Giuseppe
Emeritus
Re: European Centre of Diseases Control and Prevention (ECDC): Pandemic Influenza H1N1 2009, Situation Updates (Since August 4, 2009)
Re: European Centre of Diseases Control and Prevention (ECDC): Pandemic Influenza H1N1 2009, Situation Updates (Since August 4, 2009)
Pandemic (H1N1) 2009 - Update 21 August 2009, 17:00 hours CEST (ECDC, edited)
[Original Full Document: LINK. EDITED.]
ECDC DAILY UPDATE
Pandemic (H1N1) 2009 - Update 21 August 2009, 17:00 hours CEST
Main developments in past 24 hours
This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 21 August 2009, 16:00 hours CEST, is presented in Table 1 and Table 2.
Disclaimer:
Several countries have now announced recommendations on treatment on clinical signs only and focused laboratory testing only for specific population groups or in outbreaks. For these countries, the reported numbers of cases presented in this report will severely underestimate the true incidence in the country and will not be comparable to countries still recommending laboratory tests of all suspected influenza cases.
Epidemiologic update
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 41 788 confirmed cases, including 79 deaths, have been reported since April 2009 (Table 1). In the past 24 hours, 850 new cases from the EU and EFTA countries were confirmed, including one new fatal case from the Netherlands (with confirmed underlying illness) and five from the United Kingdom. Currently, the majority of cases are being reported from Germany and the UK. The latest available updates on hospital admissions per Member State are presented in Table 2. The majority of recent hospitalized cases are reported from the UK, and from England in particular.
Outside of the EU and EFTA countries, a total of 2 351 new cases have been reported within the last 24 hours, among which 28 were fatal (Table 3). In total, 207 153 cases including 2 351 fatal cases have been reported from non-EU and EFTA countries.
Globally, the total number of confirmed and reported pandemic (H1N1) 2009 influenza cases to date is 248 941, including 2 430 deaths.
ECDC weekly influenza surveillance bulletin
The weekly influenza surveillance bulletin has been published on the ECDC website: http://ecdc.europa.eu/en/activities...sletter/SUN_EISN_INFL_Bulletin_2009week33.pdf
Ireland and the UK (Northern Ireland) are the only countries in Europe currently reporting medium levels of influenza activity, while the UK (England) now reports low levels. The intensity appears to be rising in Bulgaria, Ireland, Poland and Sweden and to be declining in the UK (England and Northern Ireland). In week 33, for the third week in a row, the proportion of sentinel specimens positive for influenza virus continued to decrease, reaching 13% after peaking at 27% during week 30.
Updates from Eurosurveillance
In this week's edition of Eurosurveillance, an article from France describes the characteristics of 574 deaths associated with pandemic H1N1 influenza up to 16 July 2009. Data (except from Canada and Australia) suggest that the elderly may to some extent be protected from infection. Underlying diseases were present in at least half of the fatal cases. There are two risk factors that seem to be of particular importance: pregnancy and metabolic condition (including obesity, which has not been considered as risk factor in previous pandemics or seasonal influenza). http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19309
A report from the United Kingdom presents the importance of school and social activities in the transmission of influenza A(H1N1)v. During the containment phase in the United Kingdom (April to June 2009), a cluster of influenza A(H1N1)v cases was identified, prompting further investigation and public health action by the Health Protection Agency. The first confirmed case, a pupil at a school in England, was imported. During the following two weeks, 16 further cases were confirmed with epidemiological links to the first imported case. In this cluster, findings show that significant transmission occurred in two classes, with attack rates of 17% and 7%. Other settings included a party (with minimum and maximum attack rates of 14% and 25%) and a choir (where both the minimum and the maximum attack rate was 4%). No evidence of transmission was found on two school bus trips, despite exposure over 50 minutes to a symptomatic case and over two periods of 30 minutes to a case during the prodromal phase (i.e. within 12 hours of symptom onset). Nor was there onward transmission in another school despite exposure over several hours to two cases, both of whom attended school during the prodromal phase.
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19311
An article analysing the epidemiological and clinical characteristics of influenza A(H1N1)v infection in children, describes the first 45 cases confirmed in children in Cyprus. Fever, cough, rhinorrhoea and sore throat were the most common symptoms of infection. Half of the children had fever for one day or only for a few hours. Five children were hospitalised, and overall their symptoms were mild. Adherence to oseltamivir treatment was very high, with low frequency of gastrointestinal side effects such as nausea and vomiting. Camping places and summer schools played a significant role in spreading the infection among children of school age. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19312
Other developments
Sweden publishes recommendations for vaccination
The priority for vaccination with the pandemic (H1N1) 2009 influenza vaccine in Sweden will be given to pregnant women, and persons with chronic illness, including chronic lung disease, extreme obesity or neuromuscular disorders affecting respiration, chronic cardiovascular disease, immuno-suppression, chronic liver or renal dysfunction, diabetes, severe asthma, or severe neuromuscular disease. Also health professionals are included in the priority group.
More information is available from: http://www.socialstyrelsen.se/Aktuellt/Nyheter/2009/Q3/nyhet090820.htm
ECDC publishes health education guidance on the use of influenza antivirals
A new guidance document on the public health use of influenza antivirals during influenza pandemics, with particular reference to the pandemic (H1N1) 2009, is now available from ECDC?s website:
http://ecdc.europa.eu/en/healthtopi...nza_Antivirals_during_Influenza_Pandemics.pdf
Changing the format of the daily report
As the influenza pandemic evolves, new types of data become increasingly important, whereas other may become less interesting. ECDC has refreshed the format of the Situation Update to better accommodate current and anticipated information needs. The name of this report changed to "Daily Update" and some changes have been made in the data reported.
Table 1 ? reported cases by the EU/EFTA countries remains as before. In addition, we are publishing a new Table 2 on the number of current and cumulative hospitalisations and admission to intensive care in EU/EFTA Member States. The source of the information is official statements or surveillance reports published by national health authorities. It should be noted that indications and thresholds for hospitalisations vary by country, so the figures quoted may not be directly comparable between countries.
Assuming no changes in the national reporting system, trends of hospitalisations over time should give an accurate representation of the evolution of the pandemic. This might change if countries are faced with capacity issues within the healthcare system at a later stage of this evolving pandemic.
Table 3 lists only reported deaths for countries outside the EU/EFTA area; we have discontinued reporting the case numbers for these countries. The main reason for this is that more and more countries have stopped the reporting of new cases, and these figures no longer give a representative picture of the situation.
The two graphs now show number of reported deaths by week of report ? one graph for EU/EFTA, one for the entire world. The two maps depict cumulative deaths by country, one for EU/EFTA, one for the world.
Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v infections and cumulative deaths among confirmed cases by country as of 21 August 2009, 16:00 hours (CEST) in the EU and EFTA countries
[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases (a)]
cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites. Countries shaded with gray are not recommending laboratory tests for all suspect cases, therefore comparisons in time or between these countries should not be made at present.
(a) Deaths are included in the cumulative number of confirmed cases
(b) Cases reported from France include those reported from the overseas territories (434)
(c) Cases from the Netherlands include those reported from Aruba and the Dutch Antilles
(d) Cases reported from the United Kingdom include the number of individual cases from the following overseas territories: Anguilla, The Falklands, Gibraltar, Sovereign Base Area Cyprus, Turks and Caicos Islands (78)
Table 2: Reported number of confirmed influenza A(H1N1)v cases admitted to hospitals and intensive care by country as of 21 August 2009, 16:00 hours (CEST) in the EU and EFTA countries
[Country - (date of report) - Most recent number of cases admitted in hospitals - Cumulative number of cases admitted in hospitals - Most recent number of cases admitted to intensive care - Cumulative number of cases admitted to intensive care]
Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites. New updates are shaded in yellow.
(...) denotes no information readily available in official sources.
(a) Cases reported from France include those reported from the overseas territories.
(b) Data for England only. Does not include Scotland (114 cumulative hospitalisations), Wales (38) and Northern Ireland (36).
Table 3. Reported number of new and cumulative confirmed fatal pandemic influenza (H1N1) 2009 cases by country as of 21 August 2009, 16:00 hours (CEST) outside of the EU/EFTA area
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]
cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated. Yellow shading indicates a new update has been recorded for the country during the past 24 hours.
(...)
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Re: European Centre of Diseases Control and Prevention (ECDC): Pandemic Influenza H1N1 2009, Situation Updates (Since August 4, 2009)
Pandemic (H1N1) 2009 - Update 21 August 2009, 17:00 hours CEST (ECDC, edited)
[Original Full Document: LINK. EDITED.]
ECDC DAILY UPDATE
Pandemic (H1N1) 2009 - Update 21 August 2009, 17:00 hours CEST
Main developments in past 24 hours
- 850 new cases reported in the EU and EFTA countries, reaching a total of 41 788 cases; the Netherlands reported 1 new fatal case and the United Kingdom 5 new fatal cases;
- 2 351 new cases including 28 fatal cases, were reported from non-EU and EFTA countries, reaching a cumulative total of 207 153 cases;
- Sweden publishes recommendation for pandemic vaccination priority groups;
- The weekly influenza surveillance bulletin is published on the ECDC website.
This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 21 August 2009, 16:00 hours CEST, is presented in Table 1 and Table 2.
Disclaimer:
Several countries have now announced recommendations on treatment on clinical signs only and focused laboratory testing only for specific population groups or in outbreaks. For these countries, the reported numbers of cases presented in this report will severely underestimate the true incidence in the country and will not be comparable to countries still recommending laboratory tests of all suspected influenza cases.
Epidemiologic update
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 41 788 confirmed cases, including 79 deaths, have been reported since April 2009 (Table 1). In the past 24 hours, 850 new cases from the EU and EFTA countries were confirmed, including one new fatal case from the Netherlands (with confirmed underlying illness) and five from the United Kingdom. Currently, the majority of cases are being reported from Germany and the UK. The latest available updates on hospital admissions per Member State are presented in Table 2. The majority of recent hospitalized cases are reported from the UK, and from England in particular.
Outside of the EU and EFTA countries, a total of 2 351 new cases have been reported within the last 24 hours, among which 28 were fatal (Table 3). In total, 207 153 cases including 2 351 fatal cases have been reported from non-EU and EFTA countries.
Globally, the total number of confirmed and reported pandemic (H1N1) 2009 influenza cases to date is 248 941, including 2 430 deaths.
ECDC weekly influenza surveillance bulletin
The weekly influenza surveillance bulletin has been published on the ECDC website: http://ecdc.europa.eu/en/activities...sletter/SUN_EISN_INFL_Bulletin_2009week33.pdf
Ireland and the UK (Northern Ireland) are the only countries in Europe currently reporting medium levels of influenza activity, while the UK (England) now reports low levels. The intensity appears to be rising in Bulgaria, Ireland, Poland and Sweden and to be declining in the UK (England and Northern Ireland). In week 33, for the third week in a row, the proportion of sentinel specimens positive for influenza virus continued to decrease, reaching 13% after peaking at 27% during week 30.
Updates from Eurosurveillance
In this week's edition of Eurosurveillance, an article from France describes the characteristics of 574 deaths associated with pandemic H1N1 influenza up to 16 July 2009. Data (except from Canada and Australia) suggest that the elderly may to some extent be protected from infection. Underlying diseases were present in at least half of the fatal cases. There are two risk factors that seem to be of particular importance: pregnancy and metabolic condition (including obesity, which has not been considered as risk factor in previous pandemics or seasonal influenza). http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19309
A report from the United Kingdom presents the importance of school and social activities in the transmission of influenza A(H1N1)v. During the containment phase in the United Kingdom (April to June 2009), a cluster of influenza A(H1N1)v cases was identified, prompting further investigation and public health action by the Health Protection Agency. The first confirmed case, a pupil at a school in England, was imported. During the following two weeks, 16 further cases were confirmed with epidemiological links to the first imported case. In this cluster, findings show that significant transmission occurred in two classes, with attack rates of 17% and 7%. Other settings included a party (with minimum and maximum attack rates of 14% and 25%) and a choir (where both the minimum and the maximum attack rate was 4%). No evidence of transmission was found on two school bus trips, despite exposure over 50 minutes to a symptomatic case and over two periods of 30 minutes to a case during the prodromal phase (i.e. within 12 hours of symptom onset). Nor was there onward transmission in another school despite exposure over several hours to two cases, both of whom attended school during the prodromal phase.
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19311
An article analysing the epidemiological and clinical characteristics of influenza A(H1N1)v infection in children, describes the first 45 cases confirmed in children in Cyprus. Fever, cough, rhinorrhoea and sore throat were the most common symptoms of infection. Half of the children had fever for one day or only for a few hours. Five children were hospitalised, and overall their symptoms were mild. Adherence to oseltamivir treatment was very high, with low frequency of gastrointestinal side effects such as nausea and vomiting. Camping places and summer schools played a significant role in spreading the infection among children of school age. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19312
Other developments
Sweden publishes recommendations for vaccination
The priority for vaccination with the pandemic (H1N1) 2009 influenza vaccine in Sweden will be given to pregnant women, and persons with chronic illness, including chronic lung disease, extreme obesity or neuromuscular disorders affecting respiration, chronic cardiovascular disease, immuno-suppression, chronic liver or renal dysfunction, diabetes, severe asthma, or severe neuromuscular disease. Also health professionals are included in the priority group.
More information is available from: http://www.socialstyrelsen.se/Aktuellt/Nyheter/2009/Q3/nyhet090820.htm
ECDC publishes health education guidance on the use of influenza antivirals
A new guidance document on the public health use of influenza antivirals during influenza pandemics, with particular reference to the pandemic (H1N1) 2009, is now available from ECDC?s website:
http://ecdc.europa.eu/en/healthtopi...nza_Antivirals_during_Influenza_Pandemics.pdf
Changing the format of the daily report
As the influenza pandemic evolves, new types of data become increasingly important, whereas other may become less interesting. ECDC has refreshed the format of the Situation Update to better accommodate current and anticipated information needs. The name of this report changed to "Daily Update" and some changes have been made in the data reported.
Table 1 ? reported cases by the EU/EFTA countries remains as before. In addition, we are publishing a new Table 2 on the number of current and cumulative hospitalisations and admission to intensive care in EU/EFTA Member States. The source of the information is official statements or surveillance reports published by national health authorities. It should be noted that indications and thresholds for hospitalisations vary by country, so the figures quoted may not be directly comparable between countries.
Assuming no changes in the national reporting system, trends of hospitalisations over time should give an accurate representation of the evolution of the pandemic. This might change if countries are faced with capacity issues within the healthcare system at a later stage of this evolving pandemic.
Table 3 lists only reported deaths for countries outside the EU/EFTA area; we have discontinued reporting the case numbers for these countries. The main reason for this is that more and more countries have stopped the reporting of new cases, and these figures no longer give a representative picture of the situation.
The two graphs now show number of reported deaths by week of report ? one graph for EU/EFTA, one for the entire world. The two maps depict cumulative deaths by country, one for EU/EFTA, one for the world.
Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v infections and cumulative deaths among confirmed cases by country as of 21 August 2009, 16:00 hours (CEST) in the EU and EFTA countries
[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases (a)]
- Austria 6 - 270 - ...
- Belgium ... - 126 - 1
- Bulgaria ... - 57 - ...
- Cyprus ... - 297 - ...
- Czech Republic 8 - 217 - ...
- Denmark 33 - 520 - ...
- Estonia ... - 57 - ...
- Finland 3 - 207 - ...
- France (b) ... - 1125 - 1
- Germany 560 - 13740 - ...
- Greece ... - 1424 - ...
- Hungary 1 - 149 - 1
- Iceland 17 - 152 - ...
- Ireland ... - 678 - 2
- Italy ... - 1238 - ...
- Latvia ... - 23 - ...
- Liechtenstein ... - 5 - ...
- Lithuania ... - 47 - ...
- Luxemburg ... - 129 - ...
- Malta 6 - 237 - 1
- Netherlands (c) ... - 1473 - 2
- Norway ... - 868 - ...
- Poland ... - 153 - ...
- Portugal 154 - 1987 - ...
- Romania ... - 273 - ...
- Slovakia 4 - 103 - ...
- Slovenia 4 - 209 - ...
- Spain ... - 1538 - 12
- Sweden ... - 672 - ...
- Switzerland ... - 857 - ...
- United Kingdom (d) 54 - 12957 - 59
- Total 850 - 41788 - 79
cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites. Countries shaded with gray are not recommending laboratory tests for all suspect cases, therefore comparisons in time or between these countries should not be made at present.
(a) Deaths are included in the cumulative number of confirmed cases
(b) Cases reported from France include those reported from the overseas territories (434)
(c) Cases from the Netherlands include those reported from Aruba and the Dutch Antilles
(d) Cases reported from the United Kingdom include the number of individual cases from the following overseas territories: Anguilla, The Falklands, Gibraltar, Sovereign Base Area Cyprus, Turks and Caicos Islands (78)
Table 2: Reported number of confirmed influenza A(H1N1)v cases admitted to hospitals and intensive care by country as of 21 August 2009, 16:00 hours (CEST) in the EU and EFTA countries
[Country - (date of report) - Most recent number of cases admitted in hospitals - Cumulative number of cases admitted in hospitals - Most recent number of cases admitted to intensive care - Cumulative number of cases admitted to intensive care]
- Austria (7.8.) - 0 - ... - 0 - ...
- Belgium (7.8.) - 0 - ... - 0 - ...
- Bulgaria - ... - ... - ... - ...
- Cyprus - ... - ... - ... - ...
- Czech Republic (17.8.) - 0 - ... - 0 - ...
- Denmark (20.8) - ... - ... - ... - ...
- Estonia (14.8.) - 0 - 0 - 0 - 0
- Finland (18.8.) - ... - ... - ... - ...
- France(a) (18.8.) - 6 - 65 - 5 - 11
- Germany (21.8.) - ... - ... - ... - ...
- Greece (13.8.) - ... - ... - 1 - 2
- Hungary (19.8.) - ... - 27 - ... - ...
- Iceland (20.8.) - 0 - 0 - 0 - 0
- Ireland (13.8.) - 4 - 41 - ... - ...
- Italy (17.7.) - ... - ... - ... - ...
- Latvia (13.8.) - ... - 1 - ... - ...
- Liechtenstein (19.8.) - ... - ... - ... - ...
- Lithuania (13.8.) - ... - ... - ... - ...
- Luxemburg (14.8.) - ... - ... - 0 - 0
- Malta - ... - ... - ... - ...
- Netherlands (14.8.) - ... - 28 - ... - ...
- Norway (19.8.) - ... - ... - ... - ...
- Poland (18.8.) - ... - ... - ... - ...
- Portugal (20.8.) - 8 - ... - ... - ...
- Romania - ... - 18 - ... - ...
- Slovakia (12.8.) - 2 - 33 - 0 - 0
- Slovenia (10.8.) - ... - ... - ... - ...
- Spain (20.8.) - ... - ... - 32 - 92
- Sweden (20.8.) - ... - ... - ... - ...
- Switzerland (20.8.) - ... - 11 - ... - 1
- United Kingdom(b) (20.8.) - 263 - ... - 30 - ...
Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites. New updates are shaded in yellow.
(...) denotes no information readily available in official sources.
(a) Cases reported from France include those reported from the overseas territories.
(b) Data for England only. Does not include Scotland (114 cumulative hospitalisations), Wales (38) and Northern Ireland (36).
Table 3. Reported number of new and cumulative confirmed fatal pandemic influenza (H1N1) 2009 cases by country as of 21 August 2009, 16:00 hours (CEST) outside of the EU/EFTA area
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]
- OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
- No deaths reported - ... - ...
- MEDITERRANEAN AND MIDDLE-EAST
- Egypt ... - 1
- Iraq ... - 1
- Israel ... - 11
- Kuwait ... - 1
- Lebanon ... - 1
- Occupied Palestinian Territory ... - 1
- Qatar ... - 1
- Saudi Arabia 2 - 16
- United Arab Emirates 1 - 1
- Yemen ... - 1
- AFRICA
- Ghana ... - 1
- Mauritius ... - 5
- South Africa 2 - 8
- NORTH AMERICA
- Canada 4 - 71
- Mexico ... - 164
- USA ... - 477
- CENTRAL AMERICA & CARIBBEAN
- Cayman Islands ... - 1
- Costa Rica ... - 31
- Dominican Republic ... - 5
- El Salvador ... - 15
- Guatemala ... - 10
- Honduras ... - 7
- Jamaica ... - 4
- Nicaragua ... - 1
- Panama ... - 6
- Saint Kitts and Nevis ... - 1
- SOUTH AMERICA
- Argentina ... - 404
- Bolivia 2 - 19
- Brazil ... - 368
- Chile ... - 128
- Colombia ... - 23
- Ecuador ... - 23
- Paraguay ... - 39
- Peru ... - 62
- Uruguay ... - 22
- Venezuela 5 - 17
- NORTH-EAST & SOUTH ASIA
- Hong Kong SAR China ... - 4
- India 8 - 36
- Japan ... - 3
- South Korea ... - 2
- Taiwan 1 - 3
- SOUTH-EAST ASIA
- Brunei Darussalam ... - 1
- Indonesia ... - 4
- Laos Peoples Democratic Republic ... - 1
- Malaysia ... - 68
- Philippines ... - 8
- Singapore ... - 11
- Thailand ... - 111
- Vietnam ... - 2
- AUSTRALIA & PACIFIC
- Australia 3 - 131
- Cook Islands ... - 1
- New Zealand ... - 15
- Samoa ... - 2
- Tonga ... - 1
- TOTAL 28 - 2351
cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated. Yellow shading indicates a new update has been recorded for the country during the past 24 hours.
(...)
-
------
