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

Pandemic Influenza (H1N1) 2009 - Situation Update (August 11, 2009, edited)

Pandemic Influenza (H1N1) 2009 - Situation Update (August 11, 2009, edited)

Pandemic Influenza (H1N1) 2009 - Situation Update (August 11, 2009, edited)

Pandemic Influenza (H1N1) 2009 - WHO African Region situation updates


Pandemic Influenza (H1N1) 2009 in the African Region: Update 27

As of August 11, 2009, 17H30 GMT, 16 countries have officially reported 1469 laboratory confirmed human cases of pandemic (H1N1) 2009 including three deaths.

The breakdown of confirmed cases and deaths by country is given in the table below.


[Country - Cumulative total: Cases - Deaths / Newly confirmed since August 10: Cases - Deaths]

  1. Algeria 19 - 0 / 0 - 0
  2. Botswana 23 - 0 / 0 - 0
  3. Cape Verde 24 - 0 / 0 - 0
  4. C?te d?Ivoire 2 - 0 / 0 - 0
  5. Ethiopia 4 - 0 / 0 - 0
  6. Gabon 1 - 0 / 0 - 0
  7. Ghana 2 - 0 / 0 - 0
  8. Kenya 26 - 0 / 0 - 0
  9. Mauritius 21 - 1 / 0 - 0
  10. Namibia 7 - 0 / 0 - 0
  11. Seychelles 3 - 0 / 0 - 0
  12. South Africa 1307 - 2 / 0 - 0
  13. Swaziland 2 - 0 / 0 - 0
  14. Tanzania 15 - 0 / 5 - 0
  15. Uganda 9 - 0 / 0 - 0
  16. Zambia 4 - 0 / 0 - 0

  • TOTAL 1469 - 3 / 5 - 0

WHO African Region situation updates - Pandemic (H1N1) 2009

All countries in the region have activated their national emergency preparedness and contingency response plans

A crisis management team has been put in place by the Regional Director at the regional office (Brazzaville) and the sub regional levels (Intercountry Support teams in Harare, Zimbabwe, Gabon and Burkina Faso)) to work closely with countries to boost their disease surveillance to ensure that any suspected case of Pandemic (H1N1) 2009 is detected early.

Stockpiles of relevant medicines have been dispatched to all countries in the region as well as mapping laboratory and human resources capability at country and regional levels to enable WHO to support Member States to respond rapidly to any suspected outbreaks.

Our advice is to the public is not to panic but to take necessary preventive measures such as hand hygiene and respiratory etiquette in households, the community, health care facilities as well as in other settings where people gather.
-
​
<cite cite="http://www.afro.who.int/ddc/influenzaa/index.html">Pandemic Influenza (H1N1) 2009</cite>
 
WHO | Pandemic (H1N1) 2009 - update 61 (August 12, 2009, edited)

WHO | Pandemic (H1N1) 2009 - update 61 (August 12, 2009, edited)

WHO | Pandemic (H1N1) 2009 - update 61

Pandemic (H1N1) 2009 - update 61

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


The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 60) as of 6 August 2009 are:

  • Timore-Leste,
  • Pakistan,
  • Kirabati,
  • Maldives,
  • French Guiana,
  • Falkland Islands (UKOT),
  • Wallis and Futuna (FOC)
MAP of affected countries and deaths as of 6 August 2009 [png 131kb]


[Region - Cumulative total as of 6 Aug 2009: Cases* - Deaths]

  • WHO Regional Office for Africa (AFRO) 591 - 1
  • WHO Regional Office for the Americas (AMRO) 102905 - 1274
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 2346 - 7
  • WHO Regional Office for Europe (EURO) over 32000 - 53
  • WHO Regional Office for South-East Asia (SEARO) 11432 - 83
  • WHO Regional Office for the Western Pacific (WPRO) 28120 - 43

  • Total 177457 - 1462
(*) Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.


Qualitative indicators (as of Week 30: 20 July - 26 July 2009 and Week 31: 27 July - 2 August 2009)

As a part of WHO ongoing efforts to monitor the pandemic, qualitative indicators were developed to accommodate several types of data sources. Using these indicators, countries at different stages of the pandemic can participate in the monitoring effort, regardless of their surveillance and laboratory capacity.

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.


Interim WHO guidance for the surveillance of human infection with A(H1N1) virus

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

The attached maps display information on the qualitative indicators reported for weeks 30 and 31. Information is available for approximately 50 to 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.


Geographic spread of influenza activity

Geographic spread of influenza activity during week 30 [png 161kb]
Geographic spread of influenza activity during week 31 [png 159kb]


Annex 4 of the Interim WHO guidance for the surveillance of human infection with A(H1N1) virus


Trend of respiratory diseases activity compared to the previous week during week 30 and week 31

Trend of respiratory diseases activity compared to the previous week during week 30 [png 157kb]
Trend of respiratory diseases activity compared to the previous week during week 31 [png 155kb]


Annex 4 of the Interim WHO guidance for the surveillance of human infection with A(H1N1) virus


Intensity of acute respiratory diseases in the population during week 30 and week 31

Intensity of acute respiratory diseases in the population during week 30 [png 155kb]
Intensity of acute respiratory diseases in the population during week 31 [png 154kb]


Annex 4 of the Interim WHO guidance for the surveillance of human infection with A(H1N1) virus


Impact on health care services during week 30 and week 31

Impact on health care services during week 30 [png 152kb]
Impact on health care services during week 31 [png 152kb]


Annex 4 of the Interim WHO guidance for the surveillance of human infection with A(H1N1) virus


Epidemiological Update on the Global Situation and Preliminary Overview of the Southern Hemisphere Winter Influenza Season (as of 6 August 2009)

Pandemic influenza H1N1 has now been reported in over 170 countries and territories worldwide. While the case counts no longer reflect actual disease activity, WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states.

Of particular interest is the situation in temperate countries of the Southern Hemisphere, which are now passing through their winter season. This season, pandemic H1N1 has been the predominant influenza virus in nearly all of the temperate regions of Southern Hemisphere, with South Africa being a notable exception. Australia and countries in the southern part of South America experienced rapid increases in cases of pandemic influenza early in their winter season. These same areas are now starting to report decreases in the numbers of people seeking care and being admitted to hospital. Although the virus is still circulating in these areas as it moves into areas not affected earlier, the overall national trends are downward. South Africa, in contrast, experienced an early influenza season with a seasonal subtype, influenza A (H3N2). As the influenza season in South Africa reached its peak in early to mid June and began to decline, pandemic influenza H1N1 appeared and has now become the dominant subtype seen there as well.

In the temperate areas of the northern hemisphere which experienced early outbreaks of pandemic H1N1 influenza, including countries in North America and Europe, the virus continues to spread to new areas and cause intense local outbreaks. However, the overall national trend in cases is downward in the Americas.

Tropical regions of the world, which typically experience year round transmission of influenza viruses with peak transmission at different and often multiple times in a year, are now seeing increases in cases, for example in tropical areas of Central and South America and in South and South East Asia.

In summary, the overall picture of transmission globally is one of declining transmission in the temperate regions of the Southern Hemisphere with the exception of southern Africa. The season in these areas was characterized by rapid rise and fall of respiratory disease numbers, as is seen in a normal influenza season. The impact and severity of the season in these areas in terms of proportion of cases which developed severe disease and the load imposed on health care infrastructure is still being evaluated but generally appeared slightly worse than a normal influenza season in most places with increased hospitalization requiring respiratory critical care. The northern hemisphere is experiencing continued spread of the virus but declining activity is being observed in areas affected early in the course of the pandemic. Tropical areas of the world are now experiencing increasing numbers of cases at a time when the usual seasonal peaks would occur. As the pandemic H1N1 influenza virus is now the dominant strain in most areas of the world, it can be expected to persist into the coming influenza season in the Northern Hemisphere. Additionally, there is a risk of further spread of virus in highly populated areas as community spread starts occurring in Asia and Africa.
-
​
<cite cite="http://www.who.int/csr/don/2009_08_12/en/index.html">WHO | Pandemic (H1N1) 2009 - update 61</cite>
 
Pandemic (H1N1) 2009 - update 62 (WHO, August 19, 2009, edited)

Pandemic (H1N1) 2009 - update 62 (WHO, August 19, 2009, edited)

Pandemic (H1N1) 2009 - update 62 (WHO, August 19, 2009, edited)

Pandemic (H1N1) 2009 - update 62

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

[Original Page: LINK. EDITED.]



The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 61) as of 13 August 2009 are: Ghana, Zambia, and Tuvalu

Map of affected countries and deaths as of 13 August 2009 [png 313kb]

<table class="MsoNormalTable" style="width: 367pt; margin-left: 4.65pt; border-collapse: collapse;" border="0" cellpadding="0" cellspacing="0" width="489"> <tbody><tr style="height: 13.5pt;"> <td rowspan="2" style="border: 1pt solid windowtext; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> Region <o:p> </o:p>
</td> <td colspan="2" style="border-style: solid solid solid none; padding: 0mm 5.4pt; width: 114.25pt; height: 13.5pt;" valign="bottom" width="152" nowrap="nowrap">
Cumulative total <o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td colspan="2" style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 114.25pt; height: 13.5pt;" valign="bottom" width="152" nowrap="nowrap">
as of 13 Aug 2009 <o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> <o:p> </o:p>

</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
Cases* <o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
Deaths <o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> WHO Regional Office for <st1:place st="on"> Africa</st1:place> (AFRO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
1469<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
3<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> WHO Regional Office for the <st1:country-region st="on"> <st1:place st="on"> Americas</st1:place> </st1:country-region> (AMRO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
105882<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
1579<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> WHO Regional Office for the <st1:place st="on"> Eastern Mediterranean</st1:place> (EMRO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
2532<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
8<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> WHO Regional Office for <st1:place st="on"> Europe</st1:place> (EURO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
Over 32000<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
53<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> WHO Regional Office for <st1:place st="on"> South-East Asia</st1:place> (SEARO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
13172<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
106<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> WHO Regional Office for the Western Pacific (WPRO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
27111<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
50<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> <o:p> </o:p>

</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
<o:p> </o:p> ​

</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
<o:p> </o:p> ​

</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" valign="bottom" width="337" nowrap="nowrap"> Total <o:p> </o:p>
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 68.1pt; height: 13.5pt;" valign="bottom" width="91" nowrap="nowrap">
Over 182166<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; padding: 0mm 5.4pt; width: 46.15pt; height: 13.5pt;" valign="bottom" width="62" nowrap="nowrap">
1799<o:p> </o:p> ​
</td> </tr> </tbody></table>
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.

Qualitative indicators (Week 31: 27 July - 2 August 2009 and Week 32: 3 August - 9 August 2009)

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

Interim WHO guidance for the surveillance of human infection with A(H1N1) virus

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

The attached maps display information on the qualitative indicators reported for weeks 31 and 32. Information is available for approximately 50 to 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 during week 31 and 32

Geographic spread of influenza activity during week 31 [png 157kb]

Geographic spread of influenza activity during week 32 [png 269kb]


Trend of respiratory diseases activity compared to the previous week during week 31 and week 32

Trend of respiratory diseases activity compared to the previous week during week 31 [png 155kb]

Trend of respiratory diseases activity compared to the previous week during week 32 [png 266kb]


Intensity of acute respiratory diseases in the population during week 31 and week 32

Intensity of acute respiratory diseases in the population during week 31 [png 153kb]

Intensity of acute respiratory diseases in the population during week 32 [png 262kb]


Impact on health care services during week 31 and week 32

Impact on health care services during week 31 [png 151kb]

Impact on health care services during week 32 [png 259kb]

-
-----
 
WHO | Pandemic (H1N1) 2009 - update 62 (revised 21 August 2009)

WHO | Pandemic (H1N1) 2009 - update 62 (revised 21 August 2009)

WHO | Pandemic (H1N1) 2009 - update 62 (revised 21 August 2009)

Weekly update

As of this week, there have been more than 182,000 laboratory confirmed cases of pandemic influenza H1N1, 1799 deaths, in 177 countries and territories have been reported to WHO.

As more and more countries have stopped counting individual cases, particularly of milder illness, the case number is significantly lower than the actually number of cases that have occurred. However, through the WHO monitoring network, it is apparent that rates of influenza illness continue to decline in the temperate regions of the southern hemisphere, except in South Africa where pandemic influenza H1N1 appeared slightly later than the other countries of the region. Active transmission is still seen in some later affected areas of Australia, Chile and Argentina even as national rates decrease.

Areas of tropical Asia are reporting increasing rates of illness as they enter their monsoon season, as represented by India, Thailand, Malaysia, and Hong Kong, four places in the region which have active surveillance programs. Tropical regions of Central America, represented by Costa Rica and El Salvador, are also seeing very active transmission.

In the northern temperate zones, overall rates are declining in both North America and Europe though the virus is still found across a wide area throughout both regions and pockets of high activity are being reported in 3 U.S. states and a few countries of Western Europe.

It has been noted throughout the temperate zones of the southern hemisphere, which are now passing out of their winter season, that when pandemic H1N1 began to circulate, the relative importance of seasonal strains, represented by H3N2 in nearly all countries, rapidly diminished and pandemic H1N1 became the dominant strain. Some seasonal H1N1 strains were reported but were even less common than seasonal H3N2. It is too early to tell if this co-circulation of multiple strains will continue into the coming season of the Northern Hemisphere but it appears very likely that pandemic H1N1 will be the dominant influenza virus in the early part of the winter months.

Many countries including Australia, Canada, New Zealand, and the U.S. have noted that their indigenous peoples appear to be at increased risk of severe disease related to pandemic influenza. While it still has not been clearly determined how much of the increased risk observed in these groups is due to issues related to access to care, high rates of chronic medical conditions that are known to increase risk, or other factors, countries with indigenous and other vulnerable populations should carefully evaluate the situation and consider ways to mitigate the impact of the pandemic in the coming season in these populations.

WHO has also been notified of 12 cases of oseltamivir resistant virus. These isolates have a mutation in the neuraminidase (referred to as H275Y) that confers resistance to oseltamivir, though the viruses remain sensitive to zanamivir. Of these 8 have been associated with oseltamivir post exposure prophylaxis, one with treatment of uncomplicated illness, and two have been from immunocompromised patients receiving oseltamivir treatment. These isolated cases have arisen in different parts of the world (Japan 4, USA 2, China, Hong Kong SAR China 2, and 1 in Denmark, Canada, Singapore and China), and there are no epidemiological links between them. There is also no evidence of onward transmission from these cases.
-
​
<cite cite="http://www.who.int/csr/don/2009_08_21/en/index.html">WHO | Pandemic (H1N1) 2009 - update 62 (revised 21 August 2009)</cite>
 
WHO. Pandemic (H1N1) 2009 - update 63

WHO. Pandemic (H1N1) 2009 - update 63

WHO. Pandemic (H1N1) 2009 - update 63

Pandemic (H1N1) 2009 - update 63 - Weekly update

In the southern hemisphere, most countries (represented by Chile, Argentina, New Zealand, and Australia) appear to have passed their peak of influenza activity and have either returned to baseline levels or are experiencing focal activity in later affect areas; while a few others (represented by South Africa and Bolivia) continue to experience high levels of influenza activity.

Many countries in tropical regions (represented by Central America and tropical regions of Asia), continue to see increasing or sustained high levels of influenza activity with some countries reporting moderate strains on the healthcare system. In temperate areas of the northern hemisphere (represented by North America, Europe, and Central Asia), influenza and respiratory disease activity remains low overall, with some countries experiencing localized outbreaks.

In Japan, the level of influenza activity has passed the seasonal epidemic threshold, signaling a very early beginning to the annual influenza season.

Pandemic H1N1 influenza virus continues to be the predominant circulating strain of influenza, both in the northern and southern hemisphere. Antiviral susceptibility testing has increased in several countries, confirming that pandemic H1N1 influenza virus remains sensitive to the antiviral oseltamivir, except for sporadic reports of oseltamivir resistant pandemic H1N1 virus detailed in the previous web update (No. 62).

(...)
-
​
<cite cite="http://www.who.int/csr/don/2009_08_28/en/index.html">WHO | Pandemic (H1N1) 2009 - update 63</cite>
 
WHO: Pandemic (H1N1) 2009 - update 64 (edited)

WHO: Pandemic (H1N1) 2009 - update 64 (edited)

WHO: Pandemic (H1N1) 2009 - update 64 (edited)

Pandemic (H1N1) 2009 - update 64


Weekly update

Tropical regions of South and Southeast Asia continue to experience geographically regional or widespread influenza activity (represented by countries such as India, Bangladesh, Myanmar, Thailand, Cambodia, Sri Lanka, and Indonesia). Many countries in the region are reporting increasing or sustained high levels of respiratory disease, and a few (Thailand and Brunei Darussalam) have begun to report a declining trend in the level of respiratory diseases.

In tropical regions of Central America and the Caribbean (represented by countries such as Costa Rica, El Salvador, Guatemala, Honduras, Panama, and Cuba), influenza activity continues to be geographically regional or widespread, however, most are now reporting a declining trend in the level of respiratory diseases.

Countries in the equatorial and tropical regions of South America (represented by Ecuador, Venzezuela, Peru, and parts of Brazil) continue to experience geographically regional or widespread influenza activity, with many reporting an increasing trend in the level of respiratory diseases.

Although many countries in temperate regions of the southern hemisphere (Chile, Argentina, Australia, and New Zealand) have passed the peak of their winter influenza epidemic, sustained influenza activity continues to be reported in South Africa and in the Southern and Western parts of Australia.

In temperate regions of the northern hemisphere, there are wide geographical variations in the level of influenza activity being reported. In Japan, influenza activity continues to increase past the seasonal epidemic threshold, indicating an early beginning to the to annual influenza season. In Canada and the United States, influenza activity remain low overall, however regional increases are being detected in the Southeastern United States. In Europe and Central and Western Asia, although little influenza activity is being reported, a few countries are reporting geographically widespread influenza activity (Austria and Israel) or an increasing trend in respiratory diseases (Netherlands and Romania).

Pandemic (H1N1) influenza virus continues to be the predominant circulating virus of influenza, both in the northern and southern hemisphere.

All pandemic H1N1 2009 influenza viruses analysed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus. See below for detailed laboratory surveillance update.

(...)
-
​
<cite cite="http://www.who.int/csr/don/2009_09_04/en/index.html">WHO | Pandemic (H1N1) 2009 - update 64</cite>
 
Re: WHO: Pandemic (H1N1) 2009 - update 64 (edited)

Re: WHO: Pandemic (H1N1) 2009 - update 64 (edited)

Laboratory surveillance update

4 September 2009 -- The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including seasonal viruses.

Since the beginning of the pandemic in 19 April 2009 to August 15th 2009, a total of 80 countries reported to FluNet, the WHO influenza virological database. The total number of specimens reported positive for influenza viruses by National Influenza Centres (NICs) was 85923. Of these, 50,888 (59.2%) were pandemic (H1N1), 5259 (6.1%) were seasonal A (H1), 11,496 (13.4%) were A (H3), 14,816 (17.2%) were A (not subtyped) and 3464 (4.1%) were influenza B.

Twenty six countries reported to the FluNet on week 34. The total number of specimens reported positive for influenza viruses by the NICs in these countries was 6329. Of these, 3867 (61.1%) were pandemic (H1N1), 215 (3.4%) were seasonal A (H1), 1416 (22.4%) were A (H3), 730 (11.5%) were A (not subtyped) and 101 (1.6%) were influenza B. On average, the pandemic (H1N1) accounted for 61% of all influenza detections. Pandemic (H1N1) influenza virus continues to be the predominant circulating virus of influenza, both in the northern and southern hemisphere.
Virology data update

Download update (.pdf)




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 August 2009

Map of affected countries and deaths as of 30 August 2009 The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 63) as of 30 August 2009 are:

Zimbabwe and Djibouti.
<table class="MsoNormalTable" style="width: 418.05pt; margin-left: 4.65pt; border-collapse: collapse;" border="0" cellpadding="0" cellspacing="0" width="557"> <tbody><tr style="height: 13.5pt;"> <td rowspan="2" style="border: 1pt solid windowtext; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> Region <o:p> </o:p>
</td> <td colspan="2" style="border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; border-width: 1pt 1pt 1pt medium; padding: 0mm 5.4pt; width: 165.3pt; height: 13.5pt;" width="220" nowrap="nowrap" valign="bottom">
Cumulative total<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td colspan="2" style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 165.3pt; height: 13.5pt;" width="220" nowrap="nowrap" valign="bottom">
as of 30 Aug 2009<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
Cases*<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
Deaths<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> WHO Regional Office for <st1:place w:st="on"> Africa</st1:place> (AFRO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
3872<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
11<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> WHO Regional Office for the <st1:place w:st="on"> <st1:country-region w:st="on"> Americas</st1:country-region> </st1:place> (AMRO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
116046<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
2234<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> WHO Regional Office for the <st1:place w:st="on"> Eastern Mediterranean</st1:place> (EMRO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
5031<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
21<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> WHO Regional Office for <st1:place w:st="on"> Europe</st1:place> (EURO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
Over 46000<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
At least 104<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> WHO Regional Office for <st1:place w:st="on"> South-East Asia</st1:place> (SEARO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
19362<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
188<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> WHO Regional Office for the Western Pacific (WPRO) <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
63895<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
279<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
<o:p> </o:p> ​
</td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 252.75pt; height: 13.5pt;" width="337" nowrap="nowrap" valign="bottom"> Total <o:p> </o:p>
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 81pt; height: 13.5pt;" width="108" nowrap="nowrap" valign="bottom">
Over 254206<o:p> </o:p> ​
</td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 84.3pt; height: 13.5pt;" width="112" nowrap="nowrap" valign="bottom">
At least 2837<o:p> </o:p> ​
</td> </tr> </tbody></table>
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.

<!-- include ftr-->

http://www.who.int/csr/don/2009_09_04/en/index.html
 
WHO. Pandemic (H1N1) 2009 - update 65 (Sept. 11, 2009, edited)

WHO. Pandemic (H1N1) 2009 - update 65 (Sept. 11, 2009, edited)

WHO. Pandemic (H1N1) 2009 - update 65 (Sept. 11, 2009, edited)

[Source Text: LINK. EDITED.]


Pandemic (H1N1) 2009 - update 65

Weekly update


In the temperate region of the southern hemisphere (represented by countries such as Chile, Argentina, Australia, New Zealand, and South Africa), influenza activity continues to decrease or return to baseline.

Active transmission persists in tropical regions of the Americas and Asia. Many countries in Central America and the Caribbean continue to report declining activity for the second week in a row. However, countries in the tropical region of South America (represented by countries such as Bolivia, Ecuador, and Venezuela) are reporting increasing levels of respiratory disease. In the tropical regions of Asia, respiratory disease activity remains geographically regional or widespread but the trend is generally increasing as noted in India, Bangladesh, and Cambodia.

In the temperate regions of the Northern Hemisphere activity is variable. In the United States, regional increases in influenza activity are being reported, most notably in the south eastern states. Most of Europe is reporting low or moderate respiratory diseases activity, but parts of Eastern Europe are beginning to report increases in activity.

WHO Collaborating Centres and other laboratories continue to report sporadic isolates of oseltamivir resistant influenza virus. 21 such virus isolates have now been described from around the world, all of which carry the same H275Y mutation that confers resistance to the antiviral oseltamivir but not to the antiviral zanamivir. Of these, 12 have been associated with post-exposure prophylaxis, four with long term oseltamivir treatment in patients with immunosuppression. Worldwide, over 10,000 isolates of the pandemic (H1N1) 2009 virus have been tested and found to be sensitive to oseltamivir. WHO will continue to monitor the situation closely in collaboration with its partners, but is not changing its guidelines for use of antiviral drugs at this time.

Pandemic (H1N1) influenza virus continues to be the predominant circulating virus of influenza, both in the northern and southern hemisphere. All pandemic H1N1 2009 influenza viruses analysed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus. See below for detailed laboratory surveillance update.

Of note, the U.S. Centers for Disease Control and Prevention this week reported on an analysis of 36 fatal pandemic influenza cases in children under the age of 18 years. Sixty-seven percent of the children had one or more high-risk medical conditions, most commonly neurodevelopmental disorders. In addition, ten of 23 children for whom data were available were found to have strong evidence of secondary bacterial co-infections.
Weekly update (Virological surveillance data)

Qualitative indicators (Week 29 to Week 35: 13 July - 30 August 2009

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

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

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

The maps below display information on the qualitative indicators reported during weeks 29 to 34. 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 September 2009

Map of affected countries and deaths as of 6 September 2009

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 64) as of 6 September 2009 are: Lesotho and Angola.



Region - Cumulative total as of 6 September 2009

[Cases* - Deaths]

  • WHO Regional Office for Africa (AFRO) - 6336 - 35
  • WHO Regional Office for the Americas (AMRO) - 120653 - 2467
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 9844 - 51
  • WHO Regional Office for Europe (EURO) - Over 49000 - At least 125
  • WHO Regional Office for South-East Asia (SEARO) - 22387 - 221
  • WHO Regional Office for the Western Pacific (WPRO) - 69387 - 306
  • Total Over 277607 - At least 3205

*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-
------
 
WHO - Pandemic (H1N1) 2009 - update 66

WHO - Pandemic (H1N1) 2009 - update 66

WHO - Pandemic (H1N1) 2009 - update 66

Pandemic (H1N1) 2009 - update 66

Weekly update


In the temperate regions* of the northern hemisphere, influenza activity remains widely variable.

In North America, the United States is reporting increases in influenza-like-illness activity above the seasonal baseline, most notably in the southern, southeastern, and parts of the northeastern United States.

In Canada, influenza activity remains low.

In Europe and Central Asia influenza activity remains low overall, except in France, which is reporting increases in influenza-like-illness activity (for week 37) above the seasonal epidemic threshold.

Geographically localized influenza activity is being reported in several countries (Austria, Georgia, Ireland, Luxembourg, Norway, Portugal, the Czech Republic, Cyprus, and Israel).

In Japan, influenza activity remains stably increased above the seasonal epidemic threshold with the most notable increases being reported on the southern island of Okinawa.

In the tropical regions of the Americas and Asia, influenza transmission remains active.

Geographically regional to widespread influenza activity continues to be reported throughout much of South and Southeast Asia, with increasing trends in respiratory diseases being reported in India and Bangladesh.

Geographically regional to widespread influenza activity continues to be reported for the tropical regions of Central and South America without a consistent pattern in the trend of respiratory diseases (continued increases are being reported in Bolivia and Venezuela).

In the temperate regions* of the southern hemisphere, influenza activity continues to decrease or has returned to the seasonal baseline in most countries.

In Australia, later affected areas are also now reporting declining levels of influenza-like-illness.

In South Africa, influenza activity appears to have recently passed over the second peak (the first peak was due to seasonal influenza A (H3N2) and second peak was due to pandemic (H1N1) 2009).

WHO Collaborating Centres and other laboratories continue to report sporadic isolates of oseltamivir resistant influenza virus.

Twenty six such virus isolates have now been described from around the world, all of which carry the same H275Y mutation that confers resistance to the antiviral oseltamivir but not to the antiviral zanamivir.

Of these, 12 have been associated with post-exposure prophylaxis, five with long term oseltamivir treatment in patients with immunosuppression.

Worldwide, over 10,000 clinical samples and isolates of the pandemic (H1N1) 2009 virus have been tested and found to be sensitive to oseltamivir. WHO will continue to monitor the situation closely in collaboration with its partners.

Pandemic (H1N1) influenza virus continues to be the predominant circulating influenza virus, both in the northern and southern hemisphere. See below for detailed laboratory surveillance update.

(*) 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.


Weekly update (Virological surveillance data)

Qualitative indicators (Week 29 to Week 36: 13 July - 6 September 2009)

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


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

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

The maps below display information on the qualitative indicators reported during weeks 29 to 35. 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 September 2009

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 65) as of 13 September 2009 are: Malawi.

[Region - Cumulative total as of 13 September 2009 (Cases* - Deaths)

  • WHO Regional Office for Africa (AFRO) - 8125 - 40
  • WHO Regional Office for the Americas (AMRO) - 124126 - 2625
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 10533 - 61
  • WHO Regional Office for Europe (EURO) - over 52000 - at least 140
  • WHO Regional Office for South-East Asia (SEARO) - 25339 - 283
  • WHO Regional Office for the Western Pacific (WPRO) - 76348 - 337
  • Total - over 296471 - at least 3486
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-
​
<cite cite="http://www.who.int/csr/don/2009_09_18/en/index.html">WHO | Pandemic (H1N1) 2009 - update 66</cite>
 
WHO - Pandemic influenza vaccines: current status (Sep. 24, 2009, edited)

WHO - Pandemic influenza vaccines: current status (Sep. 24, 2009, edited)

WHO - Pandemic influenza vaccines: current status (Sep. 24, 2009, edited)

Pandemic influenza vaccines: current status - Pandemic (H1N1) 2009 briefing note 11

24 SEPTEMBER 2009 | GENEVA


Regulatory authorities have licensed pandemic vaccines in Australia, China, Hungary and the United States of America, soon to be followed by Japan and several countries in Europe.

The length of the approval process depends on factors such as each country's regulatory pathway, the type of vaccine being licensed, and the stage of manufacturers' readiness to submit appropriate information to regulatory authorities.


Production capacity

In May 2009, WHO estimated that, in a best case scenario, worldwide production capacity for pandemic vaccines would be approximately 5 billion doses per year. Since then, better information on production yield and appropriate vaccine formulation has become available.

WHO currently estimates worldwide production capacity for pandemic vaccines at approximately 3 billion doses per year. While this figure is lower than previously projected, early data from clinical trials suggest that a single dose of vaccine will be sufficient to confer protective immunity in healthy adults and older children, effectively doubling the number of people who can be protected with current supplies.

These supplies will still be inadequate to cover a world population of 6.8 billion people in which virtually everyone is susceptible to infection by a new and readily contagious virus. Global manufacturing capacity for influenza vaccines is limited, inadequate and not readily augmented.

Pandemic vaccines have their greatest impact as a preventive strategy when administered before or near the peak incidence of cases in an outbreak. Both regulatory authorities and vaccine manufacturers have made extraordinary efforts to expedite the availability of vaccines.

Many affluent countries have previously contracted with manufacturers to obtain sufficient vaccine supplies to cover their entire populations. However, most low- and middle-income countries lack the financial resources to compete for an early share of limited supplies. Vaccine supplies in these countries will largely depend on donations from manufacturers and other countries.


Availability in developing countries

Last week, donations of pandemic vaccines for use in developing countries were announced by the United States of America, in concert with Australia, Brazil, France, Italy, New Zealand, Norway, Switzerland and the United Kingdom. Similar support from additional countries is anticipated and warmly welcomed.

WHO will be coordinating the distribution of these donated vaccines. Earlier this year, WHO conducted surveys with its regional and country offices to identify countries that will not have pandemic vaccines unless supplies are donated.

Teams with expertise in field operations, vaccines, and the logistics of their distribution are now working in the JW Lee Centre for Strategic Health Operations (the SHOC room). Initially, they will be distributing an estimated 300 million doses of vaccine to more than 90 countries.

Distribution of the first batches of donated vaccines is expected to begin in November. WHO continues to recommend that health workers be given high priority for early vaccination.


Vaccine safety

National regulatory authorities for medicines carefully examine the known and suspected risks and benefits of any vaccine prior to its licensing. Because the pandemic virus is new, both non-clinical and clinical trials are being conducted to gain essential information on immune response and safety. Outcomes of trials completed to date suggest that pandemic vaccines are as safe as seasonal influenza vaccines.Side effects are expected to be similar to those observed with seasonal influenza vaccines. Common side effects include local reactions at the injection site (soreness, swelling, redness) and possibly some systemic reactions (fever, headache, muscle or joint aches). In almost all vaccine recipients, these symptoms are mild, self-limited and last 1-2 days.

However, even very large clinical trials will not be able to identify possible rare events that can occur when pandemic vaccines are administered to many millions of people.

WHO advises all countries administering pandemic vaccines to conduct intensive monitoring for safety and to report adverse events. Many countries already have systems for monitoring vaccine safety in place.International sharing of data from such post-marketing surveillance will be vital in guiding risk-benefit assessments and determining whether changes in vaccination policies are needed. WHO has developed standardized protocols for data collection and reporting in real-time, and will communicate findings to the international community via its web site.
-
​
<cite cite="http://www.who.int/csr/disease/swineflu/notes/pandemic_influenza_vaccines_20090924/en/index.html">WHO | Pandemic influenza vaccines: current status</cite>
 
WHO - Pandemic (H1N1) 2009 - update 67 (9/25/09, edited)

WHO - Pandemic (H1N1) 2009 - update 67 (9/25/09, edited)

WHO - Pandemic (H1N1) 2009 - update 67 (9/25/09, edited)

Pandemic (H1N1) 2009 - update 67


Weekly update

As of 20 September 2009, there have been more than 300,000 laboratory confirmed cases of pandemic influenza H1N1, 3917 deaths, in 191 countries and territories reported to WHO.

As more and more countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actually number of cases that have occurred. While the case counts no longer reflect actual disease activity, WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

In the temperate regions of the northern hemisphere, influenza-like-illness (ILI) activity continues to increase in many areas.

In North America, the United States has reported continued increases in activity above the seasonal baseline for the last 2 to 3 weeks, primarily in the southeast but now also appearing in the upper midwest and the northeast.

In Europe and Central and Western Asia, the United Kingdom is reporting regional increases in ILI activity in Northern Ireland and Scotland and the Netherlands, France, Ireland, and Israel are reporting rates above the seasonal baseline.

In In Japan, influenza activity continues to be slightly above the seasonal epidemic threshold.

The increases in ILI activity have been accompanied by increases in laboratory isolations of pandemic influenza H1N1 2009 in most of these areas.

In the tropical regions of the Americas and Asia, influenza activity remains variable.

In parts of India, Bangladesh and Cambodia, influenza transmission continues to be active, while other countries in the Southeast Asia have been recently reporting declining transmission (Indonesia, Singapore and Thailand).

Although most countries in the tropical regions of the Americas are still reporting regional to widespread geographic spread of influenza activity, there is no consistent pattern in the trend of respiratory diseases.

Peru and Mexico have reported an increasing trend in some areas, while most others are reporting an unchanged or decreasing trend (most notably Bolivia, Venezuela and Brazil).

In the temperate regions of the southern hemisphere, influenza transmission has largely returned to baseline (Chile, Argentina, and New Zealand) or is continuing to decline (Australia and South Africa).

All pandemic H1N1 2009 influenza viruses analyzed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus. See below for a detailed laboratory surveillance update.


Weekly update (Virological surveillance data)

Systematic surveillance conducted by the Global Influenza Surveillance Network (GISN), supported by WHO Collaborating Centres and other laboratories, continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to the antiviral oseltamivir.

To date, 28 resistant viruses have been detected and characterized worldwide.

All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir.

Twelve of these drug-resistant viruses were associated with the use of oseltamivir for post-exposure prophylaxis. Six were associated with the use of oseltamivir treatment in patients with severe imunosuppression. Four were isolated from samples from patients receiving oseltamivir treatment. A further two were isolated from patients who were not taking oseltamivir for either treatment or prophylaxis. Characterization of the remaining viruses is under way.

Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

WHO has just concluded its Vaccine Composition Meeting for the Southern Hemisphere (held in Melbourne, Australia) and has made recommendations for the composition of the influenza virus vaccine for use in the 2010 southern hemisphere influenza season. WHO recommends that influenza virus vaccines for use in the 2010 influenza season (southern hemisphere winter) contain the following strains: A/California/7/2009 (H1N1)-like virus; A/Perth/16/2009 (H3N2)-like virus; and B/Brisbane/60/2008-like virus. For more information see the links below.

Recommended composition of influenza virus vaccines for use in the 2010 influenza season - full report [pdf 68kb]

Frequently asked questions [pdf 19kb]

WHO has recently announced two new candidate reassortant vaccine viruses (X-181 and X-181A) which have been developed and are now available for pandemic (H1N1) 2009 virus vaccine development. For more information see link below.

Availability of two new candidate reassortant vaccine viruses for pandemic (H1N1) 2009 virus vaccine development X-181 and X-181A

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


Qualitative indicators (Week 29 to Week 37: 13 July - 13 September 2009)

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


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

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

The maps below display information on the qualitative indicators reported during weeks 29 to 37. 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 September 2009

Map of affected countries and deaths

No new countries and overseas territories/communities have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 66).

[Region - Cumulative totals of 20 September 2009 (Cases* - Deaths)]

  • WHO Regional Office for Africa (AFRO) - 8264 - 41
  • WHO Regional Office for the Americas (AMRO) - 130448 - 2948
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 11621 - 72
  • WHO Regional Office for Europe (EURO) - At least 53000 - Over 154
  • WHO Regional Office for South-East Asia (SEARO) - 30293 - 340
  • WHO Regional Office for the Western Pacific (WPRO) - 85299 - 362

  • Total - At least 318,925 - Over 3,917
(*) Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-
​
<cite cite="http://www.who.int/csr/don/2009_09_25/en/index.html">WHO | Pandemic (H1N1) 2009 - update 67</cite>
 
WHO - Pandemic (H1N1) 2009 - update 68

WHO - Pandemic (H1N1) 2009 - update 68

WHO - Pandemic (H1N1) 2009 - update 68

Pandemic (H1N1) 2009 - update 68


Weekly update

As of 27 September 2009, worldwide there have been more than 340,000 laboratory confirmed cases of pandemic influenza H1N1 2009 and over 4100 deaths reported to WHO.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actually number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

Transmission of influenza virus and rates of influenza-like-illness (ILI) continue to increase in the temperate regions of the northern hemisphere.

In North America, influenza transmission is geographically widespread and continues to increase. Levels of ILI have continued to increase and remain above the seasonal baseline for the past 4 weeks in most regions of the United States.

In Mexico, a high intensity of respiratory diseases has been reported for two consecutive weeks (week 37 - 38), with large increases in cases being reported in the north and northwest of the country.

In Europe and Central and Western Asia, although overall influenza activity remains low an increase in transmission has been noted in a number of countries and continues to intensify in others.

Rates of influenza-like-illness continue to be above baseline levels in Ireland, parts of the United Kingdom (Northern Ireland), Israel, and France; in addition, more than 10 other countries in the region have reported geographically localized spread of influenza.

In Japan, influenza activity has continued to increase above the seasonal epidemic threshold since week 33. These increases in ILI activity have been accompanied by increases in laboratory isolations of pandemic influenza H1N1 2009 in most of these areas.

In the tropical regions of the Americas and Asia, influenza transmission remains active but the trends in respiratory diseases activity are mixed. Although respiratory disease activity is geographically regional to widespread throughout the tropical region of the Americas, many countries have been recently reporting a declining trend (Bolivia, Brazil, Costa Rica, El Salvador, Panama, Paraguay, Venezuela), while others recently reported an increasing trend (Columbia and Cuba).

In tropical regions of Asia, there continues to be an increasing trend in respiratory diseases in parts of India and in Cambodia, while other countries in the Southeast Asia have been recently reporting declining transmission.

In the temperate regions of the southern hemisphere, influenza transmission has largely returned to baseline (Chile, Argentina, and New Zealand) or has declined substantially (Australia and South Africa).

All pandemic H1N1 2009 influenza viruses analyzed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus. See below for a detailed laboratory surveillance update.


Weekly update (Virological surveillance data)

Systematic surveillance conducted by the Global Influenza Surveillance Network (GISN), supported by WHO Collaborating Centres and other laboratories, continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to the antiviral oseltamivir.

To date, 28 resistant pandemic H1N1 influenza viruses have been detected and characterized worldwide.

All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir.

No new resistant pandemic H1N1 influenza viruses have been officially reported to WHO during the past week.

Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

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


Qualitative indicators (Week 29 to Week 38: 13 July - 20 September 2009)

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


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

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

The maps below display information on the qualitative indicators reported during weeks 29 to 38. 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 27 September 2009

Map of affected countries and deaths

No new countries and overseas territories/communities have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 67).

[Region - Cumulative total as of 27 September 2009 (Cases* - Deaths)]

  • WHO Regional Office for Africa (AFRO) 8352 - 42
  • WHO Regional Office for the Americas (AMRO) 137147 - 3020
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 12008 - 74
  • WHO Regional Office for Europe (EURO) Over 56000 - At least 176
  • WHO Regional Office for South-East Asia (SEARO) 33594 - 413
  • WHO Regional Office for the Western Pacific (WPRO) 96197 - 383
  • Total Over 343298 - At least 4108
(*) Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-
​
<cite cite="http://www.who.int/csr/don/2009_10_02/en/index.html">WHO | Pandemic (H1N1) 2009 - update 68</cite>
 
WHO - Pandemic (H1N1) 2009 - update 69

WHO - Pandemic (H1N1) 2009 - update 69

WHO - Pandemic (H1N1) 2009 - update 69

Pandemic (H1N1) 2009 - update 69

Weekly update


As of 4 October 2009, worldwide there have been more than 375,000 laboratory confirmed cases of pandemic influenza H1N1 2009 and over 4500 deaths reported to WHO.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actually number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

In the temperate regions of the Northern Hemisphere, transmission of influenza virus and rates of influenza-like-illness (ILI) continue to increase marking an unusually early start to fall and winter influenza season in many countries. Geographically widespread influenza is being reported throughout North America, with the United States reporting ILI levels elevated above the seasonal baseline for the past month and Mexico reporting a high intensity of respiratory diseases for the past three weeks. In Canada, although overall ILI activity remains low, focal increases have been reported in the western part of Canada.

In Europe and Central and Western Asia, early transmission of influenza virus continues to increase in many countries, with more intense focal activity being reported in a few. National or regional ILI levels remained elevated above the baseline in parts of the United Kingdom (Northern Ireland and Scotland), Ireland, and Israel. In Ireland, a high intensity of respiratory diseases has been reported for the past two weeks, with the highest rates of ILI reported among children aged 5-14 years old. In addition to Ireland and Israel, widespread geographic spread of influenza virus is also now being reported in Belgium, the Netherlands, and Cyprus. At least 10 countries in the region are also reporting an increasing trend in respiratory diseases activity.

In Japan, influenza activity continues to be elevated above the seasonal epidemic threshold since week 33, most recently in the large population centers.

In the tropical regions of the Americas and Asia, influenza virus transmission persists, however influenza activity remained variable. Geographically widespread to regional influenza activity continues to be reported throughout the tropical region of the Americas without a consistent overall trend (and increasing trend in parts of the Caribbean, and decreasing in much of tropical Central and South America). High intensity respiratory diseases activity was reported in Columbia, Cuba, and El Salvador, and moderate healthcare impact was experienced in many countries; two countries, Barbados and St. Lucia, reported severe healthcare impact. As influenza transmission slowly declines in many parts of South and Southeast Asia, several countries are reporting geographically regional spread (India, Bangladesh, and Thailand) or localized spread (Sri Lanka and Myanmar) of influenza activity; and most countries in the region have reported experiencing a low health care impact since late September.

In the temperate regions of the southern hemisphere, influenza transmission has largely subsided (Chile, Argentina, and New Zealand) or continues to decline substantially (South Africa and Australia).

All pandemic H1N1 2009 influenza viruses analyzed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus.

See below for a detailed laboratory surveillance update.


Weekly update (Virological surveillance data)

Systematic surveillance conducted by the Global Influenza Surveillance Network (GISN), supported by WHO Collaborating Centres and other laboratories, continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to the antiviral oseltamivir.

To date, 31 resistant pandemic H1N1 influenza viruses have been detected and characterized worldwide. All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir.

Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

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


Qualitative indicators (Week 29 to Week 39: 13 July - 27 September 2009)

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


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

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

The maps below display information on the qualitative indicators reported during weeks 29 to 39. 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 October 2009

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 68) as of 4 October 2009 are: Tajikistan.

[Region - Cumulative total as of 4 October 2009 (Cases* - Deaths)]

  • WHO Regional Office for Africa (AFRO) 12382 - 70
  • WHO Regional Office for the Americas (AMRO) 146016 - 3292
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 12861 - 80
  • WHO Regional Office for Europe (EURO) Over 59000 - At least 193
  • WHO Regional Office for South-East Asia (SEARO) 38038 - 480
  • WHO Regional Office for the Western Pacific (WPRO) 109926 - 410

  • Total Over 378223 - At least 4525
(*) Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-
​
<cite cite="http://www.who.int/csr/don/2009_10_09/en/index.html">WHO | Pandemic (H1N1) 2009 - update 69</cite>
 
Pandemic (H1N1) 2009 - update 70 (World Health Organization, edited)

Pandemic (H1N1) 2009 - update 70 (World Health Organization, edited)

Pandemic (H1N1) 2009 - update 70 (World Health Organization, edited)

Pandemic (H1N1) 2009 - update 70
Weekly update

[Original Page: LINK. EDITED.]

As of 11 October 2009, worldwide there have been more than 399232 laboratory confirmed cases of pandemic influenza H1N1 2009 and over 4735 deaths reported to WHO.
As many countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actually number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.
Influenza activity continues to increase in the northern temperate zones across the world.
In North America, the United States is now experiencing nationwide rates of Influenza-Like Illness (ILI) well above seasonal baseline rates with high rates of pandemic H1N1 2009 virus detections in clinical laboratory specimens.
Canada is reporting increases in ILI rates for the third straight week with some provinces now crossing the baseline.
Mexico also reports high intensity and active transmission in some areas of the country.
Western Europe and northern Asia are experiencing increased rates of ILI, well above baseline in some countries but activity is generally not as widespread as in North America.
Of note, nearly half of the influenza viruses detected in China are seasonal influenza A (H3N2) viruses, which appeared prior to and is co-circulating with pandemic H1N1 2009 virus.
The tropical zones continue to have transmission that is mixed as some countries have now peaked and are declining, while others are experiencing increases.
In the tropical region of the Americas, several Caribbean Island nations are now reporting increased rates of illness while Brazil, Costa Rica and other countries on the continent are declining.
In South Asia, most countries now report a decline in rates of illness.
Influenza rates in the temperate zones of the Southern Hemisphere have all returned to below baseline levels and very few detections of pandemic H1N1 2009 virus are being reported.
Three articles of interest published this week in the peer reviewed literature reported three different series of seriously ill pandemic influenza patients in Canada, Mexico, Australia, and New Zealand. Several important observations were made including:

  • A significant portion of patients with severe disease requiring intensive care had no predisposing conditions. The numbers are not directly comparable as the studies categorized conditions differently but nearly 1/3 of ICU patients in Australia and New Zealand had no predisposing conditions. 98% of ICU cases in Canada had a comorbid condition, which in this report included hypertension, smoking, and substance abuse, but only 30% had comorbid conditions that were considered "major". In Mexico, 84% of critical patients had an underlying condition, which in the report included hypertension, ever having smoked, and hyperlipidemia, conditions that are not considered risk factors for severe influenza outcomes. All three groups were impressed by the number of severe cases occurring in previously healthy individuals.
  • The researchers in Australia and New Zealand reaffirmed that infants under the age of 1 year have the highest risk of developing severe illness. The average age of ICU patients was 32, 40, and 44 years in Canada, Australia/New Zealand, and Mexico respectively.
  • The study from Australia and New Zealand estimated that the demand for ICU beds due to viral pneumonia during the pandemic was as much higher than in previous influenza seasons. The Canadian study reported that intensive care capacity in Winnipeg, Manitoba, was "seriously challenged" at the peak of the outbreak with full occupancy of all regional ICU beds.
All pandemic H1N1 2009 influenza viruses analyzed to date have been antigenically and genetically similar to A/California/7/2009-like pandemic H1N1 2009 virus.
Systematic surveillance conducted by the Global Influenza Surveillance Network (GISN), continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to the antiviral oseltamivir.
Weekly update (Virological surveillance data)
*Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.
Qualitative indicators (Week 29 to Week 40: 13 July - 4 October 2009)

The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.
Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance
A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.
The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.
List of definitions of qualitative indicators
Geographic spread of influenza activity

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

Map timeline
Intensity of acute respiratory diseases in the population

Map timeline
Impact on health care services

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

Map of affected countries and deaths
No new countries and overseas territories/communities have newly reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (No. 69).
[Region - Cumulative total as of 11 October 2009 (Cases* - Deaths)

  • WHO Regional Office for Africa (AFRO) 12456 - 70
  • WHO Regional Office for the Americas (AMRO) 153697 - 3406
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 13855 - 90
  • WHO Regional Office for Europe (EURO) Over 61000 - At least 207
  • WHO Regional Office for South-East Asia (SEARO) 39522 ? 530
  • WHO Regional Office for the Western Pacific (WPRO) 118702 - 432
  • Total Over 399232 - At least 4735
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
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Pandemic (H1N1) 2009 - update 71 - Weekly update (WHO, edited)

Pandemic (H1N1) 2009 - update 71 - Weekly update (WHO, edited)

Pandemic (H1N1) 2009 - update 71 - Weekly update (WHO, edited)

[Source Page: LINK. EDITED.]

Pandemic (H1N1) 2009 - update 71 - Weekly update


As of 17 October 2009, worldwide there have been more than 414,000 laboratory confirmed cases of pandemic influenza H1N1 2009 and nearly 5000 deaths reported to WHO.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actually number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.


New Activity:


  • Mongolia,
  • Rwanda, and
  • Sao Tome and Principe
  • have reported pandemic influenza cases for the first time this week.

  • Iceland,
  • Sudan, and
  • Trinidad and Tobago
  • reported their first fatal cases.

Situation update:

In general, influenza activity in the northern hemisphere is much the same as in the last week, though respiratory disease activity continues to spread and increase in intensity.

In North America, the U.S.A. is still reporting nationwide rates of Influenza-Like Illness (ILI) well above baseline rates with high rates of pandemic H1N1 2009 virus detections in clinical laboratory specimens (29% of all specimens tested are positive for influenza A and all of those subtyped are pandemic H1N1 2009 virus.

Canada reports increases in ILI rates for the fourth straight week but the highest level of activity is in the western province of British Columbia.

Mexico still reports active transmission in some areas of the country.

Although influenza activity is low in most countries in Europe, in Belgium, Israel, the Netherlands, Norway, and parts of the United Kingdom consultation ILI/ARI rates are above baseline levels. Similarly the number of influenza virus detections relatively high, which may indicate the early start of an influenza season.

Rates of respiratory illness in Eastern Europe and Northern Asia are increasing but are not yet at levels normally seen in an influenza season (baseline levels are not defined in many countries of the area).

Of note, the proportion of cases in Asia that are related to seasonal influenza A(H3N2) continue to decline globally as the proportion related to pandemic H1N1 2009 virus increases. Currently, only East Asia is reporting any significant numbers of influenza A(H3N2) isolates.

In tropical areas of the world, rates of illness are generally declining, with a few exceptions.

Cuba, Colombia, and El Salvador are reporting increases in the tropical region of the Americas. In tropical Asia, of the countries that are reporting this week, all report decreases in respiratory disease activity.

The temperate region of the southern hemisphere has no significant pandemic related activity in the past week.


Weekly update (Virological surveillance data)

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


Qualitative indicators (Week 29 to Week 40: 13 July - 4 October 2009)

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


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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline

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

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.70): Mongolia, Rwanda and Sao Tome and Principe.

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 70): Iceland, Sudan and Trinidad and Tobago.


[Region - Cumulative total as of 18 October 2009: (Cases* - Deaths)]

  • WHO Regional Office for Africa (AFRO) 13297 - 75
  • WHO Regional Office for the Americas (AMRO) 160129 - 3539
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 14739 - 96
  • WHO Regional Office for Europe (EURO) Over 63000 - At least 261
  • WHO Regional Office for South-East Asia (SEARO) 41513 - 573
  • WHO Regional Office for the Western Pacific (WPRO) 122267 - 455

  • Total Over 414945 - At least 4999
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.

-
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WHO | Pandemic (H1N1) 2009 - update 71

WHO | Pandemic (H1N1) 2009 - update 71

WHO | Pandemic (H1N1) 2009 - update 71

Pandemic (H1N1) 2009 - update 71

Weekly update (Virological surveillance data)

23 October 2009


The Global Influenza Surveillance Network (GISN) continues to monitor the global circulation of influenza viruses, in particular those infecting or with the potential of infecting humans, including seasonal influenza.

Since the beginning of the pandemic in 19 April 2009 to October 10th, a total of 80 countries have reported to FluNet. The total number of specimens reported as positive for influenza viruses by NIC laboratories was 151,070. Of these, 93,450 (61.9%) were pandemic H1N1, 6821 (4.5%) were seasonal A (H1), 19,800 (13.1%) were A (H3), 26,461 (17.5%) were A (Not subtyped) and 4538 (3%) were influenza B.

For this reporting week (4 October to 10 October 2009); a total of 27 countries reported to FluNet.

The total number of specimens reported as positive for influenza viruses by NIC laboratories was 6934.

Of these, 4526 (65.3%) were pandemic H1N1, 43 (0.6%) were seasonal A (H1), 249 (3.6%) were A (H3), 1985 (28.6%) were A (Not subtyped), 131 (1.9%) were influenza B.

Systematic surveillance conducted by the Global Influenza Surveillance Network (GISN) including WHO Collaborating Centres (WHOCCs) for reference and research on influenza, continues to detect sporadic incidents of H1N1 pandemic viruses that demonstrate resistance to the antiviral oseltamivir.

To date, 39 resistant pandemic H1N1 influenza viruses have been detected and characterized worldwide.

All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir.

Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

All pandemic H1N1 2009 influenza viruses analysed to date were antigenically and genetically closely related to the vaccine virus A/California/7/2009.
-
​
<cite cite="http://www.who.int/csr/disease/swineflu/laboratory23_10_2009/en/index.html">WHO | Pandemic (H1N1) 2009 - update 71</cite>
 
WHO - Pandemic (H1N1) 2009 - update 72

WHO - Pandemic (H1N1) 2009 - update 72

WHO - Pandemic (H1N1) 2009 - update 72

Pandemic (H1N1) 2009 - update 72

Weekly update


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

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.


Situation update:

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

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

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


Weekly update (Virological surveillance data)*

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


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

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


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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 18 October 2009

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.71): None.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 71): Russia, Jordan, Serbia, the Czech Republic, Turkey, Finland, Guadeloupe (FOC), and Moldova.

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

  • WHO Regional Office for Africa (AFRO) - 13536 - 75
  • WHO Regional Office for the Americas (AMRO) - 174565 - 4175
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 17150 - 111
  • WHO Regional Office for Europe (EURO) - Over 64000 - At least 281
  • WHO Regional Office for South-East Asia (SEARO) - 42901 - 605
  • WHO Regional Office for the Western Pacific (WPRO) - 129509 - 465
  • Total - Over 441661 - At least 5712
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-
​
<cite cite="http://www.who.int/csr/don/2009_10_30/en/index.html">WHO | Pandemic (H1N1) 2009 - update 72</cite>
 
WHO - Pandemic (H1N1) 2009 - update 73

WHO - Pandemic (H1N1) 2009 - update 73

WHO - Pandemic (H1N1) 2009 - update 73

Pandemic (H1N1) 2009 - update 73 - Weekly update

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


As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.


Situation update:

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

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

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

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

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


Pandemic (H1N1) 2009, Ukraine - update 1

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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


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

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


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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 1 November 2009

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.72): Congo.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 72): Afghanistan, Croatia, Mongolia, Tanzania and Ukraine.

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

  • WHO Regional Office for Africa (AFRO) 14109 - 76
  • WHO Regional Office for the Americas (AMRO) 185067 - 4399
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 22689 - 137
  • WHO Regional Office for Europe (EURO) Over 78000 - At least 300
  • WHO Regional Office for South-East Asia (SEARO) 44147 - 661
  • WHO Regional Office for the Western Pacific (WPRO) 138288 - 498
    • Total Over 482300 - At least 6071
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-
​
<cite cite="http://www.who.int/csr/don/2009_11_06/en/index.html">WHO | Pandemic (H1N1) 2009 - update 73</cite>
 
WHO - Pandemic (H1N1) 2009 - update 74

WHO - Pandemic (H1N1) 2009 - update 74

WHO - Pandemic (H1N1) 2009 - update 74

Pandemic (H1N1) 2009 - update 74

Weekly update

13 November 2009


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

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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


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

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


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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 8 November 2009

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.73): Somalia, Nigeria, and Burundi.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 73): Saint Lucia.

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

  • WHO Regional Office for Africa (AFRO) 14868 - 103
  • WHO Regional Office for the Americas (AMRO) 190765 - 4512
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 25531 - 151
  • WHO Regional Office for Europe (EURO) over 78000 - at least 300
  • WHO Regional Office for South-East Asia (SEARO) 44661 - 678
  • WHO Regional Office for the Western Pacific (WPRO) 149711 - 516
  • Total over 503536 - at least 6260
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
-
​
<cite cite="http://www.who.int/csr/don/2009_11_13/en/index.html">WHO | Pandemic (H1N1) 2009 - update 74</cite>
 
Re: WHO - Pandemic (H1N1) 2009 - update 74

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

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

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

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