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

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 30 September 2009, 09:00 hours CEST (ECDC, edited)

[Source Full Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 30 September 2009, 09:00 hours CEST


Main developments in past 24 hours

• European Commission authorised two pandemic influenza vaccines;
• First European report of transmission of the pandemic A(H1N1) 2009 influenza virus from humans to pigs (UK);
• Total of 174 fatal cases in Europe and EFTA countries and 4160 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 29 September 2009 16:00 hours CEST, for the world, and 30 September 09:00 hours CEST, for Europe is presented in Table 2.


General update

European Commission authorised two pandemic influenza vaccines

Following the positive scientific opinion issued by the Committee for Medicinal Products for Human Use (CHMP) at the European Medicines Agency (EMEA) on 24 September, the European Commission granted variations to two existing authorisations for vaccines for influenza pandemic (H1N1) 2009 yesterday.

The products concerned are Focetria? (Novartis), and Pandemrix? (GlaxoSmithKline).

The vaccines will be authorised for use in all Member States of the EU and the EEA (Iceland, Liechtenstein and Norway).

That should ensure that sufficient vaccines will be available before the start of the flu season and will reduce the risks for illnesses and deaths for European Citizens.

Full EC press release available at: http://europa.eu/rapid/pressReleases...nce=IP/09/1384


Public Health Development

First European report of transmission of the pandemic A(H1N1) 2009 influenza virus from humans to pigs (UK)

The UK?s Department of Agriculture and Rural Development of Northern Ireland (DARDNI) has confirmed that a pig herd has tested positive for the human pandemic influenza A(H1N1)2009. The confirmation was reported to the Department of Environment, Food and Rural Affairs (DEFRA) central office in London, which subsequently reported it to the OIE on the 18/09/2009.

Following the action taken in other countries with similar human to animal transmissions, none of the animals were slaughtered.

The OIE report mentions that no known cases of human flu are currently associated with this outbreak. The Food Standards Agency has advised, in line with WHO and international guidance, that influenza A(H1N1) 2009 does not pose a food safety risk to consumers.

The Full Public Health Development can be found at: LINK


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 174 deaths have been reported; the information is available on Table 2. In the past 24 hours no fatal cases were announced.

The latest available updates as of September 30th, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Daily Update contents

ECDC has now stop publishing numbers of confirmed cases reported from EU/EFTA member states or from countries around the world in the Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups like the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases and after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe with the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the number of fatal cases per country are likely to be gross underestimates of the true number of fatal cases associated with pandemic influenza. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 30 September 2009, 09:00 hours (CEST) in the EU and EFTA countries

[Country - (date of report) - Most recent number of cases admitted in hospitals - Cumulative number of cases admitted in hospitals - Most recent number of cases admitted to intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (07.8.) - 0 - ... - 0 - ...
2. Belgium (20.9.) - 3 - 38 - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (21.9.) - 0 - ... - 0 - ...
6. Denmark (09.9.) - ... - ... - ... - ...
7. Estonia (04.9.) - 0 - 0 - 0 - 0
8. Finland (03.9.) - ... - ... - ... - ...
9. France (23.9.) - 12 - 159 - 1 - 20
10. Germany (29.9.) - ... - ... - ... - ...
11. Greece (22.9.) - ... - 54 - 1 - 13
12. Hungary (19.9.) - ... - 32 - ... - ...
13. Iceland (25.9.) - 0 - 1 - 0 - 0
14. Ireland (24.9.) - 17 - 131 - 0 - 10
15. Italy (23.9) - 61 - 704 - ... - ...
16. Latvia (13.8.) - ... - 1 - ... - ...
17. Liechtenstein (29 .9.) - ... - ... - ... - ...
18. Lithuania (13.8.) - ... - ... - ... - ...
19. Luxembourg (25.9.) - ... - ... - 0 - 0
20. Malta (04.9.) - ... - 46 - ... - 1
21. Netherlands (25.9.) - 10 - 100 - 0 - 17
22. Norway (24.9.) - 6 - 42 - 3 - 7
23. Poland (28.9.) - ... - ... - ... - ...
24. Portugal (23.9.) - 20 - ... - 3 - 8
25. Romania (27.9) - ... - 18 - ... - ...
26. Slovakia (12.8.) - 2 - 33 - 0 - 0
27. Slovenia (10.8.) - ... - ... - ... - ...
28. Spain (20.8.) - ... - ... - 32 - 91
29. Sweden (24.9.) - ... - ... - 0 - 0
30. Switzerland (29.9.) - ... - 22 - ... - 1
31. United Kingdom (a) (24.9.) - 218 - ... - 25 - ...

Note:
Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites. New updates are shaded in yellow.

(...) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (143 cumulative hospitalisations), Wales (48) and Northern Ireland (97).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 30 September, 09:00 hours CEST, and in the rest of the world by country, as of 29 September 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 1
2. France ... - 29 (a)
3. Greece ... - 3
4. Hungary ... - 2
5. Ireland ... - 2
6. Italy ... - 3
7. Luxembourg ... - 1
8. Malta ... - 3
9. Netherlands ... - 4
10. Norway ... - 4
11. Portugal ... - 2
12. Spain ... - 36
13. Sweden ... - 2
14. United Kingdom ... - 82

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 3
2. Egypt ... - 2
3. Iran ... - 4
4. Iraq ... - 1
5. Israel ... - 23
6. Kuwait ... - 7
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 21
10. Qatar ... - 3
11. Saudi Arabia ... - 28
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen ... - 6

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa ... - 59

• NORTH AMERICA

1. Canada ... - 78
2. Mexico ... - 226
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Cayman Islands ... - 1
2. Costa Rica ... - 37
3. Dominican Republic ... - 21
4. El Salvador ... - 19
5. Guatemala ... - 13
6. Honduras ... - 15
7. Jamaica ... - 4
8. Nicaragua ... - 9
9. Panama ... - 11
10. Saint Kitts and Nevis ... - 1
11. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 538
2. Bolivia 4 - 47
3. Brazil ... - 899
4. Chile ... - 132
5. Colombia ... - 82
6. Ecuador ... - 60
7. Paraguay ... - 52
8. Peru 10 - 143
9. Uruguay ... - 33
10. Venezuela ... - 76

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. Hong Kong SAR China 1 - 22
3. India 25 - 302
4. Japan ... - 18
5. Macao SAR China ... - 1
6. South Korea ... - 11
7. Taiwan 1 - 18

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 1
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 160
9. Vietnam 1 - 14

• AUSTRALIA & PACIFIC

1. Australia ... - 178
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand ... - 17
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 42 - 4334

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 6 in the French Polynesia, 6 in the Reunion, 1 Martinique and 6 in mainland France.

(...)
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[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 01 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 01 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Comparison between the 1957 and 2009 pandemics reviewed;
• Total of 177 fatal cases in Europe and EFTA countries and 4208 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 30 September 2009 16:00 hours CEST, for the world, and 01 October 09:00 hours CEST, for Europe is presented in Table 2.


Scientific Advice

Comparison between the 1957 and 2009 pandemics ? a close but imperfect fit

Arguably the 1957 pandemic was the closest in its characteristics to the 2009 pandemic in that in both children and schools had a special focus and the case fatality rates were and are considerably lower than what was observed in say 1918-19. A comparison between the two by a unique physician who experienced both in his working lifetime reveals similarities but also differences.

Link to the full Scientific Advice will be available at: http://ecdc.europa.eu/en/activities/...lue1=Influenza


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 177 deaths have been reported; the information is available on Table 2.

The latest available updates as of September 30th, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Daily Update contents

ECDC has now stop publishing numbers of confirmed cases reported from EU/EFTA member states or from countries around the world in the Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups like the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases and after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe with the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the number of fatal cases per country are likely to be gross underestimates of the true number of fatal cases associated with pandemic influenza. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 01 October 2009, 09:00 hours (CEST) in the 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 (07.8.) - 0 - ... - 0 - ...
2. Belgium (20.9.) - 3 - 38 - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (21.9.) - 0 - ... - 0- ...
6. Denmark (09.9.) - ... - ... - ... - ...
7. Estonia (04.9.) - 0 - 0 - 0 - 0
8. Finland (03.9.) - ... - ... - ... - ...
9. France (30.9.) - 10 - 174 - 5 - 24
10. Germany (30.9.) - ... - ... - ... - ...
11. Greece (22.9.) - ... - 54 - 1 - 13
12. Hungary (19.9.) - ... - 32 - ... - ...
13. Iceland (25.9.) - 0 - 1 - 0 - 0
14. Ireland (24.9.) - 17 - 131 - 0 - 10
15. Italy (23.9) - 61 - 704 - ... - ...
16. Latvia (13.8.) - ... - 1 - ... - ...
17. Liechtenstein (30 .9.) - ... - ... - ... - ...
18. Lithuania (13.8.) - ... - ... - ... - ...
19. Luxembourg (25.9.) - ... - ... - 0 - 0
20. Malta (04.9.) - ... - 46 - ... - 1
21. Netherlands (25.9.) - 10 - 100 - 1 - 18
22. Norway (24.9.) - 6 - 42 - 3 - 7
23. Poland (30.9.) - ... - ... - ... - ...
24. Portugal (30.9.) - 21 - ... - 6 - ...
25. Romania (27.9) - ... - 18 - ... - ...
26. Slovakia (12.8.) - 2 - 33 - 0 - 0
27. Slovenia (10.8.) - ... - ... - ... - ...
28. Spain (20.8.) - ... - ... - 32 - 91
29. Sweden (24.9.) - ...- ... - 0 - 0
30. Switzerland (30.9.) - ... - 23 - ... - 1
31. United Kingdom (a) (24.9.) - 218 - ... - 25 - ...

Note:
Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites. New updates are shaded in yellow.

(...) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (143 cumulative hospitalisations), Wales (48) and Northern Ireland (97).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 01 October, 09:00 hours CEST, and in the rest of the world by country, as of 30 September 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 1
2. Bulgaria 1 - 1
3. France 1 - 30 (a)
4. Germany 1 - 1
5. Greece ... - 3
6. Hungary ... - 2
7. Ireland ... - 2
8. Italy ... - 3
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 4
13. Portugal ... - 2
14. Spain ... - 36
15. Sweden ... - 2
16. United Kingdom ... - 82

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 3
2. Egypt ... - 2
3. Iran ... - 4
4. Iraq ... - 1
5. Israel 1 - 24
6. Kuwait 1 - 8
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 21
10. Qatar ... - 3
11. Saudi Arabia 2 - 30
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen ... - 6

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa ... - 59

• NORTH AMERICA

1. Canada ... - 78
2. Mexico 5 - 231
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados 1 - 1
2. Cayman Islands ... - 1
3. Costa Rica ... - 37
4. Dominican Republic ... - 21
5. El Salvador ... - 19
6. Guatemala ... - 13
7. Honduras ... - 15
8. Jamaica ... - 4
9. Nicaragua 2 - 11
10. Panama ... - 11
11. Saint Kitts and Nevis ... - 1
12. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 538
2. Bolivia 7 - 54
3. Brazil ... - 899
4. Chile ... - 132
5. Colombia 7 - 89
6. Ecuador ... - 60
7. Paraguay ... - 52
8. Peru ... - 143
9. Uruguay ... - 33
10. Venezuela 7 - 83

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. Hong Kong SAR China ... - 22
3. India 6 - 308
4. Japan ... - 18
5. Macao SAR China ... - 1
6. South Korea ... - 11
7. Taiwan ... - 18

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 1
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand 5 - 165
9. Vietnam 1 - 15

• AUSTRALIA & PACIFIC

1. Australia 2 - 180
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand 1 - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 51 - 4385

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 Martinique and 6 in mainland France.

(...)
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[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 02 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 02 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Weekly Influenza Surveillance Overview to be published today;
• Media highlights and Eurosurveillance updates included;
• Total of 184 fatal cases in Europe and EFTA countries and 4,248 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 01 October 2009 16:00 hours CEST, for the world, and 02 October 09:00 hours CEST, for Europe is presented in Table 2.


Eurosurveillance Updates

Residual immunity in older people against the influenza A(H1N1) ? recent experience in northern Spain

[http://www.eurosurveillance.org/View...rticleId=19344 ]

The 2009 pandemic influenza A(H1N1) virus has a higher incidence in children and young adults, a pattern that has also been reported in seasonal influenza caused by the influenza A(H1N1) virus. The article from Spain analyses the age at infection in symptomatic patients with influenza in the Basque Country, reported through the sentinel influenza surveillance system which monitors 2.2-2.5% of the population. Between September 1999 and August 2009, influenza A(H3N2) or seasonal influenza A(H1N1) was detected in 941 patients, and from April to August 2009, pandemic influenza A(H1N1) was detected in 112 patients. The H3/H1 seasonal influenza ratio was between 3.3 and 3.4 in the under 60 year-olds, but 9.8 in older individuals, suggesting that people born before 1950 have residual immunity against the influenza A H1N1 subtype (both seasonal and pandemic).


Early estimates of 2009 pandemic influenza A(H1N1) virus activity in general practice in France: incidence of influenza-like illness and age distribution of reported cases

[http://www.eurosurveillance.org/View...rticleId=19341 ]

In the end of August 2009, an unusually elevated level of influenza-like illness (ILI) activity was reported to the French Sentinel Network. The article estimates the observed excess in ILI cases in France during summer 2009 and characterises age patterns in reported cases. An excess of cases has been observed since 5 July, with a time increasing trend. The cumulated estimated excess number of ILI cases was 269,935 [179,585; 316,512], corresponding to 0.5% of the French population over the period. Compared to the same period in the past years, relative cumulative incidence was greater among young subjects and lower among subjects over 65 years-old. Compared to past epidemics, the relative cumulative incidence was greater in children less than five years-old.

This excess of cases may reflect the current spread of the A(H1N1) virus in France, subject to the following limitations: estimates were based on clinical cases consulting a GP; large media coverage may have led to a non specific increase in consultation rates.


Media highlights

The news that the European Commission earlier this week granted authorisation to two A(H1N1) vaccines has been covered in all major media outlets.

The coverage has led to a number of stories at the EU and country level on when and how countries would start their vaccination campaigns and in particular how they would mix their seasonal influenza and pandemic vaccination campaigns.

In addition there has been wide coverage from the business perspective and delivery times for vaccines.

Further afield the news that Australia, which has started its vaccination plan, and that China is continuing apace following its start last week, has been covered by several media channels.

Vaccine administration has also been a top story during the week with certain media raising the questions about the effect on risk groups and whether one or two doses would be required.

Other news have concentrated on reports from around the globe suggesting that some countries, notably the US, Mexico and the UK, are beginning to see an increase in the number of A(H1N1) cases.


Weekly Influenza Surveillance Overview

The ECDC Weekly Influenza Surveillance Overview will be published this afternoon and will be available at: http://www.ecdc.europa.eu/en/activit..._Bulletin.aspx


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 184 deaths have been reported; the information is available on Table 2. The latest available updates as of October 01, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.


Daily Update contents

ECDC has now stop publishing numbers of confirmed cases reported from EU/EFTA member states or from countries around the world in the Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups like the risk groups.

The World Health Organization has also recommended that countries verify only the first few hundred cases and after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe with the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays.

For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the number of fatal cases per country are likely to be gross underestimates of the true number of fatal cases associated with pandemic influenza. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 02 October 2009, 09:00 hours (CEST) in the 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 (07.8.) - 0 - ... - 0 - ...
2. Belgium (20.9.) - 3 - 38 - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (21.9.) - 0 - ... - 0 - ...
6. Denmark (09.9.) - ... - ... - ... - ...
7. Estonia (04.9.) - 0 - 0 - 0 - 0
8. Finland (03.9.) - ... - ... - ... - ...
9. France (30.9.) - 10 - 174 - 5 - 24
10. Germany (01.10.) - ... - ... - ... - ...
11. Greece (22.9.) - ... - 54 - 1 - 13
12. Hungary (19.9.) - ... - 32 - ... - ...
13. Iceland (25.9.) - 0 - 1 - 0 - 0
14. Ireland (27.9.) - ... - 157 - 0 - 13
15. Italy (27.9) - 80 - 846 - ... - ...
16. Latvia (13.8.) - ... - 1 - ... - ...
17. Liechtenstein (01.10.) - ... - ... - ... - ...
18. Lithuania (13.8.) - ... - ... - ... - ...
19. Luxembourg (25.9.) - ... - ... - 0 - 0
20. Malta (04.9.) - ... - 46 - ... - 1
21. Netherlands (25.9.) - 10 - 100 - 1 - 18
22. Norway (30.9.) - 8 - 71 - 5 - 11
23. Poland (01.10.) - ... - ... - ... - ...
24. Portugal (30.9.) - 21 - ... - 6 - ...
25. Romania (27.9) - ... - 18 - ... - ...
26. Slovakia (12.8.) - 2 - 33 - 0 - 0
27. Slovenia (10.8.) - ... - ... - ... - ...
28. Spain (20.8.) - ... - ... - 32 - 91
29. Sweden (27.9.) - .... - ... - ... - ...
30. Switzerland (1.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (24.9.) - 218 - ... - 25 - ...

Note:
Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites. New updates are shaded in yellow.

(...) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (143 cumulative hospitalisations), Wales (48) and Northern Ireland (97).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 02 October, 09:00 hours CEST, and in the rest of the world by country, as of 01 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium 1 - 2
2. Bulgaria ... - 1
3. France ... - 30 (a)
4. Germany ... - 1
5. Greece ... - 3
6. Hungary ... - 2
7. Ireland ... - 2
8. Italy ... - 3
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 4
13. Portugal ... - 2
14. Spain 6 - 42
15. Sweden ... - 2
16. United Kingdom ... - 82

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 3
2. Egypt ... - 2
3. Iran ... - 4
4. Iraq ... - 1
5. Israel 4 - 28
6. Kuwait ... - 8
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 21
10. Qatar ... - 3
11. Saudi Arabia ... - 30
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen ... - 6

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa 25 - 84

• NORTH AMERICA

1. Canada ... - 78
2. Mexico ... - 231
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados ... - 1
2. Cayman Islands ... - 1
3. Costa Rica ... - 37
4. Dominican Republic ... - 21
5. El Salvador ... - 19
6. Guatemala ... - 13
7. Honduras ... - 15
8. Jamaica ... - 4
9. Nicaragua ... - 11
10. Panama ... - 11
11. Saint Kitts and Nevis ... - 1
12. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 538
2. Bolivia ... - 54
3. Brazil ... - 899
4. Chile ... - 132
5. Colombia 2 - 91
6. Ecuador ... - 60
7. Paraguay ... - 52
8. Peru ... - 143
9. Uruguay ... - 33
10. Venezuela ... - 83

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. Hong Kong SAR China ... - 22
3. India 7 - 315
4. Japan ... - 18
5. Macao SAR China ... - 1
6. South Korea ... - 11
7. Taiwan 1 - 19

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 1
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 165
9. Vietnam 1 - 16

• AUSTRALIA & PACIFIC

1. Australia ... - 180
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand ... - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 47 - 4432

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the R?union, 1 Martinique and 6 in mainland France.

(...)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 05 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 05 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Weekly overview of selected non-EU countries published;
• Four pandemic influenza A (H1N1) 2009 vaccines soon available on the European market
• Total of 189 fatal cases in Europe and EFTA countries and 4 305 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 04 October 2009 16:00 hours CEST, for the world, and 05 October 09:00 hours CEST, for Europe is presented in Table 2.


Weekly overview of selected non-EU countries

Chile (pop 16.6 million)

The number of pandemic influenza cases reported weekly to the national level has been decreasing since week 28. Up to week 37, the number of confirmed cases was 12 248, out of which 1 562 presented with Severe Acute Respiratory Illness (SARI). The majority of SARI cases were infants (73.9/100 000 pop) or children between 1-4 years of age (16.2/100 000pop). The majority (55%) of SARI cases had a chronic underlying illness. Out of the confirmed cases 126 have had a fatal outcome associated with pandemic influenza. The majority (64.8%) of the fatal cases had an underlying illness. No new fatalities were reported during weeks 36-37.

The majority of influenza strains identified until week 34 were A(H1N1)v and less than 0.5% were identified as seasonal H1 or H3 strains. Very few influenza viruses were identified through surveillance activities during week 34.

The Chilean surveillance report is available at: http://www.minsal.cl/


Brazil (pop. 192 million)

Since the beginning of the pandemic until week 36, 46 810 Severe Acute Respiratory Illness (SARI) cases were notified in Brazil, of which 9 249 were subsequently laboratory-confirmed as influenza A (H1N1)v infections. Underlying risk-factors were reported for 37.4% of the confirmed SARI cases. The number of confirmed cases as well as ILI cases appears to have been decreasing for the last four weeks. Of the confirmed SARI cases, 899 (9.7%) have had a fatal outcome. Mortality due to SARI cases with confirmed influenza A (H1N1)v is currently 0,47/100.000 inhabitants.

Out of the 9 249 SARI cases linked to influenza A (H1N1)v, 37.7% presented with at least one of risk factor (including pregnancy), which does not significantly differ from what is observed for seasonal influenza in the country. Among SARI cases in fertile age 24.3% were pregnant, which does not differ from what is observed with seasonal influenza (16.8%).

Out of 18 257 PCR tests conducted up to week 36, 70.1% tested positive for influenza A (H1N1)v. This proportion has not changed much in the last four weeks, although the number of samples being collected is decreasing rapidly.

For entire epidemiological update for week 36 (Portuguese) see: http://portal.saude.gov.br/portal/ar...enza_se_36.pdf

H1N1 website of the ministry of health: http://dtr2001.saude.gov.br/ascom/sv...uenza_site.htm


Australia (pop. 20.7 million)

In the national report for October 2nd, the total number of fatal cases associated with the pandemic influenza (H1N1) 2009 is now 183. There have been 36 new cases hospitalised due to (H1N1) 2009 during the preceding week and 10 of them are in Intensive Care Units. The total number of hospitalisations in Australia since the pandemic began is 4 806. All of these figures indicate a decreasing trend for last few weeks. Thirteen percent of the fatal cases and one out of the 36 new hospitalised cases are indigenous Australians. According to recent censuses, around 2.5% of the Australian population consider themselves indigenous.

The current Australian influenza report can be found at: http://www.healthemergency.gov.au/in...etins-21-27Sep

A feature articles on what Europe can learn from Australia appeared in the British Medical Journal on August 22nd http://www.bmj.com/cgi/content/full/339/aug18_1/b3317

Australian Government-Department of Health and Ageing http://www.healthemergency.gov.au/in...ontent/updates


New Zealand (pop. 4.2 million)

The latest surveillance report of week 39 indicates that the circulation of influenza in the community continues to decline, but is still above seasonal levels. The ILI consultation rate from a sentinel surveillance system has been decreasing since week 29, but is still at a higher level than during the past two years.

The number of deaths from Pandemic Influenza (H1N1) 2009 is now 17 and has not changed in the last two weeks. These are deaths where swine flu was a primary cause. There are a number of other deaths that are being investigated by the Coroner's office. As of September 27th one thousand patients were reported to have been hospitalised due to influenza (H1N1) 2009 or its complications. The pressure on ICU?s is now so low that national authorities have stopped monitoring patient numbers. In general, schools are reporting usual levels of absence for this time of year. The majority of isolates received through the sentinel surveillance system have been influenza A(H1N1)v from week since week 27. Very few influenza viruses were identified during week 38. All isolates tested so far have been sensitive to oseltamivir

NZ National influenza update is at: http://www.moh.govt.nz/moh.nsf/index...ate-152-230909

NZ Sentinel surveillance report is at: http://www.surv.esr.cri.nz/virology/...kly_update.php


South Africa (pop. 48.6 million)

As of September 29th South Africa has confirmed 11 729 cases of pandemic (H1N1) 09. The number of deaths related to the pandemic is 84, which includes 24 cases reported by private laboratories, but not confirmed by the National Health Laboratory Service. It appears that the numbers of confirmed cases and deaths have not been increasing in the last two weeks.

The median age of the fatal cases was 32 years and 58% of them were female. Fifty-two percent of the tested fatal cases were HIV-positive. Twenty-eight percent of the fatal cases were pregnant or in the puerperal period. Nine percent of the fatal cases had active tuberculosis.

The recommended national strategy is laboratory confirmation only for moderate or severe cases; however the national authorities believe it is likely that most cases are still being captured by the surveillance system.

SA surveillance report available at: http://www.nicd.ac.za/


Vaccine update

Four pandemic influenza A (H1N1) 2009 vaccines soon available on the European market

An additional vaccine, Celvapan, against pandemic influenza A (H1N1) 2009 was recommended authorisation on October 2, 2009 by the European Medicines Agency. Adoption of an authorisation decision by the European Commission is expected this week.

The vaccine from Baxter is an unadjuvanted, inactivated, whole virion vaccine containing 7.5 μg of hemagglutinin of the influenza A/California/07/2009 (H1N1) strain. It is propagated in Vero-cells.

The Celvapan vaccine is currently recommended to be offered in a two-dose schedule, at an interval of three weeks. It is recommended for adults, including pregnant women, and in children from 6 months of age. Results from first clinical trials will be available from mid-October 2009 and onwards.

For further information see http://www.emea.europa.eu/humandocs/...62290809en.pdf

Two other pandemic influenza A (H1N1) 2009 vaccines have recently been authorised by the European Commission; Focetria from Novartis and Pandemrix from GSK. Celvapan, Focetria and Pandemirix vaccines have received a central European authorisation allowing the manufacturer to replace the flu virus strain in the current ?mock-up? vaccines with the pandemic influenza A (H1N1) 2009 strain causing the current pandemic.

For further information see http://www.emea.europa.eu/

In addition, the National Regulatory Agency in Hungary, provided a national license of a pandemic vaccine produced by the Hungarian manufacturer Omnivest on the 29 September, 2009. This vaccine is an alum-adjuvanted, inactivated, whole-virion vacccine, containing 6 μg of hemagglutinin of the influenza A/California/07/2009 (H1N1) strain. It is also propagated in Vero-cells. The pandemic vaccine from Omnivest is recommended for adults, including pregnant women and children older than 6 months and will be used in Hungary. The vaccine from Omnivest is recommended to be offered in a one-dose schedule.

For further information see http://www.omninvest.hu/influenza/english/index.html


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 189 deaths have been reported; the information is available on Table 2.

The latest available updates as of October 04, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates.

Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 05 October 2009, 09:00 hours (CEST) in the 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 (07.8.) - 0 - ... - 0 - ...
2. Belgium (20.9.) - 3 - 38 - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (21.9.) - 0 - ... - 0 - ...
6. Denmark (09.9.) - ... - ... - ... - ...
7. Estonia (04.9.) - 0 - 0 - 0 - 0
8. Finland (03.9.) - ... - ... - ... - ...
9. France (30.9.) - 10 - 174 - 5 - 24
10. Germany (02.10.) - ... - ... - ... - ...
11. Greece (22.9.) - ... - 54 - 1 - 13
12. Hungary (19.9.) - ... - 32 - ... - ...
13. Iceland (02.10.) - 0 - 4 - 0 - 0
14. Ireland (01.10.) - 28 - 183 - 10 - 15
15. Italy (27.9) - 80 - 846 - ... - ...
16. Latvia (13.8.) - ... - 1 - ... - ...
17. Liechtenstein (02.10.) - ... - ... - ... - ...
18. Lithuania (13.8.) - ... - ... - ... - ...
19. Luxembourg (02.10.) - ... - ... - 0 - 0
20. Malta (04.9.) - ... - 46 - ... - 1
21. Netherlands (02.10.) - ... - 114 - ... - 19
22. Norway (30.9.) - 8 - 71 - 5 - 11
23. Poland (01.10.) - ... - ... - ... - ...
24. Portugal (30.9.) - 21 - ... - 6 - ...
25. Romania (27.9) - ... - 18 - ... - ...
26. Slovakia (12.8.) - 2 - 33 - 0 - 0
27. Slovenia (10.8.) - ... - ... - ... - ...
28. Spain (20.8.) - ... - ... - 32 - 91
29. Sweden (27.9.) - ... - ... - ... - ...
30. Switzerland (02.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (01.10.) - 286 - ... - 36 - ...

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.
(a) Data includes all probable cases for England only. Does not include Scotland (184 cumulative hospitalisations), Wales (60) and Northern Ireland (167).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 05 October, 09:00 hours CEST, and in the rest of the world by country, as of 04 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 2
2. Bulgaria ... - 1
3. France ... - 30 (a)
4. Germany ... - 1
5. Greece ... - 3
6. Hungary ... - 2
7. Ireland 2 - 4
8. Italy ... - 3
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 4
13. Portugal ... - 2
14. Spain ... - 42
15. Sweden ... - 2
16. United Kingdom 3 - 85

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain 1 - 4
2. Egypt ... - 2
3. Iran 2 - 6
4. Iraq ... - 1
5. Israel ... - 28
6. Kuwait 1 - 9
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 21
10. Qatar ... - 3
11. Saudi Arabia 5 - 35
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen ... - 6

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa ... - 84

• NORTH AMERICA

1. Canada ... - 78
2. Mexico 5 - 236
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados ... - 1
2. Cayman Islands ... - 1
3. Costa Rica ... - 37
4. Cuba 1 - 1
5. Dominican Republic 1 - 22
6. El Salvador ... - 19
7. Guatemala ... - 13
8. Honduras 1 - 16
9. Jamaica ... - 4
10. Nicaragua ... - 11
11. Panama ... - 11
12. Saint Kitts and Nevis ... - 1
13. Suriname ... - 2

• SOUTH AMERICA

1. Argentina 1 - 539
2. Bolivia 1 - 55
3. Brazil ... - 899
4. Chile ... - 132
5. Colombia ... - 91
6. Ecuador 4 - 64
7. Paraguay ... - 52
8. Peru ... - 143
9. Uruguay ... - 33
10. Venezuela 1 - 84

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. Hong Kong SAR China 1 - 23
3. India 25 - 340
4. Japan 2 - 20
5. Macao SAR China ... - 1
6. South Korea ... - 11
7. Taiwan ... - 19

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 1
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 165
9. Vietnam 2 - 18

• AUSTRALIA & PACIFIC

1. Australia 3 - 183
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand ... - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 62 - 4494

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 Martinique and 6 in mainland France.

(...)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 06 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 06 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Updates from U.S.A. and Canada included;
• Total of 189 fatal cases in Europe and EFTA countries and 4 315 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 05 October 2009 16:00 hours CEST, for the world, and 06 October 09:00 hours CEST, for Europe is presented in Table 2.


Updates from U.S.A. and Canada

United States Update

Data as of 2 October 2009 21:30 CEST, for week ending 26 September 2009 (Week 38)

Virology: 99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses. 99.7% of all specimens were type A and 0.3% were type B. 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine. Since 1 October 2008, of 2009 influenza A (H1N1) viruses tested for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) 0.6% have been found resistance to oseltamivir and none resistant to zanamivir.

Deaths: The proportion of deaths attributed to pneumonia and influenza 6.1%, reported through the 122-Cities Mortality Reporting System. This is below the epidemic threshold of 6.4% for week 38.

Influenza-associated Pediatric Deaths: 11 deaths reported in Week 38; all associated with 2009 influenza A (H1N1) virus infections. Since last year, (28 September 2008), CDC received 128 reports of influenza-associated pediatric deaths: 60 were due to 2009 influenza A (H1N1) virus infections and 14 have occurred since 30 August 2009.

Influenza-associated hospitalizations: Laboratory-confirmed influenza-associated hospitalization rates were reported during 15 April ? 26 September 2009 (rates include influenza A, influenza B, and 2009 influenza A (H1N1)). Rates for children aged 0-23 months, 2-4 years, and 5-17 years were 3.3, 1.4, and 1.1 per 10,000, respectively. Rates for adults aged 18-49 years, 50-64 years, and ≥ 65 years, the overall flu rates were 0.7, 0.8, and 0.7 per 10,000, respectively.

Influenza-like Illness (ILI): For the entire U.S., outpatient visits due to ILI (4.2%) were above the national baseline (2.4%). The north-eastern region of the U.S. (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont) was an exception with visits below the regional baseline. Four other regions noted decreasing percentage of visits due to ILI.

Geographic spread: Assessed by state and territorial epidemiologists, there was widespread activity in 27 states, regional activity in Guam and 18 states, local influenza activity in Washington, D.C., Puerto Rico and two states, and sporadic activity in one states. The U.S. Virgin Islands and two states did not report. None of the north-eastern region states above was reporting widespread activity.

Other information: 25 areas (e.g., states and major cities) placed orders for 600,000 doses of 2009 influenza A (H1N1) vaccine. The first doses of vaccine available will be nasal spray formulation for people ≥2-49 years old without chronic medical conditions and who are not pregnant. The vaccine is scheduled to arrive at sites on 6 October 2009. 300,000 courses of liquid oseltamivir for children were made available to states by the federal government. The 2009-2010 U.S. Influenza Season (for purposes of surveillance and reporting) begins 4 October 2009.

For more information: U.S. Centers for Disease Control and Prevention ?What's New on the H1N1 Flu Site? http://www.cdc.gov/h1n1flu/whatsnew.htm
U.S. Centers for Disease Control and Prevention Weekly Influenza Surveillance Report http://www.cdc.gov/flu/weekly/


Canada Update

Data as of 28 September 2009 16:00 CEST, for week ending September 19, 2009 (Week 37)

Virology: 98.3% of all subtyped influenza A viruses being reported to Public Health Agency of Canada (PHAC) were 2009 influenza A (H1N1) viruses. 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine. Of 2009 influenza A (H1N1) viruses tested by PHAC for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) 0.2% have been found resistance to oseltamivir and none resistant to zanamivir. Two cases of oseltamivir resistant Pandemic (H1N1) 2009 were reported so far in Canada from the province of Quebec on 21 July 2009 and from the province of Alberta on 15 September 2009.

Hospitalizations and Deaths: 8 hospitalizations and 2 deaths were reported for week 37. As of 19 September 2009, 1,467 hospitalized cases including 292 cases admitted to an intensive care unit (ICU) and 151 cases requiring ventilation as well as 78 deaths have been reported since the beginning of the pandemic.

Paediatric Influenza Hospitalizations and Deaths: Two laboratory-confirmed influenza-associated paediatric hospitalizations were reported through the Immunization Monitoring Program Active (IMPACT) network. One of the two hospitalizations was due to Pandemic (H1N1) 2009 and the other to seasonal influenza A. 365 hospitalizations have been reported since week 17 (April 26); 92.3% of these hospitalizations have been due to Pandemic (H1N1) 2009. Since the beginning of the pandemic, four deaths due to Pandemic (H1N1) 2009 had been reported through the IMPACT network among children aged under 16 years of age.

Influenza-like Illness (ILI): The national ILI consultation rate increased to 32 consultations per 1,000 patient visits this week which was increasing for a second consecutive week and was above the expected range for this time of the year.

Geographic spread: The number of regions with localized activity and the number of influenza outbreaks were higher compared to the previous week.

For more information: Public Health Agency of Canada FluWatch http://www.phacaspc.gc.ca/fluwatch/index.html


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 189 deaths have been reported; the information is available on Table 2.

The latest available updates as of October 05, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 06 October 2009, 09:00 hours (CEST) in the 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 (25.09.) - 0 - ... - 0 - ...
2. Belgium (20.09.) - 3 - 38 - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (21.09.) - 0 - ... - 0 - ...
6. Denmark (09.09.) - ... - ... - ... - ...
7. Estonia (04.09.) - 0 - 0 - 0 - 0
8. Finland (03.09.) - ... - ... - ... - ...
9. France (30.09.) - 10 - 174 - 5 - 24
10. Germany (05.10.) - ... - ... - ... - ...
11. Greece (22.09.) - ... - 54 - 1 - 13
12. Hungary (19.09.) - ... - 32 - ... - ...
13. Iceland (02.10.) - 0 - 4 - 0 - 0
14. Ireland (01.10.) - 28 - 183 - 10 - 15
15. Italy (27.09) - 80 - 846 - ... - ...
16. Latvia (13.08.) - ... - 1 - ... - ...
17. Liechtenstein (05.10.) - ... - ... - ... - ...
18. Lithuania (13.08.) - ... - ... - ... - ...
19. Luxembourg (02.10.) - ... - ... - 0 - 0
20. Malta (04.09.) - ... - 46 - ... - 1
21. Netherlands (02.10.) - ... - 114 - ... - 19
22. Norway (30.09.) - 8 - 71 - 5 - 11
23. Poland (05.10.) - ... - ... - ... - ...
24. Portugal (30.09.) - 21 - ... - 6 - ...
25. Romania (27.09) - ... - ... - ... - ...
26. Slovakia (12.08.) - 2 - 33 - 0 - 0
27. Slovenia (10.08.) - ... - ... - ... - ...
28. Spain (20.08.) - ... - ... - 32 - 91
29. Sweden (27.09.) - ... - ... - ... - ...
30. Switzerland (05.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (01.10.) - 286 - ... - 36 - ...

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.
(a) Data includes all probable cases for England only. Does not include Scotland (184 cumulative hospitalisations), Wales (60) and Northern Ireland (167).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 06 October, 09:00 hours CEST, and in the rest of the world by country, as of 05 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 2
2. Bulgaria ... - 1
3. France ... - 30 (a)
4. Germany ... - 1
5. Greece ... - 3
6. Hungary ... - 2
7. Ireland ... - 4
8. Italy ... - 3
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 4
13. Portugal ... - 2
14. Spain ... - 42
15. Sweden ... - 2
16. United Kingdom ... - 85

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 4
2. Egypt ... - 2
3. Iran ... - 6
4. Iraq 1 - 2
5. Israel 2 - 30
6. Kuwait ... - 9
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 21
10. Qatar ... - 3
11. Saudi Arabia ... - 35
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen ... - 6

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa ... - 84

• NORTH AMERICA

1. Canada ... - 78
2. Mexico ... - 236
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados ... - 1
2. Cayman Islands ... - 1
3. Costa Rica ... - 37
4. Cuba ... - 1
5. Dominican Republic ... - 22
6. El Salvador ... - 19
7. Guatemala ... - 13
8. Honduras ... - 16
9. Jamaica ... - 4
10. Nicaragua ... - 11
11. Panama ... - 11
12. Saint Kitts and Nevis ... - 1
13. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 539
2. Bolivia ... - 55
3. Brazil ... - 899
4. Chile ... - 132
5. Colombia ... - 91
6. Ecuador ... - 64
7. Paraguay ... - 52
8. Peru ... - 143
9. Uruguay ... - 33
10. Venezuela 1 - 85

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. Hong Kong SAR China ... - 23
3. India 4 - 344
4. Japan ... - 20
5. Macao SAR China ... - 1
6. South Korea ... - 11
7. Taiwan 2 - 21

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 1
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 165
9. Vietnam ... - 18

• AUSTRALIA & PACIFIC

1. Australia ... - 183
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand ... - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 10 - 4504

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 Martinique and 6 in mainland France.

(...)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 07 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 07 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Study suggests seasonal influenza vaccine protective against pandemic influenza;
• Review on why healthcare workers are priority group for vaccination published;
• Total of 189 fatal cases in Europe and EFTA countries and 4 335 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 05 October 2009 16:00 hours CEST, for the world, and 06 October 09:00 hours CEST, for Europe is presented in Table 2.

Scientific Advice

Why healthcare workers are a priority group for pandemic influenza A(H1N1) vaccination?

Health care workers (HCWs) are often the first priority group for H1N1 pandemic vaccination. There are three prime reasons for their being immunised: protecting their patients, personal protection and maintaining a service. Initial data from seasonal influenza vaccination campaigns and surveys of intentions of health care workers suggests vaccine coverage can be less than desirable. At the same time vaccination needs to be made much easier for HCWs to achieve high coverage in order to protect their patients and themselves.

Link to the full Scientific Advice will be available at: http://ecdc.europa.eu/en/activities/...rm.aspx?ID=664


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 189 deaths have been reported; the information is available on Table 2.

The latest available updates as of October 06, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Other updates

Seasonal influenza vaccine protective against pandemic influenza: Study from Mexico

Mexican researchers published results of a frequency-matched case-control study among patients of a specialty hospital in Mexico City. The results, published in the British Medical Journal (BMJ), suggest that the 2008-09 trivalent seasonal influenza vaccine had some protective effect against pandemic influenza infection, particularly severe forms of the disease. The study design adjusted for confounding by age and underlying diseases.

Read full article at: http://www.bmj.com/cgi/content/abstr.../oct06_2/b3928


Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates.

Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 07 October 2009, 09:00 hours (CEST) in the 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 (07.8.) - 0 - ... - 0 - ...
2. Belgium (20.9.) - 3 - 38 - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (21.9.) - 0 - .... - 0 - ...
6. Denmark (09.9.) - ... - ... - ... - ...
7. Estonia (04.9.) - 0 - 0 - 0 - 0
8. Finland (03.9.) - ... - ... - ... - ...
9. France (30.9.) - 10 - 174 - 5 - 24
10. Germany (06.10.) - ... - ... - ... - ...
11. Greece (22.9.) - ... - 54 - 1 - 13
12. Hungary (19.9.) - ... - 32 - ... - ...
13. Iceland (02.10.) - 0 - 4 - 0 - 0
14. Ireland (01.10.) - 28 - 183 - 10 - 15
15. Italy (27.9) - 80 - 846 - ... - ...
16. Latvia (13.8.) - ... - 1 - ... - ...
17. Liechtenstein (06.10.) - ... - ... - ... - ...
18. Lithuania (13.8.) - ... - ... - ... - ...
19. Luxembourg (02.10.) - ... - ... - 0 - 0
20. Malta (04.9.) - ... - 46 - ... - 1
21. Netherlands (02.10.) - ... - 114 - ... - 19
22. Norway (30.9.) - 8 - 71 - 5 - 11
23. Poland (05.10.) - ... - ... - ... - ...
24. Portugal (30.9.) - 21 - ... - 6 - ...
25. Romania (27.09) - ... - ... - ... - ...
26. Slovakia (12.8.) - 2 - 33 - 0 - 0
27. Slovenia (10.8.) - ... - ... - ... - ...
28. Spain (20.8.) - ... - ... - 32 - 91
29. Sweden (27.9.) - ... - ... - ... - ...
30. Switzerland (06.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (01.10.) - 286 - ... - 36 - ...

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.
(a) Data includes all probable cases for England only. Does not include Scotland (184 cumulative hospitalisations), Wales (60) and Northern Ireland (167).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 07 October, 09:00 hours CEST, and in the rest of the world by country, as of 06 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 2
2. Bulgaria ... - 1
3. France ... - 30 (a)
4. Germany ... - 1
5. Greece ... - 3
6. Hungary ... - 2
7. Ireland ... - 4
8. Italy ... - 3
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 4
13. Portugal ... - 2
14. Spain ... - 42
15. Sweden ... - 2
16. United Kingdom ... - 85

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 4
2. Egypt ... - 2
3. Iran ... - 6
4. Iraq ... - 2
5. Israel ... - 30
6. Kuwait ... - 9
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 21
10. Qatar ... - 3
11. Saudi Arabia ... - 35
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen ... - 6

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa ... - 84

• NORTH AMERICA

1. Canada ... - 78
2. Mexico 6 - 242
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados 1 - 2
2. Cayman Islands ... - 1
3. Costa Rica ... - 37
4. Cuba ... - 1
5. Dominican Republic ... - 22
6. El Salvador 1 - 20
7. Guatemala ... - 13
8. Honduras ... - 16
9. Jamaica ... - 4
10. Nicaragua ... - 11
11. Panama ... - 11
12. Saint Kitts and Nevis ... - 1
13. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 539
2. Bolivia ... - 55
3. Brazil ... - 899
4. Chile ... - 132
5. Colombia ... - 91
6. Ecuador ... - 64
7. Paraguay ... - 52
8. Peru ... - 143
9. Uruguay ... - 33
10. Venezuela ... - 85

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. China (Mainland) 1 - 1
3. Hong Kong SAR China ... - 23
4. India 7 - 351
5. Japan ... - 20
6. Macao SAR China ... - 1
7. South Korea ... - 11
8. Taiwan ... - 21

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia 2 - 3
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 165
9. Vietnam 2 - 20

• AUSTRALIA & PACIFIC

1. Australia ... - 183
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand ... - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 20 - 4524

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 Martinique and 6 in mainland France.

(...)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 08 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 08 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Scientific Advance on respiratory protection of healthcare workers published;
• Private web-based influenza self-assessment tool launched in US;
• Total of 192 fatal cases in Europe and EFTA countries and 4 367 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 07 October 2009 16:00 hours CEST, for the world, and 08 October 09:00 hours CEST, for Europe is presented in Table 2.


Scientific advance

N95 (FFP2) masks no more effective than surgical masks in protecting healthcare workers against human influenza ? results of the Canadian RCT among nursing staff

A well-organised controlled trial with nurses in Canadian hospitals found that during seasonal influenza epidemics there was no advantage of the use of N95 respirators (equivalent to the FFP2 level) compared to ordinary surgical mask when laboratory- confirmed influenza infection was an endpoint. This is the first published trial involving healthcare workers and is especially powerful as randomisation took place at an individual (nurse) level.

Full ECDC review available at: http://ecdc.europa.eu/en/activities/...lue1=Influenza


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 192 deaths have been reported; the information is available on Table 2.

The latest available updates as of October 07, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Other updates

Microsoft launched a web-based pandemic influenza self-assessment tool.

The tool is based on ?The Strategy for Off-Site Rapid Triage (SORT?)? and ?Real-time Epidemiological Assessment for Community Health (REACH?)? materials that were created and developed at Emory University.

The full tool is available at: https://h1n1.cloudapp.net/default.aspx


Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries.

It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 08 October 2009, 09:00 hours (CEST) in the 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 (02.10.) - ... - ... - ... - ...
2. Belgium (20.09.) - 3 - 38 - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (21.09.) - 0 - ... - 0 - ...
6. Denmark (07.10.) - ... - ... - ... - ...
7. Estonia (04.09.) - 0 - 0 - 0 - 0
8. Finland (07.10.) - ... - ... - ... - ...
9. France (07.10.) - 15 - 199 - 4 - 26
10. Germany (07.10.) - ... - ... - ... - ...
11. Greece (22.09.) - ... - 54 - 1 - 13
12. Hungary (19.09.) - ... - 32 - ... - ...
13. Iceland (02.10.) - 0 - 4 - 0 - 0
14. Ireland (01.10.) - 28 - 183 - 10 - 15
15. Italy (27.09) - 80 - 846 - ... - ...
16. Latvia (13.08.) - ... - 1 - ... - ...
17. Liechtenstein (07.10.) - ... - ... - ... - ...
18. Lithuania (13.08.) - ... - ... - ... - ...
19. Luxembourg (02.10.) - ... - ... - 0 - 0
20. Malta (04.09.) - ... - 46 - ... - 1
21. Netherlands (02.10.) - ... - 114 - ... - 19
22. Norway (07.10.) - 8 - 79 - 5 - 14
23. Poland (05.10.) - ... - ... - ... - ...
24. Portugal (07.10.) - 15 - ... - 5 - ...
25. Romania (27.09) - ... - ... - ... - ...
26. Slovakia (12.08.) - 2 - 33 - 0 - 0
27. Slovenia (10.08.) - ... - ... - ... - ...
28. Spain (20.08.) - ... - ... - 32 - 91
29. Sweden (27.09.) - ... - ... - ... - ...
30. Switzerland (07.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (01.10.) - 286 - ... - 36 - ...

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.
(a) Data includes all probable cases for England only. Does not include Scotland (184 cumulative hospitalisations), Wales (60) and Northern Ireland (167).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 08 October, 09:00 hours CEST, and in the rest of the world by country, as of 07 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 2
2. Bulgaria ... - 1
3. France 1 - 31 (a)
4. Germany 1 - 2
5. Greece ... - 3
6. Hungary ... - 2
7. Ireland ... - 4
8. Italy ... - 3
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway 2 - 6
13. Portugal ... - 2
14. Spain ... - 42
15. Sweden ... - 2
16. United Kingdom ... - 85

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain 1 - 5
2. Egypt ... - 2
3. Iran ... - 6
4. Iraq ... - 2
5. Israel ... - 30
6. Kuwait ... - 9
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 21
10. Qatar ... - 3
11. Saudi Arabia ... - 35
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen ... - 6

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa 7 - 91

• NORTH AMERICA

1. Canada ... - 78
2. Mexico 2 - 244
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados ... - 2
2. Cayman Islands ... - 1
3. Costa Rica ... - 37
4. Cuba ... - 1
5. Dominican Republic ... - 22
6. El Salvador ... - 20
7. Guatemala ... - 13
8. Honduras ... - 16
9. Jamaica ... - 4
10. Nicaragua ... - 11
11. Panama ... - 11
12. Saint Kitts and Nevis ... - 1
13. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 539
2. Bolivia 1 - 56
3. Brazil ... - 899
4. Chile ... - 132
5. Colombia 10 - 101
6. Ecuador ... - 64
7. Paraguay ... - 52
8. Peru ... - 143
9. Uruguay ... - 33
10. Venezuela 2 - 87

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. China (Mainland) ... - 1
3. Hong Kong SAR China ... - 23
4. India 8 - 359
5. Japan ... - 20
6. Macao SAR China ... - 1
7. South Korea ... - 11
8. Taiwan 1 - 22

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 3
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 165
9. Vietnam ... - 20

• AUSTRALIA & PACIFIC

1. Australia ... - 183
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand ... - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 35 - 4559

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 Martinique and 7 in mainland France.

(...)
-
-------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 09 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 09 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Eurosurveillance update: Does viral interference affect spread of influenza? Internet search-engine based influenza-monitoring for Europe unveiled;
• Media highlights published;
• Two studies on clinical aspects of pandemic influenza published;
• Total of 198 fatal cases in Europe and EFTA countries and 4 381 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 08 October 2009 16:00 hours CEST, for the world, and 09 October 09:00 hours CEST, for Europe is presented in Table 2.


Eurosurveillance Updates

Does viral interference affect spread of influenza?

A paper from Sweden published in Eurosurveillance this week presents the hypothesis that a rhinovirus epidemic after the end of the summer holidays may have interfered with the spread of pandemic influenza during a period with warm and humid weather conditions that reduces spread of influenza by aerosol. Although the laboratory data supporting this hypothesis are limited, it is meant to stimulate research into the possibility that the interaction between different circulating viruses may affect influenza epidemiology. As a possible explanation, the authors note that rhinovirus transmission is not known to be climate-dependent. Thus the spread of rhinoviruses may have had an advantage over influenza in mild and moist climate. Rhinovirus infection will elicit an innate immune response in the infected cells, stimulating the production of interferon and other cytokines. This immune reaction causes the cells to enter an antiviral state that would to some extent protect them from further infections by other viruses.

Link to the article: http://www.eurosurveillance.org/View...rticleId=19354


Google flutrends now includes several European countries

Google Flu Trends, a tool that estimates the level of influenza activity in near real-time using aggregated search queries, has been released for 14 countries in Europe on 8 October 2009 by Google.org, the philanthropic arm of Google. In total Google Flu Trends covers information for 20 countries worldwide and it is available in 37 languages.

Link to the article: http://www.eurosurveillance.org/View...rticleId=19352

Link to Google flutrends http://www.google.org/flutrends/


Media highlights

Much of the media this week has focused on the start of the US pandemic vaccination program, with many global and European press considering the attitude of many US citizens towards the vaccine. Of particular interest to the media has been the re-assurance given by US Health secretary that the vaccines which are being used are safe and have been rigorously tried and tested. This perspective has also been widely reported from statements made by the World Health Organisation (WHO), which restated its confidence in the H1N1 flu vaccine and calling it the most important tool against the pandemic. In particular that mild adverse side effects are to be expected in some people but everyone who has access to the vaccine should still be inoculated.

Other news coverage has focussed in on 22 governments placing orders for the pandemic flu vaccine with pharmaceutical company GSK and, in parallel, the news that the European Commission has approved another pandemic vaccine for use, this time produced by Baxters.


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 198 deaths have been reported; the information is available on Table 2.

The latest available updates as of October 08, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Other updates

Two studies published in New England Journal of Medicine (NEJM) online review some of the aspects of hospitalisations in the USA and Australia and New Zealand.

The first article by the Australian and New Zealand Intensive Care (ANZIC) study is an inception-cohort study of the first 722 patients admitted to ICU?s in the two countries. The authors conclude that the 2009 pandemic had a substantial impact on ICU?s during the winter in Australia and New Zealand.

The second article is written by the 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team and describes the clinical characteristics of all patients hospitalised with pandemic influenza in USA from April 2009 to mid-June 2009. Authors of this study conclude that nearly three quarters of hospitalised patients had one or more underlying medical conditions and few severe illnesses were reported among persons older than 65 years of age.

The two articles can be found at: http://content.nejm.org/cgi/content/...8481?query=TOC - http://content.nejm.org/cgi/content/...6695?query=TOC


Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates.

Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 09 October 2009, 09:00 hours (CEST) in the 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 (02.10.) - ... - ... - ... - ...
2. Belgium (08.10.) - ... - ... - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (08.10.) - ... - ... - ... - ...
6. Denmark (07.10.) - ... - ... - ... - ...
7. Estonia (04.09.) - 0 - 0 - 0 - 0
8. Finland (07.10.) - ... - ... - ... - ...
9. France (07.10.) - 15 - 199 - 4 - 26
10. Germany (08.10.) - ... - ... - ... - ...
11. Greece (08.10.) - ... - ... - ... - ...
12. Hungary (19.09.) - ... - 32 - ... - ...
13. Iceland (08.10.) - 5 - 9 - 1 - 1
14. Ireland (08.10.) - 17 - 204 - ... - 17
15. Italy (27.09) - 80 - 846 - ... - ...
16. Latvia (13.08.) - ... - 1 - ... - ...
17. Liechtenstein (08.10.) - ... - ... - ... - ...
18. Lithuania (13.08.) - ... - ... - ... - ...
19. Luxembourg (02.10.) - ... - ... - 0 - 0
20. Malta (04.09.) - ... - 46 - ... - 1
21. Netherlands (02.10.) - ... - 114 - ... - 19
22. Norway (07.10.) - 8 - 79 - 5 - 14
23. Poland (05.10.) - ... - ... - ... - ...
24. Portugal (07.10.) - 15 - ... - 5 - ...
25. Romania (27.09) - ... - ... - ... - ...
26. Slovakia (12.08.) - 2 - 33 - 0 - 0
27. Slovenia (10.08.) - ... - ... - ... - ...
28. Spain (08.10.) - ... - ... - ... - ...
29. Sweden (08.10.) - 10 - 121 - ... - ...
30. Switzerland (08.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (08.10.) - 290 - ... - 47 - ...

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.
(a) Data includes all probable cases for England only. Does not include Scotland (208 cumulative hospitalisations), Wales (71) and Northern Ireland (216).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 09 October, 09:00 hours CEST, and in the rest of the world by country, as of 08 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 2
2. Bulgaria ... - 1
3. France ... - 31 (a)
4. Germany ... - 2
5. Greece ... - 3
6. Hungary ... - 2
7. Ireland ... - 4
8. Italy ... - 3
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 6
13. Portugal ... - 2
14. Spain 1 - 43
15. Sweden ... - 2
16. United Kingdom 4 - 89

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain 1 - 6
2. Egypt ... - 2
3. Iran 1 - 7
4. Iraq ... - 2
5. Israel 1 - 31
6. Kuwait ... - 9
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 21
10. Qatar ... - 3
11. Saudi Arabia 1 - 36
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen ... - 6

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa ... - 91

• NORTH AMERICA

1. Canada ... - 78
2. Mexico 1 - 245
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados ... - 2
2. Cayman Islands ... - 1
3. Costa Rica ... - 37
4. Cuba ... - 1
5. Dominican Republic ... - 22
6. El Salvador ... - 20
7. Guatemala ... - 13
8. Honduras ... - 16
9. Jamaica ... - 4
10. Nicaragua ... - 11
11. Panama ... - 11
12. Saint Kitts and Nevis ... - 1
13. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 539
2. Bolivia ... - 56
3. Brazil ... - 899
4. Chile ... - 132
5. Colombia ... - 101
6. Ecuador ... - 64
7. Paraguay ... - 52
8. Peru ... - 143
9. Uruguay ... - 33
10. Venezuela ... - 87

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. China (Mainland) ... - 1
3. Hong Kong SAR China ... - 23
4. India 7 - 366
5. Japan ... - 20
6. Macao SAR China ... - 1
7. South Korea ... - 11
8. Taiwan ... - 22

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 3
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 165
9. Vietnam ... - 20

• AUSTRALIA & PACIFIC

1. Australia 2 - 185
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand ... - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 19 - 4579

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 Martinique and 7 in mainland France.

(...)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 12 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 12 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Weekly overview of selected non-EU countries published;
• Total of 201 fatal cases in Europe and EFTA countries and 4 675 in the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 11 October 2009 16:00 hours CEST, for the world, and 12 October 09:00 hours CEST, for Europe is presented in Table 2.


Weekly overview of selected non-EU countries

Introduction

A special section on the evolution of the pandemic influenza H1N1 2009 in selected countries outside Europe is being published in the Daily Update on Mondays. On Tuesdays, a review of the situation in USA and Canada is published. The objective of this section is to provide the interested public and professional audience with an easy to access and concise source of information to get an impression on global trends of the H1N1 pandemic. The contents are mainly based on national surveillance reports or pandemic updates, but may also contain information from media or other public sources.

The countries have been selected on the following criteria:

• They have experienced the 2009 winter influenza season,
• they represent different geographical regions,
• they have adequately large population sizes and they have accessible and reliable public-health data.

Chile (pop 16.6 million)

The number of pandemic influenza cases reported weekly to the national level decreased since week 28 and have been at low levels since week 30. Only two confirmed cases of pandemic influenza were reported during week 39. Until 6th October, the number of confirmed cases was 12 252, out of which 1 585 presented with Severe Acute Respiratory Illness (SARI). The majority of SARI cases were infants (74.3/100 000 pop.) or children between 1-4 years of age (16.5/100 000 pop.). Approximately half (53%) of SARI cases had a chronic underlying illness. Out of the confirmed cases 130 have had a fatal outcome associated with pandemic influenza. The majority (67.9%) of the fatal cases had an underlying illness.

The majority of influenza strains identified until week 34 were A(H1N1)v and less than 0.5% were identified as seasonal H1 or H3 strains. Very few influenza viruses were identified through surveillance activities during week 39.

The Chilean surveillance report is available at: http://www.minsal.cl/


Brazil (pop. 192 million)

No new updates retrieved

Since the beginning of the pandemic until week 36, 46 810 Severe Acute Respiratory Illness (SARI) cases were notified in Brazil, of which 9 249 were subsequently laboratory-confirmed as influenza A (H1N1)v infections. Underlying risk-factors were reported for 37.4% of the confirmed SARI cases. The number of confirmed cases as well as ILI cases appears to have been decreasing for the last four weeks. Of the confirmed SARI cases, 899 (9.7%) have had a fatal outcome. Mortality due to SARI cases with confirmed influenza A (H1N1)v is currently 0,47/100.000 inhabitants. Out of the 9 249 SARI cases linked to influenza A (H1N1)v, 37.7% presented with at least one of risk factor (including pregnancy), which does not significantly differ from what is observed for seasonal influenza in the country. Among SARI cases in fertile age 24.3% were pregnant, which does not differ from what is observed with seasonal influenza (16.8%). Out of 18 257 PCR tests conducted up to week 36, 70.1% tested positive for influenza A (H1N1)v. This proportion has not changed much in the last four weeks, although the number of samples being collected is decreasing rapidly.

For entire epidemiological update for week 36 (Portuguese) see: http://portal.saude.gov.br/portal/ar...enza_se_36.pdf

H1N1 website of the ministry of health: http://dtr2001.saude.gov.br/ascom/sv...uenza_site.htm


Australia (pop. 20.7 million)

In the national report for October 2nd, the total number of fatal cases associated with the pandemic influenza (H1N1) 2009 is now 185. There have been 24 new cases hospitalised due to (H1N1) 2009 during the preceding week. Out of these cases, four have been admitted into Intensive Care Units. The total number of hospitalisations in Australia since the pandemic began is 4 830. All of these figures indicate a decreasing trend for last few weeks. Thirteen percent of the fatal cases and one out of the 36 new hospitalised cases are indigenous Australians. According to recent censuses, around 2.5% of the Australian population consider themselves indigenous.

The current Australian influenza report can be found at: http://www.healthemergency.gov.au/in...etins-21-27Sep

A feature articles on what Europe can learn from Australia appeared in the British Medical Journal on August 22nd http://www.bmj.com/cgi/content/full/339/aug18_1/b3317

Australian Government-Department of Health and Ageing http://www.healthemergency.gov.au/in...ontent/updates


New Zealand (pop. 4.2 million)

The latest surveillance report of week 40 indicates that the circulation of influenza in the community continues to decline, but is returning to seasonal levels. The ILI consultation rate from a sentinel surveillance system has been decreasing since week 29, but is still at a higher level than during the past two years. The number of deaths with primary cause of deaths reported as Pandemic Influenza (H1N1) 2009 is now 18. As of October 4th 1001 patients were reported to have been hospitalised due to influenza (H1N1) 2009 or its complications. The pressure on ICU?s is now so low that national authorities have stopped monitoring patient numbers. In general, schools are reporting usual levels of absence for this time of year. The majority of isolates received through the sentinel surveillance system have been influenza A(H1N1)v from week since week 27. No influenza viruses were identified during week 40. All isolates tested so far have been sensitive to oseltamivir

NZ National influenza update is at: http://www.moh.govt.nz/moh.nsf/index...ate-153-300909

NZ Sentinel surveillance report is at: http://www.surv.esr.cri.nz/virology/...kly_update.php


South Africa (pop. 48.6 million)

As of October 8th, South Africa has confirmed 12 279 cases of pandemic (H1N1) 09. The number of deaths related to the pandemic is 91. It appears that the numbers of confirmed cases and deaths have not been increasing in the last two weeks. The median age of the fatal cases was 33 years and 59% of them were female. Out of the tested fatal cases, 52% were HIV-positive. Twenty-eight percent of the fatal cases were pregnant or in the puerperal period. Eight percent of the fatal cases had active tuberculosis. The recommended national strategy is laboratory confirmation only for moderate or severe cases; however the national authorities believe it is likely that most cases are still being captured by the surveillance system.

SA surveillance report available at: http://www.nicd.ac.za/


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 201 deaths have been reported; the information is available on Table 2. The latest available updates as of October 11, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.


Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 12 October 2009, 09:00 hours (CEST) in the 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 (09.10.) - ... - ... - ... - ...
2. Belgium (08.10.) - ... - ... - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (08.10.) - ... - ... - ... - ...
6. Denmark (07.10.) - ... - ... - ... - ...
7. Estonia (04.09.) - 0 - 0 - 0 - 0
8. Finland (07.10.) - ... - ... - ... - ...
9. France (07.10.) - 15 - 199 - 4 - 26
10. Germany (08.10.) - ... - ... - ... - ...
11. Greece (08.10.) - ... - ... - ... - ...
12. Hungary (19.09.) - ... - 32 - ... - ...
13. Iceland (08.10.) - 5 - 9 - 1 - 1
14. Ireland (08.10.) - 17 - 204 - ... - 17
15. Italy (27.09) - 80 - 846 - ... - ...
16. Latvia (13.08.) - ... - 1 - ... - ...
17. Liechtenstein (09.10.) - ... - ... - ... - ...
18. Lithuania (13.08.) - ... - ... - ... - ...
19. Luxembourg (02.10.) - ... - ... - 0 - 0
20. Malta (04.09.) - ... - 46 - ... - 1
21. Netherlands (09.10.) - 13 - 126 - 0 - 19
22. Norway (07.10.) - 8 - 79 - 5 - 14
23. Poland (05.10.) - ... - ... - ... - ...
24. Portugal (07.10.) - 15 - ... - 5 - ...
25. Romania (27.09) - ... - ... - ... - ...
26. Slovakia (12.08.) - 2 - 33 - 0 - 0
27. Slovenia (10.08.) - ... - ... - ... - ...
28. Spain (08.10.) - ... - ... - ... - ...
29. Sweden (08.10.) - 10 - 121 - ... - ...
30. Switzerland (09.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (08.10.) - 290 - ... - 47 - ...

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.
(a) Data includes all probable cases for England only. Does not include Scotland (208 cumulative hospitalisations), Wales (71) and Northern Ireland (216).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 12 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 11 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 2
2. Bulgaria ... - 1
3. France ... - 31 (a)
4. Germany ... - 2
5. Greece ... - 3
6. Hungary ... - 2
7. Ireland ... - 4
8. Italy 1 - 4
9. Luxembourg ... -1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 6
13. Portugal ... - 2
14. Spain ... - 43
15. Sweden ... - 2
16. United Kingdom 2 - 91

(...)

-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 13 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 13 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Updates from U.S.A. and Canada included;
• Three studies on treatment and outcome of critically ill patients in intensive care units published;
• Total of 204 fatal cases in Europe and EFTA countries and 4 495 in the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 12 October 2009 16:00 hours CEST, for the world, and 13 October 09:00 hours CEST, for Europe is presented in Table 2.


Updates from U.S.A. and Canada

United States Update

Data as of 9 October 2009 22:00 CEST, for week ending 03 October 2009 (Week 39)

Virology: 99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses. 99.7% of all specimens were type A and 0.3% were type B. 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine. Since 1 October 2008, of 2009 influenza A (H1N1) viruses tested for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) 0.5% have been found resistant to oseltamivir (n=12) and none resistant to zanamivir.

Pneumonia and Influenza Hospitalization and Deaths: A new system was implemented on 30 August 2009 and replaces the weekly report of laboratory confirmed 2009 H1N1-related hospitalizations and deaths that began in April 2009. Jurisdictions can now report to CDC either laboratory confirmed or pneumonia and influenza syndromic-based counts of hospitalizations and deaths resulting from all types or subtypes of influenza, not just those from 2009 H1N1 influenza virus. To allow jurisdictions to implement the new case definition, counts were reset to zero on August 30, 2009. From August 30 ? October 3, 2009, 3,874 laboratory-confirmed influenza associated hospitalizations, 240 laboratory-confirmed influenza associated deaths, 12,384 pneumonia and influenza syndrome-based hospitalizations, and 1,544 pneumonia and influenza syndrome-based deaths, were reported to CDC. CDC will continue to use its traditional surveillance systems to track the progress of the remainder of the 2008-09 season, and for the 2009-10 influenza season, which officially began October 4, 2009.

During week 39, 6.5% of all deaths reported through the 122-Cities Mortality Reporting System were due to Pneumonia and Influenza. This percentage was at the epidemic threshold of 6.5% for week 39.

Influenza-associated Pediatric Deaths: 19 deaths reported in Week 39; 16 were associated with 2009 influenza A (H1N1) virus infections and 3 with unsubtyped Influenza A virus. Since last year, (28 September 2008), CDC received 147 reports of influenza-associated pediatric deaths: 76 were due to 2009 influenza A (H1N1) virus infections and 29 have occurred since 30 August 2009.

Influenza-associated hospitalizations: Laboratory-confirmed influenza-associated hospitalization rates were reported during 15 April ? 03 October 2009 (rates include influenza A, influenza B, and 2009 influenza A (H1N1)). Rates (considered preliminary) for children aged 0-23 months, 2-4 years, and 5-17 years were3.6, 1.6, and 1.3 per 10,000, respectively. Rates for adults aged 18-49 years, 50-64 years, and ≥ 65 years, the overall flu rates were 0.8, 0.9, and 0.7 per 10,000, respectively.

Influenza-like Illness (ILI): For the entire U.S., outpatient visits due to ILI (5.1%) were above the national baseline (2.4%). The percentage of outpatient visits for ILI ranged from 1.3% to 9.5% in different surveillance regions, and increased in eight of the 10 surveillance regions. In two north-eastern regions of the U.S. (including the states of Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island and Vermont) a percentage of visits for ILI were below region-specific baselines.

Geographic spread: Assessed by state and territorial epidemiologists, there was widespread activity in 37 states, regional activity in Guam and 11 states, and local influenza activity in Washington, D.C., Puerto Rico and two states. The U.S. Virgin Islands did not report. New Hampshire and New York, although with below baseline ILI visits, reported widespread activity.

Other information:

• The 2009-2010 U.S. Influenza Season (for purposes of surveillance and reporting) began 4 October 2009.

For more information: U.S. Centers for Disease Control and Prevention ?What's New on the H1N1 Flu Site?

http://www.cdc.gov/h1n1flu/whatsnew.htm

U.S. Centers for Disease Control and Prevention Weekly Influenza Surveillance Report

http://www.cdc.gov/flu/weekly/

Canada

Update Data as of 12 October 2009 14:00 CEST, for week ending 03 October, 2009 (Week 39)

Virology: 96.9% of all subtyped influenza A viruses being reported to Public Health Agency of Canada (PHAC) were 2009 influenza A (H1N1) viruses. The proportion of tests that were positive for influenza was 3.8% which remained similar to the previous week. 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine. Of 2009 influenza A (H1N1) viruses tested by PHAC for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) none were found resistant to oseltamivir and none resistant to zanamivir. Two cases of oseltamivir resistant Pandemic (H1N1) 2009 were reported so far in Canada from the province of Quebec on 21 July 2009 and from the province of Alberta on 15 September 2009.

Hospitalizations and Deaths: 25 hospitalizations and no deaths were reported for week 39. As of 03 October 2009, 1,504 hospitalized cases including 295 cases admitted to an intensive care unit (ICU) and 155 (10.3%) cases requiring ventilation as well as 78 deaths have been reported since the beginning of the pandemic. The national hospitalization rate was 4.5 per 100,000 population with the highest rates in children aged less than 15 years of age (10.6 per 100,000).

Paediatric Influenza Hospitalizations and Deaths: Three laboratory-confirmed influenza-associated paediatric hospitalizations were reported through the Immunization Monitoring Program Active (IMPACT) network. One of the two hospitalizations was due to Pandemic (H1N1) 2009 and two to seasonal influenza A. 381 hospitalizations have been reported since week 17 (April 26); 92.4% of these hospitalizations have been due to Pandemic (H1N1) 2009. Since the beginning of the pandemic, four deaths due to Pandemic (H1N1) 2009 had been reported through the IMPACT network among children aged under 16 years of age.

Influenza-like Illness (ILI): The national ILI consultation rate increased to 36 consultations per 1,000 patient visits this week which was increasing for a third consecutive week and was above the expected range for this time of the year.

Geographic spread: Five regions reported widespread activity and four regions reported localized activity, while twenty-nine regions reported sporadic activity and sixteen regions reported no activity. Forty influenza outbreaks in schools were reported. This is the first year that all the provinces and territories are reporting on influenza outbreak in schools (greater than 10% absenteeism on any day most likely due to ILI).

For more information: Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/ Public Health Agency of Canada FluWatch

http://www.phac-aspc.gc.ca/fluwatch/09-10/w39_09/index-eng.php

Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza.

Since April 2009, a total 204 deaths have been reported; the information is available in Table 2. The latest available updates as of October 12, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Other updates

Three new studies published online in JAMA review critically in-patients treated in Mexico, Canada, Australia and New Zealand. Two articles from Mexico and Canada focus on base-line characteristics of patients, treatment and outcomes of the critically ill patients in intensive care units in the respective countries. The third article from Australia and New Zealand describes the characteristics of patients, incidents, resource utilization and patient outcomes with influenza A(H1N1)v 2009 associated Acute Respiratory Distress Syndrome (ARDS) treated with Extracorporeal Membrane Oxygenation (ECMO).

The articles can be found at:

• Critically Ill Patients with 2009 Influenza A(H1N1) in Mexico (http://jama.ama-assn.org/cgi/content...1536v1?papetoc )
• Critically Ill Patients with 2009 Influenza A(H1N1) Infection in Canada (http://jama.ama-assn.org/cgi/content...1496v1?papetoc )
• Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome (http://jama.ama-assn.org/cgi/content...1535v1?papetoc )

Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups.

The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 13 October 2009, 09:00 hours (CEST) in the 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 (09.10.) - ... - ... - ... - ...
2. Belgium (08.10.) - ... - ... - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (08.10.) - ... - ... - ... - ...
6. Denmark (07.10.) - ... - ... - ... - ...
7. Estonia (04.09.) - 0 - 0 - 0 - 0
8. Finland (07.10.) - ... - ... - ... - ...
9. France (07.10.) - 15 - 199 - 4 - 26
10. Germany (08.10.) - ... - ... - ... - ...
11. Greece (08.10.) - ... - ... - ... - ...
12. Hungary (19.09.) - ... - 32 - ... - ...
13. Iceland (08.10.) - 5 - 9 - 1 - 1
14. Ireland (08.10.) - 17 - 204 - ... - 17
15. Italy (07.10) - ... - 1053 - ... - ...
16. Latvia (13.08.) - ... - 1 - ... - ...
17. Liechtenstein (12.10.) - ... - ... - ... - ...
18. Lithuania (13.08.) - ... - ... - ... - ...
19. Luxembourg (02.10.) - ... - ... - 0 - 0
20. Malta (04.09.) - ... - 46 - ... - 1
21. Netherlands (09.10.) - 13 - 126 - 0 - 19
22. Norway (07.10.) - 8 - 79 - 5 - 14
23. Poland (05.10.) - ... - ... - ... - ...
24. Portugal (07.10.) - 15 - ... - 5 - ...
25. Romania (12.10) - ... - ... - ... - ...
26. Slovakia (12.08.) - 2 - 33 - 0 - 0
27. Slovenia (10.08.) - ... - ... - ... - ...
28. Spain (08.10.) - ... - ... - ... - ...
29. Sweden (08.10.) - 10 - 121 - ... - ...
30. Switzerland (12.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (08.10.) - 290 - ... - 47 - ...

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.
(a) Data includes all probable cases for England only. Does not include Scotland (208 cumulative hospitalisations), Wales (71) and Northern Ireland (216).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 13 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 12 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 2
2. Bulgaria ... - 1
3. France ... - 31 (a)
4. Germany ... - 2
5. Greece ... - 3
6. Hungary 1 - 3
7. Ireland ... - 4
8. Italy ... - 4
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 6
13. Portugal ... - 2
14. Spain ... - 43
15. Sweden ... - 2
16. United Kingdom 2 - 93

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 6
2. Egypt ... - 3
3. Iran ... - 7
4. Iraq ... - 2
5. Israel ... - 31
6. Kuwait 1 - 10
7. Lebanon ... - 2
8. Occupied Palestinian Territory ... - 1
9. Oman ... - 23
10. Qatar ... - 3
11. Saudi Arabia ... - 36
12. Syria ... - 2
13. United Arab Emirates ... - 6
14. Yemen 5 - 11

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa ... - 91

• NORTH AMERICA

1. Canada ... - 79
2. Mexico ... - 248
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados ... - 2
2. Cayman Islands ... - 1
3. Costa Rica 1 - 38
4. Cuba 6 - 7
5. Dominican Republic ... - 22
6. El Salvador ... - 20
7. Guatemala ... - 13
8. Honduras ... - 16
9. Jamaica 1 - 5
10. Nicaragua ... - 11
11. Panama ... - 11
12. Saint Kitts and Nevis ... - 1
13. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 580
2. Bolivia ... - 56
3. Brazil ... - 899
4. Chile ... - 134
5. Colombia ... - 101
6. Ecuador ... - 67
7. Paraguay ... - 52
8. Peru ... - 153
9. Uruguay ... - 33
10. Venezuela ... - 89

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. China (Mainland) ... - 1
3. Hong Kong SAR China ... - 29
4. India 4 - 389
5. Japan ... - 20
6. Macao SAR China ... - 1
7. South Korea 2 - 14
8. Taiwan ... - 22

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 3
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 165
9. Vietnam 1 - 23

• AUSTRALIA & PACIFIC

1. Australia ... - 185
2. Cook Islands ... - 1
3. Marshall Islands ...- 1
4. New Zealand ... - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ... - 1

• TOTAL 24 - 4699

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 Martinique and 7 in mainland France.

(...)
-
-------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 14 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 - Update 14 October 2009, 09:00 hours CEST


Main developments in past 24 hours

• Total of 204 fatal cases in Europe and EFTA countries and 4 499 in the rest of the world have been reported up to date.
• A WHO expert meeting describes the recent circulation of influenza viruses. It recommended including an A(H1N1) 2009 in the 2010 Southern Hemisphere seasonal vaccines plus changing the A(H3N2) component.
• Second European report of transmission of the pandemic A(H1N1) 2009 influenza virus from humans to pigs (Norway).
• Russian National Regulatory Agency has approved vaccines against influenza A(H1N1) 2009.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 13 October 2009 16:00 hours CEST, for the world, and 14 October 09:00 hours CEST, for Europe is presented in Table 2.


Public Health Development

Recommendation to include influenza A(H1N1) 2009 in the 2010 Southern Hemisphere seasonal vaccines plus change of the influenza A(H3N2) component.

Twice a year WHO leads a process whereby experts from the Global Influenza Surveillance Network review the most up to date information on the world-wide circulation of viruses and make recommendations for next season?s seasonal vaccine. The meeting for the Southern Hemisphere vaccine recently met and has now reported.

The report (see link below) is a useful compilation of global trends namely: the emergence and spread of the pandemic A(H1N1) 2009 and its eclipse of seasonal (AH1N1) and a limited but persistent emergence of A(H3N2) outside of the vaccine protection afforded by current vaccine strains.

Hence the meeting recommended the use of pandemic vaccine strains in future seasonal protection, dropping the current seasonal A(H1N1) and a change in the A(H3N2) component. However it did not go so far as recommending a combined vaccine. That will be considered at a further WHO expert meeting later this month.

[LINK]


Second European report of transmission of the pandemic A(H1N1) 2009 influenza virus from humans to pigs (Norway)

The Norwegian Veterinary Authorities yesterday filed with the World Organization for Animal Health (OIE) a case of transmission of pandemic A(H1N1) 2009 virus from a Norwegian farmer to a pig. The farmer tested positive for the virus Oct 7, and the pig tested positive 3 days later, the report said. No other pigs in the herd of 850 were reported ill.

[LINK]


Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 204 deaths have been reported; the information is available in Table 2.

The latest available updates as of October 13, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.

The latest available updates on hospital admissions per Member State are presented in Table 1.


Other updates

The Russian National Regulatory Agency has approved vaccines against influenza A(H1N1) 2009. They have licensed a live attenuated monovalent vaccine, Ifuvir, and an inactivated monovalent vaccine Pandeflu. Vaccines are produced by the company Microgen.


Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups.

The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.

We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.

Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 14 October 2009, 09:00 hours (CEST) in the 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 (09.10.) - ... - ... - ... - ...
2. Belgium (08.10.) - ... - ... - ... - ...
3. Bulgaria - ... - ... - ... - ...
4. Cyprus - ... - ... - ... - ...
5. Czech Republic (08.10.) - ... - ... - ... - ...
6. Denmark (07.10.) - ... - ... - ... - ...
7. Estonia (04.09.) - 0 - 0 - 0 - 0
8. Finland (07.10.) - ... - ... - ... - ...
9. France (07.10.) - 15 - 199 - 4 - 26
10. Germany (08.10.) - ... - ... - ... - ...
11. Greece (08.10.) - ... - ... - ... - ...
12. Hungary (19.09.) - ... - 32 - ... - ...
13. Iceland (08.10.) - 5 - 9 - 1 - 1
14. Ireland (08.10.) - 17 - 204 - ... - 17
15. Italy (07.10) - ... - 1053 - ... - ...
16. Latvia (13.08.) - ... - 1 - ... - ...
17. Liechtenstein (13.10.) - ... - ... - ... - ...
18. Lithuania (13.08.) - ... - ... - ... - ...
19. Luxembourg (02.10.) - ... - ... - 0 - 0
20. Malta (04.09.) - ... - 46 - ... - 1
21. Netherlands (09.10.) - 13 - 126 - 0 - 19
22. Norway (07.10.) - 8 - 79 - 5 - 14
23. Poland (13.10.) - ... - ... - ... - ...
24. Portugal (07.10.) - 15 - ... - 5 - ...
25. Romania (12.10) - ... - ... - ... - ...
26. Slovakia (12.08.) - 2 - 33 - 0 - 0
27. Slovenia (10.08.) - ... - ... - ... - ...
28. Spain (08.10.) - ... - ... - ... - ...
29. Sweden (08.10.) - 10 - 121 - ... - ...
30. Switzerland (13.10.) - ... - 23 - ... - 1
31. United Kingdom (a) (08.10.) - 290 - ... - 47 - ...

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.
(a) Data includes all probable cases for England only. Does not include Scotland (208 cumulative hospitalisations), Wales (71) and Northern Ireland (216).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 14 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 13 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES

1. Belgium ... - 2
2. Bulgaria ... - 1
3. France ... - 31 (a)
4. Germany ... - 2
5. Greece ... - 3
6. Hungary ... - 3
7. Ireland ... - 4
8. Italy ... - 4
9. Luxembourg ... - 1
10. Malta ... - 3
11. Netherlands ... - 4
12. Norway ... - 6
13. Portugal ... - 2
14. Spain ... - 43
15. Sweden ... - 2
16. United Kingdom ... - 93

• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA

1. No deaths reported - ... - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 6
2. Egypt ... - 3
3. Iran ... - 7
4. Iraq ... - 2
5. Israel ... - 31
6. Jordan 1 - 1
7. Kuwait ... - 10
8. Lebanon ... - 2
9. Occupied Palestinian Territory ... - 1
10. Oman ... - 23
11. Qatar ... - 3
12. Saudi Arabia ... - 36
13. Syria ... - 2
14. United Arab Emirates ... - 6
15. Yemen 2 - 13

• AFRICA

1. Ghana ... - 1
2. Madagascar ... - 1
3. Mauritius ... - 8
4. Mozambique ... - 2
5. Namibia ... - 1
6. South Africa ... - 91

• NORTH AMERICA

1. Canada ... - 79
2. Mexico ... - 248
3. USA ... - 593

• CENTRAL AMERICA & CARIBBEAN

1. Barbados ... - 2
2. Cayman Islands ... - 1
3. Costa Rica ... - 38
4. Cuba ... - 7
5. Dominican Republic ... - 22
6. El Salvador ... - 20
7. Guatemala ... - 13
8. Honduras ... - 16
9. Jamaica ... - 5
10. Nicaragua ... - 11
11. Panama ... - 11
12. Saint Kitts and Nevis ... - 1
13. Suriname ... - 2

• SOUTH AMERICA

1. Argentina ... - 580
2. Bolivia ... - 56
3. Brazil ... - 899
4. Chile ... - 134
5. Colombia ... - 101
6. Ecuador ... - 67
7. Paraguay... - 52
8. Peru ... - 153
9. Uruguay ... - 33
10. Venezuela ... - 89

• NORTH-EAST & SOUTH ASIA

1. Bangladesh ... - 4
2. China (Mainland) ... - 1
3. Hong Kong SAR China ... - 29
4. India ... - 389
5. Japan ... - 20
6. Macao SAR China ... - 1
7. South Korea 1 - 15
8. Taiwan ... - 22

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 1
2. Cambodia ... - 3
3. Indonesia ... - 10
4. Laos Peoples Democratic Republic ... - 1
5. Malaysia ... - 77
6. Philippines ... - 28
7. Singapore ... - 18
8. Thailand ... - 165
9. Vietnam ... - 23

• AUSTRALIA & PACIFIC

1. Australia ... - 185
2. Cook Islands ... - 1
3. Marshall Islands ... - 1
4. New Zealand ... - 18
5. Samoa ... - 2
6. Solomon Islands ... - 1
7. Tonga ...- 1

• TOTAL 4 - 4703

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 Martinique and 7 in mainland France.

(...)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 15 October 2009, 09:00 hours CEST (ECDC, edited)



[Source Full PDF Document: LINK. EDITED.]
ECDC DAILY UPDATE
Pandemic (H1N1) 2009 Update 15 October 2009, 09:00 hours CEST

Main developments in past 24 hours

• Total of 208 fatal cases in Europe and EFTA countries and 4 539 in the rest of the world have been reported up to date.
• The UK updates its pandemic influenza clinical package, and publishes plans to increase national intensive care capacity.
• Extra council meeting of the EU health ministers.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 14 October 2009 16:00 hours CEST, for the world, and 15 October 09:00 hours CEST, for Europe is presented in Table 2.

Public Health Development
UK Pandemic Influenza Clinical Package updated along with plans for significantly expanding its national capacity for intensive care
This pandemic clinical package is a set of tools designed for use by ?frontline? healthcare professionals in severe and exceptional circumstances during a pandemic. The most recent version (06 October 2009) is an update reflecting improvements in the guidance on the use of antibiotics and oseltamivir in young children.
The Package has also been revised and redesigned to clarify the circumstances in which it should be used (only when high surge demand leads to the need for strict hospital admission triage in affected areas).
In preparation for this, UK national capacity for intensive care of adults and children has also been increased and details of this are available via electronic links. (LINK)

Epidemiologic update
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 208 deaths have been reported; the information is available in Table 2.
The latest available updates as of October 14, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.
The latest available updates on hospital admissions per Member State are presented in Table 1.

Other updates
On Monday 12 October, the health ministers of the European Union met in Luxemburg for an extra meeting of the Council to discuss the pandemic influenza. Vaccination strategy and the availability of vaccine in the Member States were two of the items on the agenda.
More information can be found on the website of the Swedish Presidency: (LINK)

Daily Update contents
ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups.
The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more. We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries.
It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.
Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 15 October 2009, 09:00 hours (CEST) in the 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]

• Austria (09.10.) ? ? ? ? ? ? ? ?
• Belgium (08.10.) ? ? ? ? ? ? ? ?
• Bulgaria ? ? ? ? ? ? ? ?
• Cyprus ? ? ? ? ? ? ? ?
• Czech Republic (08.10.) ? ? ? ? ? ? ? ?
• Denmark (14.10.) ? ? ? ? ? ? ? ?
• Estonia (04.09.) ? 0 ? 0 ? 0 ? 0
• Finland (14.10.) ? ? ? ? ? ? ? ?
• France (14.10.) ? 34 ? 247 ? 5 ? 30
• Germany (08.10.) ? ? ? ? ? ? ? ?
• Greece (08.10.) ? ? ? ? ? ? ? ?
• Hungary (19.09.) ? ? - 32 ? ? ? ?
• Iceland (14.10.) ? 13 ? 26 - 3 ? ?
• Ireland (08.10.) ? 17 - 204 ? ? ? 17
• Italy (07.10) ? ? - 1053 ? ? ? ?
• Latvia (13.08.) ? ? - 1 ? ? ? ?
• Liechtenstein (14.10.) ? ? ? ? ? ? ? ?
• Lithuania (13.08.) ? ? ? ? ? ? ? ?
• Luxembourg (02.10.) ? ? ? ? ? 0 ? 0
• Malta (04.09.) ? ? - 46 ? ? ? 1
• Netherlands (09.10.) ? 13 ? 126 ? 0 ? 19
• Norway (07.10.) ? 8 ? 79 ? 5 ? 14
• Poland (14.10.) ? ? ? ? ? ? ? ?
• Portugal (14.10.) - 20 ? ? - 4 ? ?
• Romania (12.10) ? ? ? ? ? ? ? ?
• Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
• Slovenia (10.08.) ? ? ? ? ? ? ? ?
• Spain (08.10.) ? ? ? ? ? ? ? ?
• Sweden (08.10.) ? 10 - 121 ? ? ? ?
• Switzerland (14.10.) ? ? - 23 ? ? ? 2
• United Kingdom (a) (08.10.) - 290 ? ? - 47 ? ?

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.
(a) Data includes all probable cases for England only. Does not include Scotland (208 cumulative hospitalisations), Wales (71) and Northern Ireland (216).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 15 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 14 October 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  • Belgium 1 ? 3
  • Bulgaria ? ? 1
  • France 1 ? 32 (a)
  • Germany ? ? 2
  • Greece ? ? 3
  • Hungary ? ? 3
  • Ireland ? ? 4
  • Italy ? ? 4
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands ? ? 4
  • Norway ? ? 6
  • Portugal ? ? 2
  • Spain ? ? 43
  • Sweden ? ? 2
  • United Kingdom 2 ? 95
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  • No deaths reported ? ? ? ?
• MEDITERRANEAN AND MIDDLE-EAST
  • Bahrain ? ? 6
  • Egypt ? ? 3
  • Iran 3 ? 10
  • Iraq ? ? 2
  • Israel ? ? 31
  • Jordan ? ? 1
  • Kuwait ? ? 10
  • Lebanon ? ? 2
  • Occupied Palestinian Territory ? ? 1
  • Oman ? ? 23
  • Qatar ? ? 3
  • Saudi Arabia ? ? 36
  • Syria ? ? 2
  • United Arab Emirates ? ? 6
  • Yemen ? ? 13
• AFRICA
  • Ghana ? - 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • South Africa ? ? 91
• NORTH AMERICA
  • Canada 1 ? 80
  • Mexico 7 ? 255
  • USA ? ? 593
• CENTRAL AMERICA & CARIBBEAN
  • Bahamas 4 ? 4
  • Barbados ? ? 2
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 20
  • Guatemala ? ? 13
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Suriname ? ? 2
• SOUTH AMERICA
  • Argentina ? ? 580
  • Bolivia ? ? 56
  • Brazil ? ? 899
  • Chile ? ? 134
  • Colombia 10 ? 111
  • Ecuador ? ? 67
  • Paraguay ? ? 52
  • Peru ? ? 153
  • Uruguay ? ? 33
  • Venezuela 1 ? 90
• NORTH-EAST & SOUTH ASIA
  • Bangladesh ? ? 4
  • China (Mainland) ? ? 1
  • Hong Kong SAR China ? ? 29
  • India 7 ? 396
  • Japan ? ? 20
  • Macao SAR China ? - 1
  • South Korea ? ? 15
  • Taiwan 2 ? 24
• SOUTH-EAST ASIA
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 3
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 28
  • Singapore ? ? 18
  • Thailand 5 ? 170
  • Vietnam ? ? 23
• AUSTRALIA & PACIFIC
  • Australia ? ? 185
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 18
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
• TOTAL 44 ? 4747

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 1 in Mayotte and 7 in mainland France.
(?)
-
--------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 - Update 16 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE
Pandemic (H1N1) 2009 - Update 16 October 2009, 09:00 hours CEST

• Main developments in past 24 hours
  
• Total of 220 fatal cases in Europe and EFTA countries and 4 553 in the rest of the world have been reported up to date;
• Eurosurveillance updates published;
• Media highlights published;
• The American Journal of Public Health issues a Supplement on Influenza Preparedness and
  Response;
  

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 15 October 2009 16:00 hours CEST, for the world, and 16 October 09:00 hours CEST, for Europe is presented in Table 2.

Eurosurveillance updates

This week's edition of Eurosurveillance includes a perspective on the newly authorised pandemic vaccines available in Europe, two papers modelling the influence of planned vaccination campaigns in Greece and the US on the course of the pandemic, and one paper describing the resistance of turkeys to experimental infection with an early 2009 Italian human influenza A(H1N1)v virus isolate.

The perspective reports on the pandemic vaccines now available for use within the European Union (EU) from four manufacturers and describes their composition. The vaccine strain in all authorised pandemic vaccines worldwide is based on the same initial isolate of influenza A/California/7/2009 (H1N1)v but the vaccines differ in conditions for virus propagation, antigen preparation, antigen content and whether they are adjuvanted or not. According to the authors, the vaccines are likely to be effective since no significant genetic or antigenic drift has occurred and there are already mechanisms for estimating clinical effectiveness. Influenza vaccines have good safety records and no safety concerns have so far been encountered with any of the vaccines developed. However, special mechanisms have been devised for the early detection and rigorous investigation of possible significant side effects in Europe through postmarketing surveillance and analysis. (LINK)
The article from Greece describes a modelling study to assess the impact of vaccination timing and prioritisation strategies on reducing transmission of pandemic influenza A(H1N1). This was evaluated in a community with the structure of the Greek population using a stochastic simulation model. Prioritisation scenarios were based on the recommendations of the United States Centers? for Disease Control and Prevention Advisory Committee on Immunization Practices and vaccination was assumed to begin either before or during the ongoing epidemic. In the absence of intervention, an illness attack rate (AR) of 34.5% is anticipated. Vaccinating the priority groups before the epidemic (pregnant women, people who live with or care for children <6 months of age, healthcare/emergency services personnel, children aged between 6 months and 4 years and high-risk children 5-18 years old) will have a negligible impact on the overall AR. Vaccinating the recommended groups before the epidemic (priority groups as well as all persons 6 months?24 years old and high-risk individuals 25-64 years old) is anticipated to result in overall and age-specific ARs within the range of seasonal influenza (5%-15%). Initiating vaccination early during the epidemic (AR≤1% of the population) is predicted to result in overall ARs up to 15.2%-19.9% depending on daily vaccination coverage rates. When vaccination is initiated at a later stage (AR: 5%), only coverage of 80% of the whole population at intensive daily vaccination rates would be able to reduce ARs to approximately 15%. (LINK)

The report from the US used data on confirmed cases of pandemic influenza A(H1N1) disseminated by the United States Centers for Disease Control and Prevention to fit the parameters of a seasonally forced Susceptible - Infective - Recovered (SIR) model. The authors used the resulting model to predict the course of the H1N1 influenza pandemic in autumn 2009, and assessed the efficacy of the planned CDC H1N1 vaccination campaign. The model predicts that there will be a significant wave in autumn, with 63% of the population being infected, and that this wave will peak so early that the planned CDC vaccination campaign will likely not have a large effect on the total number of people ultimately infected by the pandemic H1N1 influenza virus. (LINK)
An article from Italy describes an experimental infection of 21- and 70-day-old meat turkeys with an early human isolate of the 2009 pandemic H1N1 influenza virus exhibiting an α-2,3 receptor binding profile. Virus was not recovered by molecular or conventional methods from blood, tracheal and cloacal swabs, lungs, intestine or muscle tissue. Seroconversion was detected in a limited number of birds with the homologous antigen only. The findings suggest that in its present form, the pandemic H1N1 influenza virus is not likely to be transmitted to meat turkeys and does therefore not represent an animal health or food safety issue for this species. (LINK)

Media highlights

Significant media coverage earlier this week surrounded the EU Health Council, held in Luxembourg. EU Ministers discussed the current situation with the development of pandemic H1N1 around the EU. Following discussions on how to tackle the pandemic the current EU Presidency and Swedish Public Health Minister, Maria Larsson, re-iterated that ?we have to listen to the experts who say it?s not time to lower our guard?. Vaccines and their distribution have been widely covered in the media this week as many countries start in earnest with their pandemic H1N1 vaccination strategies, notably in the US where significant activity has been covered on availability and logistics. Further the news from the WHO, suggesting that many countries who do not currently have access to vaccines, would soon be able to benefit from a vaccination donation scheme from richer countries was widely reported.

Epidemiologic update

All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 220 deaths have been reported; the information is available in Table 2.
The latest available updates as of October 15, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.
The latest available updates on hospital admissions per Member State are presented in Table 1.

Other updates

The American Journal of Public Health issued a Supplement on Influenza Preparedness and Response. The full table of content is available from: (LINK)

Daily Update contents

ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups. The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.
We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries. It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and
will vary from country to country.
Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 16 October 2009, 09:00 hours (CEST) in the 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 (09.10.) ? ? ? ? ? ? ? ?
2. Belgium (08.10.) ? ? ? ? ? ? ? ?
3. Bulgaria ? ? ? ? ? ? ? ?
4. Cyprus ? ? ? ? ? ? ? ?
5. Czech Republic (15.10.) ? ? ? ? ? ? ? ?
6. Denmark (14.10.) ? ? ? ? ? ? ? ?
7. Estonia (04.09.) ? 0 ? 0 ? 0 ? 0
8. Finland (14.10.) ? ? ? ? ? ? ? ?
9. France (14.10.) ? 34 ? 247 ? 5 ? 30
10. Germany (08.10.) ? ? ? ? ? ? ? ?
11. Greece (14.10.) ? ? ? ? ? ? ? ?
12. Hungary (19.09.) ? ? - 32 ? ? ? ?
13. Iceland (14.10.) ? 13 ? 26 - 3 ? ?
14. Ireland (15.10.) ? 22 - 265 ? ? - 24
15. Italy (14.10) ? ? - 1155 ? ? ? ?
16. Latvia (13.08.) ? ? - 1 ? ? ? ?
17. Liechtenstein (15.10.) ? ? ? ? ? ? ? ?
18. Lithuania (13.08.) ? ? ? ? ? ? ? ?
19. Luxembourg (02.10.) ? ? ? ? - 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (09.10.) ? 13 ? 126 ? 0 ? 19
22. Norway (15.10.) ? 4 ? 101 ? 1 ? 18
23. Poland (14.10.) ? ? ? ? ? ... ? ?
24. Portugal (14.10.) - 20 ? ? - 4 ? ?
25. Romania (12.10) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (15.10.) ? ? ? ? ? ? ? ?
29. Sweden (15.10.) ? 5 - 127 ? ? ? ?
30. Switzerland (15.10.) ? ? - 23 ? ? ? 2
31. United Kingdom (a) (15.10.) - 363 ? ? - 74 ? ?
    

Note:
Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites. N
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (208 cumulative hospitalisations), Wales
(193) and Northern Ireland (280).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 16 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 15 October 2009, 16:00 hours CEST.

[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Belgium ? ? 3
  • Bulgaria ? ? 1
  • France ? ? 32 (a)
  • Germany ? ? 2
  • Greece ? ? 3
  • Hungary ? ? 3
  • Ireland ? ? 4
  • Italy ? ? 4
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands ? ? 4
  • Norway ? ? 6
  • Portugal ? ? 2
  • Spain 2 ? 45
  • Sweden ? ? 2
  • United Kingdom 10 ? 105
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • No deaths reported ? ? ? ?
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 6
  • Egypt ? ? 3
  • Iran ? ? 10
  • Iraq ? ? 2
  • Israel 1 ? 32
  • Jordan ? ? 1
  • Kuwait ? ? 10
  • Lebanon ? ? 2
  • Occupied Palestinian Territory ? ? 1
  • Oman ? ? 23
  • Qatar ? ? 3
  • Saudi Arabia ? ? 36
  • Syria ? ? 2
  • United Arab Emirates ? ? 6
  • Yemen ? ? 13
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • South Africa ? ? 91
  • Tanzania 1 ? 1
• NORTH AMERICA
  
  • Canada ? ? 80
  • Mexico ? ? 255
  • USA ? ? 593
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 2
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 20
  • Guatemala ? ? 13
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago 2 ? 2
• SOUTH AMERICA
  
  • Argentina ? ? 580
  • Bolivia ? ? 56
  • Brazil ? ? 899
  • Chile ? ? 134
  • Colombia ? ? 111
  • Ecuador ? ? 67
  • Paraguay ? ? 52
  • Peru ? ? 153
  • Uruguay ? ? 33
  • Venezuela 1 ? 91
• NORTH-EAST & SOUTH ASIA
  
  • Bangladesh ? ? 4
  • China (Mainland) ? ? 1
  • Hong Kong SAR China 3 ? 32
  • India 3 ? 399
  • Japan 3 ? 23
  • Macao SAR China ? ? 1
  • South Korea ? ? 15
  • Taiwan ? ? 24
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 3
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 28
  • Singapore ? ? 18
  • Thailand ? ? 170
  • Vietnam ? ? 23
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 185
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 18
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
• TOTAL 26 ? 4773

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 1 in Mayotte and 7 in mainland France.

(?)
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[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 19 October 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]
ECDC DAILY UPDATE
Pandemic (H1N1) 2009 Update 19 October 2009, 09:00 hours CEST

Main developments in past 72 hours

• Weekly overview of selected non-EU countries published;
• Total of 225 fatal cases in Europe and EFTA countries and 4 579 in the rest of the world have been reported up to date;

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 18 October 2009 16:00 hours CEST, for the world, and 19 October 09:00 hours CEST, for Europe is presented in Table 2.

Weekly overview of selected non-EU countries
Introduction
A special section on the evolution of the pandemic influenza H1N1 2009 in selected countries outside Europe is being published in the Daily Update on Mondays. On Tuesdays, a review of the situation in USA and Canada is published. The objective of this section is to provide the interested public and professional audience with an easy to access and concise source of information to get an impression on global trends of the H1N1 pandemic. The contents are mainly based on national surveillance reports or pandemic updates, but may also contain information from media or other public sources.
The countries have been selected on the following criteria:

• They have experienced the 2009 winter influenza season,
• they represent different geographical regions,
• they have adequately large population sizes and
• they have accessible and reliable public-health data.

Chile (pop 16.6 million)
No new updates identified since last week
The number of pandemic influenza cases reported weekly to the national level decreased since week 28 and have been at low levels since week 30. Only two confirmed cases of pandemic influenza were reported during week 39. Until 6th October, the number of confirmed cases was 12 252, out of which 1 585 presented with Severe Acute Respiratory Illness (SARI). The majority of SARI cases were infants (74.3/100 000 pop.) or children between 1-4 years of age (16.5/100 000 pop.).
Approximately half (53%) of SARI cases had a chronic underlying illness.
Out of the confirmed cases 130 have had a fatal outcome associated with pandemic influenza. The majority (67.9%) of the fatal cases had an underlying illness.
The majority of influenza strains identified until week 34 were A(H1N1)v and less than 0.5% were identified as seasonal H1 or H3 strains. Very few influenza viruses were identified through surveillance activities during week 39.
The Chilean surveillance report is available at: LINK, LINK

Brazil (pop. 192 million)
No new updates identified since last week
Since the beginning of the pandemic until week 36, 46 810 Severe Acute Respiratory Illness (SARI) cases were notified in Brazil, of which 9 249 were subsequently laboratory-confirmed as influenza A (H1N1)v infections. Underlying risk-factors were reported for 37.4% of the confirmed SARI cases. The number of confirmed cases as well as ILI cases appears to have been decreasing for the last four weeks.
Of the confirmed SARI cases, 899 (9.7%) have had a fatal outcome. Mortality due to SARI cases with confirmed influenza A (H1N1)v is currently 0,47/100.000 inhabitants. Out of the 9 249 SARI cases linked to influenza A (H1N1)v, 37.7% presented with at least one of risk factor (including pregnancy), which does not significantly differ from what is observed for seasonal influenza in the country.
Among SARI cases in fertile age 24.3% were pregnant, which does not differ from what is observed with seasonal influenza (16.8%). Out of 18 257 PCR tests conducted up to week 36, 70.1% tested positive for influenza A (H1N1)v. This proportion has not changed much in the last four weeks, although the number of samples being collected is decreasing rapidly.
For entire epidemiological update for week 36 (Portuguese) see: LINK
H1N1 website of the ministry of health: LINK

Australia (pop. 20.7 million)
As of 16 October, Australia has confirmed 36 942 cases. The number of deaths remains at 185. Of these deaths four were pregnant women and 13,11% were Indigenous. Around 2.5% of the Australian population consider themselves indigenous.
In the week preceding the report 22 cases have been newly hospitalised, and two of those were admitted to Intensive Care Units. The cumulative number of hospitalizations since the beginning of the pandemic is 4 886.
Australian Government-Department of Health and Ageing LINK

New Zealand (pop. 4.2 million)
The latest surveillance report of week 41 (5-11 Oct) indicates that the ILI consultation rate from a sentinel surveillance system continues to decline. It remains highest among children and teenagers aged 0 ? 19 years. The pandemic influenza (H1N1) 09 has become the predominant strain among all influenza viruses from sentinel surveillance.
NZ Sentinel surveillance report is at: LINK

South Africa (pop. 48.6 million)
As of 15 October, South Africa has confirmed 12 331 cases of pandemic (H1N1) 09. The number of deaths related to the pandemic remains at 91, and has not increased since the last report.
The epidemic curve shows a marked decline of reported cases since end of August, and no further deaths have been reported since end September.
SA surveillance report available at: LINK

Epidemiologic update
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 225 deaths have been reported; the information is available in Table 2. The latest available updates as of October 15, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2.
The latest available updates on hospital admissions per Member State are presented in Table 1.

Daily Update contents
ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups.
The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more.
We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries.
It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.
Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 19 October 2009, 09:00 hours (CEST) in the 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 (09.10.) ? ? ? ? ? ? ? ?
2. Belgium (16.10.) ? ? ? ? ? ? ? ?
3. Bulgaria ? ? ? ? ? ? ? ?
4. Cyprus ? ? ? ? ? ? ? ?
5. Czech Republic (15.10.) ? ? ? ? ? ? ? ?
6. Denmark (14.10.) ? ? ? ? ? ? ? ?
7. Estonia (04.09.) ? 0 ? 0 ? 0 ? 0
8. Finland (14.10.) ? ? ? ? ? ? ? ?
9. France (14.10.) ? 34 ? 247 ? 5 ? 30
10. Germany (08.10.) ? ? ? ? ? ? ? ?
11. Greece (14.10.) ? ? ? ? ? ? ? ?
12. Hungary (19.09.) ? ? - 32 ? ? ? ?
13. Iceland (16.10.) ? 21 ? 40 - 4 ? ?
14. Ireland (15.10.) ? 22 - 265 ? ? ? 24
15. Italy (14.10) ? ? - 1155 ? ? ? ?
16. Latvia (13.08.) ? ? - 1 ? ? ? ?
17. Liechtenstein (15.10.) ? ? ? ? ? ? ? ?
18. Lithuania (13.08.) ? ? ? ? ? ? ? ?
19. Luxembourg (02.10.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (16.10.) ? 24 ? 151 ? 4 ? 23
22. Norway (15.10.) ? 4 ? 101 ? 1 ? 18
23. Poland (14.10.) ? ? ? ? ? ? ? ?
24. Portugal (14.10.) - 20 ? ? - 4 ? ?
25. Romania (12.10) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (15.10.) ? ? ? ? ? ? ? ?
29. Sweden (15.10.) ? 5 - 127 ? ? ? ?
30. Switzerland (15.10.) ? ? - 23 ? ? ? 2
31. United Kingdom (a) (15.10.) - 363 ? ? - 74 ? ?

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.
(a) Data includes all probable cases for England only. Does not include Scotland (272 cumulative hospitalisations), Wales (193) and Northern Ireland (280).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 19 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 18 October 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Belgium 2 ? 5
  • Bulgaria ? ? 1
  • France ? ? 32 (a)
  • Germany ? ? 2
  • Greece ? ? 3
  • Hungary 1 ? 4
  • Ireland ? ? 4
  • Italy ? ? 4
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands ? ? 4
  • Norway ? ? 6
  • Portugal 1 ? 3
  • Spain ? ? 45
  • Sweden ? ? 2
  • United Kingdom ? ? 106
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • No deaths reported ? ? ? ?
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 6
  • Egypt ? ? 3
  • Iran ? ? 10
  • Iraq ? ? 2
  • Israel ? ? 32
  • Jordan ? ? 1
  • Kuwait ? ? 10
  • Lebanon ? ? 2
  • Occupied Palestinian Territory ? ? 1
  • Oman ? ? 23
  • Qatar ? ? 3
  • Saudi Arabia ? ? 36
  • Syria ? ? 2
  • United Arab Emirates ? ? 6
  • Yemen ? ? 13
• AFRICA
  
  • Ghana ? - 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • South Africa ? ? 91
  • Tanzania ? ? 1
• NORTH AMERICA
  
  • Canada ? ? 80
  • Mexico 5 ? 260
  • USA ? ? 593
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados 1 ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 20
  • Guatemala ? ? 13
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 2
• SOUTH AMERICA
  
  • Argentina ? ? 580
  • Bolivia ? ? 56
  • Brazil ? ? 899
  • Chile ? ? 134
  • Colombia ? ? 111
  • Ecuador 3 ? 70
  • Paraguay ? ? 52
  • Peru 9 ? 162
  • Uruguay ? ? 33
  • Venezuela ? ? 91
• NORTH-EAST & SOUTH ASIA
  
  • Bangladesh ? ? 4
  • China (Mainland) 1 ? 2
  • Hong Kong SAR China ? ? 32
  • India 6 - 405
  • Japan ? ? 23
  • Macao SAR China ? ? 1
  • South Korea ? ? 15
  • Taiwan ? ? 24
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 3
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 28
  • Singapore ? ? 18
  • Thailand ? ? 170
  • Vietnam 1 ? 24
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 185
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 18
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
• TOTAL 30 ? 4804

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 1 in Mayotte and 7 in mainland France.
(?)
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[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 20 October 2009, 09:00 hours CEST (ECDC, updates)

[Source Full PDF Document: LINK. EDITED.]
ECDC DAILY UPDATE
Pandemic (H1N1) 2009 Update 20 October 2009, 09:00 hours CEST

Main developments in past 24 hours

• Scientific Advance on randomised trial in Hong Kong of basic hygiene interventions published;
• Updates from U.S.A. and Canada included;
• Total of 228 fatal cases in Europe and EFTA countries and 4 597 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases, as of 19 October 2009 16:00 hours CEST, for the world, and 20 October 09:00 hours CEST, for Europe is presented in Table 2.

Scientific Advice
Influenza transmission at home when someone is sick by hand-washing and masks ? results of a randomized trial in Hong Kong
A randomised trial in Hong Kong of basic hygiene interventions (hand-washing and mask wearing) found that if instituted soon after the illness started either hand washing alone or hand-washing and mask wearing resulted in partial protection of the household members significantly reducing the number of secondary infections.
In a comment ECDC emphasises the importance of respiratory hygiene in the home.
Full ECDC review available at: LINK

Updates from U.S.A. and Canada
United States
Update Data as of 16 October 2009, for week ending 10 October 2009 (Week 40)
Virology: 100% of all subtyped influenza A viruses reported to CDC were 2009 influenza A (H1N1) viruses. 99.6% of all specimens were type A and 0.4% were type B. 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine. Since September 1, 2009, four infections with oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified in the United States, and a total of 13 cases have been identified in the U.S. since April 2009 (10 viruses identified by CDC and three viruses identified by additional laboratories).
The 13 cases represent an increase of one case over the previous week. All tested viruses retain their sensitivity to the neuraminidase inhibitor zanamivir. Eleven patients (including nine of the viruses detected at CDC and two viruses identified by the additional laboratories) had documented exposure to oseltamivir treatment or chemoprophylaxis, and the remaining two patients are under investigation to determine exposure to oseltamivir.
Since the emergence of the 2009 influenza A (H1N1), all isolates tested have been resistant to the adamantanes (amantadine and rimantadine). Currently, adamantane antiviral susceptibility testing has been suspended at CDC to allow a focus on neuraminidase inhibitors. Because of the low level of circulation of seasonal influenza A (H1N1), A (H3N2), and influenza B viruses, no samples collected since September 1, 2009 were available for antiviral resistance testing.
Mortality Surveillance:
Pneumonia and Influenza Hospitalization and Deaths: From 30 August ? 10 October 2009, 4,958 laboratory-confirmed influenza associated hospitalizations, 292 laboratory-confirmed influenza associated deaths, 15,696 pneumonia and influenza syndrome-based hospitalizations, and 2,029 pneumonia and influenza syndrome-based deaths, were reported to CDC.
Pneumonia and Influenza (P&I) Mortality Surveillance: During week 40, 6.7% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 6.5% for week 40.
Influenza-associated Pediatric Deaths: Influenza-Associated Pediatric Mortality: Eleven influenza-associated pediatric deaths were reported to CDC during week 40. Ten 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 is undetermined. These deaths occurred between 30 August and 10 October 2009. Since 30 August 2009, CDC has received 43 reports of influenza-associated pediatric deaths that occurred during the current influenza season. (A total of 86 deaths in children associated with 2009 H1N1 virus have been reported to CDC.) Among the 43 deaths in children, 28 children had specimens collected for bacterial culture from normally sterile sites and seven (25.0%) of the 28 were positive; Staphylococcus aureus was identified in five (71.4%) of the seven children.
Influenza-associated hospitalizations: Laboratory-confirmed influenza-associated hospitalizations are monitored in the U.S. using a population-based surveillance network comprising 10 Emerging Infections Program sites and 6 new sites.
Laboratory-confirmed influenza-associated hospitalization rates were reported during 01 September ? 10 October 2009 (rates include influenza A, influenza B, and 2009 influenza A (H1N1)). Rates [EIP (new sites)] for children aged 0-4 years and 5-17 years were 1.4 (1.8) and 0.7 (1.0) per 10,000, respectively. Rates [EIP (new sites)] for adults aged 18-49 years, 50-64 years, and ≥ 65 years were 0.4 (0.4), 0.4 (0.3) and 0.3 (0.3) per 10,000, respectively.
Influenza-like Illness (ILI): Nationwide during week 40, 6.1% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.3%. On a regional level, the percentage of outpatient visits for ILI ranged from 1.8% to 12.9% during week 40, and increased in nine of the 10 surveillance regions compared to the previous week. All 10 regions reported a proportion of outpatient visits for ILI above their region-specific baseline levels.
Geographic spread: Assessed by state and territorial epidemiologists, widespread influenza activity was reported by 41 states. Regional influenza activity was reported by Guam and eight states (Connecticut, Maine, Massachusetts, Michigan, New Jersey, Rhode Island, South Carolina, and Vermont). Local influenza activity was reported by the District of Columbia, Puerto Rico, and Hawaii. The U.S. Virgin Islands did not report.
Other information:

• The 2009-2010 U.S. Influenza Season (for purposes of surveillance and reporting) began 4 October 2009.
• 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

Canada
Update Data as of 16 October 2009 19:00 CEST, for week ending 10 October, 2009 (Week 40)
Virology: 96.9%of all subtyped influenza A viruses being reported to Public Health Agency of Canada (PHAC) were 2009 influenza A (H1N1) viruses. The proportion of tests that were positive for influenza was 8.7% which was a significant increase to the previous week. 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine.
Of 2009 influenza A (H1N1) viruses tested by PHAC for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) none were found resistant to either.
Three cases of oseltamivir resistant Pandemic (H1N1) 2009 were reported to date in Canada from the province of Quebec on July 21, 2009, from Alberta on September 15, 2009 and from Ontario on October 13, 2009 [N.B. the latter case occurred after Week 40].
Hospitalizations and Deaths: 37 hospitalizations and 2 deaths were reported for week 40. As of 10 October 2009, a total of 1,541 hospitalized cases including 299 (19.4%) cases admitted to ICU and 158 (10.3%) cases requiring ventilation as well as 80 deaths of Pandemic (H1N1) 2009 have been reported since the beginning of the pandemic.
Paediatric Influenza Hospitalizations and Deaths: Two laboratory-confirmed influenza-associated paediatric hospitalizations were reported through the Immunization Monitoring Program Active (IMPACT) network. One of the two hospitalizations was due to Pandemic (H1N1) 2009 and one to seasonal influenza A. Since the beginning of the pandemic, four deaths due to Pandemic (H1N1) 2009 had been reported through the IMPACT network among children aged under 16 years of age.
Influenza-like Illness (ILI): The national ILI consultation rate increased to 43 consultations per 1,000 patient visits this week which was an increase for a fourth consecutive week and was above the expected range for this time of the year.
Geographic spread: Four regions reported widespread activity and five regions reported localized activity, while 30 regions reported sporadic activity and 15 regions reported no activity. 27 influenza outbreaks in schools and one outbreak in a long-term care facility were 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. Since April 2009, a total 228 deaths have been reported; the information is available in Table 2. The latest available updates as of October 19, 2009, at 16:00, on new and on confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.

Daily Update contents
ECDC has now stopped publishing numbers of confirmed cases reported from EU/EFTA member states ? as well as from other countries around the world ? in its Daily Update. This is due to the fact that most European countries are now recommending laboratory confirmation only in certain population groups, such as the risk groups.
The World Health Organization has also recommended that countries verify only the first few hundred cases; after that exhaustive sampling is not recommended any more. We will continue to monitor the evolution of the pandemic within Europe mirrored by the number of fatal cases by country and through the Weekly Influenza Surveillance Overview which is published on Fridays. For the countries outside of Europe, we will monitor the number of fatal cases by country and monitor the surveillance reports of selected non-European countries.
It must be emphasized that the numbers of fatal cases per country associated with pandemic influenza are likely to be gross underestimates. Access to healthcare, the quality of the laboratory network in the country, the quality of the surveillance system and the case definition used for identifying fatal cases all affect these figures and will vary from country to country.
Daily Updates will be produced by 09:00hrs every morning Monday to Friday. No updates will be produced during weekends and the Daily Update published on Monday includes the weekend?s information. The production cycle will be reviewed as needed.

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 20 October 2009, 09:00 hours (CEST) in the 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 (16.10.) ? ? ? ? ? ? ? ?
2. Belgium (16.10.) ? ? ? ? ? ? ? ?
3. Bulgaria ? ? ? ? ? ? ? ?
4. Cyprus ? ? ? ? ? ? ? ?
5. Czech Republic (15.10.) ? ? ? ? ? ? ? ?
6. Denmark (14.10.) ? ? ? ? ? ? ? ?
7. Estonia (04.09.) ? 0 ? 0 ? 0 ? 0
8. Finland (14.10.) ? ? ? ? ? ? ? ?
9. France (14.10.) ? 34 ? 247 ? 5 ? 30
10. Germany (14.10.) ? ? ? ? ? ? ? ?
11. Greece (14.10.) ? ? ? ? ? ? ? ?
12. Hungary (19.09.) ? ? - 32 ? ? ? ?
13. Iceland (19.10.) ? 26 ? 60 - 4 ? ?
14. Ireland (15.10.) ? 22 - 265 ? ? ? 24
15. Italy (14.10) ? ? - 1155 ? ? ? ?
16. Latvia (13.08.) ? ? - 1 ? ? ? ?
17. Liechtenstein (15.10.) ? ? ? ? ? ? ? ?
18. Lithuania (13.08.) ? ? ? ? ? ? ? ?
19. Luxembourg (02.10.) ? ? ? ? - 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (16.10.) ? 24 ? 151 ? 4 ? 23
22. Norway (15.10.) ? 4 ? 101 ? 1 ? 18
23. Poland (14.10.) ? ? ? ? ? ? ? ?
24. Portugal (14.10.) - 20 ? ? - 4 ? ?
25. Romania (19.10) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (15.10.) ? ? ? ? ? ? ? ?
29. Sweden (15.10.) ? 5 - 127 ? ? ? ?
30. Switzerland (15.10.) ? ? - 23 ? ? ? 2
31. United Kingdom (a) (15.10.) - 363 ? ? - 74 ? ?

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.
(a) Data includes all probable cases for England only. Does not include Scotland (272 cumulative hospitalisations), Wales (193) and Northern Ireland (280).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 20 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 19 October 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Belgium ? ? 5
  • Bulgaria ? ? 1
  • France ? ? 32 (a)
  • Germany ? ? 2
  • Greece ? ? 3
  • Hungary ? ? 4
  • Iceland 1 - 1
  • Ireland ? ? 4
  • Italy ? ? 4
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands ? ? 4
  • Norway 1 ? 7
  • Portugal ? ? 3
  • Spain ? ? 45
  • Sweden ? ? 2
  • United Kingdom 1 ? 107
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • No deaths reported ? ? ? ?
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 6
  • Egypt ? ? 3
  • Iran ? ? 10
  • Iraq ? ? 2
  • Israel ? ? 32
  • Jordan ? ? 1
  • Kuwait ? ? 10
  • Lebanon ? ? 2
  • Occupied Palestinian Territory ? ? 1
  • Oman ? ? 23
  • Qatar ? ? 3
  • Saudi Arabia ? ? 36
  • Syria ? ? 2
  • United Arab Emirates ? ? 6
  • Yemen ? - 13
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • South Africa ? ? 91
  • Tanzania ? ? 1
• NORTH AMERICA
  
  • Canada ? ? 80
  • Mexico ? ? 260
  • USA ? ? 593
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 20
  • Guatemala ? ? 13
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago 2 ? 4
• SOUTH AMERICA
  
  • Argentina ? ? 580
  • Bolivia ? ? 56
  • Brazil ? ? 899
  • Chile ? ? 134
  • Colombia ? ? 111
  • Ecuador ? ? 70
  • Paraguay ? ? 52
  • Peru ? ? 162
  • Uruguay ? ? 33
  • Venezuela ? ? 91
• NORTH-EAST & SOUTH ASIA
  
  • Bangladesh 1 ? 5
  • China (Mainland) ? - 2
  • Hong Kong SAR China ? ? 32
  • India 8 ? 413
  • Japan 4 ? 27
  • Macao SAR China ? ? 1
  • South Korea 3 ? 18
  • Taiwan ? ? 24
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 3
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 28
  • Singapore ? ? 18
  • Thailand ? ? 170
  • Vietnam ? ? 24
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 185
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 18
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
• TOTAL 21 ? 4825

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 1 in Mayotte and 7 in mainland France.
(?)
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