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  • Pandemic (H1N1) 2009 - update 106 - Weekly update: total at least 18,209 deaths, increasing activity in India, Kerala

    [Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_06_25/en/index.html">WHO | Pandemic (H1N1) 2009 - update 106</cite>. Edited.]

    Pandemic (H1N1) 2009 - update 106 - Weekly update

    25 June 2010


    As of 20 June, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18209 deaths.

    WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and Member States and through monitoring of multiple sources of information.


    Situation update:

    Worldwide, overall pandemic and seasonal influenza activity remains low. Active transmission of pandemic influenza virus persists in parts of the tropics, particularly in the Caribbean, West Africa, and South and Southeast Asia.

    Pandemic and seasonal influenza viruses have been detected only sporadically during the early part of winter in the temperate regions of the southern hemisphere.

    Global circulation of seasonal influenza virus type B viruses has declined substantially and persists at low levels in parts of East Asia, Central Africa, and Central America.

    During the past month, seasonal influenza H3N2 viruses have been detected at low levels across parts of East Africa and South America.

    In most countries of the temperate zone of the southern hemisphere (Chile, Argentina, South Africa, Australia, and New Zealand) pandemic and seasonal influenza viruses have been detected only sporadically during the first two weeks of June 2010 and overall levels of respiratory disease in the population remain low.

    In Chile, during the second week of June, approximately 1% samples tested positive for influenza (the majority were pandemic influenza virus).

    In Argentina, small numbers of influenza type B viruses were detected during early June 2010.

    In both Chile and Argentina, respiratory syncitial virus (RSV) continued to be the predominant circulating respiratory virus.

    In South Africa, very small numbers of seasonal H3N2 and type B viruses were detected since the beginning of June 2010.

    In both Australia and New Zealand, levels of ILI are below recent historical seasonal levels and there have been only sporadic detections of seasonal or pandemic influenza virus during the first half of June 2010.

    In Asia, the most active areas pandemic influenza virus transmission currently are in parts of southern India, Bangladesh, Singapore, and Malaysia.

    In India, there have been recent reports of increasing pandemic influenza activity in the southern state of Kerala, including reports of small numbers of severe and fatal cases, particularly among pregnant women; the extent of illness in the community is currently being assessed.

    In Bangladesh, pandemic and seasonal influenza type B viruses continued to co-circulate at low levels during early June 2010.

    In Thailand, limited data suggests that there continues to be low levels of pandemic and seasonal influenza virus co-circulating in parts of the country.

    In Singapore, during the third week of June 2010, levels of ARI declined below warning levels and the proportion of patients with ILI testing positive for pandemic influenza virus fell from 28% to 19%.

    In Malaysia, limited data suggests that overall pandemic influenza activity declined throughout June 2010 as pandemic virus continued to circulate at low levels.

    Throughout East Asia, overall pandemic and seasonal activity remained very low to sporadic.

    In China and Japan, levels of ILI remained at or below baseline levels for the summer months. Low and declining levels of seasonal influenza type B viruses continued to circulate across China, Hong Kong SAR (China), and Chinese Taipei.

    In the tropical regions of the Americas, overall pandemic and seasonal influenza activity remained very low, except in Cuba and Colombia, where low levels of pandemic influenza virus continue to circulate (approximately 8% of respiratory samples tested positive for pandemic influenza in both countries during the early part of June 2010).

    In Cuba, pandemic influenza virus transmission remains active but has declined substantially since peaking during mid-April to mid-May 2010; no new fatal cases have been reported over the past four reporting weeks.

    In Colombia, persistent but low level circulation of pandemic influenza virus has increased slightly since late May 2010; however, the overall level of respiratory diseases in the population was reported to be low to moderate during mid June 2010.

    In several countries of the region, there has been recent circulation of seasonal influenza viruses including type A (Venezuela during May 2010) and B (Bolivia during March and May 2010; El Salvador during late May and early June 2010). Variable ongoing co-circulation of other respiratory viruses, including RSV, continues to be reported across the region.

    In sub-Saharan Africa, pandemic and seasonal influenza activity has been limited to several countries. Ghana, in West Africa, continued to have active circulation of pandemic influenza virus long after overall activity peaked during early April 2010; the proportion of respiratory samples testing positive for pandemic influenza virus increased from 16% to 23% during the first two weeks of June 2010. Seasonal influenza type B viruses continue to circulate in parts of central and southern Africa, most notably in Cameroon. As reported in previous updates, small numbers of seasonal H3N2 viruses continue to be detected across Africa, particularly in eastern Africa; the most recent detections have been reported in Ghana, Kenya, and South Africa during the second week of June 2010. The persistence of H3N2 in this area over time very likely represents sustained community transmission of the virus.

    Overall, in the temperate regions of the northern hemisphere (North America and Europe), pandemic and seasonal influenza viruses have been detected sporadically or at very low levels during the past month.

    The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect, humans including seasonal influenza. For more information on virological surveillance and antiviral resistance please see the weekly virology update (Virological surveillance data, below).

    Weekly update (Virological surveillance data)

    Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses [pdf 16kb]

    *Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.

    **Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

    WHO Clinical Management Guidelines for Human infection with Pandemic (H1N1), 2009:

    WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses:

    MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 23: 30 MAY - 12 JUNE 2010)

    Map of influenza activity and virus subtypes [png 259kb]

    Description: Displayed data reflect the most recent data reported to Flunet, WHO regional offices or on Ministry of health websites in the last 2 weeks. The percent of specimens tested positive for influenza includes all specimens tested positive for seasonal or pandemic influenza. The pie charts show the distribution of virus subtypes among all specimens that were tested positive for influenza. The available country data were joined in larger geographical areas with similar influenza transmission patterns to be able to give an overview

    Qualitative indicators (Week 29 to Week 23: 13 July 2009 - 12 June 2010)

    The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

    Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance

    The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

    List of definitions of qualitative indicators

    Geographic spread of influenza activity
    Map timeline

    Trend of respiratory diseases activity compared to the previous week
    Map timeline

    Intensity of acute respiratory diseases in the population
    Map timeline

    Impact on health care services
    Map timeline

    Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 20 June 2010

    Map of affected countries and deaths

    The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 105): none.
    The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 105): none.

    [Region - Deaths*]
    • WHO Regional Office for Africa (AFRO)*** - 168
    • WHO Regional Office for the Americas (AMRO) - At least 8450
    • WHO Regional Office for the Eastern Mediterranean (EMRO)** - 1019
    • WHO Regional Office for the Europe (EURO) - At least 4879
    • WHO Regional Office for South-East Asia (SEARO) - 1852
    • WHO Regional Office for the Western Pacific (WPRO) - 1841
    • Total - At least 18209

    *The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related
    **No update since 7 March 2010
    ***No update since 23 May 2010

    -
    -----

    Comment


    • WHO, Pandemic (H1N1) 2009 - update 107 (July 2 2010, edited): India, Kerala: severe and fatal H1N1pdm illness, pregnant women

      WHO, Pandemic (H1N1) 2009 - update 107 (July 2 2010, edited)

      [Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_07_02/en/index.html">WHO | Pandemic (H1N1) 2009 - update 107</cite>. Edited.]

      Pandemic (H1N1) 2009 - update 107 - Weekly update

      2 July 2010


      As of 27 June, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18239 deaths.

      WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and Member States and through monitoring of multiple sources of information.


      Situation update:

      Summary:

      Worldwide, overall pandemic and seasonal influenza activity remains low. In the temperate regions of the Southern Hemisphere, Chile, and Argentina report low activity and only sporadic detections of both pandemic and seasonal influenza viruses during the early part of winter. South Africa, New Zealand, and Australia have all recently noted slight increases in the rate of respiratory disease. South Africa recently reported their first case of confirmed H1N1; however, the predominant influenza virus there currently is seasonal influenza A(H3N2). The H3N2 virus detected in South Africa is similar to the Perth-like strain, which is currently a component of the trivalent seasonal influenza vaccine.

      Active transmission of pandemic influenza virus still persists in localized areas of the tropics, particularly in South and Southeast Asia, the Caribbean and West Africa. During the last 2 to 3 weeks, seasonal influenza H3N2 viruses have also been detected at increasing levels in Nicaragua, and low levels or sporadically in Australia, Central America, South Africa and East Africa.

      Global circulation of seasonal influenza virus type B viruses persists at low levels in parts of East Asia, Central Africa, and Central America.


      Regional Details:

      In most countries of the temperate zone of the southern hemisphere (Chile, Argentina, South Africa, Australia, and New Zealand) pandemic and seasonal influenza viruses have been detected only sporadically in June 2010 and activity is low, indicating a late start of the influenza season compared to 2008. Overall levels of respiratory disease in the population remain low.

      In Argentina, small numbers of influenza type B viruses were detected during mid June 2010.

      In both Chile and Argentina, respiratory syncitial virus (RSV) continued to be the predominant circulating respiratory virus resulting in high rates of respiratory illness in children.

      In South Africa, small and slightly increasing numbers of seasonal H3N2 and type B viruses were detected during mid June 2010.

      In both Australia and New Zealand, levels of ILI are increasing, but still below recent historical seasonal levels.

      In Asia, the most active areas of pandemic influenza virus transmission currently are in parts of southern India, Bangladesh, Singapore, and Malaysia. Rates are decreasing in the latter three countries but in India, the number of laboratory confirmed cases of pandemic influenza has increased since mid June. This activity has been primarily observed in Southern state of Kerala, and includes reports of a number of severe and fatal cases, particularly among pregnant women.

      In Bangladesh, pandemic and seasonal influenza type B viruses co-circulated at low levels during early June 2010.

      In Singapore, during the third week of June 2010, the levels of ARI remained below warning levels and the proportion of patients with ILI testing positive for pandemic influenza virus fell from 19% to 15%.

      In Malaysia, data suggests that overall pandemic influenza activity has declined throughout June 2010 though pandemic virus continues to circulate at low levels.

      Throughout East Asia, influenza activity remained very low. In China and Japan, levels of ILI remained at or below baseline levels for the summer months. Low and declining levels of influenza type B viruses continued to circulate across China, Hong Kong SAR (China), Chinese Taipei and Republic of Korea.

      In the tropical regions of the Americas, overall pandemic and seasonal influenza activity remained very low.

      In Cuba, pandemic influenza virus transmission remains active but has declined substantially since peaking during mid-April to mid-May 2010; no new fatal cases have been reported over the past five reporting weeks.

      In several countries of the region, there has been recent circulation of seasonal influenza A (H3N2) viruses (Venezuela during May 2010) and B viruses (Bolivia during March and May 2010; El Salvador during late May and early June 2010).

      Nicaragua notably has seen a sharp increase in the detection of seasonal influenza A (H3N2) and Panama has detected low numbers of the same. In addition, after 20 weeks with no circulating pandemic virus, Panama reported the detection of pandemic influenza (H1N1) 2009 in early June.

      Many countries in the area also report ongoing co-circulation of other respiratory viruses, most notably RSV.

      In sub-Saharan Africa, pandemic and seasonal influenza activity has been observed in several countries.

      Ghana, in West Africa, continues to have active circulation of pandemic influenza virus several weeks after activity peaked during early April 2010.

      Seasonal influenza type B viruses continue to circulate in parts of central and southern Africa, most notably in Cameroon.

      As reported in previous updates, small numbers of seasonal H3N2 viruses continue to be detected across Africa, particularly in eastern Africa; the most recent detections have been reported in Ghana, Kenya, and South Africa during mid June 2010. The persistence of H3N2 in this area over time very likely represents sustained community transmission of the virus.

      Overall, in the temperate regions of the northern hemisphere (North America and Europe), pandemic and seasonal influenza viruses have been detected sporadically or at very low levels during the past month.


      Weekly update (Virological surveillance data)

      Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses [pdf 17kb]

      *Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.

      **Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

      WHO Clinical Management Guidelines for Human infection with Pandemic (H1N1), 2009:

      WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses:


      MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 24: 13 JUNE - 19 JUNE 2010)

      Map of influenza activity and virus subtypes [png 182kb]

      Description: Displayed data reflect the most recent data reported to Flunet, WHO regional offices or on Ministry of health websites in the last 2 weeks. The percent of specimens tested positive for influenza includes all specimens tested positive for seasonal or pandemic influenza. The pie charts show the distribution of virus subtypes among all specimens that were tested positive for influenza. The available country data were joined in larger geographical areas with similar influenza transmission patterns to be able to give an overview


      Qualitative indicators (Week 29 to Week 24: 13 July 2009 - 19 June 2010)

      The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

      Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance

      The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

      List of definitions of qualitative indicators

      Geographic spread of influenza activity
      Map timeline

      Trend of respiratory diseases activity compared to the previous week
      Map timeline

      Intensity of acute respiratory diseases in the population
      Map timeline

      Impact on health care services
      Map timeline


      Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 20 June 2010

      Map of affected countries and deaths

      The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 106): none.
      The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 106): none.

      [Region - Deaths*]
      • WHO Regional Office for Africa (AFRO)*** - 168
      • WHO Regional Office for the Americas (AMRO) - At least 8462
      • WHO Regional Office for the Eastern Mediterranean (EMRO)** - 1019
      • WHO Regional Office for Europe (EURO - At least 4879
      • WHO Regional Office for South-East Asia (SEARO) - 1866
      • WHO Regional Office for the Western Pacific (WPRO) - 1845
      • Total* - At least 18,239

      *The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related
      **No update since 7 March 2010
      ***No update since 23 May 2010
      -
      -----

      Comment


      • WHO, Pandemic (H1N1) 2009 - update 108 (July 8 2010, edited): H1N1pdm remains active in India w/severe and fatal cases.

        WHO, Pandemic (H1N1) 2009 - update 108 (July 8 2010, edited)
        [Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_07_09/en/index.html">WHO | Pandemic (H1N1) 2009 - update 108</cite>. Edited.]

        Pandemic (H1N1) 2009 - update 108 - Weekly update

        9 July 2010


        As of 4 July, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18311 deaths.

        WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and Member States and through monitoring of multiple sources of information.


        Situation update:

        Worldwide, overall pandemic influenza activity remains low. Active circulation of pandemic influenza virus persists in areas of the tropics, particularly in South and Southeast Asia, the Caribbean and West Africa. Overall pandemic and seasonal influenza activity has remained low during the early part of the current winter season in the temperate zone of the southern hemisphere. Low levels of seasonal influenza (H3N2 and type B) viruses were detected during June 2010 in South Africa, while Chile, Australia, and New Zealand, have all recently detected low levels of predominantly pandemic influenza virus. Increasing seasonal influenza activity has also recently been observed in several countries of Central America.

        Although rates of respiratory disease have begun to increase in several countries of the temperate zone of the southern hemisphere, little pandemic or seasonal influenza activity has been seen so far during early part of the winter season.

        In South Africa, a sharp increase in the detection rate of influenza virus, primarily seasonal influenza H3N2 and type B, was observed during the later part of June and early July (> 40% of sentinel respiratory samples from patients with ILI tested positive for influenza during the first week of July); however, levels of respiratory illness-related outpatient consultations and hospitalizations do not appear to be significantly elevated.

        In Australia, slight increases in the rates of ILI have been reported in recent weeks, however, the overall number of influenza virus detections (primarily pandemic H1N1 and seasonal H3N2) remain low.

        In New Zealand, rates of ILI have steadily increased over the month of June; however, only small numbers of predominantly pandemic influenza virus have been detected so far.

        In both Australia and New Zealand, current levels of ILI are similar to those observed during the same period in 2008, when the influenza season was noted to have arrived and peaked late in winter.

        In Chile, overall levels of ILI remain very low; less than 5% of respiratory samples tested positive for influenza in late June 2010 (the majority were pandemic H1N1 virus with small numbers of seasonal influenza H3N2 and type B detected as well).

        In Argentina, overall levels of ILI remained low and below levels observed during the past three winter influenza seasons; only small numbers of seasonal influenza type B viruses have been detected during recent weeks.

        In both Chile and Argentina, RSV has been the predominant circulating respiratory virus since mid-April 2010.

        In Asia, overall pandemic influenza activity remains low to sporadic, except in parts of India, Malaysia, and Singapore.

        In India, transmission of pandemic influenza virus remains active but stable in the southern state of Kerala; similar numbers of new, severe and fatal cases have been reported on a weekly basis since transmission first increased during mid-June 2010. Smaller increases in pandemic influenza virus circulation have also been observed since mid-June 2010 in other southern and western states of India.

        In Singapore, levels of ARI and pandemic influenza virus transmission declined during June 2010 after peaking in May 2010; the proportion of patients with ILI testing positive for pandemic influenza virus remained stable at 16% during the first week of July 2010. Of note, substantial co-circulation of pandemic and seasonal influenza H3N2 viruses was detected in Singapore throughout May and June 2010.

        In Malaysia, declining numbers of new cases of pandemic influenza continued to be reported suggesting that overall pandemic influenza activity continued to decline substantially in June 2010 after peaking during mid-April to mid-May 2010.

        Very low level of seasonal influenza type B viruses continue to circulate across China, Hong Kong SAR (China), Chinese Taipei and the Republic of Korea.

        In the tropical regions of the Americas, overall pandemic and seasonal influenza activity remained low, except in parts of Central America, where there has been recent active co-circulation of pandemic and seasonal H3N2 viruses.

        In Panama, a sharp increase in the circulation influenza A viruses (particularly H3N2, but also small numbers of pandemic H1N1) was reported over the month of June 2010; during the most recent reporting week, a high intensity of respiratory diseases and a moderate impact on healthcare services was reported.

        In Nicaragua, recent active transmission of seasonal influenza H3N2 viruses, which began during late May 2010 and peaked during mid June 2010, appears to have largely subsided during recent weeks.

        In Colombia, a recent period of active pandemic influenza virus transmission, spanning mid May to mid June 2010, now appears to have largely subsided.

        Many countries in the region continue to report ongoing co-circulation of other respiratory viruses, most notably RSV.

        In sub-Saharan Africa, the current situation is largely unchanged since the last update. Pandemic and seasonal influenza activity continues to be observed in several countries.

        Ghana, in West Africa, continues to have active circulation of pandemic influenza virus several months after activity peaked during early April 2010.

        Seasonal influenza type B viruses continue to circulate in parts of central and southern Africa, particularly in Cameroon.

        Small numbers of seasonal H3N2 viruses continue to be detected across Africa, particularly in eastern Africa; the most recent detections have been reported in Kenya and South Africa.

        Overall, in the temperate regions of the northern hemisphere (North America and Europe), pandemic and seasonal influenza viruses have been detected only sporadically or at very low levels during the past month.


        Weekly update (Virological surveillance data)

        Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses [pdf 16kb]

        *Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.

        **Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

        WHO Clinical Management Guidelines for Human infection with Pandemic (H1N1), 2009:

        WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses:


        MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 25: 20 JUNE - 26 JUNE 2010)

        Map of influenza activity and virus subtypes [png 186kb]

        Description: Displayed data reflect the most recent data reported to Flunet, WHO regional offices or on Ministry of health websites in the last 2 weeks. The percent of specimens tested positive for influenza includes all specimens tested positive for seasonal or pandemic influenza. The pie charts show the distribution of virus subtypes among all specimens that were tested positive for influenza. The available country data were joined in larger geographical areas with similar influenza transmission patterns to be able to give an overview


        Qualitative indicators (Week 29 to Week 25: 13 July 2009 - 26 June 2010)

        The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

        Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance

        The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

        List of definitions of qualitative indicators

        Geographic spread of influenza activity
        Map timeline

        Trend of respiratory diseases activity compared to the previous week
        Map timeline

        Intensity of acute respiratory diseases in the population
        Map timeline

        Impact on health care services
        Map timeline


        Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 4 July 2010

        Map of affected countries and deaths

        The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 107): none.
        The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 107): none.

        [Region - Deaths*]
        • WHO Regional Office for Africa (AFRO) *** - 168
        • WHO Regional Office for the Americas (AMRO) - At least 8516
        • WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
        • WHO Regional Office for Europe (EURO) - At least 4879
        • WHO Regional Office for South-East Asia (SEARO) - 1883
        • WHO Regional Office for the Western Pacific (WPRO) - 1846
        • Total* - At least 18311

        *The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related
        **No update since 7 March 2010
        ***No update since 23 May 2010

        -
        -----

        Comment


        • Pandemic (H1N1) 2009 - update 109 - Weekly update: active H1N1pdm transmission in India, Kerala, Maharashtra w/small number of fatal cases

          WHO, Pandemic (H1N1) 2009 - update 109 (edited)

          [Source: World Health Organization, full page <cite cite="http://www.who.int/csr/don/2010_07_16/en/index.html">WHO | Pandemic (H1N1) 2009 - update 109</cite>. Edited.]

          Pandemic (H1N1) 2009 - update 109 - Weekly update

          16 July 2010


          As of 12 July, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,337deaths.

          WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and Member States and through monitoring of multiple sources of information.


          Situation update:

          Worldwide, overall pandemic influenza activity remains low. The most active areas of pandemic influenza virus transmission currently are in parts of South Asia, West Africa, and Central America. In the temperate zone of the southern hemisphere, pandemic and seasonal influenza activity has remained low during the first half of the southern hemisphere winter, except in South Africa, where increased detections of primarily seasonal influenza viruses (type B and H3N2) were reported during late June and early July 2010. Seasonal influenza H3N2 viruses continue to circulate at varying levels across parts of the Americas, Africa, and Southeast Asia. Increased seasonal influenza activity continues to be observed in several countries of Central America.

          To date, most countries of the temperate zone of the southern hemisphere, with the exception of South Africa, have reported low overall levels of respiratory disease activity and low to sporadic levels of pandemic and seasonal influenza virus circulation during the first half of the southern hemisphere winter season. Pandemic influenza viruses have been detected only sporadically or at low levels in most of these countries. As reported last week, South Africa began observing a sharp increase in the proportion of sentinel respiratory samples testing positive for influenza virus (primarily seasonal influenza B and H3N2) during late June 2010, reaching a peak of ~50% detection rate during the first week of July 2010, and falling to ~40% during the second week of July 2010.

          In Chile (as of late June 2010) and Argentina (as of early July 2010), the most recent available data show that influenza activity remains sporadic in Argentina and low in Chile (~5% respiratory samples tested positive for influenza, 84% of which were pandemic virus with small numbers of seasonal influenza H3N2 and type B detected as well). In both Chile and Argentina, RSV has been the predominant circulating respiratory virus since mid-April 2010.

          In Australia, as of the last week of June 2010, overall rates of ILI remained low and below levels observed during the same period in past three winter seasons. Although a small cluster of pandemic influenza cases, including a few hospitalized cases, were recently detected in the Northern Territory of Australia, pandemic and seasonal influenza virus detections remain otherwise sporadic, albeit slightly increased during late June and early July 2010.

          Similarly, in New Zealand, rates of ILI have remained low and below the seasonal baseline, with only sporadic detections of pandemic and seasonal H3N2 viruses through the first week of July 2010. In both Australia and New Zealand, current levels of ILI are similar to those observed during the same period in 2008, when the influenza season was noted to have arrived and peaked late in winter.

          In Asia, overall pandemic influenza activity remains low to sporadic, except in parts of southern and western India, Malaysia, and Singapore. As reported last week, in India, transmission of pandemic influenza virus remains active but stable in the southern state of Kerala. The extent of illness in the community is currently being assessed and monitored by the Government of India. Similar numbers of new cases, including small numbers of fatal cases, have been reported on a weekly basis since transmission first increased during mid-June 2010. Recent, small increases in pandemic influenza virus circulation have also been observed since mid-June 2010 in other southern and western states of India, particularly in the western state of Maharashtra.

          In Singapore, levels of ARI increased during the first two weeks of July 2010; however, the intensity of pandemic influenza virus transmission has declined during June and July 2010 after peaking in May 2010. The proportion of patients with ILI testing positive for pandemic influenza virus in Singapore remained stable (14-16%) during first two weeks of July 2010. In addition, substantial co-circulation of seasonal influenza H3N2 viruses (with pandemic H1N1 virus) was detected in Singapore throughout May and June 2010.

          In Malaysia, numbers of new cases of pandemic influenza continued to decline; overall pandemic influenza activity fell substantially in June and early July 2010 after peaking during mid-April to mid-May 2010. Low levels of seasonal influenza type B viruses (and to much lesser extent pandemic influenza virus) continue to circulate across northern and southern China as levels of ILI remain stable and near seasonal levels seen in the same period in recent years. Low levels of pandemic and seasonal influenza (H3N2 and type B) viruses also continued to circulate in Hong Kong SAR (China), Chinese Taipei, and parts of Thailand.

          In the tropical regions of the Americas, overall pandemic and seasonal influenza activity remained low, except in parts of Central and South America, where there has been recent active co-circulation of pandemic and seasonal influenza H3N2 viruses. The majority of recent active transmission of pandemic influenza virus has been reported in Colombia, Costa Rica, and to a lesser extent in Cuba.

          In Colombia, although low level circulation of pandemic influenza viruses has persisted throughout the first half 2010, a second period of active transmission began in mid-May 2010, peaked in June 2010, has now largely subsided during the second of week of July 2010.

          Similarly, in Costa Rica, low level circulation of pandemic virus has persisted throughout 2010, however, there has been a recent resurgence in active transmission (though less intense than the initial 2009 wave) of pandemic influenza virus during June 2010.

          As reported previously, in Panama, a sharp increase in the circulation influenza A viruses (particularly H3N2, but also small numbers of pandemic H1N1) was reported over the month of June 2010; a high intensity of respiratory diseases and a moderate impact on healthcare services continued to be reported during the second week of July 2010.

          In Nicaragua, recent active transmission of seasonal influenza H3N2 viruses, which began during late May 2010 and peaked during mid June 2010, appears to have largely subsided during recent weeks. Many countries in the region continue to report ongoing co-circulation of other respiratory viruses, most notably RSV.

          In sub-Saharan Africa, the current situation is largely unchanged since the last update. Pandemic and seasonal influenza activity continues to be observed in several countries.

          Ghana, in West Africa, continued to have a sustained resurgence in circulation of pandemic influenza virus during June 2010, more than several months after the first period of pandemic activity peaked (early April 2010). Seasonal influenza type B viruses continue to circulate in parts of central and southern Africa, particularly in Cameroon, where an increase in influenza type B virus circulation was observed during June 2010. Small numbers of seasonal H3N2 viruses continue to be detected across Africa, particularly in eastern and southern Africa; the most recent detections have been reported in Kenya and South Africa.

          Overall, in the temperate regions of the northern hemisphere (North America and Europe), pandemic and seasonal influenza viruses have been detected only sporadically or at very low levels during the past month.


          Weekly update (Virological surveillance data)

          Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses [pdf 16kb]

          *Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.
          **Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

          WHO Clinical Management Guidelines for Human infection with Pandemic (H1N1), 2009:

          WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses:


          MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 26: 20 JUNE - 3 JULY 2010)

          Map of influenza activity and virus subtypes [png 186kb]

          Description: Displayed data reflect the most recent data reported to Flunet, WHO regional offices or on Ministry of health websites in the last 2 weeks. The percent of specimens tested positive for influenza includes all specimens tested positive for seasonal or pandemic influenza. The pie charts show the distribution of virus subtypes among all specimens that were tested positive for influenza. The available country data were joined in larger geographical areas with similar influenza transmission patterns to be able to give an overview


          Qualitative indicators (Week 29, 2009 to Week 26, 2010: 13 July 2009 - 3 July 2010)

          The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

          Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance

          The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

          List of definitions of qualitative indicators

          Geographic spread of influenza activity
          Map timeline

          Trend of respiratory diseases activity compared to the previous week
          Map timeline

          Intensity of acute respiratory diseases in the population
          Map timeline

          Impact on health care services
          Map timeline


          Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 11 July 2010

          Map of affected countries and deaths

          The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 108): none.
          The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 108): none.

          [Region / Deaths(*)]
          • WHO Regional Office fro Africa (AFRO) *** - 168
          • WHO Regional Office fro the Americas (AMRO) - At least 8523
          • WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
          • WHO Regional Office for Europe (EURO) - At least 4879
          • WHO Regional Office for South-East Asia (SEARO) - 1900
          • WHO Regional Office for the Western Pacific (WPRO) - 1848
          • Total * - At least 18,337

          *The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related
          **No update since 7 March 2010
          ***No update since 23 May 2010
          -
          -----<cite cite="http://www.who.int/csr/don/2010_07_16/en/index.html"></cite>

          Comment


          • WHO, Pandemic (H1N1) 2009 - update 110 (July 23 2010, edited)

            WHO, Pandemic (H1N1) 2009 - update 110 (July 23 2010, edited)

            [Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_07_23a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 110</cite>.]

            Pandemic (H1N1) 2009 - update 110 - Weekly update

            23 July 2010


            As of 18 July 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18366 deaths.

            WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of information.


            Situation update:

            Globally pandemic influenza activity remains low. The most active areas of influenza transmission remained in the tropical zones; primarily in West Africa, Central America, the Caribbean, and South and Southeast Asia, although activity is localized to relatively small areas in each region. In the temperate zone of the southern hemisphere, Australia and New Zealand have showed signs of increased respiratory disease in recent weeks. Both countries have continued to detect low levels of predominantly pandemic H1N1 influenza virus.

            In South Africa, the influenza season is well under way and is predominantly associated with seasonal influenza B and H3N2 viruses and small numbers of pandemic H1N1 influenza viruses.

            In the temperate zone of the southern hemisphere, overall influenza activity remained low but with notable increases in recent weeks in some areas.

            South Africa had been experiencing a sharp increase in the proportion of respiratory samples testing positive for influenza viruses since late June 2010. For the current reporting week, 30-40% of sentinel respiratory samples from patients with severe acute respiratory infections (SARI)/influenza-like-illness (ILI) tested positive for influenza. Respiratory disease activity was associated primarily with seasonal influenza B and H3N2 viruses, with a much smaller number of pandemic H1N1 influenza viruses.

            Australia has reported a gradual increase in the number of respiratory disease consultations due to ILI since end of June to early July 2010 although this is of similar to the levels experienced in 2008. This increase of respiratory disease activity may be accounted for in part by circulation of respiratory syncytial virus (RSV). Influenza viruses in Australia have been about 2/3 pandemic H1N1 influenza and 1/3 seasonal influenza H3N2.

            In New Zealand, rates of ILI have markedly increased compared to the previous reporting week but still remained below the seasonal baseline, primarily associated with pandemic H1N1 influenza virus.

            In Chile and Argentina, national rates of ILI remained low relative to last year at the same period of time.

            In Asia, overall pandemic influenza activity remained low. The most active areas of pandemic H1N1 influenza virus transmission are in India, Cambodia and Singapore. Significant transmission of pandemic H1N1 influenza is occurring in the Southern states of Kerala and the Western state of Maharashtra, India.

            Cambodia has recently observed an increase in the proportion of respiratory samples testing positive for influenza virus (primarily pandemic H1N1 influenza and seasonal influenza H3N2) since early June 2010.

            In Singapore, rates of ILI and acute respiratory infections (ARI) increased compared to previous week and reached the epidemic threshold. The proportion of patients with ILI testing positive for pandemic H1N1 influenza continues to be stable (15%) associated with co-circulation of pandemic H1N1 influenza, seasonal influenza H3N2, and influenza type B viruses.

            In sub-Saharan Africa, the current situation was largely unchanged since the last update. Pandemic H1N1 and seasonal influenza activity continued to be observed in several countries. Ghana has had a sustained circulation of pandemic H1N1 influenza virus since June 2010. Small numbers of seasonal influenza H3N2 viruses continued to be detected in eastern Africa.

            In the tropical regions of the Americas, the situation has remained similar to the previous week. Overall pandemic and seasonal influenza activity were low, except in pockets of Central and South America with co-circulation of pandemic and seasonal influenza H3N2 viruses (Costa Rica had predominantly pandemic H1N1 influenza virus, while Nicaragua and Panama had predominantly influenza H3N2 virus).

            In the temperate regions of the Northern hemisphere, pandemic and seasonal influenza viruses have been detected only sporadically or at very low levels during the past month.


            Weekly update (Virological surveillance data)

            Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses [pdf 18kb]

            *Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.

            **Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

            WHO Clinical Management Guidelines for Human infection with Pandemic (H1N1), 2009:

            WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses:


            MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 27: 5 JULY- 11 JULY 2010)

            Map of influenza activity and virus subtypes [jpg 432kb]

            Description: Displayed data reflect the most recent data reported to Flunet, WHO regional offices or on Ministry of health websites in the last 2 weeks. The percent of specimens tested positive for influenza includes all specimens tested positive for seasonal or pandemic influenza. The pie charts show the distribution of virus subtypes among all specimens that were tested positive for influenza. The available country data were joined in larger geographical areas with similar influenza transmission patterns to be able to give an overview


            Qualitative indicators (Week 29, 2009 to Week 27, 2010: 13 July 2009 -11 July 2010)

            The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

            Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance

            The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

            List of definitions of qualitative indicators

            Geographic spread of influenza activity
            Map timeline

            Trend of respiratory diseases activity compared to the previous week
            Map timeline

            Intensity of acute respiratory diseases in the population
            Map timeline

            Impact on health care services
            Map timeline


            Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 11 July 2010

            Map of affected countries and deaths

            The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 109): none.
            The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 109): none.

            [Region - Deaths*]
            • WHO Regional Office for Africa (AFRO)*** - 168
            • WHO Regional Office for the Americas (AMRO) - At least 8,525
            • WHO Regional Office for the Eastern Mediterranean (EMOR)** - 1,019
            • WHO Regional Office for Europe (EURO) - At least 4,879
            • WHO Regional Office for South-East Asia (SEARO) - 1,923
            • WHO Regional Office for the Western Pacific (WPRO) - 1,852
            • Total - At least 18,366


            *The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related
            **No update since 7 March 2010
            ***No update since 23 May 2010

            -
            -----

            Comment


            • Archive: WHO, 2009 H1N1 Pandemic Influenza - Updates (until the end of July 2010)

              This thread contains an archive of WHO situation updates about pandemic influenza H1N1 2009.

              Comment

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