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

[Giuseppe]

WHO - Pandemic (H1N1) 2009 - update 85

WHO - Pandemic (H1N1) 2009 - update 85

Pandemic (H1N1) 2009 - update 85 - Weekly update

29 January 2010


As of 24 January 2010, worldwide more than 209 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 14711 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:

Although much of the temperate northern hemisphere passed a peak of fall and wintertime pandemic influenza activity between late October and late November 2009, virus transmission remain active in several later affected areas, particularly in North Africa, limited areas of eastern and southeastern Europe, and in parts of South and East Asia.

In North Africa, limited data suggests that pandemic influenza virus transmission remains active and geographically widespread, particularly in Morocco, Algeria, Libyan Arab Jamahiriya, and in Egypt, although most countries in the region appeared to have recently passed a peak of activity during December 2009 or January 2010.

In west Asia, pandemic influenza activity continues be geographically regional to widespread, however activity levels have continued to decline or remain low since December 2009.

In South Asia, pandemic influenza activity remains active but geographically variable. Recent peaks in activity were noted during late December and early January 2010 in northern India, Nepal, and Sri Lanka. Influenza activity remained stable but elevated in western India, continued to decline substantially in northern India, and remained low overall in southern and eastern India.

In Bangladesh, regional spread influenza activity and a low intensity of respiratory diseases activity was reported.

In East Asia, transmission of pandemic influenza virus remains active, however, overall activity continued to decline in most countries. An increasing trend in respiratory diseases with localized spread was reported for DPR Korea. In the Republic of Korea, transmission of pandemic influenza virus remains active (>20% respiratory specimens tested positive for pandemic H1N1), however, overall activity continue to decline since peaking during November 2009. In Japan, influenza activity continues to decline, however high levels of transmission persist on the southern island of Okinawa.

In northern and southern China, pandemic virus isolations have declined substantially since peaking early to mid November 2009, however, in recent weeks detections of influenza type B viruses have increased.

In southeast Asia, transmission of pandemic influenza virus persists, but current activity levels are low. In Vietnam, influenza activity has declined substantially since peaking during October and November 2009. In Thailand, focal outbreaks of influenza were reported from a few provinces in northern and central parts of the country, however, overall ILI activity remains low.

In Europe, transmission of pandemic influenza virus remains geographically regional to widespread in the central, eastern, and southeastern parts of the continent, however, overall activity continues to decline in most places. Several countries (Austria, Albania, Bulgaria, Slovakia, and the Russian Federation) reported slight increases in the levels of ARI or ILI activity, however in most, levels remain well below recent peaks in activity.

The overall rate of respiratory specimens testing positive for influenza (16%) continued to fall since peaking (45%) during early November 2009.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low in most places. Of note, detections of RSV have increased in a few countries in the Americas, which may partially account for elevated ILI activity in those areas, particularly among young children.

In the US and Canada, pandemic influenza virus detections and the numbers of severe and fatal cases have decline substantially as rates of ILI have fallen below seasonal baselines.

In Central America and Caribbean, pandemic influenza virus transmission persists but overall activity remains low or unchanged in most places.

In temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

Pandemic influenza (H1N1) 2009 virus continues to be the predominant virus circulating worldwide. Seasonal H3N2 and type B viruses are circulating at low levels in parts of Africa, east and Southeast Asia and are being detected only sporadically on other continents.

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)

*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)


From the published literature:

A recent case series of 43 pregnant women hospitalized with laboratory confirmed pandemic H1N1 influenza in Victoria (Australia) highlights the risks of influenza infection during pregnancy (Hewagama et al, CID 2010:50). In the study, half of all pregnant women had no other identifiable underlying medical condition, however, the overall prevalence of asthma, diabetes, and obesity among the group was greater than that observed in the general population of Australia. The majority of cases presented during their second trimester (30%) or third trimester (65%). The most common clinical presentation was uncomplicated influenza-like-illness (58%), however, approximately 28% had evidence of pneumonia, 20% required intensive care, and one case died. Six (40%) of 15 women at <37 weeks gestation delivered preterm; and among these six births, two died in utero and one died after delivery. Five of six pregnant women who delivered prematurely also had chest X-ray evidence of pneumonia. Notably, of the seven neonates tested for H1N1, including one who died because of complications related to premature birth, all tested negative for H1N1.

Although the spectrum of influenza illness during pregnancy is broad, ranging from mild to severe, this publication again illustrates the increased risk of severe influenza associated with pregnancy, particularly among pregnant women in the second and third trimester and among those with underlying medical conditions. In addition, WHO clinical management guidelines recognizes pregnancy as a high risk condition for severe outcome and recommends early treatment of pregnant women with oseltamivir or zanamivir even in the absence of other risk factors.


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:


Qualitative indicators (Week 29 to Week 2: 13 July 2009 - 17 January 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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 24 January 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. 84): 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. 84): Cyprus and Nigeria.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 133
• WHO Regional Office for the Americas (AMRO) - At least 7166
• WHO Regional Office for the Eastern Mediterranean (EMRO) - 1002
• WHO Regional Office for Europe (EURO) - At least 3429
• WHO Regional Office for South-East Asia (SEARO) - 1426
• WHO Regional Office for the Western Pacific (WPRO) - 1555
• Total* - At least 14711

* 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.
-

<cite cite="http://www.who.int/csr/don/2010_01_29/en/index.html">WHO | Pandemic (H1N1) 2009 - update 85</cite>

[Giuseppe]

WHO - Pandemic (H1N1) 2009 - update 84

WHO - Pandemic (H1N1) 2009 - update 84

Pandemic (H1N1) 2009 - update 84 - Weekly update

22 January 2010


As of 17 January 2010, worldwide more than 209 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 14142 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:

The overall situation in largely unchanged since last week. The most intense transmission of pandemic influenza virus continues to occur in North Africa, South Asia, and in limited areas of Eastern Europe. Overall pandemic influenza activity in the temperate northern hemisphere peaked between late October and late November 2009 and has continued to decline since.

In North Africa, limited data suggest that transmission of pandemic influenza virus remains geographically widespread and active throughout the region, but has likely recently peaked in most places. During early January 2010 only the Libyan Arab Jamahiriya reported an increasing trend in respiratory diseases activity. Egypt is now reporting a declining trend after increases in respiratory diseases activity throughout December 2009, suggesting a recent peak in activity during early January 2010.

In West Asia, limited data suggests pandemic influenza virus transmission remains geographically widespread however overall activity has been declining in most places during December and January.

In South Asia, active transmission of pandemic influenza virus persists in the northern and western parts of the subcontinent, however overall activity has recently peaked. In India, influenza activity has been largely confined to the northern and western states; activity in the northern states peaked during mid December 2009 and in the western states during early January 2010. In Nepal, active transmission of virus persists, and the trend in respiratory diseases activity remains unchanged since the previous week after reporting continuous increases in activity since late October 2009.

In Europe, pandemic influenza virus transmission remains geographically widespread across parts of western, central, and southeastern Europe, however overall influenza activity continued to decline or remain low in most countries The areas of most intense transmission currently include Poland, Austria, Estonia, Romania, Hungary, and Moldova; however, in all but Romania, ILI activity has declined significantly since peaking in November.

The overall rate of specimens testing positive for influenza fell to 20% in Europe after reaching a peak of 45% during early November 2009. Pandemic H1N1 2009 virus continues to be predominant circulating influenza virus in the European region with only sporadic detections of seasonal influenza viruses.

In East Asia, pandemic influenza activity remains widespread but continues to decline in most places. Mongolia reported a very high intensity of respiratory diseases during early January 2010; rates of ILI have been elevated above expected seasonal levels since late October 2009 but are well below a significant peak of activity observed during November 2009. In Japan, overall influenza activity continued to decline since peaking at the end of November 2009, however regional increases in activity were observed during late December on the southern island of Okinawa. In China, Hong Kong SAR, and Chinese Taipei pandemic influenza activity remains widespread but continues to decline or remain stable. Pandemic H1N1 continues to be the predominant circulating virus in the region but seasonal H3N2 viruses continue to circulate in very small numbers in northern China.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low in most places.In temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

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)

*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)


Qualitative indicators (Week 29 to Week 1: 13 July 2009 - 10 January 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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 10 January 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. 83): Mali.

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. 83): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) 131
• WHO Regional Office for the Americas (AMRO) At least 7094
• WHO Regional Office for the Eastern Mediterranean (EMRO) 941
• WHO Regional Office for Europe (EURO) At least 3099
• WHO Regional Office for South-East Asia (SEARO) 1366
• WHO Regional Office for the Western Pacific (WPRO) 1511
• Total* At least 14142

* 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.
-

<cite cite="http://www.who.int/csr/don/2010_01_22/en/index.html">WHO | Pandemic (H1N1) 2009 - update 84</cite>

[Giuseppe]

WHO - Pandemic (H1N1) 2009 - update 83

WHO - Pandemic (H1N1) 2009 - update 83

Pandemic (H1N1) 2009 - update 83 - Weekly update

15 January 2010


As of 10 January 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 13554 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:

The most intense areas of pandemic influenza virus transmission currently are in parts of North Africa, South Asia, and east and southeastern Europe.

In North Africa, limited data suggest that transmission of pandemic influenza virus remains active throughout the region, particularly in Morocco, Algeria, and Egypt.

In West Asia, limit data suggest that pandemic virus continues to circulate widely with a number of countries likely having already experienced a peak in activity prior to December.

Pandemic H1N1 2009 virus continues to be predominant circulating influenza virus in the northern African and western Asian regions with only sporadic detections of seasonal influenza viruses.

In South Asia, the northern and western parts of the subcontinent continued to experience active influenza transmission. In Nepal, increasing ARI activity and geographically regional to widespread influenza activity was reported during December and January. In India, overall activity may have peaked during mid to late December, however transmission has been regionally variable with a recently increasing trend in the western states, active but decreasing transmission in the northern states, and overall low activity in the eastern and southern states. In Sri Lanka, geographically widespread transmission with increasing trend of respiratory diseases was reported throughout December, however activity may have recently plateaued.

In Europe, pandemic influenza transmission remains geographically widespread throughout the continent, however, overall activity continued to decline substantially since November. A moderate intensity of respiratory diseases activity was reported in Romania, Ukraine, Turkey, and Switzerland, however, rates of ILI/ARI have been decreasing or have plateaued in all. At least four countries testing more than 20 sentinel respiratory specimens reported greater than 25% specimens were positive for influenza (Romania, Georgia, Germany, and France). The overall rate of specimens testing positive for influenza fell to 22% in Europe after reaching a peak of 45% during early November 2009. Pandemic H1N1 2009 virus continues to be predominant circulating influenza virus in the European region with only sporadic detections of seasonal influenza viruses.

In East Asia, influenza activity remains widespread but continues to decline overall. In Japan, influenza activity remains elevated but has declined since peaking at the end of November 2009. Although influenza transmission remains active and regionally variable in China, overall activity has declined substantially since peaking during mid November 2009 in northern and southern China. In Hong Kong SAR (China), influenza activity remained stably elevated but substantially lower than a large peak of activity during late September and early October 2009. In Mongolia, rates of ILI have been elevated above seasonal baseline since late October 2009 but declined substantially since a peak of activity was observed during November 2009. In DPR Korea, geographically regional influenza activity with increasing respiratory diseases trend was reported during early January 2010. Pandemic H1N1 continues to be the predominant circulating virus in the region but seasonal H3N2 viruses continue to circulate in very small numbers in northern China.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low. In North America, peak influenza activity occurred during early, mid, and late October in Mexico, the United States, and Canada, respectively. Small areas of increased influenza activity may be occurring in central and northern Mexico.

In temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission. This suggests that the level of population immunity in areas that experienced intense, high-level transmission during a winter season is high enough to prevent sustained transmission from recurring during the summer when the virus is less transmissible.

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)

*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)


Qualitative indicators (Week 29 to Week 53: 13 July - 3 January 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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 3 January 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. 82): 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. 82): Sudan.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) 131
• WHO Regional Office for the Americas (AMRO) At least 7016
• WHO Regional Office for the Eastern Mediterranean (EMRO) 883
• WHO Regional Office for Europe (EURO) At least 2788
• WHO Regional Office for South-East Asia (SEARO) 1289
• WHO Regional Office for the Western Pacific (WPRO) 1447
• Total* At least 13554

* 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.
-

<cite cite="http://www.who.int/csr/don/2010_01_15/en/index.html">WHO | Pandemic (H1N1) 2009 - update 83</cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 82 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 82

Pandemic (H1N1) 2009 - update 82 - Weekly update

8 January 2010


As of 3 January 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 12799 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:

The most active areas of pandemic influenza transmission currently are in parts of central, eastern and southeastern Europe, North Africa, and South Asia.

In Europe, pandemic influenza transmission remains geographically widespread throughout the continent and there continues to be intense virus circulation in several countries of central, eastern, and southeastern Europe - particularly in Poland, Serbia, Ukraine, Georgia - where a high a intensity of respiratory diseases activity has been recently reported. Among countries testing more than 20 clinical specimens from sentinel sites in the past week, the greatest proportions of samples testing positive for influenza were observed in Greece (72%), Georgia (54%), Switzerland (49%), Portugal (48%), Germany (48%), Luxembourg (40%), Romania (30%), Poland (25%), and Albania (23%). In most of western and northern Europe, rates of ILI/ARI continued to decline substantially, and in many places have returned to near seasonal baselines. Sporadic cases of seasonal H3N2 influenza have been identified in Western Europe but in very small numbers.

Crude mortality rates among most European countries, measured as the cumulative number of pandemic H1N1 influenza associated deaths per million population, appear to be within the same range as rates observed elsewhere in northern and southern hemisphere, suggesting a relatively consistent global pattern of mortality.

In North Africa and West Asia, limited data suggest that influenza transmission remains active. Although west Asia may have already experienced a peak in influenza activity, parts of North Africa continues to report increasing respiratory diseases activity, particularly in Egypt.

Elevated levels of ILI activity and increased influenza virus detections were observed during November and December in Algeria and Morocco, but activity has likely peaked in the later.

In South Asia, pandemic influenza transmission remains geographically widespread and active across the subcontinent - particularly in northern India, Nepal, and in Sri Lanka - where an increasing trend in respiratory diseases activity was reported.

In Southeast Asia, influenza transmission remains geographically regional to widespread; however, overall influenza activity appears to be low but variable. Localized increases in ILI were reported in parts of Thailand over the past three weeks. In Vietnam, after a period of substantial influenza transmission during September through November, activity declined significantly in December. In Laos and Cambodia, overall respiratory disease activity was reported to be decreasing during most of December.

In East Asia, influenza transmission remains widespread and active but appears to be declining overall. Influenza/ILI activity continued to decline in Japan, in northern and southern China, Chinese Taipei, and Hong Kong SAR (China). Pandemic H1N1 is clearly still the predominant circulating virus but seasonal H3N2 viruses continue to circulate in very small numbers in northern China. Slight increases in rates of ILI were again reported in Mongolia.

In central Asia, there is evidence of declining rates of ILI/ARI since respiratory disease activity recently peaked in late November and early December in Uzbekistan and Kyrgyzstan, respectively.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low. In North America, peak influenza activity occurred during early, mid, and late October in Mexico, the United States, and Canada, respectively. In all three countries, as expected, a substantially greater number of cases were recorded during the fall and winter transmission period as compared to spring and summer transmission period. In Canada, after experiencing substantial influenza activity unusually early during the fall and winter period, rates of ILI have now dropped below the historical seasonal baseline.

In temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission. This suggests that the level of population immunity in areas that experienced intense, high-level transmission during a winter season is high enough to prevent sustained transmission from recurring during the summer when the virus is less transmissible.

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)

*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)


Qualitative indicators (Week 29 to Week 52: 13 July - 27 December 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 December 2009

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. 81): 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. 81): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) 131
• WHO Regional Office for the Americas (AMRO) At least 6880
• WHO Regional Office for the Eastern Mediterranean (EMRO) 708
• WHO Regional Office for Europe (EURO) At least 2554
• WHO Regional Office for South-East Asia (SEARO) 1165
• WHO Regional Office for the Western Pacific (WPRO) 1361
• Total* At least 12799

* 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.
-

<cite cite="http://www.who.int/csr/don/2010_01_08/en/index.html">WHO | Pandemic (H1N1) 2009 - update 82</cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 81 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 81

Pandemic (H1N1) 2009 - update 81 - Weekly update

30 December 2009


As of 27 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 12220 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 data.


Situation update:

The most active areas of pandemic influenza transmission currently are in central and eastern Europe. Focal increases in rates of ILI/ARI during recent weeks were reported in at least three eastern European countries, Georgia, Montenegro, and Ukraine.

A high intensity of respiratory diseases activity with concurrent circulation of pandemic influenza persists in parts of southern and eastern Europe, particularly in Greece, Poland, Bulgaria, Serbia, Ukraine, and the Urals Region of the Russian Federation.

In Western Europe, influenza transmission remains active and widespread, but overall disease activity has peaked. At least 13 of 21 countries (testing more than 20 sentinel samples) reported that 30% or more of sentinel specimens were positive for influenza, down from a peak of over 70%. All were influenza viruses detected in Western Europe were pandemic H1N1 2009, however, very small numbers of seasonal influenza viruses, making up less than 1% of all influenza viruses detected, were reported in Russia.

In addition, limited available data indicates that active, high intensity transmission is occurring in Northern African countries along the Mediterranean coast (Algeria, Tunisia, and Egypt).

In Central Asia, limited data suggest that influenza virus circulation remains active, but transmission may have recently peaked in some places.

In West Asia, Israel, Iran, Iraq, Oman, and Afghanistan also appear to have passed their peak period of transmission within the past month, though both areas continue to have some active transmission and levels of respiratory disease activity have not yet returned to baseline levels.

In East Asia, influenza transmission remains active but appears to be declining overall. Influenza/ILI activity continued to decline in Japan, in northern and southern China, Chinese Taipei, and Hong Kong SAR (China). Slight increases in ILI were reported in Mongolia after weeks of declining activity following a large peak of activity over one month ago.

In southern Asia, influenza activity continues to be intense, particularly in northern India, Nepal, and, Sri Lanka. Seasonal influenza A (H3N2) viruses are still being detected in very small numbers in China making up about 2.5% of the influenza A viruses detected there.

In North America, influenza transmission remains widespread but has declined substantially in all countries. In the US, sentinel outpatient ILI activity has returned to the seasonal baseline, and indicators of severity, including hospitalizations, paediatric mortality, and P&I mortality have declined substantially since peaking during late October. Rates of hospitalization among cases aged 5-17 years and 18-49 year far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged >65 years were far lower than those observed during recent influenza seasons.

In the tropical regions of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for focal increases in respiratory disease activity in a few countries.

In the temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

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)


*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)


Qualitative indicators (Week 29 to Week 51: 13 July - 20 December 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 December 2009

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. 80): 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. 80): Nepal and Armenia.


[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) 130
• WHO Regional Office for the Americas (AMRO) At least 6670
• WHO Regional Office for the Eastern Mediterranean (EMRO) 693
• WHO Regional Office for Europe (EURO) At least 2422
• WHO Regional Office for South-East Asia (SEARO) 1056
• WHO Regional Office for the Western Pacific (WPRO) 1249
• Total* At least 12220

* 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.
-

<cite cite="http://www.who.int/csr/don/2009_12_30/en/index.html">WHO | Pandemic (H1N1) 2009 - update 81</cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 80 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 80

Pandemic (H1N1) 2009 - update 80 - Weekly update

23 December 2009


As of 20 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 11516 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 data.


Situation update:

In the temperate zone* of the northern hemisphere, transmission of pandemic influenza virus remains active and geographically widespread, however overall disease activity has recently peaked in much of the hemisphere. There continues to be increases in influenza activity in later affected areas of central and eastern Europe, and in parts of west, central, and south Asia.

In United States and Canada, influenza activity continues to be geographically widespread but overall levels of ILI** have declined substantially to near the national baseline level in the US and below the seasonal baseline in Canada. Although numbers of hospitalizations and death in US have declined steadily since their peak over 6 weeks ago, the proportional mortality due to pneumonia and influenza (P&I mortality) remains elevated above the epidemic threshold for the 11th consecutive week. In Canada, rates of ILI, numbers of outbreaks, and proportions of samples testing positive for influenza have declined substantially since peaking six weeks ago. Approximately 53% of hospitalized cases in Canada had an underlying medical condition; cases with underlying medical conditions tended to be older (compared to those without), and were at increased risk of hospitalization and death. Also from Canada, a smaller proportion of hospitalized cases during the winter transmission season compared with those hospitalized cases during the summer transmission season, were persons of aboriginal origin (3.9% vs. 20.3%).

In Europe, geographically widespread and active transmission of pandemic influenza virus continued to be observed throughout the continent, however, overall pandemic influenza activity appears to have recently peaked across a majority of countries. At least ten countries reported that 30% or more of their sentinel respiratory specimens had tested positive for influenza. Greater than 98% of subtyped influenza A viruses detected in Europe were pandemic H1N1 2009, however, seasonal influenza viruses (H1N1, H3N2, and type B) continue to be detected at low levels. Of note, a few countries are experiencing increasing disease activity and have yet to peak (Hungary and Montenegro ), while several others are experiencing a resurgence in activity (Serbia, Ukraine, Georgia, and Turkey). Rates of ILI have returned to near seasonal baselines in the earlier affected areas of western Europe (Belgium, the Netherlands, Ireland, and Iceland) and a substantial decline in activity has been observed in much of northern Europe over the past month.

In central and southern Europe, where influenza virus transmission has been most active recently, disease activity in most places has either plateaued (Albania, Czech Republic, Estonia) or begun to decline (Austria, Germany, Poland, Latvia, Croatia, Slovakia, and Greece). Further east, influenza activity appears to be variable, with the Russian Federation reporting a steady decline in rates of ARI after a recent peak three weeks ago; while several other countries are reporting increases in rates of ILI/ARI (Ukraine and Georgia).

In Europe, the highest rates of ILI have been recorded among children 0-4 years of age (in 15 countries) and among older children 5-14 years of age (in 18 countries). Detections of RSV in Europe continued to increase over the past six weeks, partially accounting for elevated ILI activity among young children in some countries.

In Western and Central Asia, limited data suggest that influenza virus circulation remains active throughout the region, however disease trends remain variable. Increasing respiratory diseases activity continued to be reported in Kazakhstan and in Egypt; while several others countries, Israel and Oman, have been reporting declining trends of respiratory diseases activity after recording a peak of activity approximately one month ago.

In East Asia, the situation remains similar to last week; influenza transmission remains active but appears to be declining overall. Influenza/ILI activity has recently peaked and continues to decline in Japan, in northern and southern China, Chinese Taipei and in Mongolia.

In southern Asia, influenza activity continues to increase in the northern India, Nepal, and, Sri Lanka.

In the tropical region of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for in Barbados and Ecuador, were recent increases in respiratory diseases activity have been reported.

In the temperate region of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

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)

*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)


Qualitative indicators (Week 29 to Week 50: 13 July - 13 December 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 December 2009

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.79): 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 79): Georgia and Albania.

[Region - Deaths]*

• WHO Regional Office for Africa (AFRO) 109
• WHO Regional Office for the Americas (AMRO) At least 6670
• WHO Regional Office for the Eastern Mediterranean (EMRO) 663
• WHO Regional Office for Europe (EURO) At least 2045
• WHO Regional Office for South-East Asia (SEARO) 990
• WHO Regional Office for the Western Pacific (WPRO) 1039
• Total* At least 11516

* 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.
-

<cite cite="http://www.who.int/csr/don/2009_12_23/en/index.html">WHO | Pandemic (H1N1) 2009 - update 80</cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 79 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 79

Pandemic (H1N1) 2009 - update 79 - Weekly update

18 December 2009


As of 13 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 10582 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 data.


Situation update:

In the temperate zone* of the northern hemisphere, transmission of pandemic influenza virus remains active and geographically widespread, however disease activity has peaked or passed its peak in many places, particularly North America. Influenza activity continues to increase in later affected areas of south-eastern and central Europe, and in central and south Asia.

In United States and Canada, active influenza transmission persists but overall levels of ILI** have declined substantially to near seasonal baselines. In the US, proportional mortality due to pneumonia and influenza (P&I mortality) has remained consistently elevated above the epidemic threshold for the past 10 weeks; however, weekly numbers of lab-confirmed hospitalizations and deaths continue to decline over the past month.

The preliminary analysis of data from Northern Hemisphere countries that have now passed through an entire season of winter transmission indicate that the mortality rate, as expressed in fatal cases per million people, is in the same range as that which was observed in the Southern Hemisphere winter. This would indicate that the overall severity of the pandemic has not changed although the proportion of the population infected has been much higher in the temperate countries of the Northern Hemisphere during their winter season compared to the circulation observed in their summer season.

In Europe, geographically widespread and active transmission of pandemic influenza virus continued to be observed across the continent. At least 10 countries, mostly in western and northern Europe, reported declining respiratory disease activity. During the last reporting period, ILI/ARI activity continued to increase or reach a plateau in a limited number of countries: the Czech Republic, Estonia, Hungary, Montenegro and Switzerland (a range of 28-71% of sentinel respiratory samples were positive for influenza in these countries). A high intensity of respiratory disease activity was reported in parts of northern and south-eastern Europe and in parts of the Russian Federation.

99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009.

Detections of RSV in Europe continued to increase over the past five weeks, partially accounting for elevated ILI activity among young children in some countries.

In Western and Central Asia, influenza transmission remains active. ILI/ARI activity continues to increase in Kazakhstan and Kyrgyzstan, and has peaked in some countries including in Afghanistan, Oman, and Israel. Influenza virus continues to circulate in Iran, Iraq, Jordan, Egypt and in much of the surrounding region but may have recently peaked in some parts.

In East Asia, influenza transmission remains active but appears to be declining overall. Influenza activity has recently peaked and begun to decline in Japan. ILI activity continued to decline but remained elevated in northern and southern China, Chinese Taipei and in Mongolia.

In southern Asia, influenza activity continues to increase in the northern parts of India, Nepal, Sri Lanka, and the Maldives.

In the tropical region of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining.

Pandemic H1N1 2009 virus appears to be the predominant influenza virus circulating in northern and eastern Africa. In West Africa, a mixture of pandemic and seasonal influenza viruses have been detected. Seasonal viruses have included both seasonal H1N1 and H3N2, with the later predominating.

In the temperate region of the southern hemisphere, sporadic cases of pandemic influenza are being reported without evidence of sustained community transmission.

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)

*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)


Qualitative indicators (Week 29 to Week 49: 13 July - 6 December 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 13 December 2009

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.78): 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 78): Bahamas, Bosnia & Herzegovina, Estonia, Montenegro, Libyan Arab Jamahiriya.

[Region - Deaths**]

• WHO Regional Office for Africa (AFRO)* 109
• WHO Regional Office for the Americas (AMRO) At least 6335
• WHO Regional Office for the Eastern Mediterranean (EMRO) 572
• WHO Regional Office for Europe (EURO) At least 1654
• WHO Regional Office for South-East Asia (SEARO) 892
• WHO Regional Office for the Western Pacific (WPRO) 1020
• Total** At least 10582

* No update since web update no. 78
** 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.
-

<cite cite="http://www.who.int/csr/don/2009_12_18a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 79</cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 78 - Weekly update - 11 December 2009

WHO - Pandemic (H1N1) 2009 - update 78

Pandemic (H1N1) 2009 - update 78 - Weekly update - 11 December 2009


As of 6 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 9596 deaths.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. 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 data.


Situation update:

In the temperate zone* of the northern hemisphere, pandemic influenza activity has passed its peak in North America and in parts of western, northern, and eastern Europe, but activity continues to increase in parts of central and southeastern Europe, as well as in south and east Asia. Influenza transmission remains active in much of western and central Asia and there is evidence of pandemic virus circulation in most regions of Africa.

In United States and Canada, active influenza virus transmission persists but overall ILI** activity continues to decline for the 5th and 3rd consecutive weeks, respectively. In the US, after 8 weeks of increases, proportional mortality due to pneumonia and influenza (P&I mortality) has begun to decrease but remains elevated above the epidemic threshold; weekly numbers of lab-confirmed hospitalizations and deaths have also recently begun to decline. So far, comparing transmission during the current winter season to transmission during the summer season, there appears to be 2-3 times more hospitalized cases and deaths in the United States and approximately 4-5 times more hospitalized cases and deaths in Canada during the winter season. However, the overall rate of hospitalization and death in the population is similar to that which was observed in temperate countries of the southern hemisphere during their winter. This would indicate that transmission of the virus has been much more widespread and intense during the winter, as predicted, but overall rates of severe illness have not changed compared to southern hemisphere.

Similar to seasonal influenza, persons with certain underlying conditions (compared to those without) were at significantly increased risk of hospitalization and death associated with pandemic H1N1 2009 virus infection. During the current winter season in Canada, 52% of hospitalized cases, 60% of cases requiring ICU, and 67% of fatal cases, had a underlying chronic medical illness.

Similar to the experience of many countries, the most common underlying conditions among fatal cases in Canada were asthma followed by chronic cardiac disease, immunosuppression, and diabetes.

In Europe, geographically widespread transmission of pandemic influenza virus continued to be observed across the continent. With the exception of France where ILI activity continues to increase, ILI activity has peaked or passed its peak in much of western Europe, including in Belgium, Iceland, Ireland, Netherlands, Spain, Portugal, Italy, and Germany. In northern Europe, intensity remains high, however activity has begun to decline in Norway, Sweden, and Denmark. Increasing activity continues to be observed in parts of central and southeastern Europe, including in Albania, the Czech Republic, Estonia, Greece, Hungary, Latvia, Poland, Romania, Montenegro, Slovenia, and Turkey. Further east, declining rates of ILI or ARI have been observed in Georgia, Bulgaria, and Ukraine. In the Russian Federation, influenza virus circulation remains active, but overall activity may have recently peaked. A high intensity of respiratory diseases activity was reported in Lithuania and Greece, and a moderate impact on the healthcare system was reported in France and in parts of northern and far eastern Europe.

99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009.

Of note, detections of RSV in Europe have increased over the past four weeks which may partially account for elevated ILI activity among young children.

In Western and Central Asia, influenza virus transmission remains active. ILI/ARI activity continues to increase in Kazakhstan and Kyrgyzstan, but may have peaked in Afghanistan, Israel, and Oman. Pandemic influenza virus continues to circulate in Iran, Iraq, Jordan, and in much of the surrounding region.

In East Asia, influenza transmission remains variable. Influenza activity continues to increase in Japan and has recently begun to increase in Hong Kong SAR and Chinese Taipei both of which previously experienced a peak of transmission. Elevated but stable ILI activity has been reported in southern China, but declines in activity continue to be observed in northern China and Mongolia.

In South Asia, influenza activity has begun to increase in the north-western parts of India and in Sri Lanka. Small number of seasonal influenza viruses continue to be detected in Asia but in decreasing amounts.

In the tropical region of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining in most areas.

In Africa, limited data suggest that pandemic H1N1 2009 virus continues to be detected from all parts of the continent (except South Africa where the winter season has passed). Pandemic H1N1 2009 virus appears to be the predominant influenza virus circulating in northern and eastern Africa.

In the temperate region of the southern hemisphere, sporadic cases of pandemic influenza have been reported in recent weeks but no sustained local transmission has been observed.

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)

*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)


Qualitative indicators (Week 29 to Week 48: 13 July - 29 November 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 6 December 2009

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.77): Democratic Peoples Republic of Korea.

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 77): Austria, Lithuania, Latvia, and the United Arab Emirates.


[Region - Deaths]

• WHO Regional Office for Africa (AFRO) 109
• WHO Regional Office for the Americas (AMRO) At least 6131
• WHO Regional Office for the Eastern Mediterranean (EMRO) 452
• WHO Regional Office for Europe (EURO) At least 1242
• WHO Regional Office for South-East Asia (SEARO) 814
• WHO Regional Office for the Western Pacific (WPRO) 848
• Total At least 9596

-

<cite cite="http://www.who.int/csr/don/2009_12_11a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 78</cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 77 - Weekly update - 4 December 2009

WHO - Pandemic (H1N1) 2009 - update 77

Pandemic (H1N1) 2009 - update 77 - Weekly update - 4 December 2009


As of 29 November 2009, worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 8768 deaths.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. 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 data.


Situation update:

In the temperate zone* of the northern hemisphere, the early arriving winter influenza season continues to intensify across central Europe and in parts of central, eastern, and southern Asia. Disease activity has peaked and is declining in North America and has either recently peaked or is currently peaking in much of western and northern Europe.

In both Canada and the United States, influenza virus circulation remains active and geographically widespread, however, disease activity appears to have peaked in past 3 to 4 weeks. In the United States, deaths due to pneumonia and influenza (P&I mortality) continued to increase past the epidemic threshold for the past 8 weeks and cumulative rates of hospitalizations for the current influenza season have exceeded rates seen in recent seasons among all age groups except those aged ≥ 65.

In Europe, widespread and intense transmission of pandemic influenza virus continued to be observed across most of the continent. In western and northern Europe the peak of disease activity has passed in Belgium, Iceland, Ireland, Netherlands, Norway and parts of the United Kingdom (Northern Ireland, Wales); activity may be peaking or plateauing in Spain, Portugal, Italy, Sweden and Denmark.

Influenza activity continues to increase in much of Central Europe in the region between the Baltic and Balkan countries and from Germany to Romania.

In Eastern Europe, recent peaks or plateaus in disease activity have also been observed in Ukraine, Belarus, Bulgaria and the Republic of Moldova.

In the Russian Federation, influenza activity remains active and intense in some regions, with an overall increasing trend.

A moderate impact on the healthcare system has been reported in parts of Northern and Eastern Europe.

Over 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009.

In Western and Central Asia, influenza transmission remains active. Disease activity continues to increase in Kazakhstan, Kyrgyzstan, Uzbekistan, Iran and Iraq, while activity may have peaked in Israel, Jordan, and Afghanistan.

In East Asia, increasing ILI** or respiratory disease activity has been reported in Southern China and Japan. A recent decline in activity has been observed in Northern China.

In South and Southeast Asia, influenza activity continues to increase in the north-western parts of India, Nepal, Sri Lanka, and Cambodia, while activity in the rest of region remain low.

In the tropical zone of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining except for focal areas of increasing activity in Jamaica, Venezuela, and Ecuador.

In Africa, pandemic H1N1 2009 virus continues to be isolated from all parts of the continent, and there is evidence of continued co-circulation of pandemic (H1N1) 2009 and seasonal H3N2 viruses.

In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported.

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)

*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)


Qualitative indicators (Week 29 to Week 47: 13 July - 22 November 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 29 November 2009

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.76): 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 76): Romania and Slovakia.

[Region - Deaths]

• WHO Regional Office for Africa (AFRO) 108
• WHO Regional Office for the Americas (AMRO) 5878
• WHO Regional Office for the Eastern Mediterranean (EMRO) 392
• WHO Regional Office for Europe (EURO) at least 918
• WHO Regional Office for South-East Asia (SEARO) 766
• WHO Regional Office for the Western Pacific (WPRO) 706
• Total at least 8768

-

<cite cite="http://www.who.int/csr/don/2009_12_04/en/index.html">WHO | Pandemic (H1N1) 2009 - update 77</cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 76 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 76

Pandemic (H1N1) 2009 - update 76 - Weekly update

27 November 2009


As of 22 November 2009, worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 7820 deaths.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. 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 data.


Situation update:

In temperate regions* of the northern hemisphere, the early arriving winter influenza season continues to be intense across parts of North America and much of Europe.

In North America, the Caribbean islands and a limited number of European countries there are signs that disease activity peaked.

In the United States and Canada, influenza transmission remains very active and geographically widespread.

In the United States, disease activity appears to have peaked in all areas of the country.

In Canada, influenza activity remains similar but number of hospitalisations and deaths is increasing.

Most countries in the Caribbean have ILI and SARI levels coming down.

In Europe, widespread and increasing transmission of pandemic influenza virus was observed across much of the continent and most countries that were not yet experiencing elevated ILI activity in the last few weeks, have seen a rapid increase in ILI. Very high activity is seen in Sweden, Norway, Moldova and Italy. Over 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009.

Impact on health care services is severe in Albania and Moldova.

Some countries seem to have peaked already: Belgium, Bulgaria, Belarus, Ireland, Luxemburg, Norway, Serbia, Ukraine and Iceland.

In East Asia, influenza transmission remains active. Intense influenza activity continues to be observed in Mongolia but has peaked already. In Japan, influenza activity remains stably elevated, but may be decreasing slightly in populated urban areas.

ILI activity in India and Nepal and Sri Lanka has increased.

In the tropical zone of the Americas and Asia, influenza transmission remains variable but low in many countries. In the tropical areas of Central and South America, most countries continue to report declining influenza activity, with the exception of Ecuador and Venezuela.

In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported.


Weekly update (Virological surveillance data)

*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)


Qualitative indicators (Week 29 to Week 46: 13 July - 15 November 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 22 November 2009

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.75): Armenia.

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 75): The former Yugoslav Republic of Macedonia, Switzerland, Poland, Tunisia, Morocco and Madagascar.


[Region - Cumulative total as of 22 November 2009 (Cases* - Deaths)]

• WHO Regional Office for Africa (AFRO) 15503 - 104
• WHO Regional Office for the Americas (AMRO) ** 190765 - 5360
• WHO Regional Office for the Eastern Mediterranean (EMRO) 38359 - 330
• WHO Regional Office for Europe (EURO)** over 154000 - at least 650
• WHO Regional Office for South-East Asia (SEARO) 47059 - 738
• WHO Regional Office for the Western Pacific (WPRO) 176796 - 644
• Total over 622482 - at least 7826

*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
**The total number of cases are no longer reported from these regions
-

<cite cite="http://www.who.int/csr/don/2009_11_27a/en/index.html">WHO
</cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 75 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 75

Pandemic (H1N1) 2009 - update 75 - Weekly update

20 November 2009


As of 15 November 2009, worldwide more than 206 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6750 deaths.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. 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 data.


Situation update:

The situation remains similar since the last update.

In temperate regions* of the northern hemisphere, the early arriving winter influenza season continues to intensify across parts of North America and much of Europe. However, there are early signs of a peak in disease activity in some areas of the northern hemisphere.

In the United States, influenza transmission remains active and geographically widespread, although disease activity appears to have recently peaked in most areas except in the northeastern United States.

In Canada, influenza transmission continues to intensify without a clear peak in activity; the ILI consultation rate, which has been highest among children aged 5-19, continues to significantly exceed mean rates observed over the past 12 influenza seasons.

In Europe, widespread and increasing transmission of pandemic influenza virus was observed across much of the continent but the most intense circulation of virus occurred in northern, eastern, and southeastern Europe. Transmission appears to have peaked in few countries of Western Europe including Iceland, Ireland, the UK (Northern Ireland), and Belgium after a period of sustained intense transmission. Further east, a number of countries reported sharp increases in the rates of ILI** (Serbia, Moldova, Norway, Lithuania, Georgia) or ARI (Belarus, Bulgaria, Romania, and Ukraine). A moderate or greater impact on the healthcare system was reported in parts of northern and southeastern Europe.

Greater than 20% of all sentinel respiratory specimens tested positive for influenza in at least 20 countries, with ≥ 50% of samples testing positive for influenza in Spain, Portugal, Estonia, Slovenia, Slovakia, Moldova, Bosnia and Herzegovina, Greece, Norway, Finland, Denmark, Belgium, Iceland, and Ireland.

Over 99% of subtyped influenza A viruses in the Europe were pandemic H1N1 2009.

In Central and Western Asia, increasing diseases activity and pandemic influenza virus isolations continues to be reported in several countries. A high intensity of respiratory diseases with increasing trend was reported in Kazakhstan.

Recent increases in rates of ILI or ARI have been observed in Uzbekistan and in parts of Afghanistan (particularly in the capital region and in southern and northeastern provinces).

In Israel, sharp increases in rates of ILI and pandemic virus detections have been reported in recent weeks.

In East Asia, influenza transmission remains active. Intense influenza activity continues to be observed in Mongolia with a severe impact on the healthcare system; however, disease activity may have recently peaked in the past 1-2 weeks.

In Japan, influenza activity remains elevated but stable nationally, and may be decreasing slightly in populated urban areas.

A small number of seasonal H3N2 and H1N1 influenza viruses continue to be detected in China and South East Asia, though the proportion of seasonal viruses is declining in relation to the proportion of pandemic influenza H1N1.

In tropical zone of the Americas and Asia, the intensity of influenza transmission is variable.

In the tropical areas of Central and South America, most countries continue to report declining influenza activity, with the exception of Peru and Colombia.

In the Caribbean Epidemiology Centre (CAREC) countries, after a recent peak of disease activity, rates of ARI have declined over the past 3-4 weeks.

With the exception of Sri Lanka, overall transmission continues to decline in most parts of tropical South and Southeast Asia.

In Hong Kong SAR, rates of ILI have returned baseline after a recent wave of predominantly pandemic H1N1 influenza in September and October.

In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported.

For more epidemiologic information please refer to the recent Weekly Epidemiological Report on Transmission Dynamics and Impact of Pandemic Influenza A (H1N1) 2009 Virus. 13 November 2009, vol. 84, 46 (pp 477?484)

WHO estimates that around 80 million doses of pandemic vaccine have been distributed and around 65 million people have been vaccinated. Campaigns are using a variety of different vaccines. Although intense monitoring of vaccine safety continues, all data compiled to date indicate that pandemic vaccines match the excellent safety profile of seasonal influenza vaccines.


Weekly update (Virological surveillance data)

*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.


Qualitative indicators (Week 29 to Week 45: 13 July - 8 November 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 15 November 2009

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.74): 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 74): Sri Lanka, Pakistan and Slovenia.


Cumulative total as of 15 November 2009

[Cases* - Deaths]

• WHO Regional Office for Africa (AFRO) - 14950 - 103
• WHO Regional Office for the Americas (AMRO) ** - 190765 - 4806
• WHO Regional Office for the Eastern Mediterranean (EMRO) - 25531 - 151
• WHO Regional Office for Europe (EURO)** - over 78000 - at least 350
• WHO Regional Office for South-East Asia (SEARO) - 45844 - 710
• WHO Regional Office for the Western Pacific (WPRO) - 166750 - 613
• Total - over 525060 - at least 6770

*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
**The total number of cases are no longer reported from these regions

-<region cumulative="" totalas="" 15="" november="" 2009="" cases*="" deathswho="" africa="" (afro)="" 14950="" 103who="" americas="" (amro)="" **="" 190765="" 4806who="" eastern="" mediterranean="" (emro)="" 25531="" 151who="" europe="" (euro)**="" 78000="" 350who="" south-east="" asia="" (searo)="" 45844="" 710who="" regional="" office="" for="" western="" pacific="" (wpro)="" 166750="" 613="" over="" 525060="" at="" least="" 6770*given="" that="" countries="" required="" to="" test="" and="" report="" individual="" cases,="" actually="" understates="" the="" real="" cases.="" **the="" total="" number="" of="" cases="" are="" no="" longer="" reported="" from="" these="" regions=""></region>

<cite cite="http://www.who.int/csr/don/2009_11_20a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 75</cite>

[DrRugby]

Re: WHO - Pandemic (H1N1) 2009 - update 74

Just to add a bit of confusion to the mix, consider this.

Not tropical mind you, but guess what looks exactly like a severe
influenza for the first 2 or 3 days and then ends causing death by hemorrhage?

CCHF, Congo-Crimean Hemorrhagic Fever, found in southern Ukraine, Turkey, all the -stans.

[Giuseppe]

WHO - Pandemic (H1N1) 2009 - update 74

WHO - Pandemic (H1N1) 2009 - update 74

Pandemic (H1N1) 2009 - update 74

Weekly update

13 November 2009


As of 8 November 2009, worldwide more than 206 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6250 deaths.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. 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 data.


Situation update:

The winter influenza season, which began unusually early across much of the Northern Hemisphere, shows early signs of peaking in parts of North America but is intensifying across much of Europe and Central and Eastern Asia.

In North America, Canada reported sharp increases in rates of influenza-like-illness (ILI), detections of pandemic H1N1 virus, and school outbreaks over the past three weeks as pandemic activity continues to spread west to east.

In the United States, influenza transmission remains geographically widespread and intense but largely unchanged since the previous reporting week; rates of hospitalizations among persons aged 0-4 years, 5-17 years, and 18-49 years have now exceeded those seen during recent previous influenza seasons. Disease activity may have peaked in the earlier affected southern and south eastern parts of the United States.

In Mexico, influenza activity remains geographically widespread with a significant wave of cases reported since early September, most notably from central and southern Mexico.

In Europe and Central Asia, overall influenza transmission continues to intensify throughout the continent as pandemic activity spreads eastward. At least 10 countries of Western Europe (Iceland, Poland, Romania, Belgium, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom) now report that the proportion of sentinel samples testing positive for influenza exceeded 20% consistent with active circulation of pandemic influenza viruses. High to very high intensity of respiratory diseases with concurrent circulation of pandemic H1N1 2009 was also reported in the Netherlands, Italy, much of Northern Europe, Belarus, Bulgaria, and in the Russian Federation (particularly in the Urals).

Disease activity may be peaking in a few countries, notably Iceland, Ireland, and parts of the UK (Northern Ireland) that experienced intense transmission during early autumn.

Because of a sharp rise in pandemic influenza cases one week ago in Ukraine, the Ministry of Health requested assistance from WHO European Regional Office to evaluate and respond. The initial analysis of information indicates that the numbers of severe cases do not appear to be excessive when compared to the experience of other countries and do not represent any change in the transmission or virulence of the virus.

Over 99% of subtyped influenza A viruses in the Europe were pandemic H1N1 2009 with the exception of the Russian Federation where <10% of viruses subtyped were seasonal influenza subtypes, H3N2 and seasonal H1N1.

In Western Asia, increasing activity has been observed in several countries. In Israel, sharp increases in rates of ILI and pandemic virus detections have been observed over the past 3 weeks. In Afghanistan, the proportion of sentinel visits for acute respiratory infections (ARI) has increased over the past 3-4 weeks, but more dramatically in the last 1-2 weeks.

In East Asia, very intense and increasing influenza activity continues to be reported in Mongolia with a severe impact on the healthcare system.

In China, the proportion of sentinel hospital visits for ILI and the proportions of respiratory samples testing positive for influenza, continued to increase over the past 3-4 weeks. More than 80% of influenza viruses isolated in China were pandemic H1N1 2009. In Hong Kong SAR, rates of ILI have returned baseline after a recent wave of predominantly pandemic H1N1 influenza in September and October.

In Japan, sharp increases in influenza activity continue to be reported nationally. On northern island of Hokkaido, which to date has been the most heavily affected, disease activity may have recently peaked.

Although active, predominantly pandemic influenza transmission persists in the Caribbean region, disease activity may have recently peaked in some places as evidenced by recently declining rates of ARI and severe acute respiratory infections (SARI) in the Caribbean Epidemiology Centre (CAREC) countries. Most other countries in the tropical region of Central and South America continue to report declining influenza activity.

With the exception of Nepal and Sri Lanka, overall transmission continues to decline in most parts of South and Southeast Asia.

In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported in recent weeks. Of note, a cluster of pandemic influenza cases been reported in Argentina in the capital area.


Weekly update (Virological surveillance data)

*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.


Qualitative indicators (Week 29 to Week 44: 13 July - 1 November 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 8 November 2009

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.73): Somalia, Nigeria, and Burundi.

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 73): Saint Lucia.

[Region - Cumulative total as of 8November 2009 (Cases* - Deaths)]

• WHO Regional Office for Africa (AFRO) 14868 - 103
• WHO Regional Office for the Americas (AMRO) 190765 - 4512
• WHO Regional Office for the Eastern Mediterranean (EMRO) 25531 - 151
• WHO Regional Office for Europe (EURO) over 78000 - at least 300
• WHO Regional Office for South-East Asia (SEARO) 44661 - 678
• WHO Regional Office for the Western Pacific (WPRO) 149711 - 516
• Total over 503536 - at least 6260

*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-

<cite cite="http://www.who.int/csr/don/2009_11_13/en/index.html">WHO | Pandemic (H1N1) 2009 - update 74</cite>

[Giuseppe]

WHO - Pandemic (H1N1) 2009 - update 73

WHO - Pandemic (H1N1) 2009 - update 73

Pandemic (H1N1) 2009 - update 73 - Weekly update

As of 1 November 2009, worldwide more than 199 countries and overseas territories/communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6000 deaths.


As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. 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 data.


Situation update:

Intense and persistent influenza transmission continues to be reported in North America without evidence of a peak in activity. The proportion of sentinel physician visits due to influenza-like-illness (ILI)(8%) has exceeded levels seen over the past 6 influenza seasons; 42% of respiratory samples tested were positive for influenza and 100% of subtyped influenza A viruses were pandemic H1N1 2009. Rates of ILI, proportions of respiratory samples testing positive for influenza, and numbers of outbreaks in educational settings continues to increase sharply in Canada as activity spreads eastward.

Significantly more cases of pandemic H1N1 have been recorded in Mexico since September than were observed during the initial springtime epidemic.

In Europe and Central and Western Asia, pandemic influenza activity continues to increase across many countries, signalling an unusually early start to the winter influenza season. Active circulation of virus marked by high proportions of sentinel respiratory samples testing positive for influenza has been reported in Belgium (69%), Ireland (55%), Netherlands (51%), Norway (66%), Spain (46%), Sweden (33%), the United Kingdom (Northern Ireland:81%), and Germany (27%).

In addition, there is evidence of increasing and active transmission of pandemic influenza virus across Northern and Eastern Europe (including Ukraine and Belarus), and eastern Russia. For details on the situation in Ukraine please refer to the Disease Outbreak News update below.

In Western Asia and the Eastern Mediterranean Region, increasing activity has been reported in Oman and Afghanistan.


Pandemic (H1N1) 2009, Ukraine - update 1

In East Asia, intense and increasing influenza activity continues to be reported in Mongolia. In China, after an earlier wave of mixed influenza activity (seasonal H3N2 and pandemic H1N1), pandemic H1N1 influenza activity now predominates and is increasing. Sharp increases in pandemic influenza activity continue to be reported throughout Japan with highest rates of illness being reported on the northern island.

Active influenza transmission and increasing levels of respiratory diseases continues to be reported in parts of the Caribbean, including in Cuba, Haiti, and other Caribbean Epidemiology Centre (CAREC) countries.

Most other countries in the tropical region of Central and South America continue to report declining influenza activity.

With the exception of Nepal, Sri Lanka, and Cambodia, overall transmission continues to decline in most but not all parts of tropical South and Southeast Asia.

Influenza virus isolates from sub-Saharan Africa are predominantly pandemic H1N1 virus but some seasonal H3N2 has been detected even in recent weeks. Unconfirmed media reports from the area indicate that disease activity has increased in recent weeks.

Since the new pandemic H1N1 2009 virus emerged, infections in different species of susceptible animals (pig, turkey, ferret, and cat) have been reported. Limited evidence suggests that these infections occurred following direct transmission of the virus from infected humans. These isolated events have had no impact on the dynamics of the pandemic, which is spreading readily via human-to-human transmission. As human infections become increasingly widespread, transmission of the virus from humans to other animals is likely to occur with greater frequency. Unless the epidemiology of the pandemic changes, these will continue to pose no special risks to human health.


Weekly update (Virological surveillance data)

(*) 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.


Qualitative indicators (Week 29 to Week 43: 13 July - 25 October 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 1 November 2009

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.72): Congo.

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 72): Afghanistan, Croatia, Mongolia, Tanzania and Ukraine.

[Region - Cumulative total as of 1 November 2009 (Cases* - Deaths]

• WHO Regional Office for Africa (AFRO) 14109 - 76
• WHO Regional Office for the Americas (AMRO) 185067 - 4399
• WHO Regional Office for the Eastern Mediterranean (EMRO) 22689 - 137
• WHO Regional Office for Europe (EURO) Over 78000 - At least 300
• WHO Regional Office for South-East Asia (SEARO) 44147 - 661
• WHO Regional Office for the Western Pacific (WPRO) 138288 - 498
  • Total Over 482300 - At least 6071

*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-

<cite cite="http://www.who.int/csr/don/2009_11_06/en/index.html">WHO | Pandemic (H1N1) 2009 - update 73</cite>

[Giuseppe]

WHO - Pandemic (H1N1) 2009 - update 72

WHO - Pandemic (H1N1) 2009 - update 72

Pandemic (H1N1) 2009 - update 72

Weekly update


As of 25 October 2009, worldwide there have been more than 440,000 laboratory confirmed cases of pandemic influenza H1N1 2009 and over 5700 deaths reported to WHO.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. 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 data.


Situation update:

In the temperate zone of the northern hemisphere, influenza transmission continues to intensify marking an unusually early start to winter influenza season in some countries. In North America, the US, and parts of Western Canada continue to report high rates of influenza-like-illness (ILI) and numbers of pandemic H1N1 2009 virus detections; Mexico has reported more confirmed cases since September than during the springtime epidemic. In Western Europe, high rates of ILI and proportions of respiratory specimens testing positive for pandemic H1N1 2009 have been observed in at least five countries: Iceland, Ireland, the UK (N. Ireland), Belgium, and the Netherlands. Many other countries in Europe and Western and Central Asia are showing evidence of early influenza transmission, including in Spain, Austria, parts of Northern Europe, Russia, and Turkey. In Japan, influenza activity has also increased sharply, especially on the northern island, approximately 10 weeks ahead the usual start of the winter influenza season.

Pandemic influenza transmission remains active in many parts of the tropical zone of the Americas, most notably in several Caribbean countries. Overall transmission continues to decline in most but not all parts of the tropical zone of South and Southeast Asia

Little influenza activity has been reported in temperate region of the southern hemisphere since the last update.


Weekly update (Virological surveillance data)*

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.


Qualitative indicators (Week 29 to Week 42: 13 July - 18 October 2009)

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

A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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 18 October 2009

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.71): 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 71): Russia, Jordan, Serbia, the Czech Republic, Turkey, Finland, Guadeloupe (FOC), and Moldova.

[Region - Cumulative total as of 25 October 2009 (Cases* - Deaths)]

• WHO Regional Office for Africa (AFRO) - 13536 - 75
• WHO Regional Office for the Americas (AMRO) - 174565 - 4175
• WHO Regional Office for the Eastern Mediterranean (EMRO) - 17150 - 111
• WHO Regional Office for Europe (EURO) - Over 64000 - At least 281
• WHO Regional Office for South-East Asia (SEARO) - 42901 - 605
• WHO Regional Office for the Western Pacific (WPRO) - 129509 - 465
• Total - Over 441661 - At least 5712

*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-

<cite cite="http://www.who.int/csr/don/2009_10_30/en/index.html">WHO | Pandemic (H1N1) 2009 - update 72</cite>