different situation from when the same resistance emerged in seasonal A(H1N1) when it was associated with some evolutionary advantage and rapidly came to predominate over non-resistant seasonal A(H1N1).[4] In most cases of oseltamivir resistance in the pandemic 2009 A(H1N1) resistance has developed under the pressure of prophylaxis or more often during treatment in health care settings in patients with known risk factors for the development of oseltamivir resistance, such as defective immunocompetence. These have resulted in clusters of resistant 2009 (H1N1) virus in Europe and the USA where person to person transmission has occurred.[5,6] However these have not so far extended to healthy people in the hospital or into the community and monitoring of antiviral resistance at community level is ongoing in Europe and so far only 1% oseltamivir resistance has been found.[7] Given the declining rates of transmission in Europe now is unlikely that a pandemic virus resistant to oseltamivir would become dominant in the near future.[7] However given the propensity of influenza viruses to develop antiviral resistance such monitoring and epidemiological investigations around cases of neuraminidase resistant pandemic viruses as was done in Viet Nam is of high importance.[1]
              1. Mai LQ. Wertheim JFL, Duong TN, Van Doorn HR, Hien NT, Horby P. A community cluster of oseltamivir-resistant cases of 2009 H1N1 influenza. New England Journal of Medicine December 9, 2009 (10.1056/NEJMc0910448) The New England journal of medicine. 2009.
              2. ECDC A cluster of oseltamivir resistant 2009 pandemic influenza A(H1N1) viruses was reported in Viet Nam. No evidence of further community transmission of resistant viruses ECDC Public Health Development December 23rd 2009
              3. ECDC Oseltamivir-resistant pandemic (H1N1) 2009 influenza virus, ECDC Public Health Development November 2009
              4. Meijer A, Lackenby A, Hungnes O, Lina B, van der Werf S, Schweiger B, et al. Oseltamivir-resistant influenza A (H1N1) virus, Europe, 2007–08 season. Emerg Infect Dis. 2009 April; LINK
              5. Centers for Disease control and Prevention Oseltamivir-resistant 2009 pandemic influenza A (H1N1) virus infection in two summer campers receiving prophylaxis--North Carolina, 2009. MMWR. 2009 Sep 11;58(35):969-72.
              6 Health Protection Agency HPA statement on possible transmission of oseltamivir resistant pandemic influenza A(H1N1) HPA November 20th 2009.
              7. ECDC Weekly Influenza surveillance Overview – ECDC December 24th 2009.

              Fourth European Medicines Agency pandemic pharmacovigilance report
              The European Medicines Agency published its fourth pandemic pharmacovigilance weekly update on the agency webpage. The key messages were:
              • For the most used antivirals (oseltamivir) the adverse reaction reports received from the are consistent with the safety profile described in the product information.
              • At least 28 million persons including at least 218,000 pregnant women have been vaccinated to-date in Europe with one of the three centrally-authorised vaccines (Celvapan, Focetria,and Pandemrix) . The most frequent adverse reactions following immunisation (AEFIs) that have been reported are non-serious and as expected in the product information.
              • Up to 13 December 2009, 13 cases of Guillain-Barrι syndrome (GBS) and 1 case of Miller-Fischer syndrome (a variant of GBS) have been reported in relation with Celvapan, Focetria or Pandemrix. Given that more than 28 million persons have been vaccinated, 14 reported cases does not exceed the number of cases expected to naturally occur in the vaccinated population. Reports of other serious AEFIs have been received and are detailed in the EMA report however to date the panels that are

              For further information : LINK
              Reports from national regulatory agencies are also available and will be the prime source of reports on other pandemic vaccines that are nationally authorised. A list of these Agencies is available on the EMA web-site here.

              Table 1. Reported number of confirmed 2009 pandemic influenza A(H1N1) cases admitted to hospitals and intensive care, by country, as of 31 December 2009, 14.00 CEST in EU and EFTA countries.
              [Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]
              1. Austria (17.12.) - 172 – … – … – …
              2. Belgium (24.12.) – … – … – … – …
              3. Bulgaria (13.12) – … – … – … – …
              4. Cyprus(23.11) – … – … – … – 6
              5. Czech Republic (23.12.) – … – … – … – …
              6. Denmark (30.12.) – … – … – 2 – 70
              7. Estonia (29.12.) – … – … – … – …
              8. Finland (23.12.) - 11 – … - 3 – …
              9. France (29.12.) – … – … – 209 – 985
              10. Germany (22.12.) – … – … – … – …
              11. Greece (30.12.) – … – … – … – …
              12. Hungary (30.12.) – … – … – … – …
              13. Iceland (10.12.) – 3 – 180 – 1 – 20
              14. Ireland (23.12.) – 150 – 1027 – 10 – 87
              15. Italy (24.12.) – … - 832 – … – 452
              16. Latvia (17.12.) – … – … – … – …
              17. Liechtenstein (30.12.) – … – … – … – …
              18. Lithuania (21.12.) – … – … – … – …
              19. Luxembourg (27.12.) – … – … – 0 – 0
              20. Malta (04.09.) – … - 46 – … – 1
              21. Netherlands (28.12.) – 31 – 2156 – 6 – 209
              22. Norway (23.12.) – 5 – 1310 – 4 – 170
              23. Poland (22.12.) – … – … – … – …
              24. Portugal (30.12.) - 58 – … - 20 – …
              25. Romania (31.12.) – … – … – … – …
              26. Slovakia (22.12.) – 51 – 260 – 18 – 94
              27. Slovenia (17.12.) - 76 – … – … – …
              28. Spain (30.12.) – … – … – … – …
              29. Sweden (30.12.) – … – … – … – …
              30. Switzerland (30.12.) – 7 - 430 – … – 77
              31. United Kingdom* (24.12.) - 454 – … - 103 – …

              Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
              (…) denotes no information readily available in official sources.
              * Data includes information for England only. Other cumulative hospitalisations are: Scotland (1439), Wales (437) and Northern Ireland (574).

              Table 2. Reported number of new and cumulative confirmed fatal 2009 pandemic influenza A(H1N1) cases in EU and EFTA countries, as 31 December 2009, 14.00 CEST, and in the rest of the world by country, as of 31 December 2009, 14.00 CEST.
              [Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]
              • EU and EFTA countries
                • Austria … – 3
                • Belgium … – 17
                • Bulgaria … – 35
                • Cyprus … – 3
                • Czech Republic … – 56
                • Denmark … – 26
                • Estonia … – 10
                • Finland … – 36
                • France 7 - 230*
                • Germany … – 132
                • Greece 11 – 70
                • Hungary 7 – 52
                • Iceland … – 2
                • Ireland … – 22
                • Italy … – 188
                • Latvia 1 – 28
                • Lithuania … – 16
                • Luxembourg … – 3
                • Malta … – 3
                • Netherlands … – 53
                • Norway … – 29
                • Poland … – 122
                • Portugal … – 70
                • Romania 5 – 58
                • Slovakia … – 30
                • Slovenia … – 13
                • Spain 15 – 271
                • Sweden … – 25
                • Switzerland 3 – 12
                • United Kingdom 5 – 308
                  • Total 54 – 1923
              • Other European countries and central Asia
                • Albania … – 6
                • Armenia … – 3
                • Belarus … – 20
                • Bosnia and Herzegovina … – 7
                • Croatia 1 – 24
                • Former Yugoslav Republic of Macedonia … – 14
                • Georgia … – 10
                • Kosovo … – 14
                • Moldova … – 25
                • Montenegro … – 5
                • Russia … – 19
                • Serbia 3 – 55
                • Ukraine … – 202
                  • Total 4 – 404
              • Mediterranean and Middle-East
                • Algeria … – 42
                • Bahrain … – 7
                • Egypt … – 109
                • Iran … – 147
                • Iraq 2 – 42
                • Israel 10 – 81
                • Jordan … – 16
                • Kuwait … – 27
                • Lebanon … – 5
                • Libya … - 1
                • Morocco … – 50
                • Occupied Palestinian Territory … – 23
                • Oman … – 30
                • Qatar … – 8
                • Saudi Arabia … – 97
                • Syria … – 110
                • Tunisia … – 18
                • Turkey … – 415
                • United Arab Emirates … – 6
                • Yemen … – 27
                  • Total 12 – 1261
              • Africa
                • Ghana … – 1
                • Madagascar … – 3
                • Mauritius … – 8
                • Mozambique … – 2
                • Namibia … – 1
                • Sao Tome & Principe … – 2
                • South Africa … – 93
                • Sudan … – 5
                • Tanzania … – 1
                  • Total … – 116
              • North America
                • Canada 9 – 410
                • Mexico … – 823
                • USA … – 2160
                  • Total 9 – 3393
              • Central America and Caribbean
                • Bahamas … – 4
                • Barbados … – 3
                • Cayman Islands … – 1
                • Costa Rica … – 47
                • Cuba … – 41
                • Dominican Republic … – 23
                • El Salvador … – 31
                • Guatemala … – 18
                • Honduras … – 16
                • Jamaica … – 7
                • Nicaragua … – 11
                • Panama … – 11
                • Saint Kitts and Nevis … – 2
                • Saint Lucia … – 1
                • Suriname … – 2
                • Trinidad-Tobago … – 5
                  • Total … – 223
              • South America
                • Argentina … – 617
                • Bolivia … – 58
                • Brazil … – 1632
                • Chile … – 150
                • Colombia … – 196
                • Ecuador … – 96
                • Paraguay … – 52
                • Peru 3 – 208
                • Uruguay … – 33
                • Venezuela … – 121
                  • Total 3 – 3163
              • North-East and South Asia
                • Afghanistan … – 17
                • Bangladesh … – 6
                • China (Mainland) … - 509
                • Hong Kong SAR China 1 – 52
                • India 21 – 919
                • Japan … – 107
                • Macao SAR China … – 2
                • Maldives … – 1
                • Mongolia … – 26
                • Nepal … – 2
                • Pakistan … – 1
                • South Korea … – 170
                • Sri Lanka … – 35
                • Taiwan … – 35
                  • Total 22 – 1882
              • South-East Asia
                • Brunei Darussalam … – 1
                • Cambodia … – 6
                • Indonesia … – 10
                • Laos Peoples Democratic Republic … – 1
                • Malaysia … – 77
                • Philippines … – 30
                • Singapore … – 19
                • Thailand … – 191
                • Vietnam … – 53
                  • Total … – 388
              • Australia and Pacific
                • Australia … – 191
                • Cook Islands … – 1
                • Marshall Islands … – 1
                • New Zealand … – 20
                • Samoa … – 2
                • Solomon Islands … – 1
                • Tonga … – 1
                  • Total … – 217
              • TOTAL 104 – 12970

              * Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in La Rιunion, 1 in Martinique, 2 in Mayotte, 5 in Guadeloupe and 198 in mainland France.
              (…)
              -
              ------

              Comment

              Working...
              X