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

[tetano]

Pandemic (H1N1) 2009 - update 94

Weekly update

1 April 2010 -- As of 28 March 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17483 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 virus transmission currently are in parts of the tropical zones of Asia, the Americas, and Africa. Pandemic influenza activity remains low in much of the temperate areas of both the northern and southern hemispheres. Although pandemic influenza virus continues to be the predominant influenza virus circulating worldwide, seasonal influenza type B viruses are predominant in much of East Asia, and have been increasingly detected at low levels across southeast and western Asia, East Africa, and in parts of eastern and northern Europe. Seasonal influenza A (H3N2) is still being detected in very small numbers in parts of Asia and Australia.

In Southeast Asia, pandemic influenza virus transmission remains active but variable across the region. Thailand continues to report the most active circulation of pandemic virus in the region, however, disease activity may have recently peaked and begun to decline. Approximately half of all provinces in Thailand reported that >10% outpatient visits were due to influenza like illness (ILI). The proportion of outpatient sentinel respiratory samples testing positive for influenza dropped to 10% after peaking at approximately 30% during mid February 2010. In Malaysia, limited data suggest pandemic influenza virus transmission persists as new cases continue to be reported. In Indonesia, no recent pandemic influenza activity has been reported, however, low levels of seasonal influenza H3N2 and type B viruses continue to be detected. In Myanmar, limited data suggest that pandemic influenza has declined substantially since a period of active transmission during February 2010.

In South Asia, overall pandemic influenza activity remains low, except in Bangladesh, which reported regional spread of pandemic influenza virus in association with an increase in new cases since late February 2010. In India, low level circulation of pandemic influenza virus persists in the western part of the country.

In East Asia, overall pandemic influenza activity remained low as circulation of seasonal influenza B viruses continued to increase across the region. In China, ILI activity has greatly decreased; however, approximately 20-30% of respiratory samples have tested positive for influenza in recent weeks. Of these, over 85% were seasonal influenza B viruses. In Mongolia, recent intense influenza activity due to seasonal influenza B viruses continues to decrease. Overall rates of ILI have returned to near baseline in both Japan and the Republic of Korea as pandemic influenza virus circulation continues to wane. Seasonal influenza B viruses are circulating at low level across other parts of East and Southeast Asia and Oceania (Hong Kong SAR (China), Japan, Republic of Korea, China Taipei, Philippine, Thailand, Vietnam, Indonesia, Bangladesh and Australia). Also, small numbers of seasonal influenza H3N2 viruses have been detected in several countries of East and Southeast Asia as well as Oceania, particularly in Indonesia and in Australia.

In North Africa and Western Asia, limited data suggests that pandemic influenza virus continues to circulate at low levels, as overall disease activity remained low across much of the region. In Iran, no pandemic influenza viruses have been detected recently, however, low levels of seasonal influenza B viruses continue to be detected.

In Sub-Saharan Africa, limited data suggests that pandemic influenza virus transmission remains variable but most active in western Africa and in limited areas of eastern Africa. Localized areas of active pandemic influenza transmission persist in areas of Eastern Africa, particularly Rwanda and Tanzania. Pandemic influenza virus continues to be the predominant influenza virus circulating in West and East Africa, however, small numbers of seasonal influenza H3N2, H1N1, and seasonal influenza B viruses have also been identified.

In tropical zone of the Americas, limited data suggests that overall influenza activity remains low but variable with localized areas of active transmission in a number of countries. Guatemala, Nicaragua, El Salvador, Panama, Brazil, Peru, and Bolivia, all reported an increasing trend of respiratory diseases associated with circulation of pandemic influenza virus for at least one week during March 2010. Localized increases in pandemic influenza activity have been associated with school outbreaks in several countries; however, in some places disease activity may be partially accounted for by co-circulation of other respiratory viruses. The most active area of pandemic influenza virus circulation in the region appears to be in Brazil where disease activity in the northern region has been associated with pandemic influenza virus transmission. In Mexico, limited data suggests that localized active transmission of pandemic influenza virus continued to occur in several states throughout March 2010, although overall influenza activity did not increase to peak levels observed during fall influenza season.

In the northern and the southern temperate zones of the Americas, overall pandemic influenza transmission remained low as influenza virus continues to circulate at low levels. Although the national level of ILI activity remained below the seasonal baseline in the United States, three of ten subregions reported a resurgence of ILI activity above their respective baselines. The most active areas of pandemic influenza transmission currently appears to be in the southeastern United States, particularly in the states of Alabama, Georgia, and South Carolina, all of which reported regional spread of influenza activity. A corresponding increase in confirmed severe cases of pandemic H1N1 has also been noted in the southeastern United States in recent weeks. In Canada, overall ILI activity remained below the seasonal baseline. In temperate countries of the southern hemisphere, overall influenza activity remained low, with sporadic detections of pandemic and seasonal influenza viruses.

In Europe, low levels of pandemic influenza virus continue to circulate across the region, particularly across southern and eastern Europe. The proportion of sentinel respiratory samples testing positive for influenza remained low (4.6%). Three countries (Latvia, Lithuania and Bulgaria) reported an increasing trend of respiratory diseases activity, however, these trends have not been associated with increased detections of pandemic influenza virus. Increased circulation of seasonal influenza B virus has been observed in the Siberian and far eastern regions of the Russian Federation, and in Italy and Sweden, where it continues to be the predominant circulating virus (although at overall low levels).

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).

http://www.who.int/csr/don/2010_04_01/en/index.html

[Giuseppe]

Re: Pandemic (H1N1) 2009 - update 94

WHO - Pandemic (H1N1) 2009 - update 94

[Source: World Health Organization, (LINK). Edited.]

Pandemic (H1N1) 2009 - update 94 - Weekly update

1 April 2010


As of 28 March 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17483 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 virus transmission currently are in parts of the tropical zones of Asia, the Americas, and Africa. Pandemic influenza activity remains low in much of the temperate areas of both the northern and southern hemispheres. Although pandemic influenza virus continues to be the predominant influenza virus circulating worldwide, seasonal influenza type B viruses are predominant in much of East Asia, and have been increasingly detected at low levels across southeast and western Asia, East Africa, and in parts of eastern and northern Europe.

Seasonal influenza A (H3N2) is still being detected in very small numbers in parts of Asia and Australia.

In Southeast Asia, pandemic influenza virus transmission remains active but variable across the region. Thailand continues to report the most active circulation of pandemic virus in the region, however, disease activity may have recently peaked and begun to decline. Approximately half of all provinces in Thailand reported that >10% outpatient visits were due to influenza like illness (ILI). The proportion of outpatient sentinel respiratory samples testing positive for influenza dropped to 10% after peaking at approximately 30% during mid February 2010. In Malaysia, limited data suggest pandemic influenza virus transmission persists as new cases continue to be reported. In Indonesia, no recent pandemic influenza activity has been reported, however, low levels of seasonal influenza H3N2 and type B viruses continue to be detected. In Myanmar, limited data suggest that pandemic influenza has declined substantially since a period of active transmission during February 2010.

In South Asia, overall pandemic influenza activity remains low, except in Bangladesh, which reported regional spread of pandemic influenza virus in association with an increase in new cases since late February 2010. In India, low level circulation of pandemic influenza virus persists in the western part of the country.

In East Asia, overall pandemic influenza activity remained low as circulation of seasonal influenza B viruses continued to increase across the region. In China, ILI activity has greatly decreased; however, approximately 20-30% of respiratory samples have tested positive for influenza in recent weeks. Of these, over 85% were seasonal influenza B viruses. In Mongolia, recent intense influenza activity due to seasonal influenza B viruses continues to decrease. Overall rates of ILI have returned to near baseline in both Japan and the Republic of Korea as pandemic influenza virus circulation continues to wane. Seasonal influenza B viruses are circulating at low level across other parts of East and Southeast Asia and Oceania (Hong Kong SAR (China), Japan, Republic of Korea, China Taipei, Philippine, Thailand, Vietnam, Indonesia, Bangladesh and Australia). Also, small numbers of seasonal influenza H3N2 viruses have been detected in several countries of East and Southeast Asia as well as Oceania, particularly in Indonesia and in Australia.

In North Africa and Western Asia, limited data suggests that pandemic influenza virus continues to circulate at low levels, as overall disease activity remained low across much of the region. In Iran, no pandemic influenza viruses have been detected recently, however, low levels of seasonal influenza B viruses continue to be detected.

In Sub-Saharan Africa, limited data suggests that pandemic influenza virus transmission remains variable but most active in western Africa and in limited areas of eastern Africa. Localized areas of active pandemic influenza transmission persist in areas of Eastern Africa, particularly Rwanda and Tanzania. Pandemic influenza virus continues to be the predominant influenza virus circulating in West and East Africa, however, small numbers of seasonal influenza H3N2, H1N1, and seasonal influenza B viruses have also been identified.

In tropical zone of the Americas, limited data suggests that overall influenza activity remains low but variable with localized areas of active transmission in a number of countries. Guatemala, Nicaragua, El Salvador, Panama, Brazil, Peru, and Bolivia, all reported an increasing trend of respiratory diseases associated with circulation of pandemic influenza virus for at least one week during March 2010. Localized increases in pandemic influenza activity have been associated with school outbreaks in several countries; however, in some places disease activity may be partially accounted for by co-circulation of other respiratory viruses. The most active area of pandemic influenza virus circulation in the region appears to be in Brazil where disease activity in the northern region has been associated with pandemic influenza virus transmission. In Mexico, limited data suggests that localized active transmission of pandemic influenza virus continued to occur in several states throughout March 2010, although overall influenza activity did not increase to peak levels observed during fall influenza season.

In the northern and the southern temperate zones of the Americas, overall pandemic influenza transmission remained low as influenza virus continues to circulate at low levels. Although the national level of ILI activity remained below the seasonal baseline in the United States, three of ten subregions reported a resurgence of ILI activity above their respective baselines. The most active areas of pandemic influenza transmission currently appears to be in the southeastern United States, particularly in the states of Alabama, Georgia, and South Carolina, all of which reported regional spread of influenza activity. A corresponding increase in confirmed severe cases of pandemic H1N1 has also been noted in the southeastern United States in recent weeks. In Canada, overall ILI activity remained below the seasonal baseline.

In temperate countries of the southern hemisphere, overall influenza activity remained low, with sporadic detections of pandemic and seasonal influenza viruses.

In Europe, low levels of pandemic influenza virus continue to circulate across the region, particularly across southern and eastern Europe. The proportion of sentinel respiratory samples testing positive for influenza remained low (4.6%). Three countries (Latvia, Lithuania and Bulgaria) reported an increasing trend of respiratory diseases activity, however, these trends have not been associated with increased detections of pandemic influenza virus. Increased circulation of seasonal influenza B virus has been observed in the Siberian and far eastern regions of the Russian Federation, and in Italy and Sweden, where it continues to be the predominant circulating virus (although at overall low levels).

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)

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 10: 28 FEBRUARY - 13 MARCH 2010)

Map of influenza activity and virus subtypes [png 260kb]

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

Qualitative indicators (Week 29 to Week 11: 13 July 2009 - 20 March 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 28 March 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. 93): 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. 93): None.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 167
• WHO Regional Office for the Americas (AMRO)** - At least 8175**
• WHO Regional Office for the Eastern Mediterranean (EMRO) *** 1019
• WHO Regional Office for Europe (EURO) - At least 4669
• WHO Regional Office for South-East Asia (SEARO) - 1726
• WHO Regional Office for the Western Pacific (WPRO) - 1727
• Total* At least 17483**

*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.
**Approximately 455 of these deaths occurred during 2009 but were retrospectively reported by AMRO since the previous update
***No update since 7 March 2010

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[Giuseppe]

Pandemic (H1N1) 2009 - update 95 - Weekly update: Chile detects small numbers of severe cases ahead start of season

WHO - Pandemic (H1N1) 2009 - update 95

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_04_09/en/index.html">WHO | Pandemic (H1N1) 2009 - update 95</cite>. Edited.]

Pandemic (H1N1) 2009 - update 95 - Weekly update

9 April 2010


As of 4 April 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17700 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 current situation is largely unchanged since the last update. The most active areas of pandemic influenza virus transmission continue to be in parts of Southeast Asia, West Africa, and in the tropical zone of the Americas. In Chile, a country of the southern hemisphere temperate zone, there is evidence of early localized pandemic influenza virus transmission in advance of the usual start of the southern hemisphere winter influenza season. Seasonal influenza type B viruses continue to actively circulate in East Asia, but are also being detected at low levels across other parts of Asia and Europe.

In Southeast Asia, the most active transmission of pandemic influenza virus continues to be in Thailand, however, overall disease activity has declined substantially since peaking during late February 2009. During the most recent reporting week, 6.7% and 16% of sentinel respiratory samples from outpatients with ILI and patients hospitalized with pneumonia, respectively, were positive for pandemic influenza. Low levels of seasonal influenza H3N2 and type B viruses have also been detected in Thailand in recent weeks.

In Malaysia, limited data suggests that recent pandemic influenza activity may be declining with fewer detections of new cases.

In Indonesia, recent low level circulation of seasonal influenza H3N2 viruses appears to be subsiding.

In South Asia, limited data suggests the most active areas of pandemic influenza virus transmission continues to be in Bangladesh, where an increasing number of cases have detected since late February 2009.

Overall pandemic influenza activity remained low across the rest of the subcontinent with persistence of low level circulation of pandemic influenza virus in western India.

In East Asia, pandemic influenza virus continues to circulate at very low levels as overall rates of respiratory diseases remained low across much of the region. In China, overall rates of ILI remained at expected seasonal levels while most current influenza activity was due to circulating seasonal influenza type B viruses (accounting for >90% influenza virus detections).

In Mongolia, rates of ILI continued to decline after a recent peak of influenza activity associated with circulation of seasonal influenza type B viruses. Although overall rates of ILI and detections of influenza virus remain low in the Republic of Korea, Hong Kong SAR (China), and Chinese Taipei, an increasing proportion of virus isolates in recent weeks have been seasonal influenza type B viruses.

In Sub-Saharan Africa, limited data suggests that active circulation of pandemic influenza virus continues across parts of West and west-central Africa, and to a lesser extent in limited areas of East Africa. During early to mid-March 2009, 23% of respiratory sample tested positive for influenza in both Cote d'Ivoire and Ghana (the majority of virus isolates were pandemic H1N1). In Senegal, pandemic influenza transmission remains active but may be declining as the rate of sentinel specimens testing positive for pandemic influenza fell from a peak of 67% during early February 2009 to 17% during the most recent reporting week. In Cameroon, 38% (13/34) of respiratory samples tested positive for influenza during the past two weeks, of which 71% were pandemic and 29% were seasonal influenza type B viruses. Localized areas of active pandemic influenza transmission persist in areas of Eastern Africa, particularly Rwanda and Tanzania. Pandemic influenza virus continues to be the predominant influenza virus circulating in West and East Africa, however, small numbers of seasonal influenza H3N2 viruses have also been identified.

In Europe, low levels of pandemic influenza virus continue circulate across limited areas of Europe. The overall proportion of sentinel respiratory samples testing positive for influenza remained low (6.2%); the total number of sentinel influenza type B virus detections exceeded that of pandemic influenza virus during the most recent reporting week. In Italy, 31% (9/29) of sentinel respiratory samples tested positive for influenza, all of which were seasonal influenza type B viruses. Most countries in the region reported a low intensity of respiratory diseases, and only Georgia reported geographically widespread influenza activity.

In tropical zone of the Americas, limited data suggests that overall influenza activity remains low but variable with localized areas of active transmission in several countries, including in Cuba, Guatemala, Peru, and Bolivia, all of which reported an increasing trend of respiratory diseases in association with localized to regional spread of influenza activity in at least one of the two recent reporting weeks. In Mexico, limited data suggests that localized active transmission of pandemic influenza virus continued to occur in several states throughout March 2010, particularly in parts of the Federal District which have reported recent increases in the number of severe and fatal pandemic H1N1 virus infections.

In Brazil, increased levels of sentinel ILI have been reported across much of Brazil over the past month, however, most recent reports of severe and fatal illness due to pandemic influenza virus infection have been from the northern region.

In the northern temperate zones of the Americas, overall pandemic influenza transmission remained low as influenza virus continues to circulate at very low levels. In the United States, overall levels of ILI remained below the national baseline and were only slightly elevated above the regional baseline in the southwestern region (although this regional increase was not associated with increased sentinel detections of pandemic or other influenza viruses). The most active areas of pandemic influenza transmission in the United States currently appears to be in three southeastern states, all of which reported regional spread of influenza activity.

In temperate countries of the southern hemisphere, overall influenza activity remained low, with mostly sporadic detections of pandemic and seasonal influenza viruses. Of note, Chile has reported new detections of pandemic virus, including small numbers of severe cases, in at least three regions over the past two weeks; the significance of this early limited circulation of pandemic virus in advance of the usual winter influenza season is not yet known.

Sporadic detections of seasonal influenza H3N2 viruses continued to be reported across Asia, Africa, Australia, and the Americas, however, the most active (but overall low) circulation of seasonal H3N2 viruses has been reported in Indonesia.

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

Weekly update (Virological surveillance data)

Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses [pdf 14kb]

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 10: 28 FEBRUARY - 13 MARCH 2010)

Map of influenza activity and virus subtypes [png 260kb]

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

Qualitative indicators (Week 29 to Week 12: 13 July 2009 - 27 March 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 4 April 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. 94): 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. 94): None.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 167
• WHO Regional Office for the Americas (AMRO) - At least 8217
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4763
• WHO Regional Office for South-East Asia (SEARO) - 1733
• WHO Regional Office for the Western Pacific (WPRO) - 1801
• Total* - At least 17700

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

WHO - Pandemic (H1N1) 2009 - update 96

WHO - Pandemic (H1N1) 2009 - update 96

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_04_16/en/index.html">WHO | Pandemic (H1N1) 2009 - update 96</cite>. Edited.]

Pandemic (H1N1) 2009 - update 96 - Weekly update

16 April 2010


As of 11 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17798 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 virus transmission currently are in parts of the tropical zones of the Americas, West Africa, Eastern Africa and South East Asia. Although pandemic influenza continues to be the predominant circulating influenza virus worldwide, seasonal influenza type B virus circulation continues to be predominant in East Asia, and is being detected across other parts of Asia, and Europe at low levels. Sporadic detections of seasonal influenza H3N2 viruses have been reported across Asia, Eastern Europe and Eastern Africa most notably in recent weeks in Indonesia and Tanzania. Few seasonal H1N1 viruses were reported in the Russian Federation and Northern China in the last week.

In East Asia, pandemic influenza activity continued to decline and is now at very low levels. The predominant virus associated with influenza-like-illness in the area is now influenza type B viruses, which continue to circulate in China, Mongolia, and Republic of Korea.

The Republic of Korea reports an increasing trend of respiratory disease activity associated with detections of influenza type B viruses and small numbers of pandemic H1N1.

In China, outbreaks of acute respiratory infections associated with B virus detections are reported but none due to pandemic H1N1. The overall level of respiratory disease activity is similar to the level observed during the same period of 2007-2008 and 2008-2009 seasons. Small numbers of seasonal H3N2 and sporadic seasonal H1N1 viruses were detected in Northern China.

In Mongolia, rates of influenza-like illness (ILI) continue to decline and are associated with influenza type B only.

In South and Southeast Asia, the most active areas of influenza transmission are Thailand and Singapore, where pandemic H1N1 is the dominant influenza virus, with co-circulation at lower levels of influenza type B and H3N2. Overall, the intensity of transmission is relatively low.

In Thailand, respiratory disease activity has decreased since the previous week. Four percent of sentinel respiratory samples from ILI patients and 2.6% of sentinel respiratory samples from hospitalized patients with pneumonia were found to be positive for pandemic H1N1.

Malaysia continues to report occasional outbreaks of respiratory disease in three states, Johor, Pahang, and Melaka. Only Melaka state has reported pandemic H1N1 laboratory confirmed cases, with 4 cases treated in the Intensive Care Unit (ICU).

In India overall pandemic H1N1 activity is very low in most states, although in western India pandemic H1N1 cases continue to be reported in low numbers.

In Europe, pandemic influenza activity has continued to decrease in recent weeks and is at very low intensity in all countries. The overall proportion of sentinel respiratory samples testing positive for influenza remained low (5.4%), and the number of influenza type B virus detections exceeded that of influenza A. In Italy, 50% (7/14) of sentinel respiratory samples tested positive for influenza, all of which were seasonal influenza type B viruses.

In the northern temperate zones of the Americas, overall pandemic influenza transmission remained low as pandemic influenza H1N1 virus continues to circulate at very low levels in some areas. In temperate countries of the southern hemisphere, overall respiratory disease activity remained low.

In tropical zone of the Americas, limited data suggests that overall influenza activity remains low with localized areas of active transmission in a number of countries.

In Cuba, a slight increase of confirmed cases of pandemic virus was reported during the most recent reporting week.

In Mexico, available data suggests that localized active transmission of pandemic influenza virus continues to occur around Mexico City but is very low nationally.

In Peru, the number of pneumonia cases has increased over the last 2 weeks, especially in children less than 5 years of age, however there is no virological information available to indicate the cause of these cases. The lack of an associated increase in other age groups may indicate a cause other than influenza. Increased levels of ILI have also been reported across much of Brazil over the previous two weeks particularly in northern Brazil.

In North Africa limited available data suggests that respiratory disease activity remained low. In sub-Saharan Africa, West Africa continues to see community transmission of pandemic influenza virus with Ghana currently being the primary focus of transmission (45% of all clinical specimens tested were positive for pandemic influenza) but smaller numbers of cases were also seen in Senegal and Niger.

Pandemic influenza virus transmission appears to have peaked in Senegal approximately one month ago.

Guinea has now reported their first cases of pandemic H1N1.

In East Africa, cases of pandemic influenza H1N1 continue to be detected in Rwanda, though in declining numbers. Small numbers of seasonal influenza H3N2 and influenza type B viruses were detected during the last week in Rwanda, Kenya and South Africa. Notably, Tanzania has also recently reported significant transmission of seasonal influenza H3N2. No increases in respiratory disease activity or pandemic influenza have yet been noted in South Africa.

In the South pacific, Vanuatu and Nauru reported an increasing trend of respiratory diseases activity for this week, but this trend was not associated with laboratory confirmed detections of pandemic H1N1 virus.

In other temperate countries out of the southern hemisphere, Australia and New Zealand, influenza activity continues to be low, with mostly detections of pandemic H1N1 and sporadic seasonal influenza viruses.

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

Weekly update (Virological surveillance data)

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

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 13: 28 MARCH - 3 APRIL 2010)

Map of influenza activity and virus subtypes [png 263kb]

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

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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 11 April 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. 95): Guinea.

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. 95): Sao Tome and Principe.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 168
• WHO Regional Office for the Americas (AMRO) - At least 8274
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4776
• WHO Regional Office for South-East Asia (SEARO) - 1757
• WHO Regional Office for the Western Pacific (WPRO) - 1804
  
• Total* - At least 17798

(*) The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
(**) No update since 7 March 2010
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[Giuseppe]

Pandemic (H1N1) 2009 - update 97 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 97

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_04_23a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 97</cite>. Edited.]

Pandemic (H1N1) 2009 - update 97 - Weekly update

23 April 2010


As of 18 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17853 deaths.

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


Situation update:

Summary:
Currently the most active areas of transmission of pandemic influenza are in parts of West and Central Africa but transmission is also still occurring in South East Asia, and Central America. Pandemic influenza activity remains low in much of the temperate zone of both the northern and southern hemispheres. Seasonal influenza type B viruses have been increasingly detected over a larger area and are now the predominant circulating influenza viruses across East Asia, Central Africa and Northern and Eastern Europe. Very small numbers of type B viruses have also recently been detected in Central America. Seasonal influenza H3N2 is still being detected in South and Southeast Asia (mainly Indonesia), as well as sporadically in several countries of West Africa, and Eastern Europe.

In Europe, most countries reported a low intensity of respiratory diseases with only 6.8% of respiratory specimens testing positive for influenza. This week the total number of influenza B virus detections continued to exceed that of influenza A, as in recent weeks, although at low levels. Of note, some sporadic detections of seasonal H1N1 and H3N2 viruses were reported in Eastern Europe.

In East Asia, very few pandemic influenza viruses are being detected. In China, Mongolia, and Republic of Korea most influenza like illness (ILI) cases are now due primarily to influenza type B viruses.

In China, overall influenza activity continues to decline and no pandemic influenza virus was detected this week.

In Mongolia, influenza type B virus continues to circulate but is declining since a recent peak. An increased trend of respiratory disease activity associated with increasing circulation of influenza type B viruses has been reported in the Republic of Korea during the past few weeks. Small numbers of seasonal influenza H1N1 and H3N2 viruses continue to be sporadically reported in some countries of the region.

In South and Southeast Asia, the most active areas of transmissions of pandemic influenza are in Malaysia, Singapore, and Thailand. Although pandemic influenza virus is the predominant circulating influenza virus in the region, influenza H3N2 and influenza type B continue to co-circulate in Singapore and Thailand and Indonesia. In Singapore, rates of influenza-like illness (ILI) and acute respiratory infections (ARI) increased compared to previous week but are still below the epidemic threshold.

In Indonesia, in contrast to other countries of the area, the predominant virus circulating continues to be influenza H3N2, with few detections of influenza type B and pandemic influenza viruses. In Malaysia, an increase in the number of respiratory disease consultations due to influenza-like-illness (ILI) was reported in the majority of the states compared to previous week. In Bangladesh, a small but slightly increased (compared to the previous week) numbers of pandemic influenza cases continues to be detected.

Limited available data from North Africa suggests that respiratory disease activity there remains low. In sub-Saharan Africa, available data suggests ongoing community transmission of pandemic influenza virus in West Africa.

Transmission appears to have peaked in Senegal in February but Ghana continues to have active, though decreasing, transmission. Cote d`Ivoire and Niger reported increasing trends of respiratory disease activity but no virological data were available. In central Africa, low levels of pandemic influenza activity continue to be reported in Cameroon. In addition, small numbers of seasonal influenza H3N2 virus detections were reported by Angola. In eastern Africa, pandemic influenza virus continues to be detected in declining numbers in Rwanda with persistent reporting of small numbers of seasonal influenza H3N2 in Rwanda and Kenya. No increase in respiratory disease activity or detections of pandemic influenza viruses have yet been noted in Southern Africa. Influenza type B has been increasingly detected in some countries of central Africa.

In the tropical zone of the Americas, Ecuador, El Salvador and Guatemala, reported increases in respiratory diseases activity. In Guatemala, the number of respiratory disease consultations increased 80% compared to the previous week. Of note, co-circulation of other respiratory viruses, including respiratory syncytial virus (RSV), parainfluenza, and adenovirus has been detected in addition to small numbers of pandemic influenza virus.

In Mexico, during early April 2010, the sentinel surveillance system reported a 38.6% decrease in the number of influenza-like-illness (ILI) and severe acute respiratory illness (SARI) cases compared to the previous week.

In the temperate zone of the southern hemisphere, Chile reported regional increases in ILI activity for the past four weeks. While the national ILI levels remain below the epidemic threshold, in Los Lagos, Tarapac?, and in some southern regions, the ILI level is above epidemic threshold. For the most recent reporting week, 6.8% of sentinel surveillance samples tested positive for respiratory viruses. Of these, 52.9% for respiratory syncytial virus (RSV), 23.5% for adenovirus, and 11.8% were positive for pandemic influenza virus.

In Australia and New Zealand, there is no evidence yet of the start of winter-time community transmission of influenza viruses. Australia has had sporadic detections of pandemic H1N1 viruses and seasonal influenza type B viruses in low numbers.

Weekly update (Virological surveillance data)

The cumulative total for reports of antiviral resistant isolates of pandemic (H1N1) 2009 virus remains at 285. There have been no new cases reported since the situation update on 16 April 2010.

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 14: 4 APRIL - 10 APRIL 2010)

Map of influenza activity and virus subtypes [png 263kb]

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

Qualitative indicators (Week 29 to Week 14: 13 July 2009 - 10 April 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 18 April 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. 96):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. 96): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 168
• WHO Regional Office for the Americas (AMRO) - At least 8309
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4783
• WHO Regional Office for South-East Asia (SEARO) - 1769
• WHO Regional Office for the Western Pacific (WPRO) - 1805
  
• Total* - At least 17853

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

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[Giuseppe]

Pandemic (H1N1) 2009 - update 98 - Weekly update

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_04_30a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 98</cite>.]

Pandemic (H1N1) 2009 - update 98 - Weekly update

30 April 2010


As of 25th of April, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17919 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 current situation is largely unchanged since the last update. The most active areas of transmission of pandemic influenza H1N1 virus continue to be parts of West and Central Africa with some focal areas of activity in South and Southeast Asia. Pandemic influenza activity H1N1 remains low in much of the temperate areas of both the northern and southern hemispheres. Seasonal influenza type B virus is the predominant influenza virus, though also at low levels of circulation, across East Asia, Northern and Eastern Europe. Influenza type B viruses have also been detected in Central Africa and this week in West Africa. Seasonal influenza H3N2 viruses have continued to be detected in South and Southeast Asia, as well as sporadically in some countries of West and Central Africa, and Eastern Europe.

In Sub-Saharan Africa, data from a limited number of countries suggests that active transmission of pandemic influenza H1N1 virus is declining across West and West-central Africa. Ghana is reporting moderate amounts of pandemic virus (16 % of all clinical specimens tested were positive for pandemic influenza) but smaller numbers of cases continue to be detected in Senegal, Niger and Cameroon.

In East Africa, influenza activity has returned to low levels. Only Rwanda has detected small numbers of pandemic virus in the past week. In addition, a few seasonal influenza H3N2 viruses are seen in Ghana. Influenza type B has been increasingly detected in the area, notably in Ghana and Cameroon.

In East Asia, pandemic influenza H1N1 virus circulation is now sporadic. In China, Mongolia, and Republic of Korea most influenza like illness cases continued to be primarily due to seasonal influenza type B viruses. In China and Mongolia influenza detections have continued to decline compared to previous recent weeks. The Republic of Korea reported increasing levels of respiratory disease activity associated with increasing detections of seasonal influenza type B in respiratory specimens over five consecutive weeks. Of note, small numbers of pandemic influenza H1N1, seasonal H3N2 and H1N1 viruses continued to be sporadically detected in some countries of the region.

In Southeast Asia, overall levels of influenza activity were low. Although the predominant influenza virus circulating was still pandemic influenza H1N1, there was co-circulation of seasonal influenza type B and, to a lesser extent, H3N2 viruses in several countries including Singapore, Cambodia, Indonesia and Thailand.

Malaysia has reported increasing levels of respiratory diseases activity associated with pandemic influenza H1N1 laboratory confirmed cases. Media sources have also reported school closures in the country.

In Singapore, influenza-like-illness levels are still below the seasonal epidemic threshold but have increased compared to previous week.

In South Asia, Bangladesh reported an increase in respiratory diseases activity associated with increasing numbers of pandemic influenza H1N1 laboratory confirmed cases since beginning of April.

India reported pandemic influenza activity in the states of Maharashtra and recently Karnataka. Levels of respiratory diseases activity in both of these countries appear much less intense than in the initial wave of transmission which occurred late 2009. Although pandemic influenza is the predominant virus circulating in the region, seasonal influenza type B viruses continued to be detected in Iran and Bangladesh.

In the tropical zone of the Americas, limited data suggested that pandemic influenza H1N1 activity remains low but with a few localized areas of transmission. Jamaica, Panama and Guatemala, reported increasing trends in respiratory disease activity. In Cuba, all provinces reported an increase in numbers of acute respiratory diseases cases in the last two weeks, mainly from the city of Havana. In Peru, the number of pneumonia cases in children under 5 years of age in Lima has been increasing since six consecutive weeks and remained above the epidemic threshold. However, the extent to which these pneumonia cases have been due to pandemic influenza H1N1 virus is not known. Notably, respiratory syncitial virus (RSV) has been reported to be circulating in the area.In the temperate zone of the Northern Hemisphere, overall pandemic influenza H1N1 activity remained low.

In United States, the proportion of outpatient visits for influenza-like illness was below the national baseline. No influenza B is reported by countries of North America.

In Europe, pandemic influenza activity is at very low intensity in all countries. The overall proportion of sentinel respiratory samples testing positive for influenza remained stable at about 4.5%. For the current week, the total number of sentinel influenza B detections continued to exceed that of influenza A, mainly due to viral detections from Eastern Europe: Central, Siberian, Far Eastern regions of the Russian Federation and Kazakhstan.

In the temperate countries of the Southern Hemisphere, influenza-like illness activity remained low and at the levels experienced at the same time in previous years. Australia has continued to report sporadic detections of pandemic influenza H1N1, seasonal influenza B and H3N2 viruses in low numbers in recent weeks.

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)

The cumulative total for reports of antiviral resistant isolates of pandemic (H1N1) 2009 virus remains at 285. There have been no new cases reported since the situation update on 16 April 2010.

28 April 2010 -- For this reporting week (15-28 April 2010), no additional cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. The cumulative total remains at 285 so far. All but one of these have the H275Y substitution and are assumed to remain sensitive to zanamivir.

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 15: 11 APRIL - 17 APRIL 2010)

Map of influenza activity and virus subtypes [png 230kb]

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

Qualitative indicators (Week 29 to Week 15: 13 July 2009 - 17 April 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 25th of April 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. 97): 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. 97): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 168
• WHO Regional Office for the Americas (AMRO) - At least 8316
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4835
• WHO Regional Office for South-East Asia (SEARO) - 1773
• WHO Regional Office for the Western Pacific (WPRO) - 1808
• Total* - At least 17919

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

[Giuseppe]

Pandemic (H1N1) 2009 - update 99 - Weekly update

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_05_07/en/index.html">WHO | Pandemic (H1N1) 2009 - update 99</cite>. Edited.]

Pandemic (H1N1) 2009 - update 99 - Weekly update

7 May 2010


As of 2nd April, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18001 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 virus transmission currently are in parts of West Africa, the Caribbean, and Southeast Asia.

In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected sporadically across Asia, Africa, Europe, and the Americas, however, low levels of late season virus circulation have primarily detected in East and Central Asia, southern Europe, and central Africa.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus persists in parts of West Africa while low levels of seasonal influenza type B viruses continue to circulate in parts of central Africa.

In Ghana, pandemic influenza virus detections may be declining after peaking during early April 2010; during the most recent reporting week, 14% of respiratory specimens tested positive for pandemic influenza virus.

In Cameroon, low levels of pandemic and seasonal influenza type B virus continue to co-circulate, though the latter have been predominant during April 2010.

In the Democratic Republic of Congo, circulation of seasonal influenza H3N2 viruses during February and mid-March 2010 has been largely replaced by circulation of seasonal influenza type B viruses during April 2010.

Localized, low level pandemic influenza virus circulation continues to be observed in parts of East Africa, particularly in Rwanda and Tanzania. Sporadic detections of seasonal influenza H3N2 viruses continue to be reported across eastern, central, and western Africa.

In tropical zone of the Americas, limited data suggest that pandemic influenza virus transmission remains active in several countries.

In Central America, Guatemala reported three consecutive weeks of an increasing trend of respiratory diseases activity associated with regional spread of pandemic influenza virus and detection of severe cases.

In Cuba, detections of pandemic virus and numbers of severe cases have increased since late March, however overall pandemic influenza activity may have recently peaked during the most recent reporting week.

In Peru, the number of pneumonia cases in children under 5 years of age in the capital area has been increasing for the past seven weeks and remains above the epidemic threshold; however, the extent to which these pneumonia cases have been due to pandemic influenza H1N1 virus versus other respiratory viruses circulating in the region, is not known. Although the overall intensity of respiratory diseases across the region remained low to moderate during April 2010, for short periods of time, circulation of pandemic influenza virus was reported to widespread (in Cuba and Barbados) or regional (in Mexico, Honduras, Nicaragua, Columbia, Venezuela, Brazil, Ecuador and Bolivia).

In Southeast Asia, pandemic influenza virus continues to actively circulate in several countries of the region, however, respiratory disease trends in the region are variable.

In Malaysia, limited data suggest that pandemic influenza virus transmission persists with ongoing reports of new cases (including severe cases) and media reports of several school outbreaks, particularly during late April and early May 2010.

In Singapore, the national level of ARI has been steadily increasing since early April 2010 and now exceeds the epidemic threshold; 37% of sentinel respiratory specimens tested positive for influenza during the most recent reporting week.

In Thailand, the proportion of sentinel outpatients with ILI and sentinel inpatients with pneumonia testing positive for pandemic influenza virus infection has declined significantly since peaking during late March 2010.

In South Asia, the most active area of pandemic influenza virus transmission continues to be in Bangladesh, which continues to report increasing respiratory diseases activity associated with co-circulation of pandemic and seasonal influenza type B viruses since mid April 2010. However, persistent low level co-circulation of both viruses has been detected since late February 2010.

In India, localized low level circulation of pandemic influenza virus continues to be detected in parts of western and southern India.

In East Asia, very low levels of pandemic influenza virus continue to be detected. Although overall rates of respiratory illness remain low across the region, recent low levels of influenza activity in a number of countries in the region have been largely due to circulating seasonal influenza type B viruses. Three countries in region, Mongolia, China, and South Korea, each experienced a period of sustained seasonal influenza type B virus circulation following an earlier, generally more intense, wintertime period of pandemic influenza virus transmission.

China and South Korea continue observe active but declining levels of seasonal influenza type B virus circulation.

In the temperate zone of the southern hemisphere, overall pandemic and seasonal influenza activity remains sporadic, except in Chile, where there is evidence of low level community circulation of pandemic influenza virus, including detection of small numbers of severe cases; however it too early to know if this signals an early start to wintertime influenza season. The national level of ILI in Chile remained near baseline; however, in at least two southern regions the region specific level of ILI was elevated above baseline, and in one region, Los Lagos, the region specific baseline has been elevated slightly above the epidemic threshold for the past four weeks. Of note, 6% of sentinel respiratory samples in Chile tested positive for a respiratory virus, of these 32% were positive for respiratory syncytial virus (RSV), and 27% were positive for influenza viruses (half of which were subtyped as pandemic H1N1 virus).

In Europe, overall influenza activity remained low with very low level co-circulation of pandemic and seasonal influenza type B viruses. The overall proportion of sentinel respiratory samples testing positive for influenza remained stable at about 5.3%; and the total number of sentinel influenza B virus detections continued to exceed that of influenza A viruses, primarily due to low level seasonal influenza type B virus circulation in the Russian Federation and Kazakhstan.

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)

The cumulative total for reports of antiviral resistant isolates of pandemic (H1N1) 2009 virus remains at 285. There have been no new cases reported since the situation update on 16 April 2010.

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 16: 18 APRIL - 24 APRIL 2010)

Map of influenza activity and virus subtypes [png 231kb]

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

Qualitative indicators (Week 29 to Week 16: 13 July 2009 - 24 April 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 2nd May 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. 98): 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. 98): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 168
• WHO Regional Office for the Americas (AMRO) - At least 8357
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4860
• WHO Regional Office for South-East Asia (SEARO) - 1787
• WHO Regional Office for the Western Pacific (WPRO) - 1810
• Total* - At least 18001

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

[tetano]

Pandemic (H1N1) 2009 - update 100

Weekly update

14 May 2010 -- As of 9 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18036 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 virus transmission currently are in parts of the Caribbean and Central America, and to a lesser extent in West Africa and South and Southeast Asia. In the temperate zone* of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected at low levels across parts of Asia, Africa, and Europe.

In the tropical region of the Americas, pandemic influenza virus transmission remains most active in parts of the Caribbean, and to a lesser extent in Central America. In Cuba, pandemic influenza activity continued to decline after a recent period of intense transmission which began during late February 2010 and may have peaked during late April 2010. Geographically widespread pandemic influenza activity was reported in Jamaica (during much of February through May 2010) and in the Dominican Republic (since late April); however, other respiratory viruses are known to be co-circulating in the region and overall respiratory disease activity during this period was reported to remain low to moderate. The overall SARI** rate from sentinel sites in selected Caribbean countries (Dominica and Jamaica) increased since mid April 2010, however, the extent to which this was due circulating pandemic influenza virus versus other respiratory viruses is not known. In Central America and the tropical regions of South America: Nicaragua, Honduras, Guatemala, Columbia, Bolivia, and Peru all reported regional spread of influenza during one or more weeks since late April 2010 suggesting that low levels of circulating pandemic influenza virus persist in the region. In addition, there is evidence from several countries in this region that there is ongoing co-circulation of influenza with other respiratory viruses (including respiratory syncytial virus (RSV), and adenovirus).

In Asia, the most active areas of pandemic influenza virus transmission currently are in parts of South and Southeast Asia, particularly in Bangladesh, Malaysia, and Singapore. In Bangladesh, a consistently increasing trend of respiratory disease associated with co-circulation of pandemic influenza and seasonal influenza type B viruses have been reported since mid April 2010; however, the overall intensity of respiratory diseases activity remains low to moderate. In Malaysia, limited data suggest that recent pandemic influenza activity began during early April 2010 and has been stably elevated since mid April 2010. In Singapore, the overall level of ARI remained stably elevated above baseline since early April 2010; 38% of respiratory specimens tested positive for pandemic influenza virus infection during the most recent reporting week. In Thailand, a recent period of sustained transmission of pandemic virus, extending from January until early April 2010, appears to have largely subsided. In India, low levels of pandemic influenza virus continued to be detected in several western and southern states, however, the overall level of respiratory diseases in the population remains low. In Indonesia, a period of low level circulation of seasonal H3N2 viruses which began during early February 2010 now appears to be subsiding. In East Asia, pandemic influenza virus is being detected only sporadically, however, persistent but declining levels of circulating seasonal influenza type B viruses continued to be reported, particularly in China, Hong Kong SAR (China), and in Chinese Taipei.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus continues to decline in parts of West Africa, while low levels of seasonal influenza type B viruses continue to circulate in parts of Central Africa and to a lesser extent in East Africa. In Ghana, pandemic influenza virus detections continued decline after peaking during early April 2010; during the most recent reporting week, 10%of respiratory specimens tested positive for pandemic influenza virus. There was no report of influenza activity in Senegal where a peak of pandemic influenza activity was observed in late February 2010. In central Africa, Cameroon continued to report co-circulation of pandemic and seasonal influenza type B viruses; the latter continued to be predominant during the most recent reporting week with approximately 31% of all respiratory samples testing positive for seasonal influenza type B and 4% testing positive for pandemic influenza virus. Sporadic detections of seasonal influenza H3N2 and influenza B viruses have been reported across eastern and western Africa over the past month.

In the northern and southern temperate regions of the Americas, only sporadic detections of influenza viruses have been reported, except in Chile, which continued to report localized areas of increased ILI activity associated with co-circulation of pandemic influenza and other respiratory viruses.

In Europe, pandemic influenza virus continues to be detected sporadically as the overall intensity of respiratory diseases remained low across the continent. Low level circulation of seasonal influenza type B virus persists in parts of southern and eastern Europe, notable in the Russian Federation and in Italy. 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).

http://www.who.int/csr/don/2010_05_14/en/index.html

[Giuseppe]

Re: Pandemic (H1N1) 2009 - update 100

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_05_14/en/index.html">WHO | Pandemic (H1N1) 2009 - update 100</cite>. Edited.]

Pandemic (H1N1) 2009 - update 100 - Weekly update

14 May 2010


As of 9 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18036 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 virus transmission currently are in parts of the Caribbean and Central America, and to a lesser extent in West Africa and South and Southeast Asia.

In the temperate zone* of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected at low levels across parts of Asia, Africa, and Europe.

In the tropical region of the Americas, pandemic influenza virus transmission remains most active in parts of the Caribbean, and to a lesser extent in Central America.

In Cuba, pandemic influenza activity continued to decline after a recent period of intense transmission which began during late February 2010 and may have peaked during late April 2010.

Geographically widespread pandemic influenza activity was reported in Jamaica (during much of February through May 2010) and in the Dominican Republic (since late April); however, other respiratory viruses are known to be co-circulating in the region and overall respiratory disease activity during this period was reported to remain low to moderate. The overall SARI** rate from sentinel sites in selected Caribbean countries (Dominica and Jamaica) increased since mid April 2010, however, the extent to which this was due circulating pandemic influenza virus versus other respiratory viruses is not known.

In Central America and the tropical regions of South America: Nicaragua, Honduras, Guatemala, Columbia, Bolivia, and Peru all reported regional spread of influenza during one or more weeks since late April 2010 suggesting that low levels of circulating pandemic influenza virus persist in the region. In addition, there is evidence from several countries in this region that there is ongoing co-circulation of influenza with other respiratory viruses (including respiratory syncytial virus (RSV), and adenovirus).

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

In Bangladesh, a consistently increasing trend of respiratory disease associated with co-circulation of pandemic influenza and seasonal influenza type B viruses have been reported since mid April 2010; however, the overall intensity of respiratory diseases activity remains low to moderate.

In Malaysia, limited data suggest that recent pandemic influenza activity began during early April 2010 and has been stably elevated since mid April 2010.

In Singapore, the overall level of ARI remained stably elevated above baseline since early April 2010; 38% of respiratory specimens tested positive for pandemic influenza virus infection during the most recent reporting week.

In Thailand, a recent period of sustained transmission of pandemic virus, extending from January until early April 2010, appears to have largely subsided.

In India, low levels of pandemic influenza virus continued to be detected in several western and southern states, however, the overall level of respiratory diseases in the population remains low.

In Indonesia, a period of low level circulation of seasonal H3N2 viruses which began during early February 2010 now appears to be subsiding.

In East Asia, pandemic influenza virus is being detected only sporadically, however, persistent but declining levels of circulating seasonal influenza type B viruses continued to be reported, particularly in China, Hong Kong SAR (China), and in Chinese Taipei.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus continues to decline in parts of West Africa, while low levels of seasonal influenza type B viruses continue to circulate in parts of Central Africa and to a lesser extent in East Africa.

In Ghana, pandemic influenza virus detections continued decline after peaking during early April 2010; during the most recent reporting week, 10%of respiratory specimens tested positive for pandemic influenza virus. There was no report of influenza activity in Senegal where a peak of pandemic influenza activity was observed in late February 2010.

In central Africa, Cameroon continued to report co-circulation of pandemic and seasonal influenza type B viruses; the latter continued to be predominant during the most recent reporting week with approximately 31% of all respiratory samples testing positive for seasonal influenza type B and 4% testing positive for pandemic influenza virus. Sporadic detections of seasonal influenza H3N2 and influenza B viruses have been reported across eastern and western Africa over the past month.

In the northern and southern temperate regions of the Americas, only sporadic detections of influenza viruses have been reported, except in Chile, which continued to report localized areas of increased ILI activity associated with co-circulation of pandemic influenza and other respiratory viruses.

In Europe, pandemic influenza virus continues to be detected sporadically as the overall intensity of respiratory diseases remained low across the continent. Low level circulation of seasonal influenza type B virus persists in parts of southern and eastern Europe, notable in the Russian Federation and in Italy.

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)

As of May 12 May 2010, 4 additional cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. It brings the cumulative total to 289 so far. All but one of these have the H275Y substitution and are assumed to remain sensitive to zanamivir.

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

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 17: 25 APRIL - 1 MAY 2010)

Map of influenza activity and virus subtypes [png 228kb]

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

Qualitative indicators (Week 29 to Week 17: 13 July 2009 - 1 May 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 9 May 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. 99): 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. 99): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 168
• WHO Regional Office for the Americas (AMRO) - At least 8361
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4861
• WHO Regional Office for South-East Asia (SEARO) - 1798
• WHO Regional Office for the Western Pacific (WPRO) - 1829
• Total* - At least 18036

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

-
------

[Giuseppe]

WHO - Pandemic (H1N1) 2009 - update 101

WHO - Pandemic (H1N1) 2009 - update 101

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_05_21/en/index.html">WHO | Pandemic (H1N1) 2009 - update 101</cite>. Edited.]

Pandemic (H1N1) 2009 - update 101 - Weekly update

21 May 2010


As of 16 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18097 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 current situation is largely unchanged since the last update.

The most active areas of pandemic influenza virus transmission currently are in parts of the Caribbean and Southeast Asia.

In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains low to sporadic.

In central Africa, there has been increased transmission of seasonal influenza type B viruses, accounting for 85% of all influenza isolates in the region. Influenza B also continues to be detected at low levels across parts of Asia and Europe, and has now been reported in Central America.

In the tropical region of the Americas, the most active areas of pandemic influenza virus transmission continue to be in parts of the Caribbean.

In Cuba, a second period of active community transmission of pandemic influenza virus began during late February 2010, peaked during late April 2010, and has been declining since; this second period of transmission, although associated with severe and fatal cases, appears to be less intense overall than the first period of transmission which occurred during late September to late November 2009.

In contrast, in the Dominican Republic, low to moderate intensity of respiratory diseases activity has been primarily associated with co-circulation of respiratory viruses other than influenza; only sporadic detections of seasonal influenza viruses have been reported.

Low levels of pandemic influenza viruses have been circulating across parts of Central America and tropical areas of South America, for example, in Mexico since December 2009, in Colombia and Brazil since early 2010, and in Guatemala since early April 2010.

Nicaragua and Honduras have also been recently reporting geographically regional spread of influenza viruses, however, the relative proportions of seasonal influenza, pandemic influenza, and other respiratory virus detections are not known.

In contrast, in Panama, low levels of respiratory disease over the past three months have been primarily associated with circulating respiratory viruses other than influenza.

Of note, Bolivia experienced a recent period of low but sustained transmission of seasonal influenza type B viruses between late February and early May 2010.

There continues to be evidence from several countries in this region that there is ongoing co-circulation of influenza with other respiratory viruses (including respiratory syncytial virus (RSV), and adenovirus).

In Asia, the most active areas of pandemic influenza virus transmission are in parts of South and Southeast Asia, particularly in Bangladesh, Malaysia, and Singapore.

In Malaysia, limited data suggests that a second period of active pandemic influenza virus transmission has been occurring since early April 2010, but overall activity may have recently stabilized and does not appear to exceed pandemic influenza activity seen during an earlier period of transmission lasting from July until early September 2009.

In Singapore, levels of ARI have remained elevated since mid April 2010; during the most recent reporting week, levels of ARI exceeded the epidemic threshold and the proportion of patients with ILI testing positive for pandemic influenza virus infection was 39%.

In Bangladesh increased co-circulation of pandemic influenza and seasonal influenza type B viruses has been detected since mid April 2010 but now appears to have stabilized.

Low level circulation of pandemic influenza continues to persist in Thailand and in the western and southern parts of India; sporadic detection of pandemic influenza continue to be reported in Cambodia and in the Philippines.

In East Asia, only sporadic detections of pandemic influenza virus are being reported; seasonal influenza type B viruses have been predominant in this region, however circulation appears to be declining in China and the Republic of Korea.

In the temperate regions of the northern and southern hemisphere, overall pandemic influenza activity remains low to sporadic.

In Australia and New Zealand, slight increases in ILI activity were reported; however, in Australia, these increases have been attributed primarily to circulating respiratory viruses other than influenza.

In the southern temperate regions of the Americas, only sporadic detections of influenza viruses have been reported, except in Chile, which continues to report localized areas of increased ILI activity (in the Los Lagos area) associated with co-circulation of pandemic influenza and other respiratory viruses.

In Europe, very low to sporadic levels of pandemic and seasonal influenza type B viruses continue to be detected. Seasonal influenza type B virus persists mainly in parts of eastern and northern Europe. Georgia reported an increase in the number of respiratory disease consultations due to influenza-like-illness (ILI), mainly in children (under age 5) and school-age children (5-14 years old age group); whether this increase is associated with pandemic influenza A (H1N1) virus is not yet known.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus in West Africa has now largely subsided. In Ghana, 6% of respiratory samples tested positive for pandemic influenza virus during the most recent reporting week.

Across the rest of region, the pandemic influenza virus continues to be detected sporadically or at low levels, most recently in Angola and Rwanda. Sporadic detections of seasonal influenza H3N2 and influenza B viruses have been reported in western, central Africa and to a lesser extent southern Africa.

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)

As of May 12 May 2010, 4 additional cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. It brings the cumulative total to 289 so far. All but one of these have the H275Y substitution and are assumed to remain sensitive to zanamivir.

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 18: 25 APRIL - 8 MAY 2010)

Map of influenza activity and virus subtypes [png 230kb]

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

Qualitative indicators (Week 29 to Week 18: 13 July 2009 - 8 May 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 16 May 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. 100): 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. 100): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 168
• WHO Regional Office for the Americas (AMRO) - At least 8396
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4874
• WHO Regional Office for South-East Asia (SEARO) - 1808
• WHO Regional Office for the Western Pacific (WPRO) - 1832
• Total* - At least 18097

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

-
------

[Giuseppe]

Pandemic (H1N1) 2009 - update 102 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 102

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_05_28/en/index.html">WHO | Pandemic (H1N1) 2009 - update 102</cite>. Edited.]

Pandemic (H1N1) 2009 - update 102 - Weekly update

28 May 2010


As of 23 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18114 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 virus transmission currently are in parts of the Caribbean and Southeast Asia, where low level circulation is occurring. Except for localized areas of pandemic influenza activity in parts of Chile, there is little evidence of pandemic influenza activity in the temperate zone of the southern hemisphere. Of note, Respiratory Syncitial Virus (RSV) is widely circulating in South America resulting in an increase in respiratory disease activity, complicating somewhat the interpretation of syndromic surveillance data from the area. RSV primarily affects children under the age of 5 years.

Seasonal influenza A viruses continue to be detected at low to sporadic levels in all regions.

Influenza B has been reported in increasing but low numbers in South America, where it only recently appeared, while it is decreasing in Asia.

In the Caribbean and Central America, Cuba and to a much lesser extent Costa Rica, continue to experience active circulation of pandemic influenza virus. In Cuba, current pandemic influenza activity, which began during late February 2010, remains unchanged since reaching a plateau during mid-April 2010; in addition, over the past month, there have been sporadic detections of seasonal influenza B viruses and also evidence of co-circulation of other respiratory viruses.

In Costa Rica, sustained low levels of pandemic influenza virus have been co-circulating with other respiratory viruses since the beginning of 2010. Several other countries in the region continue to report sporadic detections of seasonal influenza B viruses and low level co-circulation of other respiratory viruses.

In the tropical zone of South America, pandemic and seasonal influenza viruses continued to circulate at low to sporadic levels. In Peru, recent regional increases in respiratory diseases activity (in children under age 5) has been largely associated with circulating respiratory syncitial virus (RSV).

In Colombia and Brazil, low levels of pandemic and seasonal influenza H3N2 viruses have been detected over the past month.

In Bolivia, a recent period of circulation of predominantly seasonal influenza type B viruses appears to have concluded.

In Asia, overall pandemic influenza activity remains low to sporadic, except in limited areas of south and southeast Asia, particularly Singapore, Malaysia, and Bangladesh.

In Singapore, levels of ARI have been elevated since April 2010 and in recent weeks have remained near epidemic threshold; approximately 39% of respiratory specimens from ILI patients tested positive for pandemic influenza virus during mid May 2010.

In neighboring Malaysia, limited data suggest that active pandemic influenza virus circulation persist after recent activity peaked during mid April 2010; small numbers of fatal cases have been reported since that time.

In Bangladesh, co-dominant circulation of pandemic and seasonal influenza B viruses has been observed since mid April 2010, however, the overall intensity of respiratory diseases was reported to low during this period.

Low levels of pandemic influenza virus continued to circulate in western India, while low and declining levels of seasonal influenza B viruses continued to be reported across East Asia.

In Sub-Saharan Africa, limited data from several countries continues to suggest that active transmission of pandemic influenza virus in West Africa has now largely subsided. In addition to the persistence of low level circulation of pandemic influenza virus in Ghana, sporadic detections of pandemic influenza virus have been reported during the past month in Cameroon, Angola, and Rwanda.

In Cameroon, there has been persistent active circulation of seasonal influenza B viruses since mid-March 2010.

In the temperate regions of the northern and southern hemisphere, overall pandemic influenza activity remains low to sporadic.

In southern hemisphere, Chile continues to report increased ILI in several regions of the country (notably Los Lagos), however, the increase in respiratory disease activity has been predominantly associated with circulating RSV and only to a much lesser extent pandemic influenza virus. In neighboring Argentina, Paraguay, and Uruguay, all recent respiratory diseases activity during the past month has been associated with viruses other than influenza. Similarly, there have been no recent detections of influenza virus in South Africa.

In New Zealand and Australia, overall levels of ILI remain low; only sporadic detections of seasonal influenza H3N2 and pandemic influenza viruses have been recently reported in Australia.

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)

As of May 12 May 2010, 4 additional cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. It brings the cumulative total to 289 so far. All but one of these have the H275Y substitution and are assumed to remain sensitive to zanamivir.

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 19: 9 MAY - 15 MAY 2010)

Map of influenza activity and virus subtypes [png 256kb]

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

Qualitative indicators (Week 29 to Week 19: 13 July 2009 - 15 May 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 23 May 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. 101): 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. 101): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) - 168
• WHO Regional Office for the Americas (AMRO) - At least 8401
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4878
• WHO Regional Office for South-East Asia (SEARO) - 1814
• WHO Regional Office for the Western Pacific (WPRO) - 1834
• Total* - At least 18114

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

[Giuseppe]

WHO - Pandemic (H1N1) 2009 - update 103

WHO - Pandemic (H1N1) 2009 - update 103

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_06_04/en/index.html">WHO | Pandemic (H1N1) 2009 - update 103</cite>. Edited.]

Pandemic (H1N1) 2009 - update 103 - Weekly update

4 June 2010


As of 30 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18138 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:

Active but declining transmission of pandemic influenza virus continued to be detected in parts of the Caribbean and Southeast Asia. In the countries of temperate southern hemisphere there is no evidence yet to suggest that the winter influenza season has begun, however there has been limited localized pandemic influenza virus transmission in Chile. In the rest of the world, overall pandemic influenza virus transmission remains low.

Seasonal influenza B viruses are currently the predominant type of influenza virus circulating globally, although at low levels.

Of note, during the later part of May 2010, low but significant levels of predominantly seasonal influenza H3N2 viruses have been detected in several countries of East Africa.

In the tropical zone of the Americas, the most active areas of pandemic influenza virus transmission continue to be in parts of the Caribbean.

In Cuba, pandemic influenza virus transmission has begun to decline after plateauing since mid-April 2010.

In both Costa Rica and Columbia, there has been persistence of low level circulation of pandemic influenza virus since the beginning of 2010. Sporadic detections of pandemic and other seasonal influenza viruses, particularly type B, have been reported from several countries in the region during May 2010. Other respiratory viruses, for example RSV, are known to be circulating to varying extents in different countries across the region.

In Asia, the most active areas of pandemic influenza virus transmission currently are in parts of South and Southeast Asia, particularly in Singapore and Malaysia, and to a lesser extent in Bangladesh.

In Singapore, during the last week of May 2010, levels of ARI fell below the epidemic threshold and the proportion of respiratory samples testing positive for pandemic influenza fell from 39% to 29%.

In Malaysia and Bangladesh, the numbers of new cases reported per week have been relative stable for the past 6 and 3 weeks, respectively, suggesting stable persistence of low level pandemic virus circulation during the past month in these areas. Very low levels of pandemic influenza virus also continue to circulate in parts of western and southern India, and in parts of Thailand.

Sporadic detections of pandemic influenza virus have been reported in many countries across the region during the past month.

In East Asia, overall influenza activity remains low, however, seasonal influenza B viruses continue to circulate at low and declining levels across the region.

In Sub-Saharan Africa, active but declining levels of pandemic influenza virus transmission continue to be detected in parts of West Africa, most notably in Ghana.

During the most recent reporting week, 15% of all respiratory samples tested positive for pandemic influenza virus in Ghana. Sporadic detections of seasonal influenza B continue to be reported in central Africa.

Of note, low but significant numbers of seasonal H3N2 viruses were recently detected in Kenya (6 of 57 respiratory samples tested) and Tanzania (13 of 25 respiratory samples tested) during the most recent reporting week.

Overall, in the temperate regions of the northern and southern hemisphere, pandemic influenza viruses have been detected only sporadically during the past month.

In the temperate southern hemisphere, Chile is the only country to recently report small number of pandemic influenza cases in a few areas of the country suggesting that overall transmission is currently limited. Other respiratory viruses, most notably RSV, are known to be circulating in Chile, Paraguay, and Argentina. There have been no recent detections of pandemic influenza virus in South Africa.

In New Zealand and Australia, overall levels of ILI remain low; only sporadic detections of seasonal and pandemic influenza viruses have been recently reported in Australia.

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

Weekly update (Virological surveillance data)

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 20: 16 MAY - 22 MAY 2010)

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

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

Qualitative indicators (Week 29 to Week 20: 13 July 2009 - 22 May 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 30 May 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. 102): 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. 102): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) *** - 168
• WHO Regional Office for the Americas (AMRO) - At least 8410
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4878
• WHO Regional Office for South-East Asia (SEARO) - 1825
• WHO Regional Office for the Western Pacific (WPRO) - 1837
• Total* At least 18138

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

-
-----

[Giuseppe]

Pandemic (H1N1) 2009 - update 103 - Weekly virological surveillance update

[Source: World Health Organization, <cite cite="http://www.who.int/csr/disease/swineflu/laboratory4_06_2010/en/index.html">WHO | Pandemic (H1N1) 2009 - update 103</cite>. Edited.]

Pandemic (H1N1) 2009 - update 103 - Weekly virological surveillance update

4 June 2010


Overall influenza activity has remained at low levels in most parts of the world.

While in most countries where human infection of influenza virus was reported, among influenza A viruses subtyped, the pandemic influenza A(H1N1) continues to be predominant (78.1% globally), in several countries in Africa, however, the proportion of A(H3N2) virus detections has increased and exceeded that of pandemic A(H1N1).

Seasonal A(H1N1) viruses were detected sporadically in the Russian Federation.

Sporadic influenza A(H3N2) activity was reported from some parts of Africa, and some countries including Australia and Russian Federation.

Influenza B was reported as the predominating influenza virus accounting for 80.7% of all influenza detections in Hong Kong SAR of China and 89.7% in Russian Federation. Sporadic influenza B activity has also been observed in some other countries.

Based on FluNet reporting for the week from 16 to 22 May 2010, the total number of specimens reportedly positive for influenza viruses by National Influenza Centres (NICs) from 29 countries was 219. Of these, 74 (34%) were typed as influenza A and 145 (66%) as influenza B.

From the start of the pandemic in 19 April 2009 to 22 May 2010, based on FluNet reporting by 88 countries, the total number of specimens reported positive for influenza by NIC laboratories was 637,613*. Of these, 484,378 (76.0%) were pandemic A(H1N1), 8,874 (1.4%) were seasonal A(H1N1), 32,501 (5.1%) were A(H3N2), 80,441(12.6%) were A (not subtyped) and 31,317 (4.9%) were influenza B.

The trend of proportions of different type and subtype influenza viruses infecting human [pdf 49kb]

Since the beginning of the pandemic on 19 April 2009 to 29th May 2010, cumulatively 156 countries shared a total of 25,752 specimens (19,728 clinical and 6024 isolates) with WHO CCs for further characterization. The majority of pandemic A(H1N1) 2009 influenza viruses analyzed to date are antigenically and genetically closely related to the recommended vaccine virus A/California/7/2009.

Antiviral susceptibility surveillance has been conducted by the WHO Global Influenza Surveillance Network (GISN) including WHO CCs. So far, pandemic A(H1N1) specimens and isolates from at least 92 countries have been tested. The data showed that oseltamivir resistant pandemic A(H1N1) viruses are sporadically detected with rare onward transmission.

So far, 292 cases of oseltamivir resistance have been reported by GISN and other partners. All of these viruses showed the H275Y substitution and all remain sensitive to zanamivir. (See below to obtain more information on oseltamivir resistant viruses).

WHO, through the GISN, continues monitoring the evolution and global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect humans.

*Some NICs report data to FluNet retrospectively and updates of previous data with new results are frequent.


For more information

• Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses [pdf 18kb]
• National Influenza Centres
• EuroFlu Weekly Electronic Bulletin
• PAHO Weekly Regional Update
• FluNet web site

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[Giuseppe]

Pandemic (H1N1) 2009 - update 104 - Weekly update

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_06_11/en/index.html">WHO | Pandemic (H1N1) 2009 - update 104</cite>. Edited. Note: Please report broken URLs.]

Pandemic (H1N1) 2009 - update 104 - Weekly update

11 June 2010


As of 6 June, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18156 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:

Active but declining transmission of pandemic influenza virus persists in limited areas of the tropics, particularly in Southeast Asia and the Caribbean. As countries of the temperate southern hemisphere enter winter, only sporadic influenza activity has been detected so far, except in Chile and Uruguay, both of which have recently reported small numbers of pandemic influenza virus detections. Although seasonal influenza B viruses have been the predominant type of influenza virus circulating worldwide since the end of February 2010, there have been increasing but low level detections of seasonal influenza H3N2 viruses, particularly in South America and in East Africa.

In the tropics of the Americas, overall pandemic influenza activity is low, however, both seasonal influenza H3N2 and type B viruses are actively circulating in parts of tropical South America.

Active but declining transmission of pandemic influenza virus continues to be detected primarily in Cuba.

Since early 2010, pandemic influenza virus has circulated at low levels in Costa Rica.

Sporadic detections of pandemic influenza virus continue to be reported in Brazil.

During the most recent reporting week (last week of May 2010), both Brazil and Venezuela reported regional spread of influenza activity associated with an increasing trend of respiratory diseases.

In Venezuela, recent influenza activity (which began during early May 2010) has been predominantly due to circulating seasonal influenza A viruses.

In Bolivia, circulation of seasonal influenza viruses, predominantly type B, was observed between March and May 2010 and now appears to be subsiding.

In Asia overall pandemic influenza virus transmission remains low, except in parts of tropical South and Southeast Asia, particularly Singapore, Malaysia, and Bangladesh.

In Singapore, overall levels of ARI remained slightly below the epidemic threshold and the proportion of respiratory samples testing positive for pandemic influenza virus increased slightly to 34%.

In Malaysia, limited data suggests that pandemic influenza virus transmission has begun to decline since plateauing during May 2010.

In Bangladesh, there has been stable persistent low level co-circulation of pandemic and seasonal influenza B viruses since March 2010.

Sporadic detections of pandemic influenza virus continued to be reported across other parts of Asia.

In East Asia, overall influenza activity remains low, however, seasonal influenza B viruses continue to circulate at low and declining levels.

In Sub-Saharan Africa, pandemic influenza virus continued to circulate at low levels in parts of West Africa, most notably in Ghana.

During the most recent reporting week, 13% of all respiratory samples tested positive for pandemic influenza virus in Ghana. Small but significant numbers of seasonal H3N2 viruses have been detected in Kenya and Tanzania since late May 2010.

Overall, in the temperate regions of the northern hemisphere, pandemic influenza viruses have been detected only sporadically during the past month.

In the temperate southern hemisphere, only two countries, Chile and Uruguay, have recently reported small numbers of pandemic influenza virus detections.

In Chile, there was low level geographically limited circulation of pandemic influenza virus during May 2010; 3.4% of respiratory samples tested positive for pandemic influenza virus during the last week of May 2010. Of note, in Uruguay, 11 (44%) of 25 samples tested positive for pandemic influenza during the most recent reporting week (the last week of May 2010); however, the corresponding intensity of respiratory diseases in the population is not yet known. Other respiratory viruses, most notably RSV, are known to be circulating in Chile and Argentina.

There have been no recent detections of pandemic influenza virus in South Africa.

In New Zealand and Australia, overall levels of ILI remain low; only sporadic detections of seasonal and pandemic influenza viruses have been recently reported in Australia.

The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect, humans including seasonal influenza.

For more information on virological surveillance and antiviral resistance please see the weekly virology update (Virological surveillance data, below).

Weekly update (Virological surveillance data)

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 21: 23 MAY - 29 MAY 2010)

Map of influenza activity and virus subtypes [png 256kb]

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

Qualitative indicators (Week 29 to Week 21: 13 July 2009 - 29 May 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 6 June 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 103): 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. 103): none.

[Region - Deaths*]

• WHO Regional Office for Africa (AFRO) *** - 168
• WHO Regional Office for the Americas (AMRO) - At least 8423
• WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
• WHO Regional Office for Europe (EURO) - At least 4879
• WHO Regional Office for South-East Asia (SEARO) - 1829
• WHO Regional Office for Western Pacific (WPRO) - 1838
• TOTAL - At least 18156

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

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-----<cite cite="http://www.who.int/csr/don/2010_06_11/en/index.html"></cite>

[Giuseppe]

Pandemic (H1N1) 2009 - update 105 - Weekly update: small number of fatal cases in Cuba, Costa Rica, Colombia, increasing activity in India, Kerala

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_06_18/en/index.html">WHO | Pandemic (H1N1) 2009 - update 105</cite>. Edited.]

Pandemic (H1N1) 2009 - update 105 - Weekly update

18 June 2010


As of 13 June, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18172 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 situation remains largely unchanged since the last update. Overall pandemic influenza activity remains low worldwide with geographically limited circulation of pandemic influenza virus in parts of the tropics, particularly in parts of Central America and the Caribbean and in parts of South and Southeast Asia. Seasonal influenza type B viruses continue to circulate at low levels across Asia and to a lesser extent across parts of Africa and South America. Recently re-emerged seasonal influenza H3N2 viruses continue to circulate in East Africa. As countries of the temperate southern hemisphere enter winter, overall only sporadic influenza activity has been detected so far.

In tropical region of the Americas, low or waning circulation of pandemic virus has been primarily reported in Costa Rica (since early 2010) and in Cuba (last reported at the end of May 2010), respectively.

In Cuba and to a lesser extent in Costa Rica, recent pandemic influenza activity has been associated with small numbers of fatal cases.

In Colombia, during the first week of June 2010, an increasing trend of respiratory diseases was associated with regional spread of pandemic influenza activity and a small number of new fatal cases, likely reflecting increasing but low level circulation of pandemic influenza virus.

Throughout the rest of the region, there have been only sporadic detections of pandemic influenza virus during the past month.

In several countries of the region, there has been recent circulation of seasonal influenza viruses including type A (Venezuela since May 2010) and B (Bolivia since March 2010).

Throughout the region there has been variable ongoing co-circulation of other respiratory viruses, particularly RSV.

In Asia, pandemic influenza virus continues to actively circulate in Malaysia, Singapore, and to a much lesser extent in parts of India, Bangladesh, and Bhutan.

In Malaysia, limited data suggest that virus transmission persists but continues to decline; the number of new cases reported per week plateaued during mid-April 2010 and began to decline at the end of May 2010.

In Singapore, during the second week of June 2010, the levels of ARI remained near the warning level but below the epidemic threshold; approximately 28% of respiratory samples from patients with ILI tested positive for pandemic influenza virus.

In South Asia, low level circulation of pandemic influenza virus has persisted in western India (since early 2010) and Bangladesh (since late February 2010); in India but not Bangladesh, regional, low intensity transmission during 2010 has been associated with small numbers of fatal cases over time.

Seasonal influenza type B viruses continue to co-circulate with pandemic influenza virus in Bangladesh and have only recently emerged and become predominant in India, although at low levels.

Of note, there have been recent media reports of increasing pandemic influenza activity in the southern Indian state of Kerala and more information is expected to become available soon.

In Bhutan, there have recent reports of school outbreaks of pandemic influenza virus infection in three separate areas of the country, however, the overall intensity of respiratory diseases in the population was reported to be low.

In Sub-Saharan Africa, pandemic influenza virus continued to circulate at low levels in limited areas of East and West Africa.

During the first week of June 2010, 10% and 16% of all respiratory samples tested positive for pandemic influenza virus in Tanzania and Ghana, respectively. Small but significant numbers of seasonal H3N2 viruses continue to be been detected in Kenya and Tanzania since late May 2010.

Overall, in the temperate regions of the northern hemisphere, pandemic influenza viruses have been detected only sporadically during the past month.

In the temperate southern hemisphere, only two countries, Chile and Uruguay, have recently reported small numbers of pandemic influenza virus detections. Other respiratory viruses, most notably RSV, are known to be circulating in Chile and Argentina.

During first two weeks of June 2010, small numbers of seasonal influenza H3N2 and type B viruses have been detected in South Africa.

In New Zealand and Australia, overall levels of ILI remain low; only sporadic detections of seasonal and pandemic influenza viruses have been recently reported in Australia.

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

Weekly update (Virological surveillance data)

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 22: 30 MAY - 5 JUNE 2010)

Map of influenza activity and virus subtypes [png 256kb]

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

Qualitative indicators (Week 29 to Week 22: 13 July 2009 - 5 June 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 13 June 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 104): 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. 104): none.

[Region - Deaths*]

• WHO Region Office for Africa (AFRO) - 168
• WHO Regional Office for the Americas - At least 8427
• WHO Regional Office for the Eastern Mediterranean (EMRO)** - 1019
• WHO Regional Office for Europe (EURO) - At least 4879
• WHO Regional Office for Sout-East Asia (SEARO) - 1838
• WHO Regional Office for Western Pacific (WPRO) - 1841
• Total - At least 18172
  

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

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-----<cite cite="http://www.who.int/csr/don/2010_06_18/en/index.html"></cite>