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

[Giuseppe]

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

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

[Giuseppe]

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

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

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

Pandemic (H1N1) 2009 - update 110 - Weekly update

23 July 2010


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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

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

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

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


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

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

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


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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


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

Map of affected countries and deaths

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

[Region - Deaths*]

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

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

-
-----

[Giuseppe]

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

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

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

Pandemic (H1N1) 2009 - update 109 - Weekly update

16 July 2010


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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

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

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


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

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

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


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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


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

Map of affected countries and deaths

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

[Region / Deaths(*)]

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

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

[Giuseppe]

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

WHO, Pandemic (H1N1) 2009 - update 108 (July 8 2010, edited)

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

Pandemic (H1N1) 2009 - update 108 - Weekly update

9 July 2010


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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

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

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

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


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

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

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


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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


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

Map of affected countries and deaths

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

[Region - Deaths*]

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

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

-
-----

[Giuseppe]

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

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

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

Pandemic (H1N1) 2009 - update 107 - Weekly update

2 July 2010


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

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


Situation update:

Summary:

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

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

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


Regional Details:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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

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

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

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


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

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

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


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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


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

Map of affected countries and deaths

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

[Region - Deaths*]

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

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

[Giuseppe]

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

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

Pandemic (H1N1) 2009 - update 106 - Weekly update

25 June 2010


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Weekly update (Virological surveillance data)

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

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

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

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

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

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

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

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

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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

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

Map of affected countries and deaths

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

[Region - Deaths*]

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

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

-
-----

[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

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

[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

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

[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

-
------

[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 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 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]

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

-
------

[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]

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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